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Chen YW, Hung CH. Fatigue in Patients with Chronic Hepatitis C. Clin Nurs Res 2022; 32:767-775. [PMID: 36384333 DOI: 10.1177/10547738221136668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to explore the factors associated with fatigue in chronic hepatitis C patients before and at 4, 8, 12, 16, 20, and 24 weeks after antiviral therapy. The study employed a prospective and repeated-measures design. The Chinese version of the brief fatigue inventory (BFI-C) and the Pittsburg sleep quality index (PSQI) were employed to collect data. Pegylated Interferon plus Ribavirin dosages and serum values (hemoglobin, alanine aminotransferase [ALT], and aspartate aminotransferase [AST]) were monitored before and during the antiviral therapy at 4, 8, 12, 16, 20, and 24 weeks. The study enlisted 115 patients as participants. Multivariate analysis indicated that gender, educational level, body mass index (BMI), and hemoglobin level were significant determinants of patients’ fatigue. When hemoglobin levels in the patients decreased in week 4 and continued to fall to the nadir at week 12, it prompted the healthcare providers to assess their fatigue levels and initiate proactive interventions as needed.
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Affiliation(s)
- Ya-Wen Chen
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Chich-Hsiu Hung
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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2
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Enriquez M, Mercier DA, Cheng AL, Banderas JW. Perceived Social Support Among Adults Struggling With Adherence to HIV Care and Treatment. J Assoc Nurses AIDS Care 2020; 30:362-371. [PMID: 30829894 DOI: 10.1097/jnc.0000000000000059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Few studies have examined perceived social support among the subgroup of the HIV population that struggles with adherence to HIV care and treatment. A secondary analysis from 2 HIV medication adherence intervention studies was conducted using a mixed method design. Participants were not taking HIV medications as prescribed or had fallen out of HIV care. Two major themes emerged from the qualitative data analysis: extreme isolation and constant turmoil. Overall social support scores were low, as measured by the Medical Outcomes Study Social Support Survey. Convergent qualitative data excerpt corresponded with low scores on every dimension of the Medical Outcomes Study Social Support Survey. Findings from our study indicate that adults living with HIV who struggled with taking HIV medications lacked social support in many areas of their lives. Interventions that focus on perceptions of available social support may be helpful for individuals with ongoing HIV medication adherence challenges.
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Moitra E, Anderson BJ, Herman DS, Hayaki J, Pinkston MM, Kim HN, Stein MD. Examination of using alcohol to cope, depressive symptoms, and perceived social support in persons with HIV and Hepatitis C. AIDS Care 2020; 32:1238-1245. [PMID: 32098484 DOI: 10.1080/09540121.2020.1734177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Depression is common among people living with HIV (PLWH) and some likely turn to alcohol to cope with this emotional distress. Using alcohol to cope is associated with increased alcohol use, persistent longitudinal alcohol use, and alcohol-related problems. This association is particularly concerning among PLWH who are co-infected with Hepatitis C (HCV) because alcohol adds to the damage already caused by HCV. Despite data showing the associated risks of using alcohol to cope, scant research has examined factors that might contribute to coping-based alcohol use in HIV-HCV patients, such as limited social support. Baseline data from a randomized trial of strategies to reduce alcohol use in co-infected HIV and HCV adult patients (n=110) were analyzed. Multiple linear regression models were used to estimate the association between using alcohol to cope, depression, and four aspects of social support, controlling for demographic variables. Results showed that using alcohol to cope was not significantly correlated with social support but was significantly correlated with depressive symptoms. In fact, depressive symptoms and severity of alcohol consumption accounted for nearly 45% of the variance related to coping-based alcohol use. These data highlight the central role of depression in the coping motives-alcohol use relationship among co-infected patients.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.,Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.,Lifespan Physicians Group, Providence RI, USA
| | - H Nina Kim
- Department of Global Health, University of Washington, Seattle WA, USA.,Department of Medicine, University of Washington, Seattle WA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston MA, USA
