Chronic liver disease--an increasing problem: a study of hospital admission and mortality rates in England, 1979-2005, with particular reference to alcoholic liver disease.

AIMS: To determine time trends in hospital admissions for chronic liver disease in England between 1989/1990 and 2002/2003, mortality rates in England and Wales between 1979 and 2005, and the influence of alcohol-related disease on these trends. METHODS: Hospital episode statistics for admissions in England were obtained from the Information Center for Health and Social Care and mortality data for England and Wales from the Office for National Statistics. RESULTS: Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females over the study period. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. While there was a smaller rise for chronic viral hepatitis B and C, admission rates declined for hepatitis A, autoimmune hepatitis, and primary biliary cirrhosis. Mortality rates for chronic liver disease more than doubled between 1979 and 2005. Two thirds of these deaths were attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic liver disease mortality was in the 45-64 age group, and the largest percentage increase between 1979 and 2005 occurred in the 25-34 age group. CONCLUSIONS: Hospital admissions and mortality in England from chronic liver disease are increasing. The underlying reasons are complex, but alcohol-induced liver disease makes a major contribution. There are clear social and health implications if the trend continues and addressing alcohol-related liver disease should be a public health priority.

Co-morbidity of infectious and addictive diseases in St. Petersburg and the Leningrad Region, Russia.

The Russian health care system is organized around specific diseases, with relatively little focus on integration across specialties to address co-morbidities. This organizational structure presents new challenges in the context of the recent epidemics of injection drug use (IDU) and HIV. This paper uses existing and new data to examine the prevalence of reported new cases of drug dependence (heroin) and HIV over time as well as associations between drug dependence and alcoholism, hepatitis B and C, and tuberculosis in the City of St. Petersburg and the Leningrad region. We found a sharp rise in reported cases of IDU beginning in 1991 and continuing until 2002/2003, followed by a sharp rise in newly reported cases of HIV. These rises were followed by a drop in new cases of HIV and drug addiction in 2002/2003 and a drop in the proportion of HIV-positive individuals with IDU as a risk factor. Infection with hepatitis B and C were common, especially among injection drug users (38 and 85%, respectively), but also in alcoholics (7 and 14%). Tuberculosis was more common in alcoholics (53%) than in persons with alcoholism and drug dependence (10%), or with drug dependence alone (4%). Though these data have many limitations, they clearly demonstrate that drug dependence and/or alcoholism, HIV, hepatitis, and tuberculosis frequently co-occur in St. Petersburg and the Leningrad Region. Prevention and treatment services across medical specialties should be integrated to address the wide range of issues that are associated with these co-morbidities.

[The legal and occupational health aspects of B and C type viral hepatitis]. / A hepatitis B-vírus- es a hepatitis C-vírus-fertozés jogi es foglalkozás-egészségügyi vonatkozásai.

INTRODUCTION: Viral hepatitis is a problem of population health. Recent data show an estimated number of 400 million patients infected with hepatitis B and 170 million with hepatitis C virus in the world. The prevalence of HBV infected patients is estimated to 50000, the prevalence of the HCV patients to 70,000 in Hungary. AIMS: The authors report the legal and occupational health aspects of viral hepatitis. The knowledge of these facts could help both the patients and doctors. This paper is on the employment, occupational restrictions of the infected patients, the legal aspects of the discrimination and the vaccination. The authors report the knowledge, rules and restrictions relating to health service employees in a separate subchapter. They call the attention to the occupational health aspects in relation to the infected patients and health service employees from the point of view of the occupational health specialist, the commissioner responsible for safeguarding the patients' interest and the specialist attending the infected patients.

A 25-year follow-up study of drug addicts hospitalised for acute hepatitis: present and past morbidity.

The aim of the study was to investigate present and past morbidity in drug addicts, 25 years after hospitalisation for acute hepatitis B or hepatitis nonA-nonB. The hospital records for 214 consecutively admitted patients were analysed, and a follow-up study on 66 of the 144 patients still alive was performed. At follow-up, 1 of 54 (1.8%) hepatitis B patients was still HBsAg positive. Twelve patients originally diagnosed as hepatitis nonA-nonB were all among 54 found to be anti-hepatitis C virus (anti-HCV) positive, and the total anti-HCV prevalence was 81.8%. Twelve (22.2%) of the HCV cases were unknown before the follow-up examination. Four (6.1%) participants were anti-human immunodeficiency virus positive, only 1 was on antiretroviral therapy, and none had developed AIDS. Other chronic somatic diseases were a minor problem, whereas drug users reported skin infections as a frequent complication. Forty-three patients (65%) had abandoned addictive drugs since the hospital stay. Serious mental disorders were reported by 19 patients (28.8%), and 17 (25.8%) regarded themselves as present (9) and former (8) compulsive alcohol drinkers. A large proportion of the participants were granted disability pension (39%), a majority because of psychiatric disorders, drug and alcohol abuse.

[Peloid application to the area of the adrenal glands projection in the rehabilitation therapy of patient with viral hepatitis A and B]. / Applikatsii peloida na oblast' proektsii nadpochechnikov v reabilitatsionnoi terapii bol'nykh, perenesshikh virusnyi gepatit A i B.

