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Natour RT, Midlej A, Mahajna E, Kopelman Y, Abo-Mouch S, Baker FA. Chronic hepatitis B beyond clinical burden: Psychosocial effects and impact on quality of life. J Viral Hepat 2024; 31:12-20. [PMID: 37920135 DOI: 10.1111/jvh.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/14/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
Chronic hepatitis B (CHB) infection has far-reaching implications for patients' quality of life (QOL), regardless of cirrhosis or complications. However, limited research exists on the psychosocial impact of CHB, particularly in asymptomatic, noncirrhotic patients. Noncirrhotic CHB patients without comorbidities affecting QOL were evaluated in hepatology clinics. Patients underwent a standardized interview and completed the Short Form-12 (SF-12) questionnaire. Multiple social and psychological parameters were compared between patients receiving chronic treatment and untreated controls with HBeAg-negative chronic infections. A total of 41 CHB patients were included in the study, with 41% in the treatment group and 59% in the control group. Both groups showed a male predominance, and their average age, ethnic distribution and family status were comparable. High unemployment rates and discrimination at work due to HBV status were prevalent, with many patients feeling their career choices were influenced by HBV, particularly among untreated patients. Treated patients reported significantly lower scores in general health perception (41% vs. 13%; p = .06) and limitation of usual activity secondary to CHB (29% vs. 0%; p = .008), resulting in a substantial impact on overall health-related QOL. This study highlights the psychosocial implications of CHB in asymptomatic, noncirrhotic patients, underscoring the importance of comprehensive support and increased awareness. Additionally, addressing challenges related to long-term treatment, such as adherence and cost, may have the potential to improve patient well-being and outcomes.
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Affiliation(s)
- Randa Taher Natour
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
- Department of gastroenterology and hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Amir Midlej
- Medicine faculty of the Technion Faculty of Medicine, Haifa, Israel
| | - Elisabeth Mahajna
- Department of gastroenterology and hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Yael Kopelman
- Department of gastroenterology and hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Saif Abo-Mouch
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Fadi Abu Baker
- Department of gastroenterology and hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel
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Wu C, Xie J, Liu F. Incidence and factors influencing sleep disorders in patients with chronic hepatitis B infection: A case-control study. J Viral Hepat 2023; 30:607-614. [PMID: 36922711 DOI: 10.1111/jvh.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/22/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
Chronic hepatitis B (HBV) infection is a disease that imposes a considerable financial burden on patients and can lead to sleep disorders (SDs), resulting in a serious deterioration to patient quality of life. This study aimed to determine the prevalence of SDs in patients with HBV and the correlated sociodemographic and clinical characteristics. A total of 747 patients with chronic HBV infection were recruited. All patients completed the Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale, Social Support Rating Scale, Short Form 36 Health Survey (SF-36), and Visual Analogue Scale (VAS). The total PSQI score of patients with each type of chronic HBV infection was significantly higher compared to healthy Chinese adults (p < .05). The incidence of SDs in HBV carriers and patients with mild HBV, moderate HBV, severe HBV, liver failure, compensated cirrhosis, and decompensated liver cirrhosis was 25%, 26%, 32%, 47%, 56%, 31%, and 49%, respectively. The incidence of SDs in all patients with chronic HBV infection was 30%. Binary logistic regression analysis revealed that the course of disease, aspartate aminotransferase levels, PHQ-9 scores, and VAS scores were independent risk factors for SDs, while the total SF-36 score was a protective factor for SDs (all p < .05). In conclusion, the prevalence of SDs was significantly higher in patients with chronic hepatitis B compared to healthy subjects. The independent risk factors for SDs included disease duration, aspartate aminotransferase levels, depression, and fatigue. Clinicians should pay more attention to SDs in patients with chronic HBV infection.
