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Dong W, Da Roza CC, Cheng D, Zhang D, Xiang Y, Seto WK, Wong WCW. Development and validation of HBV surveillance models using big data and machine learning. Ann Med 2024; 56:2314237. [PMID: 38340309 PMCID: PMC10860422 DOI: 10.1080/07853890.2024.2314237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The construction of a robust healthcare information system is fundamental to enhancing countries' capabilities in the surveillance and control of hepatitis B virus (HBV). Making use of China's rapidly expanding primary healthcare system, this innovative approach using big data and machine learning (ML) could help towards the World Health Organization's (WHO) HBV infection elimination goals of reaching 90% diagnosis and treatment rates by 2030. We aimed to develop and validate HBV detection models using routine clinical data to improve the detection of HBV and support the development of effective interventions to mitigate the impact of this disease in China. METHODS Relevant data records extracted from the Family Medicine Clinic of the University of Hong Kong-Shenzhen Hospital's Hospital Information System were structuralized using state-of-the-art Natural Language Processing techniques. Several ML models have been used to develop HBV risk assessment models. The performance of the ML model was then interpreted using the Shapley value (SHAP) and validated using cohort data randomly divided at a ratio of 2:1 using a five-fold cross-validation framework. RESULTS The patterns of physical complaints of patients with and without HBV infection were identified by processing 158,988 clinic attendance records. After removing cases without any clinical parameters from the derivation sample (n = 105,992), 27,392 cases were analysed using six modelling methods. A simplified model for HBV using patients' physical complaints and parameters was developed with good discrimination (AUC = 0.78) and calibration (goodness of fit test p-value >0.05). CONCLUSIONS Suspected case detection models of HBV, showing potential for clinical deployment, have been developed to improve HBV surveillance in primary care setting in China. (Word count: 264).
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Affiliation(s)
- Weinan Dong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cecilia Clara Da Roza
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Dandan Cheng
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Dahao Zhang
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yuling Xiang
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Wai Kay Seto
- Department of Medicine and State Key Laboratory of Liver Research, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - William C. W. Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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2
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Jin D, Brener L, Treloar C. Hepatitis B-related stigma among Chinese immigrants living with hepatitis B virus in Australia: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5602-e5611. [PMID: 36068665 PMCID: PMC10086810 DOI: 10.1111/hsc.13986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/05/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Chinese immigrants in Australia are overrepresented among people with chronic hepatitis B virus (PWCHB) but experience poor access to healthcare. Given the historical discriminatory policies against PWCHB in mainland China, this study aimed to explore the lived experiences of stigma and discrimination surrounding hepatitis B virus (HBV) among Chinese immigrants originally from mainland China. Semi-structured in-depth interviews were conducted by a researcher with a Chinese background in 2019-2020. Sixteen Chinese immigrants living with HBV were recruited across Sydney and Melbourne through advocacy and support groups. This study is positioned in social constructionism. Data analysis was informed by the Health Stigma and Discrimination Framework that highlights the interaction between layered stigmas. This study revealed the historical, social and cultural construction of HBV-related stigma among PWCHB and demonstrated how this stigma was manifested across socioecological levels in China and Australia. Findings show that HBV-related stigma has mostly been driven by knowledge deficits about HBV and fear of HBV infection. HBV-related stigma was mostly demonstrated around social isolation including isolation imposed by family and the community and employment restrictions in the Chinese workplace. In the Australian context, HBV-related stigma was related to the ethnic and cultural background of PWCHB, and primarily occurred as anticipated stigma in the community and in employment. The findings provide significant insights for crosscutting research and policy endeavours to develop and test cross-disciplinary initiatives that more broadly address the complex lived realities of Chinese immigrants living with hepatitis B virus.
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Affiliation(s)
- Defeng Jin
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
| | - Loren Brener
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
| | - Carla Treloar
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
- Social Policy Research Centre, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
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3
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Marley G, Seto WK, Yan W, Chan P, Tucker JD, Tang W, Wong WCW. What facilitates hepatitis B and hepatitis C testing and the role of stigma among primary care patients in China? J Viral Hepat 2022; 29:637-645. [PMID: 35633086 DOI: 10.1111/jvh.13711] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 01/13/2023]
Abstract
Approximately 80% of primary healthcare facilities in China were ready to deliver hepatitis care services by 2021. This study aimed to assess hepatitis B and C test uptake, identify the factors associated with testing and determine the predictors of hepatitis stigma among primary care patients. We conducted a cross-sectional survey among patients seeking care in the family medicine and primary care unit of the University of Hong Kong-Shenzhen Hospital, China. Participants were 30 years or older and had not tested for HBV and HCV in the preceding 12 months. Test uptake was defined as self-reported previous HBV and HCV testing. Descriptive statistics, Chi-square test, forward multivariable logistic regression and stepwise multiple linear regression were conducted, and a p-value <.05 was deemed statistically significant. A total of 750 eligible patients completed the survey, and 54.5% (404 ± 0.9) were between 30 and 40 years old. Most participants were heterosexuals 98.0% (n = 735), female 57.5% (n = 431), married 78.3% (587) and earned ≤1500 USD per month 54.4% (n = 408). A 66.1% (n = 496) and 13.7% (n = 103) self-reported previous HBV and HCV testing, respectively, and 62% (n = 468) were vaccinated. HCV testing was associated with HBV testing (aOR = 13.7, 95% CI:2.1-91.5); and HBV testing was associated with family history of HBV (aOR = 2.4, 95%CI:1.1-5.5). Overall hepatitis stigma was about average and decreased with family history of HBV (p = .017). In conclusion, HCV testing uptake among primary care patients was low and needs to be further promoted. Integrating HBV and HCV testing interventions and fostering family-based support for disclosure could effectively improve testing uptake.
