Animation as Supplementary Learning Material About Carcinogenic Liver Fluke in Classes for Primary Schoolchildren.

Carcinogenic liver fluke is still an issue of great concern in some countries of Southeast Asia, particularly in Thailand, Cambodia, the Lao People's Democratic Republic, and Vietnam. The infection, caused by Opisthorchis viverrini, is associated to cholangiocarcinoma and is endemic among human populations for whom raw fish is frequently consumed. Prevention and health education are required. Therefore, this study aimed to evaluate the effectiveness of educational intervention to improve knowledge among primary schoolchildren based on animation-assisted education. In this study, 80 participants (40 participants in the experimental group and 40 participants in the comparison group) were selected in 2018. The effectiveness of an interactive animation program in improving the knowledge of students studying liver fluke was determined based on scores on tests given before and immediately after completion of a 4.29-min animated program on the liver fluke life cycle, risk factors, disease, diagnosis, treatment, prevention, and control. Data were analyzed using SPSS-22 via paired t tests and independent samples t tests at a significance level of 0.05. A marked and significant improvement was observed in the immediate posttest compared with the pretest scores. More importantly, the students who had used the animated program achieved a significantly higher score on the final test than the comparison group. The results offered in the first report show that the use of the animated program facilitated education about liver fluke. It is strongly believed that animations are good supplementary learning materials for students, particularly for learning about serious concepts.

Effect of Educational Intervention Based on the Health Belief Model and Self-Efficacy in Promoting Preventive Behaviors in a Cholangiocarcinoma Screening Group.

Cholangiocarcinoma (CCA) is a neoplasm known as one of the most common causes of cancer-related deaths in Southeast Asia, particularly in Thailand, Laos, and Cambodia. Prevention and health education are required. Therefore, this study aimed to determine the effectiveness of an educational intervention to prevent CCA among a rural population in Thailand based on the health belief model (HBM) and self-efficacy frameworks. In this quasi-experimental study, 60 participants (30 participants in the experimental group and 30 participants in the control group) were selected in 2017. The educational intervention for the experimental group consisted of seven training sessions (introduction to CCA, risk factors, complications, benefits and barriers to proper consumption of cooked fish, carcinogenic agents, behavioral protection, and self-efficacy in applying preventive behaviors). A questionnaire that consisted of demographic information, knowledge, and HBM constructs (perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy) was used to measure CCA preventive behaviors before and 3 months after the intervention. Data were analyzed using SPSS-22 via chi-squared, paired t-tests, and independent samples t tests at a significance level of 0.5. Three months after the intervention, the experimental group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and CCA preventive behaviors compared to the control group. This study showed the effectiveness of the intervention based on the HBM constructs and self-efficacy in the adoption of CCA preventive behaviors 3 months post intervention in the risk group. Thus, these models may serve as a framework for designing and implementing educational interventions for the prevention of CCA.

The Effect of Health Behavior Modification Program for Liver Fluke Prevention among the Risk Group in Rural Communities, Thailand

This quasi-experimental research aimed to study the effect of health behavior modification program in relation to knowledge, self-efficacy, expectation, and practice for liver fluke prevention among the risk group from Bueng Samrong sub-district, Kaeng Sanam Nang district, Nakhon Ratchasima province, Northeast Thailand. The total of 66 participants was assigned to experimental and comparison group, 33 participants in each group, 12-weeks intervene period. The experimental group was received health behavioral modification programs based on health education, self-efficacy, motivation, social support and networking. Pre-and-post-tests were measured using predesigned questionnaires. The comparative analysis was analyzed by paired sample t-test and independent sample t-test at the 0.05 level of significance. The results revealed that the experimental group had significantly greater knowledge, self-efficacy, expectation, and practice for liver fluke prevention than those in the comparison group (p < 0.05). In conclusion, this was a successful health education program for liver fluke avoidance. Participants were gained the correct knowledge and had the higher self-efficacy, expectation, and practice regrading liver fluke prevention. Therefore, it may useful for further behavior modification in the other epidemic areas.

