ABSTRACT
BACKGROUND: The concept of positive health (PH) supports an integrated approach for patients by taking into account six dimensions of health. This approach is especially relevant for patients with chronic disorders. Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disorders are among the top-6 of the most prevalent chronically affected organ systems. The impact of chronic GI-HPB disorders on individuals may be disproportionally high because: (1) The affected organ system frequently contributes to a malnourished state; and (2) persons with chronic GI-HPB disorders are often younger than persons with chronic diseases in other organ systems. AIM: To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders. METHODS: Prospective, observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GI-HPB disorder attending the Outpatient Department of the Maastricht University Medical Center. Validated questionnaires and data from patient files were used to quantify the six dimensions of PH. Internal consistency was tested with McDonald's Omega. Zero-order Pearson correlations and t-tests were used to assess associations and differences. A P value < 0.05 was considered significant. RESULTS: The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population. Regarding quality of life, participation and daily functioning, GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems, but depressive symptoms (in 35%) and malnutrition (in 45%) were more frequent in patients with chronic GI-HPB disorders. Intercorrelation scores between the six dimensions were only very weak to weak, forcing us to quantify each domain separately. CONCLUSION: All six dimensions of PH are impaired in the GI-HPB patients. Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.
Subject(s)
Gastrointestinal Diseases , Liver Diseases , Quality of Life , Humans , Female , Male , Prospective Studies , Middle Aged , Aged , Chronic Disease , Surveys and Questionnaires , Gastrointestinal Diseases/psychology , Gastrointestinal Diseases/diagnosis , Adult , Liver Diseases/psychology , Liver Diseases/diagnosis , Biliary Tract Diseases/psychology , Biliary Tract Diseases/diagnosis , Malnutrition/diagnosis , Malnutrition/epidemiology , Malnutrition/psychology , Pancreatic Diseases/psychology , Health Status , Aged, 80 and overABSTRACT
BACKGROUND: Chronic liver disease (CLD) is one of the leading disease burdens in Pakistan. Until now, there has only been limited focus in the country on providing health services through tertiary services in urban cities, whereas there is almost no research in Pakistan on the mental health and quality of life of CLD patients. This study aimed to understand which predictors influence the mental health and quality of life of CLD patients in order to advise better policy protection. METHODS: Data was collected from CLD patients at the Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan. A total of 850 respondents were part of the final sample. The age of respondents ranged from 18 to 79 years and included the following diagnosis: (i) Chronic Viral Hepatitis (n = 271), (ii) Cirrhosis (n = 259), (iii) Hepatocellular Carcinoma (n = 193), and (iv) Non-viral Liver Disease (n = 127). RESULTS: Mean results reveal that females as well as illiterate patients need more support for mental health and communication with their physician; whereas men need more support to develop coping strategies. Structural equation modelling results reveal that the severity of symptoms (ß = 0.24, p < 0.001), coping strategies (ß=-0.51, p < 0.001), and doctor communication (ß=-0.35, p < 0.001) predict mental health. Quality of life is associated with the severity of symptoms (ß=-0.36, p < 0.001), coping strategies (ß = 0.26, p < 0.05), and doctor communication (ß = 0.09, p < 0.05). CONCLUSIONS: A 'bio-psycho-social-spiritual' model is recommended for Pakistan's CLD patients which includes the integration of social officers to provide support in four key areas to secure mental health and quality of life of patients.