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Affiliation(s)
- Gifty Marley
- The University of North Carolina Project-China, Global Health Center Office, Guangzhou, China.,Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Medicine and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
| | - Weihui Yan
- Department of Family Medicine & Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Polin Chan
- World Health Organization Western Pacific Regional Office, Manila, The Philippines
| | - Joseph D Tucker
- The University of North Carolina Project-China, Global Health Center Office, Guangzhou, China.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Faculty of Infectious and Tropical Diseases, LSHTM, London, UK
| | - Weiming Tang
- The University of North Carolina Project-China, Global Health Center Office, Guangzhou, China.,Social Entrepreneurship to Spur Health (SESH), Guangzhou, China.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William C W Wong
- Department of Family Medicine & Primary Care, School of Clinical Medicine, Li Ka Shing Faculty Medicine, The University of Hong Kong, Hong Kong, China
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4
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Zhao D, Zhang H, Cao Q, Wang Z, Zhang R. The research of SARIMA model for prediction of hepatitis B in mainland China. Medicine (Baltimore) 2022; 101:e29317. [PMID: 35687775 PMCID: PMC9276452 DOI: 10.1097/md.0000000000029317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
Hepatitis B virus infection is a major global public health concern. This study explored the epidemic characteristics and tendency of hepatitis B in 31 provinces of mainland China, constructed a SARIMA model for prediction, and provided corresponding preventive measures.Monthly hepatitis B case data from mainland China from 2013 to 2020 were obtained from the website of the National Health Commission of the People's Republic of China. Monthly data from 2013 to 2020 were used to build the SARIMA model and data from 2021 were used to test the model.Between 2013 and 2020, 9,177,313 hepatitis B cases were reported in mainland China. SARIMA(1,0,0)(0,1,1)12 was the optimal model and its residual was white noise. It was used to predict the number of hepatitis B cases from January to December 2021, and the predicted values for 2021 were within the 95% confidence interval.This study suggests that the SARIMA model simulated well based on epidemiological trends of hepatitis B in mainland China. The SARIMA model is a feasible tool for monitoring hepatitis B virus infections in mainland China.
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Affiliation(s)
- Daren Zhao
- Department of Medical Administration, Sichuan Provincial Orthopedics Hospital, Chengdu, Sichuan, China
| | - Huiwu Zhang
- Department of Medical Administration, Sichuan Provincial Orthopedics Hospital, Chengdu, Sichuan, China
| | - Qing Cao
- Department of Medical Administration, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Zhiyi Wang
- Department of Medical Administration, Sichuan Cancer Hospital & Institute,Chengdu, Sichuan, China
| | - Ruihua Zhang
- School of Management,Chengdu University of Traditional Chinese Medicine,Chengdu, Sichuan, China
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5
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Behera MK, Nath P, Behera SK, Padhi PK, Singh A, Singh SP. Unemployment and Illiteracy Are Predictors of Hepatitis B Virus-Related Stigma and Discrimination. J Clin Exp Hepatol 2022; 12:767-773. [PMID: 35677504 PMCID: PMC9168712 DOI: 10.1016/j.jceh.2021.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND HBV is a serious threat to society in India as around 1,00,000 people die from HBV every year. However, very few studies from India have evaluated the magnitude of stigma faced by HBV patients. So, there was an unmet need to estimate the HBV-related stigma to design the preventive strategies. Hence, the aim of this study was to quantitatively assess the proportions of stigma and discrimination and factors predicting them among HBV patients. METHODS A cross-sectional study was conducted from May 2016 to October 2019. A total of 350 HBV patients and 100 healthy respondents were interviewed for knowledge and awareness about HBV and various stigma characteristics. RESULTS The mean age of HBV subjects was 45.10 ± 11.70 years, and controls were 36.20 ± 12.27 years; males constituted 60% of HBV subjects and 71% of controls. Negative symptoms such as shame, avoidance, and putting others in danger were felt by 70-90% of HBV patients. Around 60% of HBV patients felt that hepatitis B could be transmitted by sharing utensils thinking that saliva is the mode of transmission. The knowledge about transmission of HBV by sexual intercourse, intravenous drug use, and mother to child was present in 88%, 75%, and 52% of HBV patients and 32%,38%, and 40% of healthy individuals, respectively. Multivariate logistic regression revealed that male gender (AOR-2.38, CI 1.48-3.81, P < 0.01), under matriculates (AOR-2.03, CI 1.22-3.44, P < 0.01) and unemployed (AOR-2.16, CI 1.33-3.53, P < 0.01) were significant independent predictors of significant discrimination. CONCLUSION The magnitude of HBV-related stigma is high in the Indian population, and illiteracy and unemployment were significant predictors of a severe grade of discrimination associated with HBV.
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Affiliation(s)
- Manas K. Behera
- Department of Hepatology, SCB Medical College and Hospital, Cuttack, India
| | - Preetam Nath
- Department of Gastroenterology, KIMS Hospital, Bhubaneswar, India
| | - Sambit K. Behera
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India
| | - Pradeep K. Padhi
- Department of Medicine, Fakir Mohan Medical College and Hospital, Balasore, India
| | - Ayaskanta Singh
- Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India,Address for correspondence: Shivaram Prasad Singh, Professor and Head, Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India.