Submitted in the paper are data secured in investigations designed to study efficacies of peloid applications to the area of projection of the adrenal glands in patients with the history of viral hepatits A and B presenting with a high risk of chronization of the illness. The analysis of the therapy effect was performed on the basis of examination of 45 VH reconvalescents with making use of clinical, biochemical and immunological investigational techniques. The findings obtained suggest restoration during the above therapy of the functional state of the liver as well as immunomodulating effect of the method, moderation of autoimmunoaggression, and expediancy of its employment in the rehabilitative period of VH in those patients presenting with signs of disfunction of the immunity system, history of allergoses and presence of concomitant pathology.

[The rehabilitation of patients with a history of viral hepatitis using UHF therapy (460 MHz)]. / Reabilitatsiia bol'nykh, perenesshikh virusnyi gepatit, s primeneniem SVCh-terapii (460 MGts).

In early convalescence after viral hepatitis C the liver region of the patients was exposed to the decimetric waves to prevent transformation of the acute disease into a chronic one. A total of 45 relevant patients were exposed to electromagnetic field of ultrahigh frequency (460 MHz). A positive effect on the disease course and liver function was noted.

[Decimeter-wave physiotherapy in viral hepatitis]. / Detsimetrovaia fizioterapiia pri virusnom gepatite.

Effectiveness was evaluated of magnetotherapy, inductothermy, UNF electric field and electromagnetic waves of decimetric wave band (460 MHz) on the projection of the liver, adrenals and thyroid gland in controlled trials enrolling a total of 835 patients with viral hepatitis (type A, B, associated forms). A conclusion is reached that optimum effectiveness of decimetric field on the projection of the adrenals and thyroid gland can be achieved through the application of minimum power and everyday alternation of exposures. It has been estimated that as many as 69 percent of the patients derive benefit from the above treatment.

Nutritional assessment of drug addicts.

OBJECTIVE: To discern if factors such as organic pathology, sex, duration and/or intensity of drug addiction, alcohol abuse, hepatitis B infection, anorexia with poor food and drink consumption, or disturbance of social and familial networks, are related to an impaired nutritional status in hospitalized drug addicts. DESIGN: Cross-sectional prospective study. SETTING: Detoxication unit and internal medicine unit of a university hospital. PATIENTS: 140 drug addicts without acute organic pathology and 18 with acute organic pathology related to drug addiction. The immunological study was compared with a control group composed of 50 healthy and well-nourished individuals (26 women and 24 men), age-matched with our patients. RESULTS: Drug addicts without organic pathology were under-nourished: 92.4% weighed under the mean weight for the population and 55.7% had had a weight loss above 5%. The distribution of mid-upper arm circumference (MUAC), triceps skinfold (TSF) measurement and mid-arm muscle area (MAMA) compared with the percentiles for the population showed a shift towards lower values. We found a high percentage of patients with a high lymphocyte count (55%). Despite the high lymphocyte count, delayed hypersensitivity was depressed in our patients. Of our patients, 66.4% exhibited anorexia at admission. The mean calorific intake was 978 +/- 89 kcal/day in females and 1265 +/- 64 kcal/day in males. However, in most cases, malnutrition (usually marasmus-like malnutrition) was not very severe; only 30% of the drug addicts weighed less than 80% of the mean weight for the population, or admitted to a weight loss above 10%, and by subjective nutritional assessment, only 18% were deeply malnourished. Otherwise, the nutritional status was very poor in drug addicts with acute organic pathology. We also found a worse nutritional status in our patients related to female sex, intensity of drug addiction, anorexia with poor food and drink consumption, and disturbance of the social and familial networks. CONCLUSIONS: Many drug addicts suffer from calorie and protein malnutrition. This mainutrition is related to female sex, intensity of drug addiction, anorexia and poor food and drink consumption, and disturbance of the social and familial links. Acute organic pathology leads to a significant worsening of the nutritional status of drug addicts.

[The efficacy of decimeter-wave therapy with exposure of the neuroendocrine organs in the treatment of viral hepatitis]. / Effektivnost' DMV-terapii v lechenii virusnykh gepatitaov s vozdeistviem na neiroéndokrinnye organy.

A controlled trial entered 343 patients with virus hepatitis A, B and associated forms. In addition to standard treatment the patients' adrenals and thyroid were exposed to electromagnetic waves (460 MHz) in alternative daily regimens and under minimal power. As shown by clinical, rheohepatographic, hormonal, immunological and follow-up evidence, positive results were achieved in 69% of the patients.

[Diagnostic and expert-testimony errors in the evaluation of permanent complications of hepatitis B]. / Bledy diagnostyczne i orzecznicze w ocenie trwalych nastepstw przebytego wirusowego zapalenia watroby typu B.

The analysis of incorrect evaluation of permanent consequences resulting after hepatitis B has been conducted. False diagnostical and expert evidence in evaluation of permanent effects after hepatitis B influenced to disadvantage the decisions concerning disability and compensation payments.