Subject(s)
Liver Diseases , Mental Health , Quality of Life , Humans , Female , Male , Middle Aged , Adult , Pakistan/epidemiology , Aged , Young Adult , Adolescent , Liver Diseases/psychology , Chronic Disease , Adaptation, Psychological , Latent Class Analysis , Liver Cirrhosis/psychology , Liver Neoplasms/psychology , Carcinoma, Hepatocellular/psychology , Sex FactorsSubject(s)
Empathy , Gastroenterology , Palliative Care , Humans , Liver Diseases/therapy , Liver Diseases/psychologyABSTRACT
BACKGROUND: Management of benign liver lesions (BLLs) is still an object of discussion. Frequently, patients receive multiple opinions about their diagnosis and treatment from physicians specialized in different areas, which can be opposite and controversial. This study aimed to understand patients' decision-making process in electing surgery and assess their satisfaction after resection for BLLs. METHODS: A 104-question survey was administered to 98 patients who had a resection for BLLs in 4 different hepatopancreatobiliary and transplant centers in Argentina. The first section included 64 questions regarding the initial discovery of the BLL, the decision-making process, and the understanding of the patient's feelings after surgery. The second section, 42 queries, referred to the quality of life. The patient's final diagnosis and outcome were correlated with the survey results using univariate analysis. RESULTS: Among 97 patients who had undergone liver resection for BLLs, 69 (70%) completed the survey. The median age was 51.71 years (range, 18-75), and 63% of the patients were females. Moreover, 21% of patients received conflicting information from different healthcare providers. Surgeons were the best to describe the BLL to the patient (63%), and 30% of patients obtained opinions from multiple surgeons. The respondents were quite or fully satisfied with their decision to have surgery (90%) and the decision-making process (91%). Only 59% of patients considered their lifestyle better after surgery, and 89% of patients would have retaken the same decision. CONCLUSION: Patients with resected BLLs are delighted with the decision to have surgery, regardless of the final diagnosis and outcome. The role of surgeons is crucial in the decision-making process.
Subject(s)
Hepatectomy , Liver Diseases , Patient Satisfaction , Quality of Life , Humans , Female , Male , Middle Aged , Hepatectomy/psychology , Adult , Patient Satisfaction/statistics & numerical data , Aged , Liver Diseases/surgery , Liver Diseases/psychology , Adolescent , Young Adult , Surveys and Questionnaires , Decision Making , ArgentinaABSTRACT
Causes of chest pain can vary from benign to life-threatening conditions, and in many cases not necessary of cardiac origin. A possible reason for noncardiac chest pain could be anxiety or depression caused by chronic liver diseases. The aim of this study was to investigate the association of anxiety and depression with chronic liver disease in patients with noncardiac pain. Patients with chest tightness or pain referred for treadmill exercise testing were recruited from a regional hospital in southern Taiwan. Medical records of the patients were used to define the presence and type of chronic liver disease. Multiple logistic regression analyses were conducted to assess the association of anxiety and depression with chronic liver disease. A total of 2537 patients with liver function test results and abdominal sonography data were analyzed, and 1965 patients showed a negative treadmill exercise testing. The mean age of these 1965 patients was 51.9 years and 54.2% were male. The prevalence of alcoholic liver disease, hepatitis B, hepatitis C, and fatty liver disease was 10.6%, 10.9%, 3.7%, and 27.0%, respectively. Results from multiple logistic regression analyses showed that the risk of anxiety (adjusted odds ratio [aOR] = 1.83, P < .001) and depression (aOR = 1.85, P < .001) was significantly higher in patients with alcoholic liver disease. Anxiety was significantly higher in patients with fatty liver disease (aOR = 1.30, P = .031), and the risk of depression was significantly higher in patients with chronic hepatitis C (aOR = 2.18, P = .005). In conclusion, in patients with noncardiac chest pain, alcoholic liver disease was significantly associated with anxiety and depression, while those with fatty liver and chronic hepatitis C were associated with anxiety and depression, respectively. Clinicians should be vigilant to these correlations in their practice.