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6
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Le Gautier R, Wallace J, Richmond JA, Pitts M. The personal and social impact of chronic hepatitis B: A qualitative study of Vietnamese and Chinese participants in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1420-1428. [PMID: 33064908 DOI: 10.1111/hsc.13197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 08/09/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
This study explores the lived experiences of chronic hepatitis B (CHB) among Vietnamese and Chinese-born people living in Melbourne, Australia. The aims of this study were to investigate the personal and social implications of CHB, and the extent to which these implications, including experiences of stigma and marginalisation, affect individuals' overall quality of life. This study is based on individual semi-structured interviews with 37 Vietnamese and Chinese people with CHB in Australia (n = 22 and n = 15 respectively). The interviews were conducted between February 2015 and November 2016. Electronically recorded interviews of up to 1.5 hr were conducted, translated where necessary and transcribed verbatim. Transcripts were coded using NVivo, with coding themes guided by the principles of thematic analysis. Fundamental to most participants' accounts was the experience of living in constant fear of stigma and marginalisation, which participants unanimously attributed to prevailing misconceptions about hepatitis B-related transmission routes and disease outcomes. The accompanying experiences of social isolation-whether imposed upon themselves or by others-brought on additional feelings of shame and emotional pain, which had a profound impact on participants' overall quality of life. By exploring participants' lived experiences of hepatitis B, it became clear that concerns about the clinical implications related to hepatitis B as a biomedical infection make up only a small part of their experiences. Of particular significance were personal and social concerns around transmission, disclosure as well as the impact of stigma and marginalisation on participants and their families. Adopting a comprehensive multi-pronged response to tackle the multitude of complexities surrounding this infection among key affected communities will be more effective than just recognising the physical experience of the infection.
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Affiliation(s)
- Roslyn Le Gautier
- Palliative Nexus, Department of Medicine, University of Melbourne, Fitzroy, VIC, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne VIC, Australia
- Australian Research Centre in Sex, Health & Society, La Trobe University, Bundoora, VIC, Australia
| | - Jacqueline A Richmond
- Burnet Institute, Melbourne VIC, Australia
- Australian Research Centre in Sex, Health & Society, La Trobe University, Bundoora, VIC, Australia
| | - Marian Pitts
- Australian Research Centre in Sex, Health & Society, La Trobe University, Bundoora, VIC, Australia
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7
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Jin D, Treloar C, Brener L. Hepatitis B virus related stigma among Chinese living in mainland China: a scoping review. PSYCHOL HEALTH MED 2021; 27:1760-1773. [PMID: 34190017 DOI: 10.1080/13548506.2021.1944651] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Stigma related to hepatitis B virus (HBV) has a detrimental impact on health outcomes of people living with HBV. A scoping review of published peer-reviewed articles focused on the Chinese population in mainland China published between 2010 and 2019 was undertaken. This review consists of five stages: identifying the research question, identifying relevant literature, study selection, charting the data, and collating, summarizing and reporting the results. Articles in Chinese were identified from the collection of Core Journals in the database of CNKI (China Academic Journals Full-text Database). Publications in English were identified in Global Health, Scopus, PsycINFO, Proquest and Web of Science. Forty-five peer-reviewed articles were selected for inclusion. Most studies under review focused on negative individual attitude and discrimination against people living with HBV (PLHBV) in employment, education, community and healthcare settings. There is limited information on lived experiences of those living with HBV and how they manage this stigma. The reviewed studies provide evidence for the existence of different forms of HBV-related stigma in a variety of settings. Knowledge about HBV and the level of education of research participants were the most frequently identified factors related to this stigma. These findings are useful to support HBV responses in China and countries with migration from China.
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Affiliation(s)
- Defeng Jin
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, University of New South Wales, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, University of New South Wales, Sydney, Australia
| | - Loren Brener
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, University of New South Wales, Sydney, Australia
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8
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Liu R, Nicholas S, Leng A, Qian D, Maitland E, Wang J. The influencing factors of discrimination against recovered Coronavirus disease 2019 (COVID-19) patients in China: a national study. Hum Vaccin Immunother 2021; 18:1913966. [PMID: 34085898 PMCID: PMC8920212 DOI: 10.1080/21645515.2021.1913966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Over 26 million recovered COVID-19 patients will suffer from discrimination in work, education and social interactions. We analyzed the determinants of discrimination against recovered COVID-19 patients and suggest policy recommendations to reduce such discrimination. Methods Twenty-seven Chinese cities were selected randomly based on their geographical location and GDP rank. One hundred adults were interviewed in each city with an equal number of men and women and three urban residents for every two rural residents. A multiple ordered logistic regression model was used to assess the associations between potential determinants and the COVID-19 discrimination level. Results Of 2377 participants, 79.76% displayed discrimination toward recovered COVID-19 patients. The female discrimination level was 1.25 times that of males; the discrimination level increased with age; and was occupation-specific, with physicians’ (OR = 0.352) and students’ (OR = 0.553) discrimination level lower than that of farmers. The discrimination level of participants from the central regions was 1.828 times, and the eastern region 1.504 times, that of participants from western region. The participants’ discrimination level was lower when they scored higher in transmission knowledge, prevention knowledge and other COVID-19 knowledge, treatment methods and quarantine time. Conclusion Sex, age, occupation, infections of relatives and friends, regions and scores on COVID-19 knowledge were determinants of discrimination level against recovered COVID-19 patients. In contrast with qualitative studies, our quantitative study recommends targeted education campaigns, focusing on physicians, women, older people and certain occupations. Only the COVID-19 vaccination program for the whole population will resolve the COVID-19 discrimination problem.