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4
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Sims OT, Melton PA, Ji S. A Descriptive Analysis of a Community Clinic Providing Hepatitis C Treatment to Poor and Uninsured Patients. J Community Health 2019; 43:725-730. [PMID: 29511988 DOI: 10.1007/s10900-018-0476-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study describes clinical characteristics of poor and uninsured patients living with hepatitis C virus (HCV) who received care from a multidisciplinary HCV clinic, reports treatment completion and cure rates, and estimates the cost of HCV medications provided at no cost to uninsured patients. A retrospective chart review was performed and identified 69 uninsured HCV patients who received medical care at Mercy Health Center, a small non-profit community clinic, between January 2008 and March 2015. Three-fourths of the patients were unemployed, a third had multiple HCV exposures, nearly half acquired HCV due to illicit drug use, and more than half had active psychiatric disorders. Of those who received HCV treatment, 81% completed treatment and 85% were achieved virological cure. The multidisciplinary community clinic provided > $1.4 million of HCV antivirals at no cost to uninsured patients. Findings suggest a multidisciplinary community clinic comprised of a social worker, pharmacist, gastroenterologist, nurse, nurse practitioner, psychologist, and dietitian can help patients achieve HCV treatment completion and cure rates comparable to traditional physician-led clinics, and successfully manage uninsured and underserved HCV patients-who are often regarded as "difficult-to-treat" patients. Public health social workers and other health professionals are encouraged to advocate for treatment and care of poor and uninsured patients living with HCV in health agencies and health systems, otherwise population-wide reductions in HCV morbidity and mortality will not be realized.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S., Birmingham, AL, 35294-1260, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S., Birmingham, AL, 35294-1260, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S., Birmingham, AL, 35294-1260, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S., Birmingham, AL, 35294-1260, USA.
| | - Pamela A Melton
- School of Social Work, Tulane University, 127 Elk PL, New Orleans, LA, 70112, USA
| | - Shaonin Ji
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
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Sims OT, Hong BA, Ji S, Pollio DE, North CS. A Systematic Comparison of African American and Non-African American Patients on Psychosocial Aspects of Hepatitis C Infection. JOURNAL OF RELIGION AND HEALTH 2018; 57:1764-1770. [PMID: 29411232 DOI: 10.1007/s10943-018-0565-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to compare African American and non-African American hepatitis C virus (HCV) patients on self-reported symptoms of HCV liver disease and psychosocial characteristics commonly affected by it in a sample of 309 patients enrolled in a randomized controlled trial. African Americans (n = 196) rated a higher reliance on religion/spirituality for coping with HCV compared to non-African Americans. This study's findings are a basis for encouragement of public health efforts and programs to seek partnerships with African American faith and religious communities to identify and treat undiagnosed cases of HCV and promote HCV awareness.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmi, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
| | - Barry A Hong
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Shaonin Ji
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Pollio
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, HB 414, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA
| | - Carol S North
- The Altshuler Center for Education and Research, Metrocare Services, Dallas, TX, USA
- Department of Psychiatry, School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Sims OT, Maynard QR, Melton PA. Behavioral Interventions to Reduce Alcohol Use Among Patients with Hepatitis C: A Systematic Review. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:565-73. [PMID: 27295132 DOI: 10.1080/19371918.2016.1160346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Alcohol use is a barrier to pharmacologic treatment for hepatitis C virus (HCV). It is advantageous for medical and clinical social workers engaged in HCV care to be knowledgeable of behavioral interventions that can be used to reduce alcohol use among patients with HCV. This article identifies and describes studies that designed and implemented behavioral interventions to reduce alcohol use among patients with HCV in clinical settings. To achieve this goal, this article conducts a rigorous systematic review to identify peer-reviewed articles, describes each behavioral intervention, and reports primary outcomes of each study included in the review.