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Affiliation(s)
- Cichun Wu
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Jianping Xie
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Fei Liu
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
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3
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General practice-based cancer research publications: a bibliometric analysis 2013-2019. Br J Gen Pract 2022; 73:e133-e140. [PMID: 36702582 PMCID: PMC9762764 DOI: 10.3399/bjgp.2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND General practice plays a critical role in the prevention, diagnosis, management, and survivorship care of patients with cancer. Mapping research outputs over time provides valuable insights into the evolving role of general practice in cancer care. AIM To describe and compare the distribution of cancer in general practice research publications by country, cancer type, area of the cancer continuum, author sex, and journal impact factor. DESIGN AND SETTING A bibliometric analysis using a systematic approach to identify publications. METHOD MEDLINE and Embase databases were searched for studies published between 2013 and 2019, which reported on cancer in general practice. Included studies were mapped to the cancer continuum framework. Descriptive statistics were used to present data from the included studies. RESULTS A total of 2798 publications were included from 714 journals, spanning 79 countries. The publication rate remained stable over this period. Overall, the US produced the most publications (n = 886, 31.7%), although, per general population capita, Denmark produced nearly 10 times more publications than the US (20.0 publications per million compared with 2.7 publications per million). Research across the cancer continuum varied by country, but, overall, most studies focused on cancer screening, diagnosis, and survivorship. More than half of included studies used observational study designs (n = 1523, 54.4%). Females made up 66.5% (n = 1304) of first authors, but only 47.0% (n = 927) of last authors. CONCLUSION Cancer in general practice is a stable field where research is predominantly observational. There is geographical variation in the focus of cancer in general practice research, which may reflect different priorities and levels of investment between countries. Overall, these results support future consideration of how to improve under-represented research areas and the design, conduct, and translation of interventional research.
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Mude WW, Fisher CM, Richmond J, Gautier RL, Wallace J. Social impacts of living with chronic hepatitis B in South Sudanese community in Australia. ETHNICITY & HEALTH 2022; 27:529-541. [PMID: 32568555 DOI: 10.1080/13557858.2020.1782849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
Introduction: Chronic hepatitis B presents significant issues to public health and clinical practices. The infection requires lifelong clinical management and is a leading risk factor for liver cancer and liver cirrhosis. Limited studies currently exist on the social impacts of living with chronic hepatitis B, especially for people from Sub-Saharan Africa. The current study explored the experiences of South Sudanese people living with chronic hepatitis B in Australia.Methods: A qualitative inquiry using face-to-face interviews with fifteen South Sudanese people with chronic hepatitis B in Australia explored the social impacts of living with chronic hepatitis B. The study purposively sampled participants who self-identified as South Sudanese with hepatitis B and over 18 years of age. Interviews were coded and analysed using thematic analysis.Results: The study identified three themes relating to the experiences of living with chronic hepatitis B, and were grouped into psychological, interpersonal and healthcare system levels. Psychological level experiences related to the uncertainty of living with chronic hepatitis B and liver cancer risk, where participants expressed persistent fear of disease progression and anxiety around death related to the disease. Interpersonal level experiences involved the disclosure of hepatitis B and its social impacts including stigma, social distancing and isolation. Healthcare system level experiences included receiving mixed messages about hepatitis B, challenges with regular testing and difficulty receiving hepatitis B treatment.Conclusion: The findings provide valuable insights into the social impacts of hepatitis B. It underlines the importance of integrated public health interventions at the community level to improve knowledge and awareness of hepatitis B which address stigma in the South Sudanese community in Australia.
