Assessing hepatitis C spontaneous clearance and understanding associated factors-A systematic review and meta-analysis

New advances in the treatment of hepatitis C provide high levels of sustained viral response but their expense limits availability in publicly funded health systems. The aim of this review was to estimate the proportion of patients who will spontaneously clear HCV, to identify factors that are associated with clearance and to support better targeting of directly acting antivirals. We searched Ovid EMBASE, Ovid MEDLINE and PubMed from 1 January 1994 to 30 June 2015 for studies reporting hepatitis C spontaneous clearance and/or demographic, clinical and behavioural factors associated with clearance. We undertook meta-analyses to estimate the odds of clearance for each predictor. Forty-three studies met the inclusion criteria, representing 20 110 individuals, and 6 of these studies included sufficient data to estimate spontaneous clearance. The proportion achieving clearance within 3, 6, 12 and 24 months following infection were, respectively, 19.8% (95% CI: 2.6%-47.5%), 27.9% (95% CI: 17.2%-41.8%), 36.1% (95% CI: 23.5%-50.9%) and 37.1% (95% CI: 23.7%-52.8%). Individuals who had not spontaneously cleared by 12 months were unlikely to do so. The likelihood of spontaneous clearance was lower in males and individuals with HIV co-infection, the absence of HBV co-infection, asymptomatic infection, black or nonindigenous race, nongenotype 1 infection, older age and alcohol or drug problems. This study suggests that patients continue to spontaneously clear HCV for at least 12 months following initial infection. However, injecting drug users are comparatively less likely to achieve clearance; thus, they should be considered a priority for early treatment given the continuing risks that these individuals pose for onwards transmission.

Stigma toward people with mental health problems in Indonesia

Introduction

Mental health problems are serious issues in Indonesia. The prevalence of severe mental disorder in Indonesian population is 1.7‰. In community, people with mental disorder are often stigmatized, while in fact this stigmatization could negatively impact them. One of the most common form of discrimination toward people with mental disorder is the practice of pasung.

Method

This research conducted a survey study on 1,269 respondents in East Java (in which the prevalence of severe mental disorder is 2.2‰). The instruments used were Community Attitudes towards Mental Illness (CAMI), Mental Health Knowledge Schedule (MAKS), and a sociodemographic questionnaire.

Result

The result shows that better knowledge about mental health was associated with lower public stigma toward people with mental disorder. Significance differences in stigma toward people with mental illness were also found across groups of age, sex, experience of contact, history of mental disorder, attitude toward pasung, marital status, and income level.

Conclusion

The finding implies that anti-stigma interventions in Indonesia should consider associated sociodemographic factors and use psychosocial approach to improve literacy and contact with mental health patients.

Risk factors for severe postpartum haemorrhage: A population-based retrospective cohort study

BACKGROUND

Severe postpartum haemorrhage (PPH) is a serious clinical problem that is increasing in incidence.

AIM

To identify risk factors for severe PPH.

MATERIALS AND METHODS

Population-based retrospective cohort study of all women who gave birth in Victoria in 2009-2013 using the validated Victorian Perinatal Data Collection. Three multivariable logistic regression models estimated the adjusted risk of severe PPH. Adjusted odds ratios (aOR) and their 95% confidence intervals are reported. The primary outcome was severe PPH (estimated blood loss of ≥1500 mL).

RESULTS

Severe PPH occurred in 1.4% of all births (n = 5122). Maternal characteristics significantly associated with severe PPH included: multiple pregnancy; older maternal age; overweight/obesity; first births. Other risk factors included placental complications, macrosomia, instrumental vaginal birth, third and fourth degree perineal lacerations, in-labour caesarean section, birth at a gestation other than 37-41 weeks, duration of labour 12 to <24 h, and use of oxytocin infusions in labour. Planned pre-labour caesarean section was associated with reduced odds of severe PPH. Severe PPH also occurred in 0.7% (n = 104) of women with none of the identified risk factors.

CONCLUSIONS

Numerous risk factors for severe PPH are identified but some cases are not modifiable or predictable. Limiting use of oxytocin infusions in labour to cases with clear indications, and strategies to prevent severe perineal lacerations would prevent some severe PPHs. Close surveillance of all women in the hours immediately following birth is crucial to detect and manage excessive blood loss and reduce severe PPH and associated morbidity.

Depression and Its Association with Health-Related Quality of Life in Postmenopausal Women in Korea

Menopause is associated with depressive symptoms that can significantly affect a woman's quality of life. The objective of this study was to evaluate the association between depression and health-related quality of life (HRQoL) in postmenopausal women. In this cross-sectional descriptive study, participants (n = 3860) were selected from the 2013⁻2015 Korea National Health and Nutrition Examination Survey (KNHANES). The sociodemographic characteristics, medical history of depression, and EQ-5D scores of the participants were obtained from the KNHANES dataset. Age, educational level, and income were associated with HRQoL in these participants. Moreover, depression exerted a considerable influence on HRQoL in postmenopausal women. The adjusted odds ratios in participants with depression for the EQ-5D dimensions were as follows: 5.52 (95% CI = 4.04⁻7.55, p < 0.001) for anxiety/depression, 3.86 (95% CI = 2.78⁻5.36, p < 0.001) for usual activities, and 2.52 (95% CI = 1.68⁻3.78, p < 0.001) for self-care. Our findings suggest a strong association between depression and HRQoL. Hence, preventing the onset or exacerbation of depression may significantly improve quality of life in postmenopausal women.