Detection of Opisthorchis viverrini Infection among the ASEAN Population in Thailand Using a Verbal Screening Test and Fecal Concentrator Kit.

BACKGROUND: Opisthorchis viverrini is a serious health problem in Southeast Asia. The infection is associated with cholangiocarcinoma. Therefore, this study was aimed to detect O. viverrini infections among the ASEAN population in Thailand. METHODS: A cross-sectional study was conducted among 249 individuals from ASEAN populations in Thailand including Thai, Laotian, Cambodian, and Myanmar. Participants were screened using the O. viverrini verbal screening test (OvVST). Fecal samples were processed by the mini-parasep sf parasite fecal concentrator. RESULTS: The infection rate of O. viverrini was 27.21%. The majority of infections was detected in females, in the age group 31-40 yr old, in the primary school education level, and in the occupation of labor. By country, O. viverrini infection was detected more often in the Lao PDR (30.77%). In screening for O. viverrini infection, OvVST had a high sensitivity (93.48%), specificity (86.70%), NPV (98.32%), and accuracy (87.95%). The PPV was 61.43% for OvVTS. The observed agreement was substantial for OvVST (k-value = 0.64). CONCLUSION: O. viverrini infections are still detected in ASEAN countries therefore large scale active surveillance is required. OvVST had a high sensitivity, specificity, and accuracy for screening the risk groups for O. viverrini.

Active screening of gastrointestinal helminth infection in migrant workers in Thailand.

OBJECTIVE: This study aimed to detect gastrointestinal helminth infection in migrant workers in Thailand. METHODS: A cross-sectional survey study was conducted in 403 migrant workers in the factories of Nakhon Ratchasima Province, northeastern Thailand during October 2016 to June 2017. Gastrointestinal helminth infections were detected by the formalin ether acetate concentration technique and microscopy. The data were analyzed using the χ2-test and logistic regression. RESULTS: The rate of gastrointestinal helminth infection was 24.07%. The most common species involved in infection was O pisthorchis viverrini (11.91%), followed by hookworm (5.46%), Trichuris trichiura (5.21%), Strongyloides stercoralis (0.5%), Ascaris lumbricoides (0.5%), and Taenia spp. (0.5%). The majority of infections were found in men aged ≥40 years, married participants, uneducated participants, laborers, those who worked for 1 year, and those who had an income of 9000 to 12,000 THB. CONCLUSIONS: Gastrointestinal helminth infection is still found in migrant workers. Therefore, active surveillance is required in this large group for investigating and eradicating this type of infection.

Detection of Risk Groups for Carcinogenic Liver Fluke Infection by Verbal Screening Questionnaire Using a Mobile Application

The carcinogenic liver fluke, Opisthorchis viverrini, is a serious health problem in Southeast Asia where infection is associated with cholangiocarcinoma, a major cause of death in Thailand. This cross-sectional study aimed to screen for O. viverrini infection among a Thai rural population of 560 individuals from Nakhon Ratchasima, Khonkaen, and Chaiyaphum provinces with a verbal screening test with a mobile application (OvApp). Faecal samples were also processed with a mini-parasep sf parasite faecal concentrator. The infection rate of O. viverrini was found to be 2.86%. The majority of infections were detected in males aged 41­50, with primary school being their highest education level, and who were engaged in agricultural occupations. In screening for O. viverrini infection, the OvApp had a high sensitivity (87.5%), specificity (94.6%), negative predictive value (98.9%), and accuracy (98.6%). The positive predictive value was 70.0% for the OvApp. The observed agreement was substantial for this application (k-value = 0.64) indicated that it is a potentially useful tool for decreasing the cost of large-scale O. viverrini screening.

Genetic polymorphisms in TLR1, TLR2, TLR4, and TLR10 of Helicobacter pylori-associated gastritis: a prospective cross-sectional study in Thailand.