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Affiliation(s)
- William W Mude
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Christopher M Fisher
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Roslyn Le Gautier
- Palliative Medicine Research Group, The University of Melbourne & St Vincent's Hospital, Melbourne Australia
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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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6
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Behera MK, Nath P, Behera SK, Padhi PK, Singh A, Singh SP. Unemployment and Illiteracy Are Predictors of Hepatitis B Virus-Related Stigma and Discrimination. J Clin Exp Hepatol 2022; 12:767-773. [PMID: 35677504 PMCID: PMC9168712 DOI: 10.1016/j.jceh.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND HBV is a serious threat to society in India as around 1,00,000 people die from HBV every year. However, very few studies from India have evaluated the magnitude of stigma faced by HBV patients. So, there was an unmet need to estimate the HBV-related stigma to design the preventive strategies. Hence, the aim of this study was to quantitatively assess the proportions of stigma and discrimination and factors predicting them among HBV patients. METHODS A cross-sectional study was conducted from May 2016 to October 2019. A total of 350 HBV patients and 100 healthy respondents were interviewed for knowledge and awareness about HBV and various stigma characteristics. RESULTS The mean age of HBV subjects was 45.10 ± 11.70 years, and controls were 36.20 ± 12.27 years; males constituted 60% of HBV subjects and 71% of controls. Negative symptoms such as shame, avoidance, and putting others in danger were felt by 70-90% of HBV patients. Around 60% of HBV patients felt that hepatitis B could be transmitted by sharing utensils thinking that saliva is the mode of transmission. The knowledge about transmission of HBV by sexual intercourse, intravenous drug use, and mother to child was present in 88%, 75%, and 52% of HBV patients and 32%,38%, and 40% of healthy individuals, respectively. Multivariate logistic regression revealed that male gender (AOR-2.38, CI 1.48-3.81, P < 0.01), under matriculates (AOR-2.03, CI 1.22-3.44, P < 0.01) and unemployed (AOR-2.16, CI 1.33-3.53, P < 0.01) were significant independent predictors of significant discrimination. CONCLUSION The magnitude of HBV-related stigma is high in the Indian population, and illiteracy and unemployment were significant predictors of a severe grade of discrimination associated with HBV.
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Affiliation(s)
- Manas K. Behera
- Department of Hepatology, SCB Medical College and Hospital, Cuttack, India
| | - Preetam Nath
- Department of Gastroenterology, KIMS Hospital, Bhubaneswar, India
| | - Sambit K. Behera
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India
| | - Pradeep K. Padhi
- Department of Medicine, Fakir Mohan Medical College and Hospital, Balasore, India
| | - Ayaskanta Singh
- Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India,Address for correspondence: Shivaram Prasad Singh, Professor and Head, Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, India.
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7
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Le Gautier R, Wallace J, A Richmond J, Pitts M. The role of explanatory models of chronic hepatitis B on illness experience: a qualitative study of Vietnamese participants in Australia. ETHNICITY & HEALTH 2021; 26:1225-1241. [PMID: 31072132 DOI: 10.1080/13557858.2019.1612519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
ABSTRACTObjective: This study utilises Kleinman's theory of explanatory models of health and illness to explore the experience of chronic hepatitis B (CHB) among Vietnamese people living in Australia. It examines how these explanatory models are formed and shaped by the broader community, and the extent to which this influences understandings and responses to CHB.Design: This study is based on semi-structured interviews with 22 Vietnamese people with CHB in Melbourne, Australia. The individual interviews ranged from 30 minutes to 1.5 hours in length, and were electronically recorded, translated where necessary and transcribed verbatim. Transcripts were thematically coded using NVivo 10, with coding themes guided by categories identified in Kleinman's explanatory models framework.Results: Fundamental to most participants' narratives was the profound impact of cultural, social and economic environments on their understandings and responses to CHB. Regardless of socio-demographic background, most participants juxtaposed biomedical elements of CHB with their own existing humoral-based health belief system. In the context of a chronic asymptomatic condition that, for the most part, does not require pharmaceutical treatment, a humoral-based health belief system provided a familiar conceptual framework from which participants could immediately respond and take control of their infection. This was observed through changes in diet and lifestyle, and the use of traditional herbal medicine in an attempt to 'cure' or halt the progression of their infection.Conclusions: By speaking to people living with CHB directly, it became clear that there is a disjuncture between what is commonly assumed by the biomedical model of CHB and what is understood by individuals with the infection. The public health burden of CHB will continue unless the healthcare system, including public health policies, deliver a hepatitis B model of care that is responsive to the needs and expectations of priority populations.