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Affiliation(s)
- Rugang Liu
- School of Health Policy & Management, Nanjing Medical University, Nanjing, PRC.,Center for Global Health, Nanjing Medical University, Nanjing, PRC
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Sydney, Australia.,Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, PRC.,School of Economics and School of Management, Tianjin Normal University, Tianjin, PRC.,Newcastle Business School, University of Newcastle, University Drive, Newcastle, Australia
| | - Anli Leng
- School of Political Science and Public Administration, Institute of Governance, Shandong University, Shandong, PRC
| | - Dongfu Qian
- School of Health Policy & Management, Nanjing Medical University, Nanjing, PRC.,Center for Global Health, Nanjing Medical University, Nanjing, PRC
| | | | - Jian Wang
- Dong Fureng Economic and Social Development School, Wuhan University, Beijing, China.,Center for Health Economics and Management at School of Economics and Management, Wuhan University, Wuhan, China
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9
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Li L, Wang J, Leng A, Nicholas S, Maitland E, Liu R. Will COVID-19 Vaccinations End Discrimination against COVID-19 Patients in China? New Evidence on Recovered COVID-19 Patients. Vaccines (Basel) 2021; 9:vaccines9050490. [PMID: 34064737 PMCID: PMC8150813 DOI: 10.3390/vaccines9050490] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/01/2021] [Accepted: 05/09/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: By April 2021, over 160 million Chinese have been vaccinated against coronavirus disease 2019 (COVID-19). This study analyzed the impact of vaccination on discrimination against recovered COVID-19 patients and the determinants of discrimination among intended vaccinated people. (2) Methods: A self-designed questionnaire was used to collect data on COVID-19 associated discrimination from nine provinces in China. Pearson chi-square tests and a multivariate ordered logistic regression analyzed the determinants of COVID-19-related discrimination. (3) Results: People who intended to be COVID-19 vaccinated displayed a high level of discrimination against recovered COVID-19 patients, with only 37.74% of the intended vaccinated without any prejudice and 34.11% displaying severe discrimination. However, vaccinations reduced COVID-19-related discrimination against recovered COVID-19 patients from 79.76% to 62.26%. Sex, age, education level, occupation, geographical region, respondents' awareness of vaccine effectiveness and infection risk, and COVID-19 knowledge score had a significant influence on the COVID-19 related discrimination (p < 0.05). (4) Conclusions: Vaccination significantly reduced COVID-19 associated discrimination, but discrimination rates remained high. Among the intended vaccinated respondents, females, the older aged, people with high school and above education level, retirees, migrant workers, and residents in central China were identified as key targets for information campaigns to reduce COVID-19 related discrimination.
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Affiliation(s)
- Lu Li
- School of Business Administration, Jiangsu Vocational Institute of Commerce, Nanjing 211168, China;
| | - Jian Wang
- Dong Fureng Economic and Social Development School, Wuhan University, Beijing 100010, China;
- Center for Health Economics and Management at School of Economics and Management, Wuhan University, Wuhan 430072, China
| | - Anli Leng
- School of Political Science and Public Administration, Institute of Governance, Shandong University, Qingdao 266237, China;
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Eveleigh, Sydney, NSW 2015, Australia;
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou 510420, China
- School of Economics, Tianjin Normal University, Tianjin 300074, China
- School of Management, Tianjin Normal University, Tianjin 300074, China
- Newcastle Business School, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Chatham Building, Chatham Street, Liverpool L69 7ZH, UK;
| | - Rugang Liu
- School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
- Center for Global Health, Nanjing Medical University, Nanjing 211166, China
- Correspondence:
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10
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Liu L, Wang L, Zhang H, Ou W, Li D, Feng Y, Zhuang H, Shao Y. Changing Epidemiology of Hepatitis B Virus and Hepatitis C Virus Coinfection in a Human Immunodeficiency Virus-Positive Population in China: Results From the Third and Fourth Nationwide Molecular Epidemiologic Surveys. Clin Infect Dis 2021; 73:642-649. [PMID: 34398954 DOI: 10.1093/cid/ciab058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The transmission of human immunodeficiency virus (HIV) and hepatitis B virus (HBV)/hepatitis C virus (HCV) is similar in modes/routes and related risk factors. Understanding the long-term changing epidemiology of HIV, HBV, and HCV coinfection is important for evaluation of existing disease control policy and healthcare planning. We describe HBV and HCV coinfection based on the latest 2 nationwide molecular epidemiologic surveys of HIV infection in mainland China in 2007 and 2015. METHODS Seroprevalence of HBV and HCV infections was determined in antiretroviral treatment (ART)-naive people living with HIV-1 (PLWH) from 2 nationwide surveys conducted in 2007 and 2015 from 31 provinces, municipalities, and autonomous regions in mainland China. Demographic characteristics, route of HIV transmission, and CD4+ cell count were captured in the national database. Logistic regression was used to study the association between coinfection status and possible relevant risk factors. RESULTS A total of 6611 (n = 1571 in 2007; n = 5040 in 2015) ART-naive PLWH met the eligibility criteria. The prevalence of HBV and HCV coinfection in PLWH decreased from 61.1% in 2007 to 18.0% in 2015. Significant coinfection proportion reduction was found for HCV (from 53.7% to 4.9%), and a moderate decrease for HBV (17.8% to 13.9%). There was an increase of HBV/HIV coinfections among 12 provinces, municipalities, and autonomous regions, associated with domestic migration (adjusted odds ratio, 6.34 [95% confidence interval, 1.82-22.09]). CONCLUSIONS A significant decrease of HBV and HCV coinfection in PLWH was observed. Due to limited health resources and high transmission efficiency, concerted efforts should be made to further control viral hepatitis epidemics in HIV-positive populations.
