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Wang N, Li P, Suo D, Wei H, Wei H, Guo R, Si W. A Predictive Model for Identifying Low Medication Adherence Among Patients with Cirrhosis. Patient Prefer Adherence 2023; 17:2749-2760. [PMID: 37933304 PMCID: PMC10625737 DOI: 10.2147/ppa.s426844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose This study aims to identify the novel risk predictors of low medication adherence of cirrhosis patients in a large cohort and construct an applicable predictive model to provide clinicians with a simple and precise personalized prediction tool. Patients and Methods Patients with cirrhosis were recruited from the inpatient populations at the Department of Infectious Diseases of Tangdu Hospital. Patients who did not meet the inclusion criteria were excluded. The primary outcome was medication adherence, which was analyzed by the medication possession ratio (MPR). Potential predictive factors, including demographics, the severity of cirrhosis, knowledge of disease and medical treatment, social support, self-care agency and pill burdens, were collected by questionnaires. Predictive factors were selected by univariable and multivariable logistic regression analysis. Then, a nomogram was constructed. The decision curve analysis (DCA), clinical application curve analysis, ROC curve analysis, Brier score and mean squared error (MSE) score were utilized to assess the performance of the model. In addition, the bootstrapping method was used for internal validation. Results Among the enrolled patients (460), most had good or moderate (344, 74.78%) medical adherence. The main risk factors for non-adherence include young age (≤50 years), low education level, low income, short duration of disease (<10 years), low Child-Plush class, poor knowledge of disease and medical treatment, poor social support, low self-care agency and high pill burden. The nomogram comprised these factors showed good calibration and good discrimination (AUC = 0.938, 95% CI = 0.918-0.956; Brier score = 0.14). In addition, the MSE value was 0.03, indicating no overfitting. Conclusion This study identified predictive factors regarding low medication adherence among patients with cirrhosis, and a predictive nomogram was constructed. This model could help clinicians identify patients with a high risk of low medication adherence and intervention measures can be taken in time.
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Affiliation(s)
- Na Wang
- Department of Infectious Diseases, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Pei Li
- Department of Infectious Diseases, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Dandan Suo
- Department of Infectious Diseases, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Hongyan Wei
- Department of Infectious Diseases, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Huanhuan Wei
- Department of General Practice Medicine, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Run Guo
- Department of General Practice Medicine, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Wen Si
- Department of General Practice Medicine, Tangdu Hospital, Air Force Medical University, Xi’an, People’s Republic of China
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Neloska M, Isjanovski V, Isjanovski I. Knowledge of hepatitis B among healthy population in community. Arch Public Health 2022. [DOI: 10.3889/aph.2022.6039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Hepatitis B is the world’s most common blood‑borne viral infection, accounting for 2 billion infections, 350 million carriers, and 6 lakh deaths annually. Aim of the paper is to determine the level of knowledge among healthy population in North Macedonia regarding Hepatitis B virus infection. Material and methods: A community‑based cross‑sectional study was undertaken. Questionnaire was administered to 600 healthy individuals, who heard about hepatitis B. Data handled and analyzed by using statistical package SPSS. Results: The profile of those who give the correct answer regarding the cause of hepatitis B that it is a virus are women (65.3%), aged 40 to 49 (42.8%), by nationality are Macedonian, have higher education (52.8%), 92.8% live in urban areas, 74.3% are married, employed (79.2%) and have a moderate monthly income (68.9). About one‑third of the sample said that loss of appetite, diarrhea, nausea/vomiting also associated with hepatitis B. There is a significant difference in knowledge related to early (prodromal) (symptoms such as cold and flu - fever, runny nose, cough) symptoms of hepatitis infection. Only 17.7% give the correct answer that they register, and 81.7% do not. Jaundice is one of the common symptoms of hepatitis, 32.2% give the correct answer, and 25.8% of the symptoms that are present and common are nausea, vomiting and loss of appetite. Conclusions: Important knowledge deficits about the routes of hepatitis B transmission/prevention were identified. Continued efforts should be made to develop and implement hepatitis B educational campaigns/health promotion for these communities.
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Freeland C, Mendola L, Cheng V, Cohen C, Wallace J. The unvirtuous cycle of discrimination affecting people with hepatitis B: a multi-country qualitative assessment of key-informant perspectives. Int J Equity Health 2022; 21:77. [PMID: 35642059 PMCID: PMC9158347 DOI: 10.1186/s12939-022-01677-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background An estimated 296 million individuals live with chronic hepatitis B worldwide, most have not been diagnosed and remain at risk of liver disease and cancer. People with hepatitis B often face discrimination that denies them employment or education opportunities, results in unfair treatment at work or in school, limits their ability to emigrate to certain countries, and in some cases prohibits them from serving in the military. Discrimination specific to hepatitis B has not been widely documented within the literature. This study aims to investigate and describe hepatitis B related discrimination, document discrimination occurring around the globe, and provide initial recommendations for addressing discrimination using key informant interviews. Methods Purposive and snowball sampling were used to identify potential key informants for qualitative interview. Key informants identified as community health leaders, public health scientists, doctors, and researchers, many of whom were also living with hepatitis B. Using a semi-structured guide, participants were asked to describe their experience and any challenges for people living with hepatitis B including marginalization and its’ consequences. A codebook was used to guide the organization of data for analysis, and all transcripts N = 17 were double coded. Results The overarching themes identified from interviews demonstrate explicit experiences with discrimination of those directly affected, the psychological responses, and the negative health outcomes associated with the unvirtuous cycle of discrimination. All key informants reported on the substantial quality of life implications and often poorer health outcomes resulting from hepatitis B discrimination. Participants also identified the significant impact of hepatitis B discrimination occurring within a range of education-based services across several countries as well as military exclusion or removal if individuals are found to have hepatitis B. Conclusion Our data demonstrate that hepatitis B discrimination has a significant impact. Discrimination can occur at various points in life from education, to seeking employment, to marriage, to restrictions on entry, travel and stay in other countries. This study demonstrates the impact of discrimination and the need for future research that can lead to policy change and protections for people living with and impacted by hepatitis B.
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Affiliation(s)
| | - Lindsay Mendola
- Temple University, 1801 N Broad St, Philadelphia, PA, 19122, USA
| | - Vivian Cheng
- Arcadia University, 450 S Easton Rd, Glenside, PA, 19038, USA
| | - Chari Cohen
- Hepatitis B Foundation, 3805 Old Easton Rd, Doylestown, PA, 18902, USA
| | - Jack Wallace
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Center for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia.,La Trobe University, Bundoora, VIC, 3086, Australia
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4
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Wallace J, Xiao Y, Howell J, Thompson A, Allard N, Adamson E, Richmond J, Hajarizadeh B, Eagle M, Doyle J, Hellard M. Understanding how to live with hepatitis B: a qualitative investigation of peer advice for Chinese people living with hepatitis B in Australia. BMC Public Health 2022; 22:536. [PMID: 35303855 PMCID: PMC8932317 DOI: 10.1186/s12889-022-12907-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been diagnosed with hepatitis B, significant gaps remain in health care access and in accurate knowledge about hepatitis B. Most people with hepatitis B in Australia were born in China, where the infection has an intergenerational impact with significant social implications resulting from the infection. Understanding how people of Chinese ethnicity with hepatitis B understand and respond to hepatitis B is imperative for reducing morbidity, mortality, and the personal and social impact of the infection. METHODS Qualitative semi-structured interviews with people with hepatitis B of Chinese ethnicity recruited through a specialist service identified the advice people with hepatitis B thought was important enough to inform the experience of people newly diagnosed with hepatitis B. A thematic analysis of the data privileged the lived experience of participants and their personal, rather than clinical, explanations of the virus. RESULTS Hepatitis B infection had psychological and physical consequences that were informed by cultural norms, and to which people had responded to with significant behavioural change. Despite this cohort being engaged with specialist clinical services with access to the most recent, comprehensive, and expert information, much of the advice people with hepatitis B identified as important for living with hepatitis B was not based on biomedical understandings. Key suggestions from people with hepatitis B were to form sustainable clinical relationships, develop emotional resilience, make dietary changes, regulate energy, and issues related to disclosure. CONCLUSIONS The study highlights conflicts between biomedical and public health explanations and the lived experience of hepatitis B among people of Chinese ethnicity in Australia. Beliefs about hepatitis B are embedded within cultural understandings of health that can conflict with bio-medical explanations of the infection. Acknowledging these perspectives provides for insightful communication between health services and their clients, and the development of nuanced models of care informed by the experience of people with hepatitis B.