Disparity in outcomes of melanoma adjuvant immunotherapy by demographic profile

Background

Randomized comparisons have demonstrated survival benefit of adjuvant immunotherapy in node-positive melanoma patients but have limited power to determine if this benefit persists across various demographic factors.

Materials & methods

We assessed the impact of demographic factors on the survival benefit of adjuvant immunotherapy in a database of 38,189 node-positive melanoma patients using the Kaplan-Meier method and Cox proportional hazards models.

Results

All assessed demographic factors other than race significantly impacted survival of node-positive melanoma patients in univariate analysis. In multivariable analysis, only the age group interacted with immunotherapy.

Conclusion

Analysis of this large database of unselected node-positive melanoma patients demonstrated a positive survival benefit of immunotherapy across all demographic factors assessed and the impact was greater for patients 65 years of age and older.

Factors related to parenting stress among fathers of preschool children in Japan

BACKGROUND

Even though fathers participate in childcare at a higher rate than before, there remains a lack of research on the factors that contribute to parenting stress among fathers. This study explored the socioeconomic and demographic factors associated with parenting stress among fathers of preschool children.

METHODS

Our study included 17 645 fathers who participated in the 2016 Comprehensive Survey of Living Conditions in Japan. Parenting stress was assessed using a single question. Socioeconomic and demographic factors were predictors. Logistic regression analysis was conducted to estimate the odds ratio (OR) and 95% confidence interval (CI) for parenting stress.

RESULTS

Overall, 6.6% fathers experienced parenting stress. Fathers with a youngest child aged 0-2 years were more likely to experience parenting stress than those with a youngest child aged 3-6 (OR: 1.45, 95% CI: 1.25-1.68). Compared with fathers who lived in two-parent households without grandparents, those who lived in single-father households (both with and without grandparents) were more likely to experience parenting stress (OR: 12.13, 95% CI: 5.60-26.29 and OR: 4.19, 95% CI: 2.04-8.60, respectively). Furthermore, there was a significant negative association between education and parenting stress.

CONCLUSIONS

Having a child aged 0-2 years, single fatherhood, and higher education were associated with parenting stress among fathers of preschool children. Healthcare professionals need to be aware of these factors when supporting fathers in raising their children.

Demographic factors and delay of treatment for alcohol use disorders among 6584 Danish men receiving alcohol treatment

PURPOSE

This study aimed to investigate the time lag between onset and treatment (treatment delay) for alcohol use disorders (AUD) and associations between demographic factors and treatment delay for AUD.

METHODS

The study included 6,584 men registered in the Copenhagen Alcohol Cohort, containing information on civil status, employment status, estimated age at onset of alcohol problems, and age at first outpatient AUD treatment. Data on year of birth, intelligence, and educational level were obtained from the Danish Conscription Database. Information on first hospital AUD treatment was retrieved from Danish national psychiatric registers. Associations between the demographic factors and treatment delay were analysed in separate linear regression models adjusted for year of birth and in a mutually adjusted model including all demographic factors.

RESULTS

The mean treatment delay for AUD was 6.9 years (SD = 4.1). After mutual adjustment, an SD increase in intelligence score was associated with 0.17 years increase in treatment delay. Educational level was unrelated to treatment delay. Men with estimated age at onset of alcohol problems at age 20 years or younger had a 5.30 years longer treatment delay than men who had estimated age at onset of alcohol problems at age 51 years or older. Employed men had shorter treatment delays than unemployed men, especially among the oldest birth cohorts.

CONCLUSIONS

The treatment delay of 6.9 years highlights the necessity to promote access to AUD treatment, perhaps in particular among adolescents and young individuals. Cognitive factors may affect treatment delay more than non-cognitive personal factors.

Suicide and its risk factors - An ecological study

BACKGROUND

There is tremendous variation in both the prevalence of suicide and the factors that contribute to its occurrence across geographic locations, cultures, and time. Therefore, the present study aims to identify the various socio-demographic risk factors and psychosocial stressors using population data.

MATERIALS AND METHODS

The countries that were included in the study were based on data from the World Health Organization. We considered the top ten suicide countries and the ten lowest suicide nations. We searched five global databases for the most recent socio-demographic data and data on psychosocial stressors during the period of August and September 2022. We analyzed the correlation between suicide rates and various factors, and we considered a P value of less than 0.05 to be statistically significant.

RESULTS

The correlation of suicide with sociodemographic factors like age (P 0.246), gender (male, P 0.357, and female, P 0.357), net enrolment rate (P 0.725), gender parity index (P 0.929), urban population percentage (P 0.571), marital status (male, P 0.345, and female, P 0.752), and literacy rate percentage (P 0.199) was not significant. The correlation of suicide with psychosocial stressors like unemployment percentage (P 0.552), alcoholism percentage (P 0.271), the prevalence of depression (P 0.523), the number of psychiatrists (P 0.605), the number of mental hospitals (r = -0.090, P 0.713), and the poverty rate percentage (P 0.538) were also not significant.

CONCLUSION

Suicide is a major public health issue, yet global suicide data is scarce. Sociodemographic factors like age, urbanization, and literacy rate were negatively correlated, whereas psychosocial stressors like unemployment, alcohol misuse, and poverty were positively correlated, but none were significantly associated.