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Affiliation(s)
- Omar T Sims
- a Department of Social Work, College of Arts and Sciences , The University of Alabama at Birmingham , Birmingham , Alabama , USA
- b Department of Health Behavior, School of Public Health , The University of Alabama at Birmingham , Birmingham , Alabama , USA
- c Center for AIDS Research, The University of Alabama at Birmingham , Birmingham , Alabama , USA
- d Center for Comprehensive Healthy Aging, The University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Quentin R Maynard
- e School of Social Work, The University of Alabama , Tuscaloosa , Alabama , USA
| | - Pam A Melton
- e School of Social Work, The University of Alabama , Tuscaloosa , Alabama , USA
- f School of Social Work, Tulane University , New Orleans , Louisiana , USA
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Sbarigia U, Denee TR, Turner NG, Wan GJ, Morrison A, Kaufman AS, Rice G, Dusheiko GM. Conceptual framework for outcomes research studies of hepatitis C: an analytical review. Infect Drug Resist 2016; 9:101-17. [PMID: 27313473 PMCID: PMC4890693 DOI: 10.2147/idr.s99329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hepatitis C virus infection is one of the main causes of chronic liver disease worldwide. Until recently, the standard antiviral regimen for hepatitis C was a combination of an interferon derivative and ribavirin, but a plethora of new antiviral drugs is becoming available. While these new drugs have shown great efficacy in clinical trials, observational studies are needed to determine their effectiveness in clinical practice. Previous observational studies have shown that multiple factors, besides the drug regimen, affect patient outcomes in clinical practice. Here, we provide an analytical review of published outcomes studies of the management of hepatitis C virus infection. A conceptual framework defines the relationships between four categories of variables: health care system structure, patient characteristics, process-of-care, and patient outcomes. This framework can provide a starting point for outcomes studies addressing the use and effectiveness of new antiviral drug treatments.
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Affiliation(s)
| | | | - Norris G Turner
- Johnson & Johnson Health Care Systems, Inc., Titusville, NJ, USA
| | - George J Wan
- Mallinckrodt Pharmaceuticals, St. Louis, MO, USA
| | | | | | - Gary Rice
- Diplomat Specialty Pharmacy, Flint, MI, USA
| | - Geoffrey M Dusheiko
- The University College London Medical Institute for Liver and Digestive Health, London, UK
- Kings College Hospital, London, UK
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Majid A, McAninch J, Morgan DJ, El Kamary SS, Zhan M, Kapelusznik L, Talwani R. Predictors of early treatment discontinuation in a cohort of patients treated with boceprevir-based therapy for hepatitis C infection. J Viral Hepat 2014; 21:585-9. [PMID: 24224781 DOI: 10.1111/jvh.12201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/21/2013] [Indexed: 12/31/2022]
Abstract
In this real-world cohort, 49% of patients stopped boceprevir-based hepatitis C therapy early, with only 20% stopping due to treatment futility. Having more comorbidities was significantly associated with early discontinuation. Tolerability of boceprevir-based regimens may be substantially worse than reported in clinical trials, particularly for patients with comorbidities.