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Affiliation(s)
- Jack Wallace
- Burnet Institute, Melbourne, VIC, 3004, Australia. .,La Trobe University, Bundoora, VIC, 3086, Australia. .,Centre for Social Research in Health, University of New South Wales Sydney, Kensington, NSW, 2052, Australia.
| | - Yinzong Xiao
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jess Howell
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Alex Thompson
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia
| | - Nicole Allard
- World Health Organization Collaborating Centre for Viral Hepatitis, The Doherty Institute, Melbourne, VIC, 3004, Australia
| | | | - Jacqui Richmond
- Burnet Institute, Melbourne, VIC, 3004, Australia.,La Trobe University, Bundoora, VIC, 3086, Australia
| | - Behzad Hajarizadeh
- Kirby Institute, University of New South Wales Sydney, Kensington, NSW, 2052, Australia
| | | | - Joseph Doyle
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, 3004, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, 3004, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, 3004, Australia
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5
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Freeland C, Racho R, Kamischke M, Moraras K, Wang E, Cohen C, Kendrick S. Health-related quality of life for adults living with hepatitis B in the United States: a qualitative assessment. J Patient Rep Outcomes 2021; 5:121. [PMID: 34757456 PMCID: PMC8581088 DOI: 10.1186/s41687-021-00398-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2019, an estimated 296 million people were living with chronic hepatitis B virus (HBV) globally with approximately 2.4 million living within the United States. Those living with HBV require years if not decades of regular monitoring to prevent liver complications from occurring. The aim of this study was to explore the working conceptual framework of health related quality of life (HRQL) for those living with chronic HBV through qualitative analysis. METHODS Data were collected by in-depth telephone interviews conducted in 2019 using purposeful sampling as part of a disease understanding assessment on the HBV patient experience within the United States. A directed content analysis approach was utilized by creation of a codebook to guide the organization of data, codes were developed by review of the literature (a priori) and through line-by-line reading of a subsample of queries. All transcripts were analyzed by at least two members of the study team and intercoder reliability was assessed using Dedoose software. FINDINGS A sample of 19 individuals living with chronic HBV were included within this study. Themes identified from transcripts noted the significant overlap between the reported experience of HBV and constructs within the HRQL model. The psychological impact of chronic HBV on study participants' HRQL overall was considerable and contributed to depression, anxiety, homelessness, drug use, and incarceration. CONCLUSION Our analysis supports the hypothesis that HBV impacts HRQL and often negatively affects emotional health. Our findings suggest that it would be beneficial to include HRQL assessment in the medical management of HBV, so that interventions can focus on reducing the burden of disease and improving quality of life for those living with HBV.
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Affiliation(s)
- Catherine Freeland
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA.
| | - Rhea Racho
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
| | - Maureen Kamischke
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
| | - Kate Moraras
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
| | - Evangeline Wang
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
| | - Chari Cohen
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
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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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Zhang Y. WITHDRAWN: The health management status of medical and health service institutions and its correlation with residents' health risk. Work 2021:WOR210263. [PMID: 34308895 DOI: 10.3233/wor-210263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ahead of Print article withdrawn by publisher.
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8
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Common concerns, barriers to care, and the lived experience of individuals with hepatitis B: a qualitative study. BMC Public Health 2021; 21:1004. [PMID: 34044808 PMCID: PMC8161662 DOI: 10.1186/s12889-021-11093-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background An estimated between 257 and 292 million people live with chronic HBV globally. While much is known about the causes, and epidemiology of HBV, little is understood about the quality of life and impact of HBV on those living with the infection. Methods A random sample of HBV-related email queries sent to the Hepatitis B Foundation, a U.S.-based non-profit organization, over a 12-month period in 2018–2019 were retrieved, tabulated, and analyzed qualitatively to highlight information needs and explore the experiences of people living with HBV and their families and loved ones. Codebook development was informed by the literature and through line-by-line reading of a sub-sample of queries. Data analysis was facilitated by NVivo12 software. Data were coded independently by two members of the research team and intercoder reliability was assessed to assure coding accuracy throughout the coding phase. Results A total of 338 queries from people around the globe were identified and analyzed. The analysis revealed three thematic groups: 1) health-specific challenges associated with diagnosis and treatment, 2) emotional needs related to experiences with HBV stigma, discrimination, fear, social isolation, and distress and 3) informational needs related to HBV prevention and transmission, and interpretation of laboratory tests. Conclusions People living with HBV are in need of information to manage their disease and prevent its spread. Analysis of queries uncovered significant misconceptions about HBV transmission and treatment. Additionally, the emotional and psychological impact of an HBV diagnosis on those living with the infection is significant. There is a clear need for patient and community education to expand knowledge and awareness of HBV globally to achieve 2030 WHO HBV elimination goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11093-0.
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Bahap M, Kara E, Cagla Sonmezer M, Inkaya AC, Aydin-Hakli D, Unal S, Demirkan K. Pharmacist intervention to improve patients' knowledge and attitude towards hepatitis B infection. Int J Clin Pract 2021; 75:e13952. [PMID: 33342028 DOI: 10.1111/ijcp.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Lack of knowledge/awareness of people living with hepatitis B (PLH) often leads to misinformation and stigmatisation. This study aimed to assess the contribution of the clinical pharmacist (CP)-led education on knowledge of PLH about their disease. METHODS This prospective, cross-sectional study was carried out between 1 October 2017 and 1 April 2018, at infectious disease and gastroenterology outpatient clinics in a university hospital. All PLH were interviewed face-to-face by a CP and a questionnaire about hepatitis B virus (HBV) knowledge was applied both at the beginning of the study (first interview) and 3 months later (second interview). Correct information was provided verbally to the patients by the CP concerning their incorrect answers during the first interview. A 10% increase in the number of correct answers was targeted for the second interview. RESULTS A total of 147 PLH with a mean age of 43.05 ± 13.25 years were included in the study (55.8% female). In the first interview, the mean (±standard deviation) number of correct answers was 35.53 ± 9.15 out of 51 questions. In the second interview, correct answers were 48.67 ± 2.74 with an increase of 25.8% (P < .001). In the first interview, the number of correct answers was higher for the following groups: 20-39 age group, people with monthly income of >1081 $ and university graduates. The number of correct answers to all questions but one was elevated (P < .001) in the second interview. Answers to the question "there is a carrier state in chronic hepatitis B (CHB)" did not change (P = .125). CONCLUSION Significant improvement was observed in the correct answer rate after CP's contribution, therefore as a team member, CP has an important role in improving patients' knowledge and attitude towards HBV infection.