Subject(s)
Anxiety , Chest Pain , Depression , Liver Diseases , Anxiety/epidemiology , Chest Pain/epidemiology , Chronic Disease , Cross-Sectional Studies , Depression/epidemiology , Female , Humans , Liver Diseases/epidemiology , Liver Diseases/psychology , Male , Middle AgedABSTRACT
BACKGROUND: There are conflicting results regarding the association between chronic liver disease (CLD) and depression and the underlying biological mechanisms are lack of investigation. To address the impact of depression and its effects on the management of CLD, its biological marker is critical to be identified. The present study explored the association between serum albumin and depression in CLD patients and whether the association varied in different liver histological stages. METHODS: Based on the United States National Health and Nutrition Examination Survey 2017-2018, the data of serum albumin and depressive symptoms from 627 participants with CLD were used. Depression symptoms were assessed with the nine-item Patient Health Questionnaire (PHQ-9). We used multivariate linear regression to evaluate the association between serum albumin and PHQ-9 scores. Stratified analysis was performed according to the liver histology examined by vibration controlled transient elastography. RESULTS: Serum albumin level was inversely associated with PHQ-9 scores in the multivariate regression model after adjusting for mainly potential confounders (ß = - 1.113, 95% CI: - 2.065 to - 0.162, P = 0.0221). In the subgroup analysis stratified by gender, controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), the inverse association remained significant in female (ß = - 2.002, 95% CI: - 3.515 to - 0.489, P = 0.0100), patients with CAP < 274 dB/m (ß = - 2.215, 95% CI: - 3.621 to - 0.808, P = 0.0023) and patients with LSM ≥8.2 kPa (ß = - 4.074, 95% CI: - 6.237 to - 1.911, P = 0.0003). Moreover, the association was much stronger when the serum albumin was higher than 3.4 g/dL among patients with LSM ≥8.2 kPa (ß = - 4.835, 95% CI: - 7.137 to - 2.533, P < 0.0001). CONCLUSION: Our study revealed an inverse association between serum albumin and depression in CLD patients and this association differed according to liver histological changes. Serum albumin could be a warning marker for depressive symptoms in CLD patients. It is essential for taking corresponding intervention strategies.
Subject(s)
Depression , Liver Diseases , Serum Albumin , Depression/complications , Female , Humans , Liver/pathology , Liver Diseases/complications , Liver Diseases/psychology , Male , Nutrition Surveys , United StatesABSTRACT
Depression and chronic liver disease (CLD) are important causes of disability, morbidity and mortality worldwide and their prevalence continues to rise. The rate of depression in CLD is high compared to that of the general population and is comparable to the increased rates observed in other medical comorbidities and chronic inflammatory conditions. Notably, a comorbid diagnosis of depression has a detrimental effect on outcomes in cirrhosis. Systemic inflammation is pivotal in cirrhosis-associated immune dysfunction - a phenomenon present in advanced CLD (cirrhosis) and implicated in the development of complications, organ failure, disease progression, increased infection rates and poor outcome. The presence of systemic inflammation is also well-documented in a cohort of patients with depression; peripheral cytokine signals can result in neuroinflammation, behavioural change and depressive symptoms via neural mechanisms, cerebral endothelial cell and circumventricular organ signalling, and peripheral immune cell-to-brain signalling. Gut dysbiosis has been observed in both patients with cirrhosis and depression. It leads to intestinal barrier dysfunction resulting in increased bacterial translocation, in turn activating circulating immune cells, leading to cytokine production and systemic inflammation. A perturbed gut-liver-brain axis may therefore explain the high rates of depression in patients with cirrhosis. The underlying mechanisms explaining the critical relationship between depression and cirrhosis remain to be fully elucidated. Several other psychosocial and biological factors are likely to be involved, and therefore the cause is probably multifactorial. However, the role of the dysfunctional gut-liver-brain axis as a driver of gut-derived systemic inflammation requires further exploration and consideration as a target for the treatment of depression in patients with cirrhosis.
Subject(s)
Depression/etiology , Gastrointestinal Microbiome/physiology , Inflammation/complications , Liver Diseases/complications , Depression/psychology , Disease Progression , Humans , Inflammation/psychology , Liver Diseases/psychologyABSTRACT
BACKGROUND: Improvement in the quality of life (QoL) of patients with chronic diseases is as important as medical care. This study aimed to evaluate the QoL of children with chronic liver diseases and to determine related factors. METHODS: For this study, 101 children with chronic liver disease, 100 healthy controls, and their parents were included. The Pediatric Quality of Life Scale (PedsQL) was used to evaluate health-related QoL; higher scores indicate better QoL. Patients were evaluated before and after initiation of treatment and being educated about their illness. RESULTS: The mean patient age was 12.9 ± 3.9 years. Total PedsQL scores of the patients and the healthy control group were 38.6 ± 18.9 and 55.4 ± 14.3, respectively (P = .01). The scores of the parents of the patient and control groups were 35.4 ± 14.2 and 54.0 ± 16.9, respectively (P = .02). Patient and parent scores were positively correlated. Significantly higher scores were found in the 5-10 age group compared to the 10-15 and 15-18 age groups in the psychosocial score category. An increase in the QoL scores of patients who were started on medication other than steroid treatment was observed in the sixth month of treatment (35.8 ± 13.4 vs. 33.6 ± 8.9, P = .01, respectively). CONCLUSION: Both children with chronic liver diseases and their parents have a perceived lower QoL than healthy peers. The effect of chronic liver disease on psychosocial health is more pronounced in children older than 10 years. The quality of life is inversely proportional to the severity of the disease. It was observed that primary or symptomatic treatments have a positive impact on the perception of QoL, with the exception of steroid treatment.