The toll-like receptors (TLRs) mediate the recognition of Helicobacter pylori and initiate the innate immune response to infection. We hypothesized those genetic polymorphisms in the TLR1, TLR2, TLR4, and TLR10 influence bacterial infection, affecting susceptibility H. pylori to disease outcomes. Genomic DNA was extracted and genotypes of TLR1 (rs4833095), TLR2 (rs3804099 and rs3804100), TLR4 (rs10759932), and TLR10 (rs10004195) polymorphism were detected by the TagMan single-nucleotide epolymorphisms genotyping assay using the real-time PCR hybridization probe method. The TLR1 (rs4833095), C allele and the TLR10 (rs10004195), A allele frequency was significantly increased risk in the H. pylori infection group (odds ratio=1.76, 95% confidence interval=1.84-2.15, P=0.01 and odds ratio=1.81, 95% confidence interval=1.18-3.26, P=0.04, respectively). The TLR1 (rs4833095), C allele and TLR10 (rs10004195), A allele are susceptible TLRs polymorphisms in the Thai population. These findings suggest that TLR1 rs4833095 and TLR10 rs10004195 may play crucial roles in H. pylori susceptibility and gastric pathogenesis.

Expression of Cancer Stem Cell Marker CD44 and Its Polymorphisms in Patients with Chronic Gastritis, Precancerous Gastric Lesion, and Gastric Cancer: A Cross-Sectional Multicenter Study in Thailand.

Here we investigated CD44 protein expression and its polymorphisms in patients with chronic gastritis, precancerous gastric lesions, and gastric cancer; and we evaluated our result with the risk of CD44 protein expression and clinicopathological characteristics. Our results obtained by analyzing 162 gastric cancer patients, 125 chronic gastritis, and 165 precancerous gastric lesions from three study centers in Thailand showed that CD44 expression was significantly higher in patients with precancerous gastric lesions and gastric cancer while patients with chronic gastritis were negative for CD44 staining (p = 0.036). We further observed the significant association of variant genotype; gastric cancer patients carrying AG or GG of CD44 rs187116 had more increased risk of CD44 expression than wild-type (WT) carriers (AG: odds ratio (OR) = 5.67; 95% CI = 1.57-7.23; p = 0.024 and GG: OR = 8.32; 95% CI = 2.94-11.42; p = 0.016), but no significant difference in the risk of CD44 expression due to polymorphism in patients with precancerous gastric lesions. Our results suggested that CD44 expression could be used as a marker for the prediction of gastric cancer development, particularly in patients with precancerous gastric lesions carrying AG or GG, who were selected to surveillance follow-up for gastric cancer prevention.

Modifying Health Behavior for Liver Fluke and Cholangiocarcinoma Prevention with the Health Belief Model and Social Support Theory.

The liver fluke Opisthorchis viverrini is a serious health problem in Thailand. Infection is associated with cholangiocarcinoma (CCA), endemic among human populations in northeast and north Thailand where raw fish containing fluke metacercariae are frequently consumed. Recently, Thailand public health authorities have been organized to reduce morbidity and mortality particularly in the northeast through O. viverrini and CCA screening projects. Health modfication is one of activities included in this campaign, but systemic guidelines of modifying and developing health behavior for liver flukes and CCA prevention in communities towards health belief and social support theory are still various and unclear. Here we review the guidelines for modifying and developing health behavior among populations in rural communities to strengthen understanding regarding perceived susceptibility, severity, benefits, and barriers to liver fluke and CCA prevention. This model may be useful for public health of cancers and related organizations to further health behavior change in endemic areas.

TLR1 Polymorphism Associations with Gastric Mucosa Morphologic Patterns on Magnifying NBI Endoscopy: a Prospective CrossSectional Study.

