Lay management of chronic disease: a qualitative study of living with hepatitis C infection.

OBJECTIVES: To examine management strategies and goals reported by people diagnosed with chronic hepatitis C. METHODS: We analyzed data from semistructured interviews (N = 42) and from electronic sources [illness narratives (N = 79) and Internet threaded discussions (N = 264)]. Line-by-line coding, comparisons, and team discussions generated catalogs of lay management strategies and goals. We analyzed code-based files to identify informants' selection of specific strategies for each goal. RESULTS: We classified lay management strategies into 3 categories: medical self-care, behavior change, and coping. These strategies were used selectively in addressing multiple goals, categorized as fighting the virus, strengthening the body, and managing consequences. CONCLUSIONS: Results underscore the diversity of strategies for living with a disease characterized by uncertain prognosis and variable expression of symptoms.

Communicating about alcohol consumption to nonharmful drinkers with hepatitis C: patient and provider perspectives.

BACKGROUND: Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C (HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not be a problem in the absence of their HCV diagnosis. OBJECTIVE: This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear. DESIGN: We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N = 50) and healthcare providers (N = 14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program. RESULTS: We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients. Patient respondents who reported hearing "stop completely" were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in "medical language" than were GI providers. CONCLUSIONS: To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV.

Communicating about alcohol consumption to nonharmful drinkers with Hepatitis C: patient and provider perspectives.

BACKGROUND: Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C(HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not bea problem in the absence of their HCV diagnosis. OBJECTIVE: This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear. DESIGN: We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N=50) and healthcare providers (N=14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program. RESULTS: We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients.Patient respondents who reported hearing "stop completely"were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in"medical language" than were GI providers. CONCLUSIONS: To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV.

The long-term relationships between the motivation for change and alcohol use severity among patients with severe and persistent mental illness.

This study examined the long-term relationship of changes in the motivation to remedy alcohol abuse to alcohol use severity among patients with a dual diagnosis of substance abuse disorder and severe and persistent mental illness. Linear regression analyses showed that patients who increasingly recognized alcohol use problems over a 9-month period exhibited significantly greater alcohol use severity at 9 months and a significant increase in alcohol use severity over time. Moreover, patients who became increasingly determined to take actions against alcohol use over a 9-month period exhibited significantly lower alcohol use severity at 9 months and a significant decrease in alcohol use severity over time. The findings support Prochaska et al.'s transtheoretical model of the motivation for change. They suggest that the recognition of alcohol use problems comes along with learning adverse consequences of alcohol use and that increased determination to take actions is critical to the long-term behavioral changes in alcohol use.

Clinical characteristics of individuals with serious mental illness and type 2 diabetes.

OBJECTIVE: Data from 157 individuals with serious mental illness and comorbid diabetes enrolled in an ongoing treatment study were used to examine clinical correlates of diabetes control. METHODS: Factors assessed included depressive symptoms (Montgomery-Åsberg Depression Rating Scale), global psychopathology severity (Brief Psychiatric Rating Scale), and glycosylated hemoglobin (HbA1c), a biomarker of diabetes control. RESULTS: Seventy-seven participants had depression, 40 had schizophrenia, and 40 had bipolar disorder. Most were moderately to severely depressed with poor diabetes control. No correlation between diagnosis and diabetes control was found after adjustment for gender, race, health literacy, diabetes duration, and diabetes knowledge. Greater depression severity and longer diabetes duration were related to poorer diabetes control. Lower severity of global psychopathology was related to poorer diabetes control, perhaps because of overall low levels of psychosis and mania. CONCLUSIONS: People with serious mental illness and diabetes face multiple challenges, which, along with severe depression, may impede diabetes self-management.

Suicide prevalence in chemical dependency programs: preliminary data from a national sample, and an examination of risk factors.

Completed suicides over a one year period of time were reported from a nationwide survey of Department of Veteran Affairs medical centers. Of a total of 248 completed suicides, 11 occurred in outpatient substance abuse programs, and an additional 5 occurred among patients receiving combined outpatient substance abuse and psychiatric treatment. There were no inpatient suicides. During this time, there were 7 suicide attempts on inpatient units and 37 suicide attempts in outpatient chemical dependency treatment. The majority of suicides were committed by males who had a primary alcohol addiction (63%). Thirty-eight percent of the sample had a comorbid mood disorder and 38% had a comorbid personality disorder. Risk factors relating to the potential for suicide in chemical dependency programs are discussed.