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Affiliation(s)
- Lin Liu
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China
| | - Lin Wang
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Weidong Ou
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China
| | - Dan Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China
| | - Yi Feng
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China
| | - Hui Zhuang
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China.,Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
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11
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Li J, Wang J, Nicholas S, Maitland E, Fei T. Regional differences of hepatitis B discrimination in rural China. Hum Vaccin Immunother 2021; 17:2257-2267. [PMID: 33499705 DOI: 10.1080/21645515.2020.1853999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Hepatitis B (HB) is the most serious and common viral hepatitis in China. Previous studies on HB discrimination mainly have focussed on stratified analysis, and there has been no consideration of the impact of geographical-environmental factors on HB discrimination from a spatial perspective.Objective: This study conducted a large nationwide village-based survey to test whether there were significant regional differences in HB discrimination, and to explore the relationship between different socio-economic geographical factors and HB discrimination.Methods: The sample comprised 22618 rural adults, aged over 18 years old, from villages in seven provinces, representing central, southern, and eastern coastal regions of China. Using face-to-face interviews, we surveyed participants' discrimination against HB patients or carriers. Chi-square tests were used to analyze the effects of the region on differences in proportions between three discrimination levels (low, medium, and high). A geographical detector was used to explore the relationship between different socio-economic and geographical-environmental factors and HB discrimination.Results: The distribution of HB discrimination levels across the 42 villages was statistically significant. The level of HB discrimination in the central and southern regions was generally low, and the level of HB discrimination in the eastern coastal regions was higher. Both socio-economic and geographic-environmental factors had a significant relationship with HB discrimination. Most of these relationships were not linear.Conclusions: Developing the economy and accelerating urbanization did not automatically eliminate discrimination against HB. We recommend government HB publicity and education campaigns to inform the population of HB causes and effects, and strengthen the education of students so that they can have a clear and correct understanding of HB from a young age, both of which will address HB discrimination.
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Affiliation(s)
- Jun Li
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development; Research Center of Health Economics and Management, Wuhan University, Beijing, China
| | - Stephen Nicholas
- Newcastle Business School, University of Newcastle, Newcastle, Australia
| | | | - Teng Fei
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
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12
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Mohanty P, Jena P, Patnaik L. Vaccination against Hepatitis B: A Scoping Review. Asian Pac J Cancer Prev 2020; 21:3453-3459. [PMID: 33369439 PMCID: PMC8046310 DOI: 10.31557/apjcp.2020.21.12.3453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: Elimination of viral hepatitis by 2030 as one of the international Sustainable Development Goals puts the hepatitis B vaccination on the forefront. However, barriers to vaccination reported in various studies are of concern. This study explores the global barriers for effective uptake of Hepatitis-B vaccination. Methods: A scoping review of studies reporting hepatitis B vaccination barriers was done using PMC data base and Google scholar search engine. About 803 journal articles and reports on hepatitis B barriers were retrieved but only 36 most relevant items during last 10 years were identified, pile sorted, grouped and analyze. Results: Overall 74 barriers have been identified for effective uptake of hepatitis-B vaccines. Most studies focused on non-zero dose of hepatitis B vaccine, One-third of the barriers are related to system issues, one-fourth of the barriers were related to caregiver education or awareness, fear of side effect, migration etc., one-fifth barriers were related to service provider issues like poor out-reach, home visits, poor communication and/relation with the caregivers, failure to identify unimmunized children etc., and other barriers were social-cultural issues. The review reveals limited availability and accessibility to health-facility based immunization, lack of awareness among caregivers, poor communication by the healthcare workers and negative relationships with the beneficiaries, cost of vaccine in private sector, inconvenience time and place of vaccination etc. as the major barriers for hepatitis B vaccination. Barriers varied from country to country. Conclusion: Myriad barriers for reduced hepatitis-B vaccine uptake need to be addressed contextually as countries are at different stages of hepatitis-B vaccination implementation.
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Affiliation(s)
- Parimala Mohanty
- Department of Community Medicine, IMS & SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Pratap Jena
- School of Public Health, KIIT Deemed to be University, Bhubaneswar, India
| | - Lipilekha Patnaik
- Department of Community Medicine, IMS & SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
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13
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Li G, Wang G, Hsu FC, Xu J, Pei X, Zhao B, Shetty A. Effects of Depression, Anxiety, Stigma, and Disclosure on Health-Related Quality of Life among Chronic Hepatitis B Patients in Dalian, China. Am J Trop Med Hyg 2020; 102:988-994. [PMID: 32124716 DOI: 10.4269/ajtmh.19-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic hepatitis B virus (HBV) infection is a major public health problem in China. We evaluated the impact of psychosocial factors (stigma, disclosure, depression, and anxiety) on health-related quality of life (HRQoL) among people living with chronic HBV infection (CHB) in the city of Dalian, Liaoning Province, China. In this hospital-based cross-sectional study, 401 patients living with chronic HBV infection were enrolled as study participants. Study measures included the Beck depression and anxiety inventory, the WHO Quality of Life (WHOQOL-BREF) assessment, the Toronto Chinese HBV Stigma Scale, and disclosure of HBV status to sexual partners. The primary outcome was HRQoL score as measured by the WHOQOL-BREF. A linear regression model was used to examine the association between HRQoL and the potential risk factors including stigma, disclosure, depression, anxiety, and sociodemographic variables. Stigma, disclosure, depression, and anxiety were the covariates of interest. A majority of the participants were females (n = 251, 65.6%), married (81.6%), and had a college or higher degree (32.4%). Depression, anxiety, stigma, and disclosure of HBV infection were associated with low HRQoL in all four domains of the WHOQOL-BREF (physical, psychological, social, and environmental domains) (P < 0.05), when all psychological factors were included in the model separately. Depression was found to be independently associated with low HRQoL in people living with HBV, when all psychological factors were included in the model simultaneously (P < 0.0001). Our data indicate the urgent need for healthcare providers (HCPs) and policy-makers to implement psychological interventions to improve HRQoL among people living with CHB.