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Affiliation(s)
- Roslyn Le Gautier
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | - Jacqueline A Richmond
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | - Marian Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
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Howell J, Pedrana A, Schroeder SE, Scott N, Aufegger L, Atun R, Baptista-Leite R, Hirnschall G, ‘t Hoen E, Hutchinson SJ, Lazarus JV, Olufunmilayo L, Peck R, Sharma M, Sohn AH, Thompson A, Thursz M, Wilson D, Hellard M. A global investment framework for the elimination of hepatitis B. J Hepatol 2021; 74:535-549. [PMID: 32971137 PMCID: PMC7505744 DOI: 10.1016/j.jhep.2020.09.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/28/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS More than 292 million people are living with hepatitis B worldwide and are at risk of death from cirrhosis and liver cancer. The World Health Organization (WHO) has set global targets for the elimination of viral hepatitis as a public health threat by 2030. However, current levels of global investment in viral hepatitis elimination programmes are insufficient to achieve these goals. METHODS To catalyse political commitment and to encourage domestic and international financing, we used published modelling data and key stakeholder interviews to develop an investment framework to demonstrate the return on investment for viral hepatitis elimination. RESULTS The framework utilises a public health approach to identify evidence-based national activities that reduce viral hepatitis-related morbidity and mortality, as well as international activities and critical enablers that allow countries to achieve maximum impact on health outcomes from their investments - in the context of the WHO's 2030 viral elimination targets. CONCLUSION Focusing on hepatitis B, this health policy paper employs the investment framework to estimate the substantial economic benefits of investing in the elimination of hepatitis B and demonstrates how such investments could be cost saving by 2030. LAY SUMMARY Hepatitis B infection is a major cause of death from liver disease and liver cancer globally. To reduce deaths from hepatitis B infection, we need more people to be tested and treated for hepatitis B. In this paper, we outline a framework of activities to reduce hepatitis B-related deaths and discuss ways in which governments could pay for them.
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Affiliation(s)
- Jessica Howell
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Gastroenterology, St Vincent's Hospital Melbourne, Australia.
| | - Alisa Pedrana
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia E. Schroeder
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nick Scott
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ricardo Baptista-Leite
- Universidade Catolica Portuguesa, Lisbon, Portugal,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Gottfried Hirnschall
- Strategic Information, Global Hepatitis Programme, World Health Organization,Formerly Department of HIV and Global Hepatitis Programme, World Health Organization
| | - Ellen ‘t Hoen
- Global Health Unit, University Medical Centre, Groningen, the Netherlands,Medicines Law & Policy, Amsterdam, The Netherlands
| | - Sharon J. Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK,Health Protection Scotland, Meridian Court, Cadogan St, Glasgow, UK
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lesi Olufunmilayo
- Department of Medicine, Medicine, College of Medicine, University of Lagos, Nigeria
| | | | - Manik Sharma
- Division of Gastroenterology and Hepatology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Annette H. Sohn
- TREAT Asia/amfAR, Foundation for AIDS Research, Bangkok, Thailand
| | - Alexander Thompson
- Department of Medicine, University of Melbourne, Melbourne, Australia,Department of Gastroenterology, St Vincent's Hospital Melbourne, Australia
| | - Mark Thursz
- Department of Hepatology, Imperial College London, London, UK
| | - David Wilson
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Programme, Burnet Institute, Melbourne, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,Department of Infectious Diseases, The Alfred and Monash University, Australia
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9
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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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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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Wallace J, Smith E, Hajarizadeh B, Richmond J, Lucke J. Addressing cultural diversity: the hepatitis B clinical specialist perspective. ETHNICITY & HEALTH 2019; 24:816-828. [PMID: 28854823 DOI: 10.1080/13557858.2017.1370540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/17/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Hepatitis B is a viral infection primarily affecting people from culturally diverse communities in Australia. While vaccination prevents infection, there is increasing mortality resulting from liver damage associated with