BACKGROUND: Helicobacter pylori is now recognized as a causative factor of chronic gastritis, gastroduodenal ulcers, gastric cancer and mucosaassociated lymphatic tissue lymphoma. Tolllike receptors are important bacterial receptors in gastric epithelial cell signaling transduction and play critical roles in gastric carcinogenesis. MATERIALS AND METHODS: A total of 400 patients undergoing esophagogastroduodenoscopy for investigation of chronic abdominal pain were genotyped for singlenucleotide polymorphisms (SNPs) in TLR1 (rs4833095) using TagMan SNPs genotyping assay by realtime PCR hybridization. Relationships with susceptibility to H. pylori infection and premalignant gastric mucosa morphological patterns, classified by magnifying NBI endoscopy, were investigated. RESULTS: The percentages of TLR1 rs4833095, CC homozygous, CT heterozygous and TT homozygous cases were 34, 46.5 and 19%, respectively. CC showed statistical differences between H. pylori positive and negative cases (P<0.001). CT and TT correlated with type 1 and type 2 gastric mucosal morphological patterns (P<0.01) whereas CC correlated with types 3 and 4 (P<0.01). CONCLUSIONS: This study demonstrated good correlation of TLR1 rs4833095 genotype with severity of inflammation in H. pylori infected gastric mucosa according to gastric mucosal morphologic patterns with magnifying NBI endoscopy.

Raw Fish Consuming Behavior Related to Liver Fluke Infection among Populations at Risk of Cholangiocarcinoma in Nakhon Ratchasima Province, Thailand.

Opisthorchiasis is a health problem in rural communities of Thailand, particularly in the northeast and north regions. Therefore, this study aimed to investigate raw fish consuming behavior related to liver fluke infection among the population at risk for opisthorchiasis and cholangiocarcinoma (CCA). A cross-sectional descriptive study was conducted in Meuang Yang district, Nakhon Ratchasima province, northeast Thailand, between June and October 2015. Participants were screened for CCA, and samples who had a high score of CCA risk were purposively selected. A predesigned questionnaire was utilized to collect the data from all participants. X2-test was used for analysis of associations between demographic data and raw fish consumption. The results revealed that participants had past histories of stool examination (33.0%), liver fluke infection (21.0%), praziquantel use (24.0%), raw fish consumption (78.0%), relatives family consuming raw fish (73.0%), and relatives family with CCA (3.0%). Participants consumed several dished related to liver fluke infection, mainly raw fermented fish (13.0%), under smoked catfish (5.00%), raw pickled fish (4.00%), and raw spicy minced fish salad (3.00%). The most common types of cyprinoid fish were Barbodes gonionotus (39%), Hampala dispar (38%), Puntius brevis (37%), Cyclocheilichthys armatus (33%), Puntioplites proctozysron (32%), and Luciosoma bleekeri (30%), respectively. Participants had a low level of knowledge (mean=3.79, SD=0.74), moderate attitude (mean=7.31, SD=7.31) and practice (mean=38.64, SD=6.95) regarding liver fluke prevention and control. Demographic variables like age (>36 years old; X2-test=17.794, p-value=0.001), education (primary school; X2-test=18.952, p-value=0.001), marital status (married; X2-test=12.399, p-value=0.002), and income (<5,000 baht; X2-test=27.757, p-value=0.015) were significantly associated with raw fish consumption. This result indicates that the population had risk consumption for liver fluke infection particularly of various cyprinoid fishes that are 2nd intermediate hosts. Therefore, health education is required to improve their behavior.

Behavioral Modification Regarding Liver Fluke and Cholangiocarcinoma with a Health Belief Model Using Integrated Learning.

This study aimed to modify behavior regarding liver fluke and cholangiocarcinoma prevention in Chumphuang district, Nakhon Ratchasima province, Thailand through integrated learning. A total of 180 participants were included through purposive selection of high-risk scores on verbal screening. Participants attended the health education program which applied the health belief model included family based, knowledge station based, academic merit based and community based learning. Data were collected using a questionnaire composed of 4 parts: 1) personal information, 2) knowledge, 3) perceived susceptibility, severity, benefits, and barriers, 4) practice regarding liver fluke and cholangiocarcinoma prevention. The result revealed that the majority were female (79.9%), age ≥60 years old (33.2%), primary school educational level (76.1%), and agricultural occupation (70.1%). The mean scores of knowledge, perception, and practice to liver fluke and cholangiocarcinoma prevention, before participated the integrative learning were low, moderate, and low, respectively. Meanwhile, the mean score of knowledge, perceived susceptibility, severity, benefits, and barriers, and practice regarding liver fluke and cholangiocarcinoma prevention, were higher with statistical significance after participation in the integrated learning. This finding indicates that health education programs may successfully modify health behavior in the rural communities. Therefore they may useful for further work behavior modification in other epidemic areas.

