Peter Bradshaw

Infection with Opisthorchis viverrini and Use of Praziquantel among a Working-age Population in Northeast Thailand

Infection with Opisthorchis viverrini (OV) due to eating certain traditional freshwater fish dishes is the principal risk factor for cholangiocarcinoma in Northeast Thailand where the infection is endemic and the incidence of this form of primary liver cancer has been the highest in the world. This paper is the second report of a prospective research project to monitor the impacts of a national liver fluke control programme in a rural community of Northeast Thailand. A sample of 684 villagers aged 20-65 years completed an interview questionnaire and were tested for infection using the Kato thick smear technique. The questionnaire was designed for the exploration of associations between OV infection, previous treatment with praziquantel, and knowledge and beliefs about the drug. The data were analysed using descriptive statistics and multiple logistic regression. The overall prevalence of OV infection was 37.2% and was highest in the 20-35 year age group, in those with a university degree and in those employed in the government sector. As many as 91.8% reported eating fish dishes known to place them at risk of infection. In the multiple regression analysis, previous use of praziquantel and lack of knowledge about whether or not the drug has a protective effect against re-infection were the only factors related to OV infection (ORadj= 2.31, 95%CI =1.40-3.79 and ORadj= 1.95, 95%CI= 1.24-3.05). The findings were discussed in terms of the possibly unwise dependency on praziquantel as a primary element in a control programme.

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

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.

Prevalence of OV infection in Yasothon Province, Northeast Thailand.

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 undercooked 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 Cervical Cancer Screening Uptake by Hmong Hilltribe Women in Thailand

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.

Reinfection by Opisthorchis Viverrini after Treatment with Praziquantel.

BACKGROUND The prevalence of infection by the liver fluke, Opisthorchis viverrini (O. viverrini), has remained high in Northeast Thailand where it is a major risk factor for the eventual development of cholangiocarcinoma (CCA). The infection is acquired by the consumption of dishes containing unsafely prepared freshwater fish, a dietary tradition which has proved resistant to change. Since many people are aware that dosing with praziquantel (PZQ) is a successful treatment for an episode of the infection, there is a risk that, to avoid the long term consequences, they will engage in a cycle of infection, dosing and reinfection. OBJECTIVES There is a dearth of studies of reinfection by O. viverrini, and the aims of this study were to assess re-infection rates in a typical province of Northeastern Thailand where O. viverrini infection is likely and to investigate factors associated with reinfection. MATERIALS AND METHODS A total of infected 607 villagers were treated with PZQ, and those found to be no longer infected were followed up at six-monthly intervals over 12 months. RESULTS At the end of this period data on 457 subjects were available for analysis using descriptive statistics and logistic regression, and 50 were found to have become reinfected, giving a cumulative reinfection rate of 10.9%. The results of a multiple logistic regression analysis showed that the only factor found to be associated with reinfection was past use of PZQ. CONCLUSIONS Recommendations are made for future larger scale and better designed reinfection studies in the light of limitations of the current study. Further efforts are needed to discourage people from eating fish dishes likely to contain viable metacariae.

Prevalence and Risk Factors for Infection by Opisthorchis viverrini in an Urban Area of Mahasarakham Province, Northeast Thailand.

The aim of this cross-sectional analytic study was to investigate the prevalence and risk factors for Opisthorchis viverrini (OV) infection in an urban area of Northeastern Thailand. The participants were 254 household representatives aged 15 years or older living in the most urbanised part of Chiang Yuen municipality in Mahasarakham Province. All participants provided stool samples which were examined using the modified Kato-Katz procedure, and a structured interview questionnaire was used to collection demographic information, knowledge about OV infection, and the consumption of unsafely prepared freshwater fish. The data were analyzed using descriptive statistics and logistic regression. The overall prevalence of OV infection was 15.0%, and in the multivariate analysis male gender was found to be significantly and positively associated with OV infection (ORadj=9.75, 95%CI: 34.03-23.58) while education to secondary school level or above was a significant protective factor (ORadj=0.30, 95%CI: 0.12-0.74). The eating of unsafely prepared fish and knowledge about OV were not significantly related to infection status. The findings were discussed in terms of issues for future research, especially the need to consider the possibility of higher rates of OV infection in urban areas than might be expected and to investigate the sources of infected fish products which may well be different from those in rural villages.

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

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 (ORadj=5.17, 95%CI=2.49- 10.74), the similar habit of family members (ORadj=3.25, 95%CI=1.63-6.49) , a history of O. viverrini infection (ORadj=5.64, 95%CI=2.10-15.18), a history of taking praziquantel (ORadj=5.66, 95%CI=3.11-10.29), and the unsafe disposal of waste food (ORadj=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.

Relationship between the body mass index and abnormal pap smears.

This cross-sectional analytic study aimed to investigate any relationship between the body mass index (BMI) and an abnormal Pap smear. The subjects were 7,720 women aged 30-69 years who lived in Khon Kaen Province, Thailand, and had been recruited as participants in the Khon Kaen Cohort Study during 1990-2001. All had received Pap smear screening for cervical cancer. The data were analyzed using descriptive and inferential statistics. Multiple logistic regression was used to determine the relationship between body mass index and an abnormal Pap smear. The mean BMI was 24.53 kg/m(2) (SD =3.98), and 2.14% had abnormal Pap smears. Compared with the reference group of women with a BMI ≤ 22.9 kg/m(2), those with a body mass index of 23.0- 24.9 kg/m(2) had a reduced risk of an abnormal smear (OR(adj) = 0.92, 95%CI: 0.57-1.47), but women with a BMI 25.0-29.9 kg/m(2) were found to have an approximately 1.24 times higher risk (OR(adj) = 1.24, 95%CI: 0.86-1.80), and those with a BMI ≥ 30.0 kg/m2 had an approximately 1.63 times higher risk (OR(adj)=1.63, 95%CI: 0.98-2.69). The results indicated that the risk of Pap smear abnormalities is increased in women who have a higher than normal body mass index, but this finding was not statistically significant. Nevertheless, public health personnel should encourage women to maintain their BMI in the normal range to reduce the possible future risk of cervical cancer.

Health vulnerability of households in flooded communities and their adaptation measures: case study in northeastern Thailand

Floods adversely affect community well-being and health. This study aims to assess the present health vulnerability of households to floods in a rural flood-prone area of northeastern Thailand, as well as their adaptation measures. The participants were the representatives of 312 randomly selected households, and data were collected using an interview questionnaire. Health vulnerability was assessed in terms of flood exposure, flood sensitivity, and flood adaptive capacity. The data were analyzed with descriptive statistics. The results showed that 47.1% of the households had a low level of health vulnerability to flooding, while in 21.2% the level was high. Households had been adapting themselves to cope with the health impacts from flood. Their coping practices included special arrangements for the protection of property, food management, the provision of water supply and waste disposal, the elimination of sources of vector-borne diseases, family health care, the protection of family livelihood, and communication and transportation.