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Affiliation(s)
- Ge Li
- Department of Precision Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Gongchen Wang
- Department of Infectious Disease, Dalian Sixth People Hospital, Liaoning, China
| | - Fang-Chi Hsu
- Division of Public Health, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jianzhao Xu
- Department of Biochemistry, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Xia Pei
- Department of Infectious Disease, Dalian Sixth People Hospital, Liaoning, China
| | - Bo Zhao
- Department of Infectious Disease, Dalian Sixth People Hospital, Liaoning, China
| | - Avinash Shetty
- Office of Global Health, Department of Pediatric/Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina
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The Lived Experience of Chronic Hepatitis B: A Broader View of Its Impacts and Why We Need a Cure. Viruses 2020; 12:v12050515. [PMID: 32392763 PMCID: PMC7290920 DOI: 10.3390/v12050515] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic hepatitis B (CHB) is one of the most widespread liver diseases in the world. It is currently incurable and can lead to liver cirrhosis and cancer. The considerable impacts on society caused by CHB through patient mortality, morbidity, and economic loss are well-recognised in the field. This is, however, a narrow view of the harms, given that people living with CHB can be asymptomatic for the majority of their life-long infection. Of less-appreciated importance are the psychosocial harms, which can continue throughout an affected person's lifetime. Here we review the broad range of these impacts, which include fear and anxiety; financial loss and instability; stigma and discrimination; and rejection by society. Importantly, these directly affect patient diagnosis, management, and treatment. Further, we highlight the roles that the research community can play in taking these factors into account and mitigating them. In particular, the development of a cure for hepatitis B virus infection would alleviate many of the psychosocial impacts of CHB. We conclude that there should be a greater recognition of the full impacts associated with CHB to bring meaningful, effective, and deliverable results to the global community living with hepatitis B.
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15
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Smith-Palmer J, Cerri K, Sbarigia U, Chan EKH, Pollock RF, Valentine WJ, Bonroy K. Impact of Stigma on People Living with Chronic Hepatitis B. PATIENT-RELATED OUTCOME MEASURES 2020; 11:95-107. [PMID: 32214859 PMCID: PMC7082540 DOI: 10.2147/prom.s226936] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022]
Abstract
Background People with chronic infectious diseases such as hepatitis B can face stigma, which can influence everyday life as well as willingness to engage with medical professionals or disclose disease status. A systematic literature review was performed to characterize the level and type of stigma experienced by people infected with hepatitis B virus (HBV) as well as to identify instruments used to measure it. Methods A literature review was performed using the PubMed, Embase and Cochrane Library databases to identify studies describing HBV-related stigma. For inclusion, articles were required to be published in full-text form, in English and report quantitative or qualitative data on HBV-related stigma that could be extracted. Results A total of 23 (17 quantitative and 6 qualitative) articles examined HBV-related stigma. The scope of the review was global but nearly all identified studies were conducted in countries in the WHO Southeast Asia or Western Pacific regions or within immigrant communities in North America. Several quantitative studies utilized tools specifically designed to assess aspects of stigma. Qualitative studies were primarily conducted via patient interviews. Internalized and social stigma were common among people living with chronic HBV . Some people also perceived structural/institutional stigma, with up to 20% believing that they may be denied healthcare and up to 30% stating they may experience workplace discrimination due to HBV. Conclusion HBV-related stigma is common, particularly in some countries in Southeast Asia and the Western Pacific region and among Asian immigrant communities, but is poorly characterized in non-Asian populations. Initiatives are needed to document and combat stigma (particularly in settings/jurisdictions where it is poorly described) as well as its clinical and socioeconomic consequences.
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16
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Shen K, Yang NS, Huang W, Fitzpatrick TS, Tang W, Zhao Y, Wang Y, Li L, Tucker JD. A crowdsourced intervention to decrease hepatitis B stigma in men who have sex with men in China: A cohort study. J Viral Hepat 2020; 27:135-142. [PMID: 31571341 PMCID: PMC8163661 DOI: 10.1111/jvh.13213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
Stigma against people with hepatitis B virus (HBV) is a barrier to prevention, diagnosis and treatment of HBV in China. Our study examined an innovative intervention to reduce HBV stigma among men who have sex with men (MSM) in China. We extracted data from a randomized controlled trial conducted in May 2018, where the intervention consisted of crowdsourced images and videos to promote viral hepatitis testing and reduce HBV stigma. HBV stigma was assessed using a 20-item scale at baseline and four weeks post-enrolment. Participants were divided into three groups based on their exposure to intervention: full exposure, partial exposure and no exposure. Linear regression was used to determine associations between baseline stigma and participant characteristics. Data from 470 MSM were analysed. Mean participant age was 25 years old and 56% had less education than a college bachelor's degree. Full exposure to intervention was associated with significant stigma reduction (adjusted beta = -3.49; 95% CI = -6.11 to -0.87; P = .01), while partial exposure led to stigma reduction that was not statistically significant. The mean stigma score was 50.6 (SD ± 14.7) at baseline, and stigma was most prominent regarding physical contact with HBV carriers. Greater HBV stigma was associated with not having a recent doctor's visit (adjusted beta = 4.35, 95% CI = 0.19 to 8.52; P = .04). In conclusion, crowdsourcing can decrease HBV stigma among MSM in China and may be useful in anti-stigma campaigns for vulnerable populations in low- and middle-income countries.