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.

Opisthorchis viverrini Infection Among People in the Border Areas of Three Provinces, Northeast of Thailand.

Opisthorchis viverrini is still a serious problem in Northeastern and Northern Thailand. Active surveillance is required to determine updated data for further prevention and control planning. Therefore, this study aimed to examine the prevalence and risk factors for O. viverrini in three provinces, Northeastern Thailand. A cross- sectional survey was conducted during October 2015 to March 2016 at Kaeng Sanam Nang district of Nakhon Ratchasima province, Waeng Noi district of Khon Kaen province, and Khon Sawan district of Chaiyaphum province, Thailand. Stool samples were examined by using a modified Kato-Katz Thick smear technique. From a total of 978 participants screened, O. viverrini infection was found in 1.74%, the majority opf positive cases being male (6.62%), age group 51-60 years old (4.21%), educated at primary school (8.43%), occupied with agriculture (9.62%),having an income <4,000 baht per month (4.82%), and living in Khon Sawan district (8.43%). Participants had a high knowledge level (42.43%), good attitude level (34.76%), and fair level (38.04%). The present study indicates the O. viverrini infection rate is low, but elderly males with primary school education involved in agriculture are still frequently effected particularly in Khon Sawan district. Therefore, this risk group requires behavior modification and continued monitoring.

Overweight Relation to Liver Fluke Infection among Rural Participants from 4 Districts of Nakhon Ratchasima Province, Thailand.

A cross-sectional survey was conducted among 730 participants from 4 rural districts of Nakhon Ratchasima province, Thailand, with a reported high incidence of liver fluke infection. This study was aimed to examine and evaluate the nutritional status in relation to Opisthorchis viverrini infection. Participants were purposive selected from Chum Phuang, Mueang Yang, Bua Yai, and Kaeng Sanam Nang districts. Stool samples were prepared by Kato Katz technique and then assessed by microscopy. Anthropometry was evaluated according to the body mass index from weight and height. Descriptive statistics and Spearman rank correlation coefficients were used to evaluate the association between the nutritional status and O. viverrini infection. Of 1.64% infected with O. viverrini the highest proportions were found in age groups ≥61 and 41-50 years old, Mueang Yang district. The majorities of participants had normal weight (32.2%), followed by class II obesity (28.1%), class I obesity (21.8%), underweight (10.3%), and class III obesity (8.63%). Nutritional status with class II obesity (rS=0.639, <0.01) and class I obesity (rS=0.582, <0.05), had moderately statistical significant correlations with O. viverrini infection. Meanwhile, normal weight (rS=0.437, <0.05) and class III obesity (rS=0.384, <0.05) demonstrated lower statistical significance. These findings raise the possibility that infection with O. viverrini may contribute to fat deposition and thereby have long-term consequences on human health. Further studies are needed to better understand whether O. viverrini contributes directly to fat deposition and possible mechanisms.

Diagnosis of Helicobacter pylori Infection.

Helicobacter pylori infection plays an important role in the pathogenesis of chronic gastritis, peptic ulcer disease and gastric malignancy. A diagnosis of infection is thus an important part of a treatment strategy of many gastrointestinal tract diseases. Many diagnostic tests are available but all have some limitations in different clinical situations and laboratory settings. A single gold standard cannot available, but be used for diagnosis of Helicobacter pylori infection in daily clinical practice in all areas, so several techniques have been developed to give reliable results, especially focusing on real time endoscopic features. The narrow band imaging system (NBI) and high resolution endoscopy are imaging techniques for enhanced visualization of infected mucosa and premalignant gastric lesions. The aim of this article is to review the current diagnostic options and possible future developments detection of Helicobacter pylori infection.

Implementation of Health Behavior Education Concerning Liver Flukes among Village Health Volunteers in an Epidemic Area of Thailand.