Subject(s)
Liver Diseases , Quality of Life , Adolescent , Case-Control Studies , Child , Humans , Liver Diseases/drug therapy , Liver Diseases/psychology , Parents/psychology , Patients/psychology , Quality of Life/psychology , Steroids/therapeutic use , Surveys and QuestionnairesABSTRACT
ABSTRACT: Aging of population is characterized by multiple chronic conditions in the same individual. Health-related quality of life (HR-QOL) reflects the multidimensional impact of chronic disease on population and it is increasingly analysed as outcomes.The aim of this study was the evaluation of the predictors of quality of life among elderly patients hospitalized in internal medicine ward, investigating the effect of comorbidities on health-related quality of life.Data collected in this cross-sectional study were analysed. Socio-demographic, clinical characteristics, disease distribution and quality of life by the 12-Item Short Form Health Survey (SF-12) were evaluated.Of 240 inpatients, subjects with Barthel Index (BI)≤40 were 23.7%, 55% had a Geriatric Depression Scale (GDS)≥2. After categorizing mental component score (MCS) and physical component score (PCS) in five classes, we found that diabetics and patients with cancer were more frequent in the first class of MCS while patients with NYHA III-IV are significantly more frequent in the first class of PCS. When we classified patients according to GDS≥2 orâ<â2, subjects with GDS≥2 had BI and MCS significantly lower. In the multivariate analysis GDS score ≥2 was independently associated with first MCS class [16.32 (3.77-70.68)] while NYHA III-IV class and claudicatio intermittents were strong predictors of the worst PCS class [9.54 (1.97-47.40), 2.53 (1.16-5.49), respectively]. Liver disease was independently associated with GDS≥2 [5.26 (1.13-24.39)].Our study highlighted the impact of chronic diseases on health-related quality of life in elderly subjects hospitalized in an internal medicine ward pointing out the importance of taking into account patient's needs and perception and the setting up of a personalised health-care. Patients with diabetes and liver disease along with persons affected by cancer need psychological support to improve their quality of life. A GDS score ≥ 2 is a strong predictor of poor quality of life and should trigger an in-depth assessment of mental health in this kind of patients.
Subject(s)
Depression/psychology , Frail Elderly/psychology , Hospitalization , Multiple Chronic Conditions/psychology , Patient Health Questionnaire , Quality of Life , Aged , Cross-Sectional Studies , Diabetes Mellitus/psychology , Female , Hospital Departments , Humans , Internal Medicine , Liver Diseases/psychology , Male , Neoplasms/psychology , Social SupportABSTRACT
INTRODUCTION: Seasonal influenza is a major global health problem causing substantial morbidity and health care costs. Yet, in many countries, the rates of influenza vaccination remain low. Chronic kidney or liver diseases (CKLD) predispose patients to severe influenza infections, but data on vaccination acceptance and status is limited in this risk population. We investigated the influenza vaccination awareness considering sociodemographic factors in CKLD patients. PATIENTS AND METHODS: This cross-sectional, questionnaire-based study recruited CKLD patients managed at three Viennese tertiary care centers between July and October 2020. CKLD was defined as chronic kidney- (all stages) or compensated/decompensated liver disease, including kidney/liver transplant recipients. Questionnaires assessed sociodemographic and transplant- associated parameters, patients vaccination status and the individuals self-perceived risks of infection and associated complications. RESULTS: In total 516 patients (38.1% female, mean age 56.4 years) were included. 43.9% of patients declared their willingness to be vaccinated in the winter season 2020/2021, compared to 25.4% in 2019/2020 and 27.3% in 2016-2018. Vaccination uptake was associated with the self-perceived risks of infection (OR: 2.8 (95%CI: 1.8-4.5), p<0.001) and associated complications (OR: 3.8 (95%CI: 2.3-6.3), p<0.001) as well as with previously received influenza vaccination (2019/2020: OR 17.1 (95%CI: 9.5-30.7), p<0.001; season 2016-2018: OR 8.9 (95%CI: 5.5-14.5), p<0.001). Most frequent reasons for not planning vaccination were fear of a) graft injury (33.3%), b) complications after vaccination (32.4%) and c) vaccine inefficiency (15.0%). CONCLUSION: While influenza vaccination willingness in patients with CKLD is increasing in the 2020/2021 season, vaccination rates may still remain <50%. Novel co-operations with primary health care, active vaccination surveillance and financial reimbursement may substantially improve vaccination rates in high-risk CKLD patients.
