Community-Based Health Education and Communication Model Development for Opisthorchiasis Prevention in a High Risk Area, Khon Kaen Province, Thailand

Promthet, Paitoon,Kessomboon, Pattapong,Promthet, Supannee Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.17

Background: This study aimed to evaluate the impact of a community-based health education and communication programme on reducing liver fluke infections caused by the consumption of uncooked fish among people in a high-risk area of Thailand. Materials and Methods: The study was quasi-experimental in nature, with three-stages. Stage 1 involved a situational and capacity analysis of designated communities in Khon Kaen province. This was followed by the development of a model for community-based health education and communication to prevent liver fluke infections among high-risk people, and, lastly, implementation and evaluation of the model were performed. Data were collected using both qualitative and quantitative methods. In total, 390 people were surveyed, and quasi-experimental and comparison groups, each with 90 people, were assessed between May 2011 and April 2012. Analysis was using statistical OR, 95 % CI, the Willcoxon matched pairs signed ranks test, the chi-square test, and the Mann-Whitney U test. Results: The findings showed that most respondents had a high level of knowledge and understanding of liver fluke disease (89.5%, 95% CI:86.0-92.4), and positive attitudes toward the prevention of the disease (94.4%, 95% CI:91.6-96.4). However, with regard to changes in consumption of uncooked fish, most respondents were still in the pre-contemplation phase (55.1%, 95% CI:50.0-60.1), followed by the contemplation phase, 22.6%. Furthermore, four factors were found to be associated with the consumption of uncooked fish - the consumption of alcohol (OR 4.16, 95% CI:1.79-9.65), gender (OR 3.17, 95% CI:1.53-6.54), smoking (OR 3.03, 95% CI:1.31-7.05), and age 40 years and above (OR 2.68, 95% CI:1.02-7.05). After nine months of the health education and communication programme using local media based on local wisdom, culture and persons, the results showed that, compared to the control group, members of the experimental group had a higher level of knowledge, a better attitude and lower levels of ill-advised consumption behaviour. Also, it was found that consumption of uncooked fish, by an assessment of the level of stage of change, was reduced. (p-value 0.002). Conclusions: The health education and communication programme developed as part of the study was effective in changing the consumption of uncooked fish. Therefore, this approach should be promoted in other high-risk areas in Thailand in the future.

Evaluation of Health Education in the Multi-professional Intervention and Training for Ongoing Volunteer-based Community Health Programme in the North-East of Thailand

Promthet, Supannee,Wiangnon, Surapon,Senarak, Wiporn,Saranrittichai, Kesinee,Vatanasapt, Patravoot,Kamsa-ard, Supot,Wongphuthorn, Prasert,Kasinpila, Chananya,Moore, Malcolm Anthony Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.5

This was a survey research conducted in Northestern Thailand during 2009-2010 and designed to evaluate the success of a health education program by comparing levels of health knowledge in the community before and after the launching of a Multi-professional Intervention and Training for Ongoing Volunteer-based Community Health Programme. The survey questionnaire included items about demographic characteristics and health knowledge. The participants were 1,015 members of various communities, who were randomly selected to be included in the survey before launching the intervention, and 1,030 members of the same communities randomly selected to be included in the survey after the intervention was completed. The demographic characteristics of both groups were similar. Overall knowledge and knowledge of all the diseases, except lung and cervical cancer, were significantly higher after the intervention. In conclusion, a Volunteer-based Community Health Programme has advantages for areas where the numbers of health personnel are limited. The use of trained community health volunteers may be one of the best sustainable alternative means for the transfer of health knowledge.

Risk Factors for Rectal Cancer and Methylenetetrahydrofolate Reductase Polymorphisms in a Population in Northeast Thailand

Promthet, Supannee,Pientong, Chamsai,Ekalaksananan, Tipaya,Songserm, Nopparat,Poomphakwaen, Kirati,Chopjitt, Peechanika,Wiangnon, Surapon,Tokudome, Shinkan Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.8

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.