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Affiliation(s)
- Melda Bahap
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Emre Kara
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Meliha Cagla Sonmezer
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Cagkan Inkaya
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Duygu Aydin-Hakli
- Department of Biostatistics, Faculty of Medicine, Okan University, Istanbul, Turkey
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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10
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Dagnew M, Million Y, Destaw B, Adefris M, Moges F, Tiruneh M. Knowledge, Attitude, and Associated Factors Towards Vertical Transmission of Hepatitis B Virus Among Pregnant Women Attending Antenatal Care in Tertiary Hospitals in Amhara Region, Northwest Ethiopia: A Cross-Sectional Study. Int J Womens Health 2020; 12:859-868. [PMID: 33116935 PMCID: PMC7585551 DOI: 10.2147/ijwh.s273560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/01/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Hepatitis B virus (HBV) infection is a major public health problem globally. Mother-to-child transmission (MTCT) of HBV is high in endemic countries; however, little is known about pregnant women`s knowledge and attitudes regarding MTCT and prevention methods in Ethiopia. Therefore, this study aimed to assess the knowledge, attitude and associated factors of pregnant women towards MTCT of HBV and its prevention in three tertiary hospitals in the Amhara region, northwestern Ethiopia. MATERIALS AND METHODS A cross-sectional study was conducted from May 1, 2018 to September 30, 2019. A total of 1121 pregnant women participated in the study. A structured questionnaire was used to collect the sociodemographic, knowledge, and attitudes of pregnant women towards MTCT of HBV and its prevention. Data were analyzed using SPPS version 20. χ 2-test, multivariate logistic regression, Spearman correlation, and analysis of variance (ANOVA) were used for data analysis. RESULTS The majority of 89.6%; 95% CI (87.9-91.3%) pregnant women had poor knowledge of MTCT of HBV and its prevention. However, more than half of the study participants had favorable attitudes. Only 141 (12.6%) of the pregnant women knew that HBV transmitted from mother-to-child and 169 (15.1%) knew that HBV had a vaccine. There was a significant difference in attitude between the three hospitals (P<0.001). In multivariable analysis, education, gravida and vaccination history were independent factors significantly associated with good knowledge and favorable attitudes while income and residence significantly associated only to knowledge and attitude, respectively. There was a significant positive correlation between the knowledge and attitude of pregnant women (P<0.001). CONCLUSION The knowledge of pregnant women was found to be poor and their attitude was also limited to MTCT of HBV infection and its prevention. Educational status and vaccination history were predictors of knowledge and attitude, but income and residence only to knowledge and attitude, respectively. This study revealed a lack of knowledge in pregnant women for the prevention and control of MTCT of HBV. This calls for the Amhara Health Bureau and Ministry of Health to promote health education programs for pregnant women attending antenatal care on MTCT of HBV and its prevention methods to improve knowledge and attitudes.
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Affiliation(s)
- Mulat Dagnew
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, Gondar, Ethiopia
| | - Yihenew Million
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, Gondar, Ethiopia
| | - Bikes Destaw
- University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Department of Environmental and Occupational Health and Safety, Gondar, Ethiopia
| | - Mulat Adefris
- University of Gondar, College of Medicine and Health Sciences, School of Medicine, Department of Obstetrics and Gynecology, Gondar, Ethiopia
| | - Feleke Moges
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, Gondar, Ethiopia
| | - Moges Tiruneh
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, Gondar, Ethiopia
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Zheng Y, Zhu L, Patrick D, Li Y, Xu F, Zhang L, Song M, Cheng X, Chen B, Chen Y, Lu X, Wang H. Work-health-personal life conflicts in naive patients with chronic hepatitis B receiving initial treatment in China: a qualitative study. BMJ Open 2020; 10:e035688. [PMID: 32928849 PMCID: PMC7490961 DOI: 10.1136/bmjopen-2019-035688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES People with chronic hepatitis B (CHB) perform sick roles, work roles and personal roles simultaneously. At times, role conflicts arise because of failure to meet the expectations of different roles. Role conflicts may increase dissatisfaction in work and family and impair their physical and mental health. This study aimed to explore the perceptions of role conflicts of treatment-naive patients with CHB in work, personal and sick roles, together with ameliorating factors in the Chinese cultural context. DESIGN A qualitative descriptive study. Semistructured interviews were used to collect the experience of work-health-personal life conflicts (WHPLCs), and a brief questionnaire was used to collect demographic and clinical information. SPSS V.21.0 was used for descriptive analysis and Dedoose (V.7.5.9) was used to code and analyse interview transcripts. This study selected six cities with different socioeconomic levels in Zhejiang Province, China. Then, researchers chose one tertiary hospital from each city as the study site, so a total of six tertiary hospitals were involved. PARTICIPANTS We recruited 32 patients with CHB (59.38% male) who had just started antiviral therapy for no more than three months. Participants were within the age range of 19-57 years, and the average age was 36.03 (SD=9.56) years. RESULTS Participants noted that having CHB influenced their daily life and intersected with work and personal roles, therefore causing role conflicts. Role conflicts focused on three types: time-based conflicts, strain-based conflicts and behaviour-based conflicts. The contextual factors contributing to role conflicts were identified, including personal characteristics, financial strain, traditional social roles and work environment. CONCLUSIONS These findings enhance our understanding of the WHPLCs experience of treatment-naive patients with CHB in China. Our findings suggest that multidimensional role conflicts should be taken into account in the intervention design and psychological counselling to improve role balance and well-being among patients with CHB.
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Affiliation(s)
- Yingjing Zheng
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lin Zhu
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Donald Patrick
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Ying Li
- Department of Public Health, Xi'an Medical University, Xi'an, Shaanxi, China
| | - Fengjiao Xu
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Zhang
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mengna Song
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao Cheng
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Boyan Chen
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Chen
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyang Lu
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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12
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. "To die is better than to tell": reasons for and against disclosure of chronic hepatitis B status in Ghana. BMC Public Health 2020; 20:663. [PMID: 32398150 PMCID: PMC7216649 DOI: 10.1186/s12889-020-08811-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/29/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People with a condition subject to stigmatisation, such as chronic hepatitis B, face the dilemma of whether or not to disclose their status. In Ghana, 12.3% of the adult population has the hepatitis B virus (HBV). One key strategy for breaking the cycle of hepatitis B transmission is the disclosure of hepatitis B status by people with chronic hepatitis B (PWHB). Disclosure can facilitate preventive actions to reduce hepatitis B transmission (e.g., not sharing personal items and avoiding contact with blood and body fluids). Disclosure can also motivate family members of PWHB to get tested, linked to care and clinically managed in order to reduce the progression of hepatitis B to liver cirrhosis and cancer. Given the importance of disclosure, we set out to explore reasons for and against disclosure of chronic hepatitis B status in the Greater Accra and Upper East region of Ghana. METHODS In this exploratory qualitative study, 18 participants (10 from the Greater Accra region and 8 from the Upper East region) were recruited for semi-structured interviews. Interviews were recorded and transcribed verbatim. Data were then processed using QSR Nvivo version 10.0 and analysed for themes. RESULTS Participants were selective disclosers, disclosing in some contexts and not in others. Reasons for non-disclosure of chronic hepatitis B status were: 1) fear of stigmatisation and 2) previous negative experiences with disclosure. Reasons for disclosure were: 1) wanting close contacts to get tested or vaccinated, 2) trusting the disclosure target(s), and 3) needing social and/or financial support. CONCLUSIONS Our findings highlight various reasons for and against disclosure of chronic hepatitis B status in Ghana. Because anticipated, observed, and experienced stigma were important motivations for non-disclosure of chronic hepatitis B status, we recommend the development and implementation of theory and evidence-based stigma reduction interventions that are culturally appropriate, and that prioritize the participation of target populations. We also recommend the provision of counselling and support services that assist PWHB in their disclosure decision-making processes.
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Affiliation(s)
- Charles Ampong Adjei
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands.
- Department of Community Health Nursing, University of Ghana, Accra, Ghana.
| | - Sarah E Stutterheim
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - Florence Naab
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
| | - Robert A C Ruiter
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
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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: 53] [Impact Index Per Article: 13.3] [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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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: 40] [Impact Index Per Article: 10.0] [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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15
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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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16
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. Chronic Hepatitis B stigma in Ghana: a qualitative study with patients and providers. BMJ Open 2019; 9:e025503. [PMID: 31248915 PMCID: PMC6597648 DOI: 10.1136/bmjopen-2018-025503] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study explored beliefs contributing to Hepatitis B stigma, and the ways in which Hepatitis B stigma manifests, from the perspectives of people with chronic Hepatitis B as well as healthcare providers in Northern and Southern Ghana. DESIGN We used an exploratory qualitative design with a purposive sampling technique. Face-to-face interviews and focus group discussions were conducted. Data were processed using QSR Nvivo V.10.0 and analysed using inductive thematic analysis. SETTINGS Participants were recruited from one tertiary and one regional hospital in Ghana between February and November 2017. PARTICIPANTS Overall, 18 people with chronic Hepatitis B (PWHB) and 47 healthcare providers (primary care physicians, nurses and midwives) between the ages of 21 and 57 years participated in the study. RESULTS PWHB face stigma in their sociocultural context and the healthcare environment. Three main beliefs underlying stigma were found: (1) the belief that Hepatitis B is highly contagious; (2) the belief that Hepatitis B is very severe and (3) the belief that Hepatitis B is caused by curses. Stigmatisation manifested as avoidance and social isolation (discrimination). In healthcare settings, stigmatisation manifested as excessive cautiousness, procedure postponement or avoidance, task-shifting and breaches of confidentiality. CONCLUSIONS Given the prevalence of incorrect knowledge, as reflected in the beliefs about Hepatitis B, we recommend public awareness campaigns that emphasise Hepatitis B transmission routes. Also, given the manifestations of the stigma in healthcare settings, we recommend the development and implementation of a continuing professional development programme on Hepatitis B and adjusted policy on Hepatitis B vaccination for Healthcare providers (HCPs).