Subject(s)
Decision Making , Influenza Vaccines/administration & dosage , Influenza, Human/immunology , Liver Diseases/psychology , Patient Acceptance of Health Care/psychology , Renal Insufficiency, Chronic/psychology , Vaccination/psychology , Chronic Disease , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Humans , Influenza A virus/isolation & purification , Influenza, Human/virology , Male , Middle Aged , Surveys and Questionnaires , Vaccination/statistics & numerical dataABSTRACT
INTRODUCTION AND OBJECTIVES: Higher rates of psychiatric disorders are reported among cirrhotic patients. This study examines the demographic and clinical outcomes post-liver transplant (LT) among cirrhotic patients with a major psychiatric diagnosis (cases) compared to those without psychiatric diagnosis (controls). MATERIALS AND METHODS: Retrospective case control design was used among 189 cirrhotic patients who had undergone LT at Methodist University Hospital Transplant Institute, Memphis, TN between January 2006 and December 2014. Multivariable regression and Cox proportional hazard regression were conducted to compare allograft loss and all-cause mortality. RESULTS: The study sample consisted of a matched cohort of 95 cases and 94 controls with LT. Females and those with Hepatic Encephalopathy (HE) were more likely to have psychiatric diagnosis. Patients with hepatocellular carcinoma (HCC) were twice as likely to have allograft loss. Psychiatric patients with HCC had two and a half times (HR 2.54; 95% CI: 1.20-5.37; pâ¯=â¯0.015) likelihood of all-cause mortality. Data censored at 1-year post-LT revealed that patients with psychiatric diagnosis have a three to four times higher hazard for allograft loss and all-cause mortality compared to controls after adjusting for covariates, whereas when the data is censored at 5â¯year, allograft loss and all-cause mortality have two times higher hazard ratio. CONCLUSIONS: The Cox proportional hazard regression analysis of censored data at 1 and 5â¯year indicate higher allograft loss and all-cause mortality among LT patients with psychiatric diagnosis. Patients with well-controlled psychiatric disorders who undergo LT need close monitoring and medication adherence.
Subject(s)
Liver Diseases/psychology , Liver Diseases/surgery , Liver Transplantation , Mental Disorders/complications , Adult , Aged , Female , Graft Survival , Humans , Liver Diseases/mortality , Male , Middle Aged , Proportional Hazards Models , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
INTRODUCTION AND OBJECTIVES: Patient-reported outcomes (PROs) are important for comprehensive assessment of chronic liver disease (CLD). Latin America and the Caribbean have a high burden of CLD, but PROs are lacking. We assessed health-related quality of life (HRQL) in Cuban patients with compensated CLD. MATERIALS AND METHODS: A cross sectional study performed of adult patients with a diagnosis of chronic viral infection B and C (HBV, HCV), non-alcoholic fatty liver diseases (NAFLD) and autoimmune liver diseases (AILD) including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and overlap syndrome (AIH+PBC). PROs were collected using: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Work Productivity and Activity-Specific Health Problem (WPAI: SHP), and the Chronic Liver Disease Questionnaire (CLDQ)-disease-specific. RESULTS: 543 patients enrolled, n=91 (HBV), n=188 (HCV), n=221 (NAFLD), n=43 (AILD). Of those with AILD, 22 had AIH, 14 PBC, and 7 overlap AIH/PBC. Mean age was 53.5 years, 64.1% female, 69.2% white, and 58.0% employed. Patients with HCV and AILD had more severe liver disease. A significant impairment in PROs was observed in HCV group whereas the AILD patients had more activity impairment. CLDQ-HRQL scores were significantly lower for patients with NAFLD and AILD compared to HBV. Male gender and exercising ≥90min/week predicted better HRQL. The strongest independent predictors of HRQL impairment were fatigue, abdominal pain, anxiety, and depression (p<0.05). CONCLUSIONS: HRQL for Cuban patients with compensated CLD differs according to the CLD etiology. Patients with HCV and AILD had the worst PRO scores most likely related to severe underlying liver disease and/or extrahepatic manifestations.