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Affiliation(s)
- Karen Shen
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Nancy S. Yang
- University of Minnesota Medical School – Twin Cities, Minneapolis, MN, USA
| | - Wenting Huang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Thomas S. Fitzpatrick
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Weiming Tang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,Social Entrepreneurship to Spur Health Global, Guangzhou, China,Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Yang Zhao
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,School of Social Science, University of Queensland, Brisbane, Queensland, Australia
| | - Yehua Wang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Linghua Li
- Center for Infectious Diseases, Guangzhou Eighth People’s Hospital, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,Social Entrepreneurship to Spur Health Global, Guangzhou, China,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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17
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Wei MT, Henry L, Nguyen MH. Nonliver Comorbidities in Patients With Chronic Hepatitis B. Clin Liver Dis (Hoboken) 2019; 14:126-130. [PMID: 31632664 PMCID: PMC6784802 DOI: 10.1002/cld.829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Mike T. Wei
- Department of MedicineDivision of Gastroenterology and HepatologyStanford UniversityPalo AltoCA
| | - Linda Henry
- Department of MedicineDivision of Gastroenterology and HepatologyStanford UniversityPalo AltoCA
| | - Mindie H. Nguyen
- Department of MedicineDivision of Gastroenterology and HepatologyStanford UniversityPalo AltoCA
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18
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Kong LN, He S, Li L, Lei QS, Wang T, Yao Y. Factors for self-management activities among rural patients with chronic hepatitis B: A cross-sectional study. J Clin Nurs 2019; 28:3949-3956. [PMID: 31408559 DOI: 10.1111/jocn.15037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/03/2019] [Accepted: 08/04/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To assess the self-management activities among rural patients with chronic hepatitis B (CHB), and the influence of psychosocial and demographic factors on their self-management activities. BACKGROUND Chronic hepatitis B is a serious public health concern. Rural patients may have limited access to healthcare services. Although self-management is important for controlling chronic hepatitis B, few studies focus on the self-management activities among rural patients with chronic hepatitis B. Understanding self-management activities and related factors in this population are important to design and implement appropriate intervention strategies. DESIGN A cross-sectional study. METHODS From June-December 2017, totally 236 rural patients with chronic hepatitis B were recruited from hepatology department in two hospitals in Chongqing, China. The questionnaire included demographic characteristics, Chronic Hepatitis B Self-Management Scale, Self-Efficacy for Managing Chronic Disease, and Social Support Rating Scale. The study followed the STROBE checklist. RESULTS Rural patients with chronic hepatitis B reported poor self-management activities for the score indexes of symptom management (57.36%), lifestyle management (54.89%), psychosocial coping (54.84%) and disease information management (53.11%) were all below 60%. Self-efficacy, objective support, subjective support, gender, education level and marital status showed significant effect on self-management activities. CONCLUSION Rural patients with chronic hepatitis B were found to perform insufficient self-management activities. Self-efficacy, social support, gender, education level and marital status were identified to influence their self-management activities. RELEVANCE TO CLINICAL PRACTICE Self-management activities should be promoted among rural patients with chronic hepatitis B. The factors that were identified in this study should be addressed when developing interventions to promote the performance of self-management activities for rural patients with chronic hepatitis B.
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Affiliation(s)
- Ling-Na Kong
- School of Nursing, Chongqing Medical University, Chongqing, PR China.,School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Shan He
- School of Nursing, Chongqing Medical University, Chongqing, PR China
| | - Lin Li
- Department of liver disease, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, PR China
| | - Qing-Song Lei
- Department of infectious disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Tian Wang
- Department of infectious disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yu Yao
- School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, PR China
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19
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Abstract
Migrants are mainly employed in “3D jobs” which are dirty, dangerous, and difficult, are characterized by monotony and intense rhythms, and are found in sectors with higher risks such as construction, heavy industry, and agriculture. The aim of this study is to construct a systematic review in order to identify the main occupational risks and occupational diseases of this category. Research included articles published from 2013 to 2018 on major online databases (PubMed, Cochrane Library, and Scopus), which were obtained using a combination of keywords (migrant workers, expatriates, physical health, diseases, illnesses, travel, travelers, work, and occupational medicine). The online search included 1109 references. We excluded 977 studies because they were unrelated to physical health and another 64 due to duplication. There were 68 articles which were analyzed, including six reviews and 62 original articles. The main risks which emerged are developing infectious diseases, metabolic cardiovascular diseases and manifesting a lower quality of life, in particular due to difficulties in accessing local health services. It will be crucial to implement the role of occupational medicine in order to introduce multilevel interventions designed to prevent work-related injuries and illnesses, and to promote healthier working environments.
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20
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Mokaya J, McNaughton AL, Burbridge L, Maponga T, O'Hara G, Andersson M, Seeley J, Matthews PC. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res 2018; 3:29. [PMID: 30483598 PMCID: PMC6234740 DOI: 10.12688/wellcomeopenres.14273.2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms ‘hepatitis B’, ‘stigma’ to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a ‘blind spot’, representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.