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Affiliation(s)
- Charles Ampong Adjei
- Community Health Nursing Department, University of Ghana, Accra, Ghana
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Sarah E Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Florence Naab
- Department of Maternal and Child Health, University of Ghana, Accra, Ghana
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
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17
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Social Determinants of Stigma and Discrimination in Vietnamese Patients with Chronic Hepatitis B. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030398. [PMID: 30708943 PMCID: PMC6388214 DOI: 10.3390/ijerph16030398] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 12/26/2022]
Abstract
Vietnam is among the countries with the highest prevalence of chronic hepatitis B (CHB) and individuals who suffer from CHB oftentimes perceive high levels of stigma and discrimination. Our study aimed to provide evidence on the prevalence of stigma against hepatitis B virus (HBV), HBV infection, and social determinants of stigma and discrimination in patients. A cross-sectional study was conducted at Viet-Tiep Hospital, Hai Phong, Vietnam. Stigma and discrimination against CHB in the last month were measured via four dimensions: (1) Blame/Judgment; (2) Shame; (3) Discrimination in different settings; (4) Disclosure of CHB status. Multivariate Logistic and Tobit regressions were used to identify factors associated with CHB-related stigma and discrimination. Among 298 enrolled patients, 4.8% experienced blame/judgement, 10.2% perceived shame, 48.5% felt discriminated in healthcare facilities, and 90.6% disclosed their health status with spouses/partners. Factors associated with lower odds of CHB-related stigma/discrimination included living with spouses/partners, old age, being employed, and the existence of comorbidities was linked with higher odds of stigma. Anti-stigma programs should target those who are younger and have comorbidities. This could be done by community-based interventions which focus on inaccurate beliefs about viral hepatitis. Furthermore, families, healthcare providers, and society should play a crucial role in supporting CHB patients.
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18
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Rajamoorthy Y, Taib NM, Munusamy S, Anwar S, Wagner AL, Mudatsir M, Müller R, Kuch U, Groneberg DA, Harapan H, Khin AA. Knowledge and awareness of hepatitis B among households in Malaysia: a community-based cross-sectional survey. BMC Public Health 2019; 19:47. [PMID: 30630464 PMCID: PMC6327400 DOI: 10.1186/s12889-018-6375-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hepatitis B (HepB) is a major public health concern in Malaysia yet little is known about knowledge and awareness of this infection in the country. Such information is essential for designing effective intervention strategies for HepB prevention and control. The aim of this study was to characterize knowledge and awareness regarding HepB in Malaysia and to identify their associated sociodemographic determinants. METHODS A community-based cross-sectional survey was conducted between January and May 2016 in Selangor state of Malaysia. A two-stage cluster random sampling design was used and one adult member of selected households was interviewed face-to-face. Logistic regression was used to estimate the differences in knowledge and awareness between groups. RESULTS A total of 764 households completed the interviews and were included in the final analysis. Only 36.9 and 38.8% of the participants had good knowledge and awareness, respectively. The factors associated with good knowledge were being in the 35-44 year age group, Malay ethnicity, high educational attainment and high family income. Being Chinese, being older and having high educational attainment were determinants of having good awareness towards HepB. Participants who had good knowledge were 2.5 times more likely to also have good awareness (OR: 2.41, 95% CI: 1.78-3.26, p < 0.001). CONCLUSIONS This study reveals a low level of knowledge and awareness of HepB among households in Malaysia. This finding highlights the need to improve public knowledge and awareness through well-designed programs targeting vulnerable groups in order to reduce hepatitis B virus transmission and achieve the governmental target of eliminating viral hepatitis as a public health concern by 2030.
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Affiliation(s)
- Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Sungai Long Campus, Jalan Sungai Long, Cheras, 43000 Kajang, Selangor Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - Subramaniam Munusamy
- School of Management and Business, Manipal International University, Putra Nilai, Negeri Sembilan Malaysia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | | | - Mudatsir Mudatsir
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Jl. T. Tanoeh Abe, Darussalam, Banda Aceh, 23111 Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Ruth Müller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
- Unit of Medical Entomology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - David Alexander Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Jl. T. Tanoeh Abe, Darussalam, Banda Aceh, 23111 Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia Australia
| | - Aye Aye Khin
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Sungai Long Campus, Jalan Sungai Long, Cheras, 43000 Kajang, Selangor Malaysia
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19
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Rajamoorthy Y, Radam A, Taib NM, Rahim KA, Wagner AL, Mudatsir M, Munusamy S, Harapan H. The relationship between perceptions and self-paid hepatitis B vaccination: A structural equation modeling approach. PLoS One 2018; 13:e0208402. [PMID: 30521602 PMCID: PMC6283584 DOI: 10.1371/journal.pone.0208402] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/15/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malaysia has a comprehensive, publicly-funded immunization program for hepatitis B (HepB) among infants, but adults must pay for the vaccine. The number of HepB carriers among adults is expected to increase in the future; therefore, we examined the impact of five constructs (cues to action, perceived barriers, perceived benefit, perceived severity, and perceived susceptibility) on adults' willingness to pay (WTP) for HepB vaccine; secondarily, we examined the association between perceived barriers and perceived benefits. METHODS Adults were selected through a stratified, two-stage cluster community sample in Selangor, Malaysia. The reliability, convergent validity, and discriminant validity of the measurement model were assessed before implementing a partial least squares structural equation model (PLS-SEM) to evaluate the significance of the structural paths. RESULTS A total of 728 participants were enrolled. The five constructs all showed adequate internal reliability, convergent validity, and discriminant validity. There was a significant, positive relationship to WTP from constructs (perceived barriers [Path coefficient (β) = 0.082, P = 0.036], perceived susceptibility [β = 0.214, P<0.001], and cues to action [β = 0.166, P<0.001]), and the model all together accounted for 8.8% of the variation in WTP. There was a significant, negative relationship between perceived barriers and perceived benefit [β = -0.261, P<0.001], which accounted for 6.8% of variation in perceived benefit. CONCLUSIONS Policy and programs should be targeted that can modify individuals' thoughts about disease risk, their obstacles in obtaining the preventive action, and their readiness to obtain a vaccine. Such programs include educational materials about disease risk and clinic visits that can pair HepB screening and vaccination.