Prevalence of OV Infection in Yasothon Province, Northeast Thailand

Saengsawang, Phubet,Promthet, Supannee,Bradshaw, Peter Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.7

A liver fluke, Opisthorchis viverrrini (OV), is the major cause of the high incidence of cholangiocarcinoma in Thailand. The prevalence of OV infection remains high in various parts of the country, especially in Northeast Thailand and particularly in wetland rural areas where a large proportion of the community work in agriculture and continue the traditional practice of eating raw or uncooked cyprinoid fish products. The national control program seems to have had little impact in many of these areas, and it has been difficult to make precise assessments of the overall effectiveness of the program. This paper is the first report of prospective research project designed to monitor the impact of the national control program in rural communities located in a northeastern province and at high risk of OV infection. The participants in this initial survey were 1,569 villagers, aged 20-65 years, living in two subdistricts of Yasothon Province. Stool examinations showed that 38.68% were infected with OV. Males were slightly more likely to be infected than females, but the difference was not statistically significant. Infection was found to be positively associated with age in both males and females. The preliminary data indicate that the population selected for study is suitable for the purpose of the monitoring project.

Factors Affecting Survival Time of Cholangiocarcinoma Patients: A Prospective Study in Northeast Thailand

Woradet, Somkiattiyos,Promthet, Supannee,Songserm, Nopparat,Parkin, Donald Maxwell Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.3

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).

Factors Affecting Cervical Cancer Screening Uptake by Hmong Hilltribe Women in Thailand

Wongwatcharanukul, Laead,Promthet, Supannee,Bradshaw, Peter,Jirapornkul, Chananya,Tungsrithong, Naowarat Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.8

Background: Cervical cancer is relatively common in Thai women, but the proportion of females receiving Pap smear screening is still low. Objective: The purpose of this cross-sectional study was to study factors related to cervical cancer screening uptake by Hmong hilltribe women in Lomkao District, Phetchabun Province. Materials and Methods: Interview data were collected from 547 of these women aged 30-60 years living in the study area and analyzed using multiple logistic regression. Results: The results showed that 64.9% of the study sample had received screening, and that 47.2% had attended due to a cervical screening campaign. The most common reason given for not receiving screening was lack of time (21.4%). The factors found to be positively associated with uptake (p value <0.05) were as follows: number of years of school attendance (OR=1.56, 95%CI:1.02-2.38), animistic religious beliefs (OR=0.55, 95%CI:0.33-0.91), a previous pregnancy (OR=6.20, 95%CI:1.36-28.35), receipt of information about cervical cancer screening (OR=2.25, 95%CI:1.35-3.76), and perceived risk of developing cervical cancer (OR=1.83, 95%CI:1.25-2.67). Conclusions: To promote the uptake of cervical screening, Hmong hilltribe women need to know more about cervical cancer and cervical cancer screening, and access to screening services should be provided in conjunction with existing everyday services, such as family planning and routine blood pressure monitoring or diabetes services.

Prevalence and Co-infection of Intestinal Parasites among Thai Rural Residents at High-risk of Developing Cholangiocarcinoma: A Cross-sectional Study in a Prospective Cohort Study

Songserm, Nopparat,Promthet, Supannee,Wiangnon, Surapon,Sithithaworn, Paiboon Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.12

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.

Effectiveness of Aromatherapy with Light Thai Massage for Cellular Immunity Improvement in Colorectal Cancer Patients Receiving Chemotherapy

Khiewkhern, Santisith,Promthet, Supannee,Sukprasert, Aemkhea,Eunhpinitpong, Wichai,Bradshaw, Peter Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.6

Background: Patients with colorectal cancer are usually treated with chemotherapy, which reduces the number of blood cells, especially white blood cells, and consequently increases the risk of infections. Some research studies have reported that aromatherapy massage affects the immune system and improves immune function by, for example, increasing the numbers of natural killer cells and peripheral blood lymphocytes. However, there has been no report of any study which provided good evidence as to whether aromatherapy with Thai massage could improve the immune system in patients with colorectal cancer. The objectives of this study were to determine whether the use of aromatherapy with light Thai massage in patients with colorectal cancer, who have received chemotherapy, can result in improvement of the cellular immunity and reduce the severity of the common symptoms of side effects. Materials and Methods: Sixty-six patients with colorectal cancer in Phichit Hospital, Thailand, were enrolled in a single-blind, randomised-controlled trial. The intervention consisted of three massage sessions with ginger and coconut oil over a 1-week period. The control group received standard supportive care only. Assessments were conducted at pre-assessment and at the end of one week of massage or standard care. Changes from pre-assessment to the end of treatment were measured in terms of white blood cells, neutrophils, lymphocytes, CD4 and CD8 cells and the CD4/CD8 ratio and also the severity of self-rated symptom scores. Results: The main finding was that after adjusting for pre-assessment values the mean lymphocyte count at the post-assessment was significantly higher (P=0.04) in the treatment group than in the controls. The size of this difference suggested that aromatherapy with Thai massage could boost lymphocyte numbers by 11%. The secondary outcomes were that at the post assessment the symptom severity scores for fatigue, presenting symptom, pain and stress were significantly lower in the massage group than in the standard care controls. Conclusions: Aromatherapy with light Thai massage can be beneficial for the immune systems of cancer patients who are undergoing chemotherapy by increasing the number of lymphocytes and can help to reduce the severity of common symptoms.