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Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Lela Burbridge
- Department of Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tongai Maponga
- Department of Virology, University of Stellenbosch, Tygerberg Hospital, Bellville, Cape Town , 7500, South Africa
| | - Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, 51/59 Nakiwogo Rd, Entebbe, Uganda
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.,Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
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21
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Mokaya J, McNaughton AL, Burbridge L, Maponga T, O'Hara G, Andersson M, Seeley J, Matthews PC. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res 2018; 3:29. [PMID: 30483598 DOI: 10.12688/wellcomeopenres.14273.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms 'hepatitis B', 'stigma' to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a 'blind spot', representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.
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Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Lela Burbridge
- Department of Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tongai Maponga
- Department of Virology, University of Stellenbosch, Tygerberg Hospital, Bellville, Cape Town , 7500, South Africa
| | - Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, 51/59 Nakiwogo Rd, Entebbe, Uganda
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.,Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
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22
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Han B, Yuan Q, Shi Y, Wei L, Hou J, Shang J, Han Y, Jin C, Chan PL, Zhuang H, Li J, Cui F. The experience of discrimination of individuals living with chronic hepatitis B in four provinces of China. PLoS One 2018; 13:e0195455. [PMID: 29649232 PMCID: PMC5896961 DOI: 10.1371/journal.pone.0195455] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/22/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess chronic hepatitis B (CHB) patients' knowledge about hepatitis B and their experience of discrimination with regard to study, work, and daily life. METHODS We administered a questionnaire to 797 CHB patients in four provinces of China and used one-way analysis of variance (ANOVA) and a generalized linear model (GLM) to identify factors associated with discrimination. RESULTS CHB patients had low levels of knowledge about hepatitis B. Patients under 40 years of age with a junior college education or above knew more about hepatitis B than CHB patients over 40 years of age who had only a high school education. Three-fourths of patients had experienced discrimination because of their hepatitis B infection, with no differences in the proportion experiencing discrimination by sex or age. People with more education reported less discrimination. Patients in Beijing and Henan province perceived less discrimination than those in Shaanxi and Guangdong provinces. Discrimination was significantly associated with negative emotions. CHB patients had little awareness of China's anti-discrimination laws and policies. Among patients who had experienced discrimination, fewer than 10% knew organizations or institutions that could offer help. Over 60% of CHB patients who experienced discrimination chose not to respond. CONCLUSION CHB patients in China commonly experienced discrimination, which was associated with significant, negative emotional stress. To mitigate the damaging effects of discrimination, our study suggests raising general population knowledge about hepatitis B, raising awareness of the availability of legal protection and organizations that can fight discrimination, and providing psychological support for CHB patients.
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Affiliation(s)
- Bingfeng Han
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Qianli Yuan
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuhui Shi
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Lai Wei
- Hepatology Unit, Peking University People’s Hospital, Beijing, China
| | - Jinlin Hou
- Hepatology Unit, Nanfang Hospital, Guangzhou, China
| | - Jia Shang
- Hepatology Unit, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Ying Han
- Hepatology Unit, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Cunduo Jin
- Central sterile supply Department, 302 Military Hospital of China, Beijing, China
| | - Po-Lin Chan
- World Health Organization China, Beijing, China
| | - Hui Zhuang
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Jie Li
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
- * E-mail: (FC); (JL)
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
- * E-mail: (FC); (JL)
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Liu Y, Tang K, Long J, Zhao C. The association between hepatitis B self-awareness and depression: Exploring the modifying effects of socio-economic factors. J Viral Hepat 2017; 24:330-336. [PMID: 27891718 DOI: 10.1111/jvh.12647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/13/2016] [Indexed: 01/21/2023]
Abstract
China has a high prevalence of HBV. Despite previous studies, uncertainty remains about the association of HBV with depression. This study explores the strength of the association and the modifying effects of participants' self-awareness of the disease and their socio-economic status. Data from the baseline of a Chinese cohort study of approximately 500 000 adults were analysed. Depression was assessed using the Composite International Diagnostic Inventory. Blood spot tests were conducted to detect hepatitis B surface antigen. Logistic regression was used to assess the association between depression and HBV adjusting for demographic, socio-economic and lifestyle factors of major depression. To understand the effect modifications of disease self-awareness and socio-economic factors, a series of stratified analyses were undertaken. The overall prevalence of HBV is 3.2%, with 2.8% screen-detected and 0.3% self-reported cases. There was an 84% increased odds of depression among self-reported HBV patients (OR=1.84, 95% CI: 1.16-2.90), but no association was found in the screen-detected group (OR=0.98, 95% CI: 0.79-1.23). Male (OR=2.28, 95% CI: 1.30-3.98), younger age (OR=3.57, 95% CI: 1.82-7.00), rural resident (OR=2.31, 95% CI: 1.36-3.94), lower household income (OR=2.38, 95% CI: 1.34-4.25) and agricultural worker (OR=2.92, 95% CI: 1.63-5.77) were found having greater odds of depression in the HBV self-aware group, compared to those without HBV. A strong association between hepatitis B self-awareness and depression was found. Lower socio-economic status could modify the association between hepatitis B status and depression. Further studies are needed to understand the underlying psychosocial mechanisms of the association.
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Affiliation(s)
- Y Liu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - K Tang
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - J Long
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - C Zhao
- School of Public Health, Peking University Health Science Center, Beijing, China
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