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Affiliation(s)
- Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Alias Radam
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Khalid Ab Rahim
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Abram Luther Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Subramaniam Munusamy
- Department of Economics, Faculty of Economics and Management, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- School of Management and Business, Manipal International University, Nilai, Negeri Sembilan, Malaysia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
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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: 33] [Impact Index Per Article: 5.5] [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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Valizadeh L, Zamanzadeh V, Zabihi A, Negarandeh R, Jafarian Amiri SR. Qualitative study on the experiences of hepatitis B carriers in coping with the disease. Jpn J Nurs Sci 2018; 16:194-201. [PMID: 30088344 DOI: 10.1111/jjns.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/23/2017] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
AIM Hepatitis is a systemic infection that causes restrictions in the life of many patients due to its chronic nature and it necessitates the use of coping strategies to improve the quality of life. This study aims to demonstrate the experiences of hepatitis B carriers in coping with the disease. METHODS The present study was conducted by using a qualitative content analysis. The data were collected through 18 unstructured and in-depth interviews from 2014 to 2016 at medical centers, a gastrointestinal and liver diseases research center in the cities of Babol and Amol (northern Iran) and Tabriz (north-western Iran) with patients infected with hepatitis B. The study was carried out by using purposive sampling. RESULTS The data analysis led to the extraction of the main theme, "attempting an active expansion of interactions," and its three subthemes, including: "denial of the disease," "protecting oneself or others," and "coping with the disease." CONCLUSION Patients with hepatitis B use different strategies to cope with this disease. In order for patients to properly face the disease and to live with minimum challenges and limitations, they need to be suitably understood and supported. Therefore, consideration of education and consultation programs regarding the different aspects of this disease is urgent.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Zabihi
- Department of Nursing, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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23
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Tosun S, Aygün O, Özdemir HÖ, Korkmaz E, Özdemir D. The impact of economic and social factors on the prevalence of hepatitis B in Turkey. BMC Public Health 2018; 18:649. [PMID: 29789002 PMCID: PMC5964685 DOI: 10.1186/s12889-018-5575-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/17/2018] [Indexed: 12/16/2022] Open
Abstract
Background Viral Hepatitis is one of the major global health problems, affecting millions of people every year. Limited information is available on the impact of social and economic factors on the prevalence of Hepatitis B virus (HBV) in Turkey. This study, contrary to other studies in the literature, was undertaken with the aim of examining the Majority of the excluded data come from the volunteers. Methods There are medical and the social-economic factors affecting the prevalence of HBV. This research, while taking medical factors as control variables, clarify the social and economic factors affecting the prevalence of HBV by utilising clinical data with the use of the Binary Probit Model (BPM). The BPM estimation is a powerful tool to determine not only the factors but explain also the exact impacts of each factor. Results The estimations of the BPM shows that economic and social variables such as age, gender, migration, education, awareness, social welfare, occupation are very important factors for determining HBV prevalence. Compared to the youngest population, the 46 to 66+ age group has a higher prevalence of HBV. The male respondents were 5% more likely to develop HBV compared to females. When region-specific differences are taken into account, migrating from the poorest parts of the country such as the eastern and south-eastern regions of Turkey are approximately 16% more likely to be infected. The welfare indicators such as a higher number of rooms in the respondent’s house or flat decreases the probability of having HBV and, relatively higher income groups are less likely to develop HBV compared to labourers. The Self-employed/Business owner/Public sector worker category are approximately 10% less likely to develop HBV. When people are aware of the methods of prevention of HBV, they are 6% less likely to be infected. Previous HBV infection history increases the probability of having HBV again B by 17%. Conclusions These findings strongly suggest that the impact of social and economic factors on the prevalence of HBV is vital. Any improvements in these factors are likely to reduce prevalence of HBV.
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Affiliation(s)
- Selma Tosun
- Department of Clinical Microbiology and Infectious Diseases, University of Health Sciences, Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Olgu Aygün
- Number 2 General Practioner Center, Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Hülya Özkan Özdemir
- Department of Clinical Microbiology and Infectious Diseases, University of Health Sciences, Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Elif Korkmaz
- Department of Economics, Yaşar University, Üniversite Caddesi No: 37-39, 35040 Bornova, İzmir, Turkey
| | - Durmuş Özdemir
- Department of Economics, Yaşar University, Üniversite Caddesi No: 37-39, 35040 Bornova, İzmir, Turkey.
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24
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Gulati R, Nawaz M, Pyrsopoulos NT. Health literacy and liver disease. Clin Liver Dis (Hoboken) 2018; 11:48-51. [PMID: 30992787 PMCID: PMC6314282 DOI: 10.1002/cld.690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/18/2017] [Accepted: 12/07/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rishabh Gulati
- Department of Gastroenterology and HepatologyUniversity of New Mexico School of MedicineAlbuquerqueNM
| | - Mohammad Nawaz
- Department of MedicineState University of New York, Downstate Medical CenterBrooklynNY
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25
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Abstract
The social stigma in patients with hepatitis B virus infection has caused several complications for both the patients and the associated medical system. This study aimed at demonstrating the social stigma experienced by these patients in Iran. This is a qualitative study using a content analysis approach with references to primary and secondary sources. The data were collected through 15 unstructured and in-depth interviews conducted in 2014. By analyzing the data, two main themes were noted: extrinsic concepts of social stigma (causing reprehension, embarrassment, and discrimination) and intrinsic concepts of social stigma (sense of rejection, isolation, and frustration). The analysis of participants' experiences showed that social stigma is a simple lack of knowledge among the patients and society and it is more intense in the first days after the diagnosis. Stigma is prevalent among patients with hepatitis B virus, causes them to hide the disease, and provokes various complications for them as well as society. This study emphasizes the necessity of implementing health education programs about hepatitis B and its associated stigma, especially considering the potential impact of a mass media campaign.
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26
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Li J, Zhang X, Chen L, Zhang Z, Zhang J, Wang W, Wu M, Shi B, Zhang X, Kozlowski M, Hu Y, Yuan Z. Circulating miR-210 and miR-22 combined with ALT predict the virological response to interferon-alpha therapy of CHB patients. Sci Rep 2017; 7:15658. [PMID: 29142236 PMCID: PMC5688172 DOI: 10.1038/s41598-017-15594-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/25/2017] [Indexed: 12/15/2022] Open
Abstract
Interferon-alpha (IFN-α) therapy of chronic hepatitis B (CHB) patients is constrained by limited response and side effects. We described a panel of circulating microRNAs (miRNAs) which could potentially predict outcome of IFN-α therapy. Here, we report development of a simplified scoring model for personalized treatment of CHB patients. 112 CHB patients receiving IFN-α treatment were randomly divided into a training (n = 75) or a validation group (n = 37). The expression of 15 candidate miRNAs was detected in training group with 5 miRNAs exhibiting significantly different levels (p < 0.0001) between early virological response (EVR) and non-early virological response (N-EVR). These 5 miRNAs were further tested in validation phase. Refinement analyses of results from training phase established a model composed of miR-210, miR-22 and alanine aminotransferase (ALT), with area under ROC curve (AUC) of 0.874 and 0.816 in training and validation groups, respectively. In addition, this model showed prognostic value for sustained virological response (SVR) (AUC = 0.821). Collectively, this simplified scoring model composed of miR-210, miR-22 and ALT can reproducibly predict the EVR and SVR of IFN-α therapy in CHB patients. The model should help to forecast the outcome of IFN-α treatment prior to therapy decision involving nucleoside analogs or IFNs.
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Affiliation(s)
- Jin Li
- Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Key Laboratory of Medical Molecular Virology at the School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaonan Zhang
- Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Key Laboratory of Medical Molecular Virology at the School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhanqing Zhang
- Department of Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jiming Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Weixia Wang
- Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Key Laboratory of Medical Molecular Virology at the School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Wu
- Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Key Laboratory of Medical Molecular Virology at the School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bisheng Shi
- Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Key Laboratory of Medical Molecular Virology at the School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinxin Zhang
- Institute of Infectious and Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Ruijin Hospital, Shanghai, China
| | - Maya Kozlowski
- Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Key Laboratory of Medical Molecular Virology at the School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yunwen Hu
- Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
| | - Zhenghong Yuan
- Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China. .,Key Laboratory of Medical Molecular Virology at the School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.
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27
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Adjei CA, Naab F, Donkor ES. Beyond the diagnosis: a qualitative exploration of the experiences of persons with hepatitis B in the Accra Metropolis, Ghana. BMJ Open 2017; 7:e017665. [PMID: 29102991 PMCID: PMC5722085 DOI: 10.1136/bmjopen-2017-017665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study explored the experiences of people with hepatitis B in the Accra metropolis. DESIGN The study employed qualitative exploratory descriptive design with purposive sampling technique. Data were collected through face-to-face interview and transcribed verbatim. The data were analysed using content analysis. SETTINGS Participants were recruited from one government and one mission hospital in Ghana. PARTICIPANTS Fourteen individuals aged between 26 and 45 years with hepatitis B infection were interviewed. RESULTS The findings of the study showed that people with hepatitis B in the Accra metropolis were unclear about the impact of their infection. Furthermore, they experienced psychological and social problems especially when they were initially informed about their hepatitis B status. Sadness, fear, shock, shame and disbelief were some of the experiences reported by participants. Coping strategies adopted include religiosity, denial and lifestyle modification. CONCLUSIONS It is, therefore, necessary as a country to integrate hepatitis B counselling into the already existing HIV structures in the health delivery system to offer support for individuals diagnosed with hepatitis B. Furthermore, it is important to draw lessons from the process used in the diagnosis of HIV, particularly in ensuring that people provide consent for being tested.