XRCC1 Gene Polymorphism, Clinicopathological Characteristics and Stomach Cancer Survival in Thailand

Putthanachote, Nuntiput,Promthet, Supannee,Suwanrungruan, Krittika,Chopjitt, Peechanika,Wiangnon, Surapon,Chen, Li-Sheng,Yen, Ming-Fang,Chen, Tony Hsiu-Hsi Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.14

Background: Stomach cancer is one of leading causes of death worldwide. In Thailand, the incidence and mortality of stomach cancer are in the top ten for cancers. Effects of DNA repair gene X-ray repair cross complementary protein 1 (XRCC1) polymorphisms and clinicopathological characteristics on survival of stomach cancer in Thailand have not been previously reported. The aim of this study was to investigate the effects of XRCC1 gene and clinicopathological characteristics on survival of stomach cancer patients in Thailand. Materials and Methods: Data and blood samples were collected from 101 newly diagnosed stomach cancer cases pathologically confirmed and recruited during 2002 to 2006 and followed-up for vital status until 31 October 2012. Genotype analysis was performed using real-time PCR-HRM. The data were analyzed using the Kaplan-Meier method to yield cumulative survival curve, log-rank test to assess statistical difference of survival and Cox proportional hazard models to estimate adjusted hazard ratio. Results: The total followed-up times were 2,070 person-months, and the mortality rate was 4.3 per 100 person-months. The median survival time after diagnosis was 8.07 months. The cumulative 1-, 3-, 5-years survival rates were 40.4%, 15.2 % and 10.1 % respectively. After adjustment, tumour stage were associated with an increased risk of death (p= 0.036). The XRCC1 Gln339Arg, Arg/Arg homozygote was also associated with increased risk but statistically this was non-significant. Conclusions: In addition to tumour stage, which is an important prognostic factor affecting to the survival of stomach cancer patients, the genetic variant Gln339Arg in XRCC1 may non-significantly contribute to risk of stomach cancer death among Thai people. Larger studies with different populations are need to verify ours findings.

Risk factors for Opisthorchis viverrini Infection in Nong Khai Province, Thailand

Chudthaisong, Nittaya,Promthet, Supannee,Bradshaw, Peter Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.11

Background: Opisthorchis viverrini (OV) infection is the main risk factor for cholangiocarcinoma and is often found in Northeastern Thailand. The prevalence of OV infection and the incidence of cholangiocarcinoma are major public health problems in this region. Objectives: The objectives of this study were to identify factors associated with OV infection among people in Nong Khai Province in order to develop a prevention programme in the community. Materials and Methods: The data were collected in July 2013. Stool specimens were examined for intestinal parasites within hours after collection using a normal saline wet preparation and the modified Kato-Katz technique. A case-control study was conducted to collect information about demographic data, the habit of eating unsafely prepared fish, the safe disposal of waste food, and the practice of defaecating in fields. Structured questionnaires were used to interview 351 participants (117 cases and 234 controls) in a random selection of 30 villages across Nong Khai Province. Multiple logistic regression was used to identify risk factors for OV infection. Results: In the multivariate analysis, the results showed that the factors which had a statistically significant association with OV infection were the habit of consuming unsafely prepared fish ($OR_{adj}=5.17$, 95%CI=2.49-10.74), the similar habit of family members ($OR_{adj}=3.25$, 95%CI=1.63-6.49), a history of O. viverrini infection ($OR_{adj}=5.64$, 95%CI=2.10-15.18), a history of taking praziquantel ($OR_{adj}=5.66$, 95%CI=3.11-10.29), and the unsafe disposal of waste food ($OR_{adj}=2.1$, 95%CI=1.10-3.80). Conclusions: The findings of this study highlight the features on which a community programme should focus in order to reduce the prevalence of opisthorchiasis and incidence of bile duct cancer.