chronic infection. Deficits in the national policy and clinical response to hepatitis B result in a low diagnosis rate, inadequate testing and diagnosis processes, and poor access to hepatitis B treatment services. While research identifies inadequate hepatitis B knowledge among people with the virus and primary health care workers, this project sought to identify how specialist clinicians in Australia negotiate cultural diversity, and provide often complex clinical information to people with hepatitis B. Design: A vignette was developed and presented to thirteen viral hepatitis specialist clinicians prior to an electronically recorded interview. Recruitment continued until saturation of themes was reached. Data were thematically coded into themes outlined in the interview schedule. Ethical approval for the research was provided by the La Trobe University Human Research Ethics Committee. Results: Key messages provided to patients with hepatitis B by clinical specialists were identified. These messages were not consistently provided to all patients with hepatitis B, but were determined on perceptions of patient knowledge, age and highest educational level. While the vignette stated that English was not an issue for the patient, most specialists identified the need for an interpreter. Combating stigma related to hepatitis B was seen as important by the specialists and this was done through normalising the virus. Having an awareness of different cultural understandings about hepatitis B specifically, and health and well-being generally, was noted as a communication strategy. Conclusion: Key core competencies need to be developed to deliver educational messages to people with hepatitis B within clinical encounters. The provision of adequate resources to specialist clinics will assist in addressing gaps in the clinical response to hepatitis B.
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Affiliation(s)
- Jack Wallace
- a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne , VIC , Australia
| | - Elizabeth Smith
- a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne , VIC , Australia
| | - Behzad Hajarizadeh
- a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne , VIC , Australia
- b The Kirby Institute, UNSW Australia (University of New South Wales) , Sydney , NSW , Australia
| | - Jacqueline Richmond
- a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne , VIC , Australia
| | - Jayne Lucke
- a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne , VIC , Australia
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Kanzaki N, Iwane S, Oeda S, Okada M, Kimura H, Eguchi Y, Fujimoto K. Categorization and Characterization of Activities Designed to Help Health-care Professionals Involved in Hepatitis Care Increase Their Awareness of the Disease: The Classification of Hepatitis Medical Care Coordinators. Intern Med 2019; 58:1825-1834. [PMID: 30799338 PMCID: PMC6663536 DOI: 10.2169/internalmedicine.1755-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective This study aimed to investigate the current state of the activities performed by hepatitis medical care coordinators, categorize coordinators according to the activities they perform, and determine the backgrounds of these coordinators. Methods A self-administered questionnaire survey was completed by 414 coordinators. The surveyed items included gender, occupation, activity items performed, and barriers that inhibited the performance of these activities. A hierarchical cluster analysis was applied, and cases were classified based on the contents of the activities in question. Results The coordinators were classified into four groups (A-D). Group A, consisting primarily of public health nurses, was classified as "the type that conducted activities aimed at providing information and recommendations." Group B, which included registered dieticians and clerks, was classified as "the type that uses multidisciplinary collaboration to perform their tasks." Group C, which included clinical nurses, was classified as "the type that was more likely to perform activities as leaders in an organization." Group D, consisting primarily of pharmacists, was classified as "the type that promoted activities centered on providing instructions regarding medication dosage and administration." Conclusion Our study showed that coordinators' professional skills and abilities are reflected in the contents of the activities they conduct, and that, to adequately perform their roles, they must acquire skills in addition to those required in their original occupations. To implement high-quality hepatitis countermeasures, there is a need to foster an environment that facilitates cooperation between coordinators, as well as relationship-building.
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Affiliation(s)
- Naruyo Kanzaki
- Department of Medicine Sciences, Graduate School of Medicine, Saga University, Japan
| | | | | | | | - Hiromi Kimura
- Department of Nursing, Faculty of Medicine, Fukuoka University, Japan
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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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