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Affiliation(s)
- A Majid
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA; VA Maryland Healthcare System, Baltimore, MD, USA
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Machado DDA, Silva GF, Torres AR, Cerqueira ATDAR. Depressive symptoms and harmful alcohol use in hepatitis C patients: prevalence and correlates. Rev Soc Bras Med Trop 2014; 47:149-57. [DOI: 10.1590/0037-8682-0270-2013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
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Lubega S, Agbim U, Surjadi M, Mahoney M, Khalili M. Formal hepatitis C education enhances HCV care coordination, expedites HCV treatment and improves antiviral response. Liver Int 2013; 33:999-1007. [PMID: 23509897 PMCID: PMC3692599 DOI: 10.1111/liv.12150] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/19/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Formal Hepatitis C virus (HCV) education improves HCV knowledge but the impact on treatment uptake and outcome is not well described. We aimed to evaluate the impact of formal HCV patient education on primary provider-specialist HCV comanagement and treatment. METHODS Primary care providers within the San Francisco safety-net health care system were surveyed and the records of HCV-infected patients before and after institution of a formal HCV education class by liver specialty (2006-2011) were reviewed retrospectively. RESULTS Characteristics of 118 patients who received anti-HCV therapy were: mean age 51, 73% males and ~50% White and uninsured. The time to initiation of HCV treatment was shorter among those who received formal education (median 136 vs 284 days, P < 0.0001). When controlling for age, gender, race and HCV viral load, non-1 genotype (OR 6.17, 95% CI 2.3-12.7, P = 0.0003) and receipt of HCV education (OR 3.0, 95% CI 1.1-7.9, P = 0.03) were associated with sustained virologic treatment response. Among 94 provider respondents (response rate = 38%), mean age was 42, 62% were White, and 63% female. Most providers agreed that the HCV education class increased patients' HCV knowledge (70%), interest in HCV treatment (52%), and provider-patient communication (56%). A positive provider attitude (Coef 1.5, 95% CI 0.1-2.9 percent, P = 0.039) was independently associated with referral rate to education class. CONCLUSIONS Formal HCV education expedites HCV therapy and improves virologic response rates. As primary care provider attitude plays a significant role in referral to HCV education class, improving provider knowledge will likely enhance access to HCV specialty services in the vulnerable population.
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Affiliation(s)
- Samali Lubega
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| | - Uchenna Agbim
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| | - Miranda Surjadi
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| | - Megan Mahoney
- Department of Family and Community Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| | - Mandana Khalili
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA,Liver Center, University of California San Francisco, San Francisco, CA
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Lieveld FI, van Vlerken LG, Siersema PD, van Erpecum KJ. Patient adherence to antiviral treatment for chronic hepatitis B and C: a systematic review. Ann Hepatol 2013. [PMID: 23619254 DOI: 10.1016/s1665-2681(19)31000-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Poor adherence to treatment for various chronic diseases is a frequent phenomenon. Current guidelines for the treatment of chronic hepatitis B (HBV) and hepatitis C (HCV) recommend optimal adherence, since it has been suggested that poor adherence is associated with an increased risk of virological failure. We aimed to give an overview of studies exploring adherence to combination treatment (PEG-interferon plus ribavirin) for HCV and nucleos(t)ide analogues for HBV. Material and methods. A systematic review was conducted using the databases PubMed, Embase, Cochrane Library and Web of Knowledge. Search terms included "adherence" or "compliance" combined with "hepatitis B", "hepatitis C" or "viral hepatitis". RESULTS The final selection included 19 studies (13 HCV, 6 HBV). Large differences in patient numbers and adherence assessment methods were found between the various studies. For HCV mean adherence varied from 27 to 97%, whereas the proportion of patients with ≥ 80% adherence varied from 27 to 96%. Mean adherence reported in HBV studies ranged from 81 to 99%, with 66 to 92% of patients being 100% adherent. For both HCV and HBV studies, the highest adherence rates were reported in studies using self-report whereas lower adherence rates were reported in studies using pharmacy claims. Poor adherence to treatment was associated with an increased risk of virological failure. CONCLUSION Non-adherence to treatment in chronic viral hepatitis is not a frequent phenomenon. However, given the increased risk of virological failure in poorly adherent patients, clinicians should routinely address adherence issues in all patients treated for chronic viral hepatitis.