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Affiliation(s)
| | - Florence Naab
- Department of Maternal and Child Health, School of Nursing, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernestina S Donkor
- Department of Maternal and Child Health, School of Nursing, College of Health Sciences, University of Ghana, Accra, Ghana
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28
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Families Living with Blood-Borne Viruses: The Case for Extending the Concept of "Serodiscordance". Interdiscip Perspect Infect Dis 2017; 2017:4352783. [PMID: 29230242 PMCID: PMC5688372 DOI: 10.1155/2017/4352783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/14/2017] [Indexed: 12/23/2022] Open
Abstract
The concept of “serodiscordance” (mixed infection status) is primarily associated with epidemiological concerns about HIV transmission risk in couples. We make the case for extending this concept to include families with mixed HIV and viral hepatitis status. Social research on couples with mixed HIV and hepatitis C status has laid an important foundation for illuminating how experiences of serodiscordance within intimate partnerships are much broader than concerns about risk. This body of work attests to serodiscordance holding promise as a valuable concept for understanding viral infections as socially situated and intensely relational phenomena. However, serodiscordance is still limited as a concept because of its near universal focus on couples. It is rarely applied to wider relationships, including family networks beyond the couple. Despite evidence in the literature that families are affected by blood-borne viruses in multiple social, emotional, financial, and generational ways, the concept of serodiscordance does not capture these broader dynamics. Making serodiscordance more inclusive is an important step in recognising the diverse ways families' everyday lives, relationships, and futures can be entangled with HIV, hepatitis C, and hepatitis B, and for understanding how today's era of effective treatment options might shape the “family life” of viral infections.
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29
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Yi S, Ngin C, Tuot S, Chhoun P, Fleming T, Brody C. Utilization of traditional, complementary and alternative medicine and mental health among patients with chronic diseases in primary health care settings in Cambodia. Int J Ment Health Syst 2017; 11:58. [PMID: 29021821 PMCID: PMC5612333 DOI: 10.1186/s13033-017-0167-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/18/2017] [Indexed: 12/23/2022] Open
Abstract
Background Coping with chronic illnesses often involves major lifestyle changes that may lead to poor mental health. Furthermore, in order to treat the chronic conditions, many sufferers in Asia turn to traditional, complementary and alternative medicines (TCAM). This study explores prevalence of TCAM use and factors associated with anxiety and depressive symptoms among patients with chronic diseases in Cambodia. Methods In 2015, this cross-sectional study was conducted with outpatients receiving treatment and care for chronic diseases in two urban and two rural primary health centers. Every eligible patient was randomly selected at the health centers using a systematic sampling procedure. Symptoms of anxiety and depression were assessed by using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression models were constructed to explore factors associated with anxiety and depressive symptoms. Results The study participants included 1528 patients, of whom 77.2% were female, with a mean age of 46.5 years (SD = 15.3). After adjustment, patients with depressive symptoms remained significantly more likely to be in the age groups between 41 and 60 years old and to be married, separated/divorced or widowed compared to those without depressive symptoms. Regarding the use of TCAM, patients with depressive symptoms remained significantly more likely to report using an herbalist, practicing visualization and praying for own health, but less likely to report using vitamins or supplements in the past 12 months. For quality of life, patients with depressive symptoms remained significantly less likely to agree that they had enough energy for their everyday life and had enough money to meet their daily needs. Similar risk factors were also found to be significantly associated with anxiety symptoms. Conclusions Cambodian patients with chronic diseases who experienced symptoms of anxiety or depression were more likely to report reduced quality of life, greater chronic disease-related stigma and more TCAM use. Given the potential interaction of TCAM, mental health and other chronic conditions, a history of TCAM use and mental health should be elicited in clinical practices in primary health care settings, particularly in developing countries.
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Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia.,Public Health Program, Touro University California, Vallejo, CA USA
| | - Chanrith Ngin
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Tyler Fleming
- Public Health Program, Touro University California, Vallejo, CA USA
| | - Carinne Brody
- Public Health Program, Touro University California, Vallejo, CA USA
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30
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Han Z, Yin Y, Zhang Y, Ehrhardt S, Thio CL, Nelson KE, Bai X, Hou H. Knowledge of and attitudes towards hepatitis B and its transmission from mother to child among pregnant women in Guangdong Province, China. PLoS One 2017; 12:e0178671. [PMID: 28575040 PMCID: PMC5456270 DOI: 10.1371/journal.pone.0178671] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/17/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection remains a serious public health problem worldwide. Mother-to-child transmission (MTCT) of HBV is the major mode of transmission in HBV-endemic areas, including China, where little is known about pregnant women's knowledge of and attitudes towards HBV infection and MTCT. METHODS A cross-sectional survey, conducted in pregnant women in Guangdong Province, China, measured HBV knowledge and attitudes using a questionnaire, at one tertiary and two rural hospitals. RESULTS The total response rate was 94.5% (737/780). Of the 11 knowledge questions, the mean score was 6.73 ± 3.04 (mean ± SD). Most pertinent to preventing MTCT, 53.3% of the respondents did not know that HBV can be transmitted through unprotected sexual intercourse and nearly 20% did not know that HBV can be transmitted from mother to infant. The results of the four attitude questions was better with 83% and 85% being willing to be screened for HBV and let their baby receive HBV vaccine and HBIg, respectively. However, only 16.5% of respondents agreed that they would be willing to take drugs that are known not to harm the fetus to prevent MTCT of HBV. In multivariable analysis, higher education level was associated with better knowledge and attitude scores. CONCLUSIONS Knowledge about HBV among pregnant women was poor and needs to be improved to prevent MTCT of HBV. Health education needs to be directed towards pregnant mothers, particularly less educated mothers, in high HBV endemicity settings.
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Affiliation(s)
- Zhenyan Han
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- * E-mail: (HYH); (ZYH)
| | - Yuzhu Yin
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yuan Zhang
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Chloe L. Thio
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, United States of America
| | - Kenrad E. Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Xiaoyi Bai
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Hongying Hou
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- * E-mail: (HYH); (ZYH)
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31
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Jeon JH. Evaluation of a smartphone application for self-care performance of patients with chronic hepatitis B: A randomized controlled trial. Appl Nurs Res 2016; 32:182-189. [PMID: 27969026 DOI: 10.1016/j.apnr.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 07/26/2016] [Indexed: 02/06/2023]
Abstract
AIM To verify the usefulness of a smartphone application (App) for facilitating self-care in patients with chronic hepatitis B (CHB). BACKGROUND CHB is a global health problem, and patients with CHB need to routinely perform self-care. Health-related smartphone apps could help users self-manage their disease. METHODS Fifty-three CHB patients were assessed in this randomized controlled before-and-after experimental study. The patients were randomly and equally assigned to groups that did (n=26) or did not (n=27) use the smartphone app for 12weeks. The experimental and control groups were analyzed for differences in disease knowledge, self-efficacy, and self-care before and after use of the smartphone app. RESULTS After intervention, patients who used the app displayed significantly increased disease knowledge compared with the control group (p=.015). Self-efficacy and self-care also significantly increased in the experimental group (p=0.006 and 0.001, respectively). CONCLUSION The smartphone app can be useful for increasing self-care in CHB patients. ABBREVIATIONS App: application, CHB: chronic hepatitis B, CVI: content validity.
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Affiliation(s)
- Jae Hee Jeon
- Department of Nursing, Semyung University, Jecheon, Chungbuk 390-711, Republic of Korea.
