Opisthorchis viverrini (OV) infection, which can progress to cholangiocarcinoma (CCA), poses a critical public health challenge. While numerous studies have investigated behavior modification programs aimed at preventing OV and CCA, the effectiveness of these interventions remains inconclusive. This systematic review and meta-analysis sought to synthesize evidence on the efficacy of behavior modification programs, particularly those based on self-efficacy, in preventing OV and CCA. We reviewed experimental and quasi-experimental studies, comprising 2-group comparisons or 1-group pretest-posttest designs, that evaluated health education interventions focused on behavior modification for OV and CCA prevention. Relevant literatures was systematically retrieved from the PubMed, Google Scholar, ThaiJo, and ThaiLis databases. Of 702 identified studies, 13 met the systematic review and meta-analysis inclusion criteria. The analysis assessed the quality of the studies, extracted data, and evaluated the risk of bias. Standardized mean differences were calculated to determine the impact of self-efficacy– based programs on knowledge, self-efficacy, and behavior modification. The results indicated significant post-intervention improvements in all outcomes (P<0.001) despite high heterogeneity in knowledge (I²=76%), self-efficacy (I²=77%), and behavior modification (I²=93%). The experimental group demonstrated significantly more significant improvements in knowledge (mean difference=1.52, 95% confidence interval (CI)=1.36–1.68), self-efficacy (mean difference=1.08, 95% CI=0.90–1.26), and behavior modification (mean difference=1.78, 95% CI=1.63–1.92) compared to the comparison group, with I² values of 74%, 84%, and 92%, respectively. In conclusion, health education programs grounded in self-efficacy principles effectively enhance knowledge, selfefficacy, and behavior modification to prevent OV and CCA. These findings suggest that self-efficacy–based behavior modification programs may also apply to the prevention of other diseases.
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Re: Impact of self-efficacy–based health education programs on behavior modification for Opisthorchis viverrini and cholangiocarcinoma prevention in Thailand: A systematic review and meta-analysis Nathkapach Kaewpitoon Rattanapitoon, Chutharat Thanchonnang, Schawanya Kaewpitoon Rattanapitoon Parasites, Hosts and Diseases.2025; 63(4): 378. CrossRef
This study aimed to identify the recent risk factors for Opisthorchis viverrini infection and cholangiocarcinoma (CCA) to improve disease prevention. The participants were divided into the following 3 groups based on their health status: healthy control (nonOV and nonCCA), those with O. viverrini infection (OV), and those with CCA. A questionnaire was used to explore their lifestyle and behaviors. Multivariate logistic regression and backward elimination were used to identify the significant risk factors. The results showed that the significant risk factors for both O. viverrini infection and CCA were age>50 years (odd ratio (OR)=8.44, p<0.001, 95% confidence intervals (CI) 2.98–23.90 and OR=43.47, p=0.001, 95% CI 14.71–128.45, respectively) and raw fish consumption (OR=8.48, p< 0.001, 95% CI 3.18–22.63 and OR=3.15, p=0.048, 95% CI 1.01–9.86, respectively). A history of O. viverrini infection was identified as an additional risk factor for CCA (OR=20.93, p=0.011, 95% CI 2.04–215.10). This study provided an update on the risk factors for O. viverrini infection and CCA. Asymptomatic patients with O. viverrini infection, particularly those>50 years old, should be carefully monitored to prevent CCA.
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Clonorchis sinensis is a Group-I bio-carcinogen, associated with cholangiocarcinoma (CCA). The hamster is the only experimental model of C. sinensis-mediated CCA, but we oblige another animal model. The present study intended to develop a C. sinensis (Cs) mediated CCA model using C3H/He mice, co-stimulated with N-nitrosodimethyl-amine (NDMA) and dicyclanil (DC). The mice were divided into 8 groups with different combinations of Cs, NDMA, and DC. Six months later the mice were sacrificed and subjected to gross and histopathological examination. The body weights were significantly reduced among the groups treated with 2 or more agents (eg. Cs+NDMA, Cs+DC, NDMA+DC, and Cs+NDMA+DC). In contrast, liver weight percentages to body weight were increased in above groups by 4.1% to 4.7%. A Change of the spleen weight was observed only in Cs+NDMA group. Though C. sinensis infection is evident from hyperplastic changes, only 1 worm was recovered. T wo mice, 1 from Cs and the other from Cs+DC group, showed mass forming lesions; 1 (281.2 mm3) from the Cs group was a hepatocellular adenoma and the other (280.6 mm3) from the Cs+DC group was a cystic mass (peliosis). Higher prevalence of gray-white nodules was observed in Cs group (42.9%) followed by Cs+NDMA+DC group (21.4%). The mice of the Cs+NDMA+DC group showed hyper-proliferation of the bile duct with fibrotic changes. No characteristic change for CCA was recognized in any of the groups. In conclusion, C3H/He mice produce no CCA but extensive fibrosis when they are challenged by Cs, NDMA, and DC together.
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Opisthorchis viverrini (O. viverrini) is a well-known causative agent of cholangiocarcinoma (CCA) in humans. CCA is very resistant to chemotherapy and is frequently fatal. To understand the pathogenesis of CCA in humans, a rodent model was developed. However, the development of CCA in rodents is time-consuming and the xenograft-transplantation model of human CCA in immunodeficient mice is costly. Therefore, the establishment of an in vivo screening model for O. viverrini-associated CCA treatment was of interest. We developed a hamster CCA cell line, Ham-1, derived from the CCA tissue of O. viverrini-infected and N-nitrosodimethylamine-treated Syrian golden hamsters. Ham-1 has been maintained in Dulbecco's Modified Essential Medium supplemented with 10% fetal bovine serum for more than 30 subcultures. These cells are mostly diploid (2n=44) with some being polyploid. Tumorigenic properties of Ham-1 were demonstrated by allograft transplantation in hamsters. The transplanted tissues were highly proliferative and exhibited a glandular-like structure retaining a bile duct marker, cytokeratin 19. The usefulness of this for in vivo model was demonstrated by berberine treatment, a traditional medicine that is active against various cancers. Growth inhibitory effects of berberine, mainly by an induction of G1 cell cycle arrest, were observed in vitro and in vivo. In summary, we developed the allo-transplantable hamster CCA cell line, which can be used for chemotherapeutic drug testing in vitro and in vivo.
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