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Affiliation(s)
- Faydra I Lieveld
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Modabbernia A, Poustchi H, Malekzadeh R. Neuropsychiatric and psychosocial issues of patients with hepatitis C infection: a selective literature review. HEPATITIS MONTHLY 2013; 13:e8340. [PMID: 23550100 PMCID: PMC3582302 DOI: 10.5812/hepatmon.8340] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 08/20/2012] [Accepted: 10/08/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT We briefly reviewed the evidence on the association of hepatitis C (HCV) infection with several aspects of mental and psychosocial health. EVIDENCE ACQUISITION Medline was searched with appropriate keywords. The primary sources were the systematic reviews. If systematic reviews were not available for a subject, then the most relevant and methodologically sound original studies were selected. RESULTS HCV infection is associated with poorer health-related quality of life, and physical, mental, and social health. A part of impaired health of these patients is related to cirrhosis, intravenous drug use, co morbid psychiatric disorders, stigmatization, poor social support, alcohol abuse, and interferon treatment. However, HCV itself is also associated with poorer health status particularly in the physical and cognitive domains, which might be related to brain alterations induced by the virus. Interferon treatment is an important cause of depression in HCV patients and sometimes is associated with irritability, manic episode, or acute confusional state. Social health of HCV patients is significantly impaired by stigmatization, poor social support, psychiatric comorbidties, and impaired coping. Psychosocial impairment of HCV patients significantly impairs their treatment adherence. A supportive and nonjudgmental multidisciplinary team is required for optimal management of these patients. CONCLUSIONS Patients with HCV infection had complex neuropsychiatric and psychosocial problems. These problems are challenges for management of HCV infection, affect the patient's care significantly, and might alter the course of the disease. A multidisciplinary approach, a supportive environment, and a nonjudgmental healthcare team are required for optimal medical and psychosocial management of patients with HCV.
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Affiliation(s)
- Amirhossein Modabbernia
- Digestive Disease Research Centre, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Poustchi
- Digestive Disease Research Centre, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Reza Malekzadeh
- Digestive Disease Research Centre, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
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Ekmann A, Avlund K, Osler M, Lund R. Do negative aspects of social relations influence fatigue? A cross-sectional study on a non-clinical sample of middle-aged Danish men. J Psychosom Res 2012; 73:277-82. [PMID: 22980533 DOI: 10.1016/j.jpsychores.2012.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/24/2012] [Accepted: 08/07/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Fatigue is a common complaint among young and old adults and may be associated with negative aspects of social relations. Hence, the purpose of this study was to explore the association between demands from and conflicts with different sources of social relations and fatigue. METHODS The study was based on sub-populations of the 6292 members of the Danish Metropolit Cohort. The cohort comprises men born in 1953 in the Copenhagen Metropolitan area who participated in a questionnaire survey in 2004. Data were analysed using χ(2)-tests and multivariable logistic regression. RESULTS The results showed that demands from and conflicts with children were independently associated with fatigue in a dose-response pattern. The adjusted odds ratio for fatigue was 1.48 (95% CI: 1.01-2.17) when the men experienced frequent demands from children and 1.89 (95% CI: 1.17-3.06) when they had frequent conflicts with their children. Crude analyses of demands from or conflicts with spouse, relatives or friends, respectively showed associations with fatigue compared to no demands or no conflicts. However, adjustment for depression and physical chronic disease cancelled out these associations. CONCLUSION We concluded that middle-aged Danish men, who had frequent negative social interactions with their children, more frequently experienced fatigue. However, negative social interactions with spouse, relatives or friends were not associated with fatigue.
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Affiliation(s)
- Anette Ekmann
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark.