Impacts of motivation for change on the severity of alcohol use by patients with severe and persistent mental illness.

OBJECTIVE: This study examined the effect of motivation for change, measured by the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), on alcohol use severity among alcoholic patients with severe and persistent mental illness. METHOD: At a Veterans Affairs hospital, 390 dually diagnosed patients were recruited and assessed for motivation for change, alcohol use severity, psychotic symptoms and global functioning at baseline and 9-month follow-up. RESULTS: Regression analyses showed that patients who were highly ambivalent about their alcohol use at baseline consumed significantly more alcohol 9 months later, on the basis of Addiction Severity Index ratings (p < or = .01), than patients who felt less ambivalent. CONCLUSIONS: The findings suggest that increased awareness of alcohol-related problems is essential to reducing alcohol use severity for alcoholic patients with severe and persistent mental illness. The implications and limitations of the findings are discussed.

Who or what is the preembryo?

... The moral status -- and specifically the controversial issue of personhood -- is related to attainment of developmental individuality... This contrasts with the view that holds that personhood occurs earlier, at the point of genetic uniqueness. I believe that an embryo that has developed to the point where it can be one individual and one individual only, differs in moral status from a preembryo that has not, even if in many cases we may choose to treat them similarly... In view of the conviction that the preembryo is not yet a person and that its statistical potential for becoming such is small, it is not clear that nontherapeutic experiments can be excluded in principle. However, because the preembryo does have intrinsic potential...the preembryo should be treated as a person... Any exceptions from the prima facie duty to treat the preembryo as a person should be based on criteria established at the national level....

The preembryo as potential: a reply to John A. Robertson.

... In conclusion, let me agree with Robertson that reasonable persons may indeed disagree on concrete conclusions touching preembryo freezing, discard, research, and diagnosis. But it is one of the challenges to reasonable people to give reasons for their conclusions. When Robertson notes that preembryo research "has been found acceptable by most bodies that have examined the subject," he leaves unstated the fact that many of these bodies have not given reasons for their conclusions. This is especially true of the Warnock Committee. It is definitely not true of John Robertson. He has attempted to give analytic support for his rather permissive positions. I find this support too fragile for its assigned task, though I hasten to say that this does not mean that only a totally prohibitive position is defensible or is mine. Prima facie still means prima facie.

Human reproduction: dominion and limits.

The general struggle throughout Christian history has been to seek the proper balance between dominion and limits, intervention and nonintervention, givenness, and creativity. This struggle has worked itself out in six areas that touch human life. In this essay, I will revisit the Catholic tradition's treatment of these in terms of dominion and limits to see whether we can discern developmental patterns that might suggest an approach to issues pertaining to the sources of life (reproductive ethics) as we move into the next century.

How the Report made a difference: reflections on a 15th anniversary.

To mark the 15th anniversary of the Hasting Center Report, six authors who have written for the Report since its beginning comment briefly on an article or a theme from the Report that has had an impact on their thinking or on the way that bioethics has developed as a discipline. The titles of the commentaries are as follows: "In praise of William May's 'attitudes'" (A.M. Capron); "On opening human experimentation to moral debate" (S. Bok); "Learning from Ramsey" (R.A. McCormick); "Toward a science of particulars" (E.J. Cassell); "Challenging the power of codes" (R.M. Veatch); and "Relating moral principles and moral behavior" (D. Callahan).

Does Christianity make a difference?

The human person makes great demands on the physician and calls for unique attention. Hence the doctor-patient relationship calls for the highest ideals of kindness, patience, trustworthiness, generosity and skill. The Catholic physician brings to these demands a specific meaning: ministering to the sick is to see Christ in them and to show Him to them.

Alcohol Consumption Decisions among Nonabusing Drinkers Diagnosed with Hepatitis C: An Exploratory Sequential Mixed Methods Study.

Most studies of decisions to curtail alcohol consumption reflect experiences of abusing drinkers. We employ an exploratory sequential research design to explore the applicability of this research to the experience of nonabusing drinkers advised to curtail alcohol consumption after a Hepatitis C diagnosis. A qualitative component identified 17 new decision factors not reflected in an inventory of factors based on synthesis of existing scales. We triangulated qualitative data by supplementing semi-structured interviews with Internet postings. A quantitative component estimated prevalence and association with current drinking of these new decision factors. Patients who quit drinking tended to attribute post-diagnosis drinking to occasional triggers, whereas patients who were still drinking were more likely to endorse rationales not tied to specific triggers.