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32
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Jaquet A, Wandeler G, Tine J, Dagnra CA, Attia A, Patassi A, Ndiaye A, de Ledinghen V, Ekouevi DK, Seydi M, Dabis F. HIV infection, viral hepatitis and liver fibrosis among prison inmates in West Africa. BMC Infect Dis 2016; 16:249. [PMID: 27267370 PMCID: PMC4895802 DOI: 10.1186/s12879-016-1601-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 05/27/2016] [Indexed: 12/26/2022] Open
Abstract
Background Prisoners represent a vulnerable population for blood-borne and sexually transmitted infections which can potentially lead to liver fibrosis and ultimately cirrhosis. However, little is known about the prevalence of liver fibrosis and associated risk factors among inmates in sub-Saharan Africa. Methods Screening of liver fibrosis was undertaken in a randomly selected sample of male inmates incarcerated in Lome, Togo and in Dakar, Senegal using transient elastography. A liver stiffness measurement ≥9.5 KPa was retained to define the presence of a severe liver fibrosis. All included inmates were also screened for HIV, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection. Substances abuse including alcohol, tobacco and cannabis use were assessed during face-to-face interviews. Odds Ratio (OR) estimates were computed with their 95 % Confidence Interval (CI) to identify factors associated with severe liver fibrosis. Results Overall, 680 inmates were included with a median age of 30 years [interquartile range: 24–35]. The prevalence of severe fibrosis was 3.1 % (4.9 % in Lome and 1.2 % in Dakar). Infections with HIV, HBV and HCV were identified in 2.6 %, 12.5 % and 0.5 % of inmates, respectively. Factors associated with a severe liver fibrosis were HIV infection (OR = 7.6; CI 1.8–32.1), HBV infection (OR = 4.8; CI 1.8–12.8), HCV infection (OR = 52.6; CI 4.1–673.8), use of traditional medicines (OR = 3.7; CI 1.4–10.1) and being incarcerated in Lome (OR = 3.3; CI 1.1–9.8) compared to Dakar. Conclusions HIV infection and viral hepatitis infections were identified as important and independent determinants of severe liver fibrosis. While access to active antiviral therapies against HIV and viral hepatitis expands in Africa, adapted strategies for the monitoring of liver disease need to be explored, especially in vulnerable populations such as inmates.
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Affiliation(s)
- Antoine Jaquet
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.
| | - Gilles Wandeler
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal.,Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Judicaël Tine
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal
| | - Claver A Dagnra
- Service de virologie, BIOLIM, Université de Lomé, Lomé, Togo
| | - Alain Attia
- Service de hépato-gastroentérologie, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Akouda Patassi
- Service de maladies infectieuses et tropicales, CHU Sylvanus Olympio, Lomé, Togo
| | | | - Victor de Ledinghen
- Centre d'investigation de la fibrose hepatique, Hopital Haut-Leveque, CHU de Bordeaux & INSERM U1053, Université de Bordeaux, Bordeaux, France
| | - Didier K Ekouevi
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.,Département de Santé Publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo
| | - Moussa Seydi
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal
| | - François Dabis
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France
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33
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Hajarizadeh B, Richmond J, Ngo N, Lucke J, Wallace J. Hepatitis B-Related Concerns and Anxieties Among People With Chronic Hepatitis B in Australia. HEPATITIS MONTHLY 2016; 16:e35566. [PMID: 27630722 PMCID: PMC5010884 DOI: 10.5812/hepatmon.35566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/02/2016] [Accepted: 04/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The psychological wellbeing of people with chronic hepatitis B (CHB) may be negatively affected due to the chronic and transmissible nature of the disease, and possible serious complications (e.g. cirrhosis and liver cancer). There are limited data investigating concerns and anxieties among people living with CHB. OBJECTIVES This study examined feelings about having hepatitis B among people with CHB, including hepatitis B-related concerns and anxieties. PATIENTS AND METHODS Using convenience sampling, people with CHB attending four public liver clinics and one general practice in three Australian jurisdictions between April and September 2013 completed a self-administered questionnaire about their feelings about having hepatitis B. RESULTS Ninety-three people completed the survey. Mean age was 45 years, 57% were men, and 93% were born overseas (75% from Asia). Seventy-six percent of participants reported having hepatitis B-related concerns and anxieties. The most common concerns were of developing liver cancer (57%), and infecting other people (53%). Thirty-five percent of participants were unwilling to talk to anyone about their hepatitis B while 25% changed how they lived as a result of having hepatitis B. Lower educational level was associated with feeling scared of hepatitis B (adjusted Odds Ratio [OR]: 4.04; 95%CI: 1.09, 14.90; P = 0.04), and an unwillingness to talk to anyone about hepatitis B (adjusted OR: 4.41; 95%CI: 1.09, 17.83; P = 0.04). Very good English proficiency was associated with a higher likelihood of participants changing how they lived (adjusted OR: 12.66; 95%CI: 2.21, 72.42; P < 0.01), and seeing life differently as a result of having hepatitis B (adjusted OR: 21.10; 95%CI: 3.70, 120.19; P < 0.01). Health professionals were the key person for 34% of participants in helping them cope with having hepatitis B, while 18% reported that no one supported them. CONCLUSIONS Hepatitis B-related concerns and anxieties are prevalent among people with CHB. Clinical management of people with CHB must address their psychological support needs as an essential component of comprehensive care.
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Affiliation(s)
- Behzad Hajarizadeh
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, Australia
- Corresponding Author: Behzad Hajarizadeh, Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia. Tel: +61-394798736, Fax: +61-392855220, E-mail:
| | - Jacqui Richmond
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Naomi Ngo
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
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Hepatitis B Stigma and Knowledge among Vietnamese in Ho Chi Minh City and Chicago. Can J Gastroenterol Hepatol 2016; 2016:1910292. [PMID: 28101498 PMCID: PMC5214171 DOI: 10.1155/2016/1910292] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 12/07/2016] [Indexed: 12/15/2022] Open
Abstract
Stigma regarding viral hepatitis and liver disease has psychological and social consequences including causing negative self-image, disrupting relationships, and providing a barrier to prevention, testing, and treatment. The aim of this study was to characterize and compare HBV knowledge and stigma in Vietnamese in Ho Chi Minh City and Chicago and to begin to evaluate the cultural context of HBV stigma. Methods. A written survey including knowledge questions and a validated HBV stigma questionnaire was distributed to Vietnamese in Ho Chi Minh City and Chicago. 842 surveys from Ho Chi Minh City and 170 from Chicago were analyzed. Results. Vietnamese living in Chicago had better understanding of HBV transmission and that HBV can cause chronic infection and liver cancer. Vietnamese in Chicago had higher stigma scores on a broad range of items including guilt and shame about HBV and were more likely to feel that persons with HBV can bring harm to others and should be isolated. Conclusions. Vietnamese in Ho Chi Minh City and Chicago have knowledge deficits about HBV, particularly regarding modes of transmission. Persons in Ho Chi Minh City expressed lower levels of HBV stigma than Vietnamese living in Chicago, likely reflecting changing cultural attitudes in Vietnam. Culturally appropriate educational initiatives are needed to address the problem of HBV stigma.
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Hepatitis B Awareness and Knowledge in Asian Communities in British Columbia. Can J Gastroenterol Hepatol 2016; 2016:4278724. [PMID: 27446839 PMCID: PMC4904637 DOI: 10.1155/2016/4278724] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/09/2015] [Indexed: 01/13/2023] Open
Abstract
Background. Our study examined hepatitis B virus (HBV) awareness and knowledge in Asian communities in British Columbia (BC). Methods. A statistical random sample representation of Chinese, Korean, Filipino, South Asian, and Southeast Asian populations in Greater Vancouver was surveyed by telephone. Multiple logistic regression analysis was performed to identify predictors of HBV knowledge. Results. General awareness of HBV was reported in 78.8% (798/1013). HBV awareness was the highest in Chinese (89%) and Filipino (88%) populations and the lowest in the South Asian (56%) population. "Reasonable" knowledge of HBV was elicited in 76.8% (778/1013). Higher HBV knowledge was associated with younger age (p = 0.014), higher education (p < 0.0001), Chinese ethnicity (p < 0.0001), and use of media (p = 0.01) and Internet (p = 0.024) for health information. Compared to the Chinese (OR = 1.0) population, "reasonable" knowledge of HBV was lower in Korean (OR = 0.3, 95% CI: 0.1-0.5), Filipino (OR = 0.3, 95% CI: 0.2-0.6), South Asian (OR = 0.3, 95% CI: 0.2-0.4), and Southeast Asian (OR = 0.3, 95% CI: 0.1-0.6) populations. 54.8% (555/1013) felt that HBV education was inadequate and 80.1% (811/1013) preferred HBV education in their native languages. Conclusion. Compared to the Chinese population, other Asian communities in BC have lower HBV awareness and knowledge. Public education should target older and less educated and Korean, Filipino, South Asian, and Southeast Asian populations in their native languages via media and Internet.