BACKGROUND: Liver fluke infection is associated with cholangiocarcinoma; the bile duct cancer found frequently in the northeast and north of Thailand. Prevention and control particularly requires health education and behavior change. OBJECTIVE: This study aimed to improve health behavior among village health volunteers (VHV) regarding liver fluke exposure in an epidemic area. MATERIALS AND METHODS: A quasi-experimental study was performed during July 2015 to January 2016 in Sang Kha district of Surin province, Thailand. A total of 67 VHVs underwent a health education program (HEP) and data were collected on knowledge, attitude, and practice (KAP) before and after participation for HEP 3 months with a pre-designed questionnaire. The Students paired T-test was used for comparisons of mean KAP levels before/after the intervention. RESULTS: The results revealed that knowledge (P-value=0.004), attitude (P-value=0.004), and practice level (P-value=0.000) were significantly improved after participation in the HBP. Attitude was significantly associated with knowledge (r=0.266, <0.05), and practice (r=0.348, <0.01) . CONCLUSIONS: The implementation of health education among VHVs is feasible and increases their KAP. This improvement should have potential in liver fluke prevention and control in local communities in rural Thailand.

Improved Detection of Helicobacter pylori Infection and Premalignant Gastric Mucosa Using Conventional White Light Source Gastroscopy.

BACKGROUND: The gold standard diagnosis of H. pylori related gastritis is evidence of bacteria on histopathological examination of gastric mucosa. Our aim was to study the correlation between gastric mucosal morphology and histopathological severity of H. pylori related gastritis. MATERIALS AND METHODS: Division was made on morphological features into:Type 1, showing regular arrangement of red dots; Type 2, showing cleft-like appearance; Type 3, with a mosaic appearance; and Type 4, having a mosaic appearance with focal or diffuse hyperemia. RESULTS: Types 1 and 2 gastric mucosal morphologies were statistically significant in predicting an H. pylori negative status (137/145, <0.01), while Types 3 and 4 were significant a positive status (139/155, <0.01). The sensitivity, specificity, positive and negative predictive values of Type 3 and 4 morphologies for predicting H. pylori positive were 94.6%, 89.5%, 89.7% and 94.5%, respectively, with a good correlation with inflammation grading (<0.01). CONCLUSIONS: Our study suggests that gastric mucosal morphology can be reliably identified using conventional white light source gastroscopy with good correlation between findings and inflammation grading.

Health Behavior Regarding Liver Flukes among Rural People in Nakhon Ratchasima, Thailand.

Opisthorchiasis is a health problem in Thailand particularly in northeast and north regions where have been reported the highest of cholangiocarcinoma. Active surveillance is required, therefore a cross-sectional surveyed was conducted in Nong Bunnak sub-district of Nakhon Ratchasima province, Thailand. A total of 367 participants were selected by multistage sampling from 5 villages located near natural water resources. Participants completed a predesigned questionnaire containing behavior questions regarding liver fluke disease, covering reliability and validity knowledge (Kuder-Richardon-20) = 0.80, attitude and practice (Cronbach's alpha coefficient) = 0.82 and 0.79, respectively. Descriptive statistics included frequencies, percentages, means, and standard deviations. The majority of the participants were female (58.3%), age group between 21-30 years old (42.5%), with primary school education (59.9%), occupation in agriculture (38.1%), and married (80.9%). They had past histories of raw fish consumption (88.3%), stool examination (1.4%), anti-parasite medication used (4.6%). Heads of villages, village health volunteers, television, and village newstations were the main sources for disease information. Participants had a moderate level of behavior regarding liver fluke disease. The mean scored of knowledge regarding liver fluke life cycle, transmission, severities, treatment, prevention and control was 10.9 (SD=0.5), most of them had a moderate level, 95.1%. The mean score for attitude regarding liver fluke prevention and control was 45.7 (SD=9.7), and for practice was 30.6 (SD=10.5). Participants had a moderate level of attitude and practice, 94.5% and 47.7, respectively. This study indicates that health education is required in this community including stool examination for liver fluke as further active surveillance screening.

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.