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14
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Hepgul N, Kodate N, Anderson JE, Henderson M, Ranjith G, Hotopf M, Pariante CM. Understanding clinical risk decision making regarding development of depression during interferon-alpha treatment for hepatitis-C: a qualitative interview study. Int J Nurs Stud 2012; 49:1480-8. [PMID: 22889554 DOI: 10.1016/j.ijnurstu.2012.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/20/2012] [Accepted: 07/24/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) affects 170 million worldwide. Currently, around 30% of patients receiving interferon-alpha (IFN-α) treatment for HCV experience clinically significant depression. Effective and timely detection of depression is crucial to ensuring appropriate treatment and support. However, little is known about how clinical nurse specialists identify patients at risk of developing interferon-alpha-induced depression, and monitor those receiving antiviral treatment for the occurrence of depression. OBJECTIVE This study aimed to gain an in-depth understanding of staff experience of, and attitudes towards, the identification and monitoring of interferon-alpha-induced-depression and the decision-making process concerning the use of liaison psychiatry and other clinical services. DESIGN A qualitative interview study was conducted among clinical staff involved in the care of patients with hepatitis C, using the perspective of naturalistic decision making. SETTINGS Outpatient liver clinics in three large teaching hospitals in South London, the United Kingdom. PARTICIPANTS All clinical nurse specialists from the three outpatient liver clinics were included. All were involved directly in the care of patients receiving interferon-alpha treatment and had at least one year experience (mean 6.4 years, range 1-11 years) in this field. METHODS Semi-structured face-to-face interviews were conducted between 2010 and 2011. Data collection and analysis were carried out iteratively to ensure the reliability of the analysis using the constant comparison method. RESULTS Staff used verbal and non-verbal cues when assessing risks of patients developing depression before and during IFN-α treatment. Major sources of uncertainty were patient engagement and familiarity, referrals to psychiatrists, language barriers, and distinguishing between psychological and physical symptoms. Good rapport with patients and good communication among multidisciplinary professional groups were key strategies identified to reduce uncertainty. CONCLUSION Current methods of identifying vulnerable patients rely on the availability of clinical experts and good communication within a multidisciplinary team. Detection and management of depression in this population is complex, however, various strategies are employed by nurses to overcome difficulties when making decisions regarding patient welfare. Current clinical practices should be taken into account when developing new tools and methods.
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Affiliation(s)
- Nilay Hepgul
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
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15
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Bonner JE, Esserman D, Evon DM. Reliability and validity of a self-efficacy instrument for hepatitis C antiviral treatment regimens. J Viral Hepat 2012; 19:316-26. [PMID: 22497810 PMCID: PMC3334309 DOI: 10.1111/j.1365-2893.2011.01550.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Self-efficacy or confidence in one's ability to successfully engage in goal-directed behaviour has been shown to influence medication adherence across many chronic illnesses. In the present study, we investigated the psychometric properties of a self-efficacy instrument used during treatment for chronic hepatitis C viral infection (HCV). Baseline (n = 394) and treatment week 24 (n = 254) data from the prospective, longitudinal Viral Resistance to Antiviral Therapy of Chronic Hepatitis C study were examined. Baseline participants were randomly split into two equal-sized subsamples (S(1) and S(2) ). Initial exploratory and confirmatory factor analyses (EFA/CFA) were performed on S(1), while S(2) was used to validate the factor structure of the S(1) results using CFA. An additional CFA was performed on the treatment week 24 participants. Convergent and discriminant validity were assessed by comparing the revised instrument with other psychosocial measures: depression, social support, quality of life and medication-taking behaviour. Our findings supported a reduced 17-item global measure of HCV treatment self-efficacy (HCV-TSE) with four underlying factors: patient communication self-efficacy, general physical coping self-efficacy, general psychological coping self-efficacy and adherence self-efficacy. The global score (0.92-0.94) and four factors (0.85-0.96) demonstrated good internal consistency. Correlations of convergent and discriminant validity yielded low to moderate associations with other measures of psychosocial functioning. The revised HCV-TSE instrument provides a reliable and valid global estimate of confidence in one's ability to engage in and adhere to HCV antiviral treatment. The four-factor structure suggests different types of efficacy beliefs may function during HCV treatment and should be explored further in relation to clinical outcomes.
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Affiliation(s)
- Jason E. Bonner
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill
| | - Denise Esserman
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill,Department of Biostatistics, Gillings School of Public Health, University of North Carolina, Chapel Hill
| | - Donna M. Evon
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill
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