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Lee H, Fawcett J, Kim D, Yang JH. Correlates of Hepatitis B Virus-related Stigmatization Experienced by Asians: A Scoping Review of Literature. Asia Pac J Oncol Nurs 2016; 3:324-334. [PMID: 28083549 PMCID: PMC5214865 DOI: 10.4103/2347-5625.195896] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: Although remarkable progress in the pharmacological components of the prevention and treatment of hepatitis B virus (HBV) and liver cancer has been achieved, HBV-related stigma is recognized as a major barrier to HBV management. The purpose of this Revised Social Network Model (rSNM)-guided review was to examine the existing research literature about HBV-related stigma among Asians and Asian immigrants residing in other countries. Methods: A scoping review of literature was conducted to determine the depth and breadth of literature. Totally, 21 publications were identified. The review findings were linked with the concepts of rSNM to demonstrate how individual factors and sociocultural contexts shape and affect the experience of HBV-related stigma. Results: Most studies were quantitative cross-sectional surveys or qualitative methods research that had been conducted among Chinese in China and in the USA. The three concepts in rSNM that have been identified as important to stigma experience are individual factors, sociocultural factors, and health behaviors. The major factors of most studies were on knowledge and attitudes toward HBV; only three studies focused on stigma as the primary purpose of the research. Few studies focused on the measurement of stigma, conceptual aspects of stigma, or interventions to alleviate the experience of being stigmatized. Conclusions: The scoping review revealed the existing depth and breadth of literature about HBV-related stigma. Gaps in the literature include lack of research address group-specific HBV-related stigma instruments and linkages between stigma and stigma-related factors.
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Affiliation(s)
- Haeok Lee
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jacqueline Fawcett
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA
| | - Deogwoon Kim
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jin Hyang Yang
- Department of Nursing, School of Medicine, Inje University, Busan, South Korea
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Hajarizadeh B, Wallace J, Richmond J, Ngo N, Enright C. Hepatitis B knowledge and associated factors among people with chronic hepatitis B. Aust N Z J Public Health 2015; 39:563-8. [PMID: 26095536 DOI: 10.1111/1753-6405.12378] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/01/2014] [Accepted: 01/01/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess hepatitis B knowledge among people with chronic hepatitis B (CHB) in Australia. METHODS People with CHB in three Australian jurisdictions completed a self-administered questionaire, including 24 hepatitis B knowledge questions across four domains: transmission; natural history; epidemiology and prevention; and clinical management. RESULTS Ninety-three people completed the survey. Mean age was 45 years, 43% were women and 93% were born overseas (75% from Asia). Mean total knowledge score was 55 out of 100 with 17 participants (18%) scoring ≥75 (defined as a high knowledge). Clinical management scored the lowest (median: 25) and natural history scored the highest (median: 80). In adjusted linear regression, tertiary education (vs. secondary and under) was associated with higher knowledge score (β: 11.95; 95%CI: 2.45, 21.44; p=0.01). In adjusted logistic regression, very good English proficiency (vs. limited/no proficiency) was associated with high knowledge (OR: 7.65; 95%CI: 1.94, 30.19; p<0.01). Participants reporting hepatitis B-related anxiety demonstrated a significantly higher knowledge score compared to those reporting no such anxiety (β: 15.11; 95%CI: 4.40, 25.81; p<0.01). CONCLUSIONS AND IMPLICATIONS Hepatitis B-related knowledge gaps were identified among people with CHB. Interventions to improve knowledge should focus on people with low levels of academic education and limited English proficiency.
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Affiliation(s)
- Behzad Hajarizadeh
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Victoria.,The Kirby Institute, UNSW Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Victoria
| | - Jacqui Richmond
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Victoria
| | - Naomi Ngo
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Victoria
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Prevention of Liver Cancer Through the Early Detection of Risk-Related Behavior Among Hepatitis B or C Carriers. Cancer Nurs 2015; 38:169-76. [DOI: 10.1097/ncc.0000000000000153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Dahl TFM, Cowie BC, Biggs BA, Leder K, MacLachlan JH, Marshall C. Health literacy in patients with chronic hepatitis B attending a tertiary hospital in Melbourne: a questionnaire based survey. BMC Infect Dis 2014; 14:537. [PMID: 25338513 PMCID: PMC4287473 DOI: 10.1186/1471-2334-14-537] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/24/2014] [Indexed: 12/21/2022] Open
Abstract
Background Current estimates suggest over 218,000 individuals in Australia are chronically infected with hepatitis B virus. The majority of these people are migrants and refugees born in hepatitis B endemic countries, where attitudes towards health, levels of education, and English proficiency can be a barrier to accessing the Australian health care system, and best managing chronic hepatitis B. This study aimed to assess the knowledge of transmission and consequences of chronic hepatitis B among these patients. Method A prospective study was conducted between May and August 2012. Patients with chronic hepatitis B were recruited from three Royal Melbourne Hospital outpatient clinics. Two questionnaires were administered. Questionnaire 1, completed during observation of a prospective participants’ consultation, documented information given to the patient by their clinician. After the consultation, Questionnaire 2 was administered to assess patient demographics, and overall knowledge of the effect, transmission and treatment of hepatitis B. Results 55 participants were recruited. 93% of them were born overseas, 17% used an interpreter, and the average time since diagnosis was 9.7 years. Results from Questionnaire 1 showed that the clinician rarely discussed many concepts. Questionnaire 2 exposed considerable gaps in hepatitis B knowledge. Few participants reported a risk of cirrhosis (11%) or liver cancer (18%). There was a high awareness of transmission routes, with 89% correctly identifying sexual transmission, 93% infected blood, and 85% perinatal transmission. However, 25% of participants believed hepatitis B could be spread by sharing food, and over 50% by kissing and via mosquitoes. A knowledge score out of 12 was assessed for each participant. The average score was 7.5. Multivariate analysis found higher knowledge scores among those with a family member also diagnosed with chronic hepatitis B and those routinely seeing the same clinician (p = 0.009 and p = 0.002, respectively). Conclusion This is the largest Australian study assessing knowledge and understanding of the effect, transmission, and treatment of hepatitis B among chronically infected individuals. The findings highlight the knowledge gaps and misconceptions held by these patients, and the need to expand education and support initiatives. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-537) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Caroline Marshall
- Victorian Infectious Disease Service (VIDS), Royal Melbourne Hospital, Grattan St, Parkville, 3050 Victoria, Australia.
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Chen GY, Zhu MF, Zheng DL, Bao YT, Wang J, Zhou X, Lou GQ. Baseline HBsAg predicts response to pegylated interferon-α2b in HBeAg-positive chronic hepatitis B patients. World J Gastroenterol 2014; 20:8195-8200. [PMID: 25009392 PMCID: PMC4081692 DOI: 10.3748/wjg.v20.i25.8195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/16/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the predictive effect of baseline hepatitis B surface antigen (HBsAg) on response to pegylated interferon (PEG-IFN)-α2b in hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) patients.
METHODS: This retrospective analysis compared the treatment efficacy of PEG-IFN-α2b alone in 55 HBeAg-positive CHB patients with different baseline HBsAg levels. Serum HBV DNA load was measured at baseline, and at 12, 24 and 48 wk of therapy. Virological response was defined as HBV DNA < 1000 IU/mL. Serum HBsAg titers were quantitatively assayed at baseline, and at 12 and 24 wk.
RESULTS: Eighteen patients had baseline HBsAg > 20 000 IU/mL, 26 patients had 1500-20000 IU/mL, and 11 patients had < 1500 IU/mL. Three (16.7%), 11 (42.3%) and seven (63.6%) patients in each group achieved a virological response at week 48, with a significant difference between groups with baseline HBsAg levels > 20000 or < 20000 IU/mL (P = 0.02). Thirteen patients had an HBsAg decline > 0.5 log10 and 30 patients < 0.5 log10 at week 12; and 6 (46.2%) and 10 (33.3%) in each group achieved virological response at week 48, with no significant difference between the two groups (P = 0.502). Eighteen patients had an HBsAg decline > 1.0 log10 and 30 patients < 1.0 log10 at week 24, and 8 (44.4%) and 11 (36.7%) achieved a virological response at week 48, with no significant difference between the two groups (P = 0.762). None of the 16 patients with HBsAg > 20000 IU/mL at week 24 achieved a virological response at week 48.
CONCLUSION: Baseline HBsAg level in combination with HBV DNA may become an effective predictor for guiding optimal therapy with PEG-IFN-α2b against HBeAg-positive CHB.
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