Subject(s)
Liver Diseases/complications , Liver Diseases/psychology , Quality of Life , Absenteeism , Adult , Aged , Chronic Disease , Cross-Sectional Studies , Cuba , Female , Health Status , Humans , Male , Middle Aged , Patient Reported Outcome Measures , Surveys and QuestionnairesSubject(s)
Gastroenterology/methods , Inflammatory Bowel Diseases/therapy , Liver Diseases/therapy , Patient Reported Outcome Measures , Anxiety/therapy , Chronic Disease/psychology , Chronic Disease/therapy , Female , Health Status , Humans , Inflammatory Bowel Diseases/psychology , Liver Diseases/psychology , Male , Pain Management , Patient Acceptance of Health Care , Psychological Distress , Quality of Life , SleepABSTRACT
INTRODUCCIÓN: la biopsia hepática percutánea es un procedimiento necesario para el diagnóstico de hepatopatías no exento de complicaciones y con malestar psicológico para el paciente. OBJETIVO: determinar el perfil de seguridad del propofol en la biopsia hepática percutánea, las complicaciones de la técnica per se y la satisfacción de los pacientes tras su realización. MÉTODOS: estudio observacional retrospectivo mediante recogida de datos de tolerancia y complicaciones en pacientes sometidos a biopsia hepática bajo sedación profunda con propofol. Valoración de la calidad y satisfacción percibida por los pacientes mediante una encuesta transversal. RESULTADOS: incluimos 97 pacientes con una dosis media de propofol de 170,46 mg. De las complicaciones derivadas de la sedación, se registraron seis desaturaciones leves (6,2 %) resueltas con maniobras posturales (50 %) y parada de la bomba de propofol (50 %) y once episodios de hipotensión (11,3 %) resueltos de forma espontánea (82,82 %) o fluidoterapia (18,18 %). De las complicaciones derivadas de la técnica, se registraron tres casos de dolor precoz (3,1 %) y uno tardío (1,03 %), todos resueltos con 1 g de paracetamol intravenoso. Todos los pacientes iniciaron tolerancia oral y fueron dados de alta a las 24 horas del procedimiento sin necesidad de analgesia ambulatoria. La satisfacción general, así como el malestar psicológico fueron evaluados como muy buenos/excelentes en el 100 % de los pacientes. DISCUSIÓN: el propofol presenta un adecuado perfil de seguridad en la biopsia hepática y mantiene el éxito de la prueba, con buena tolerancia de la misma por el paciente. Consideramos posible ampliar la utilidad de la sedación con propofol a este procedimiento
No disponible
Subject(s)
Humans , Female , Middle Aged , Liver/pathology , Liver Diseases/pathology , Deep Sedation/methods , Propofol/administration & dosage , Treatment Outcome , Biopsy , Liver Diseases/diagnosis , Biopsy, Needle/methods , Liver Diseases/psychology , Cross-Sectional Studies , Acetaminophen/administration & dosage , Patient Satisfaction , Retrospective Studies , Surveys and QuestionnairesABSTRACT
BACKGROUND: Psychiatric co-morbidity is a frequent finding in patients with chronic liver disease (CLD). Patients with CLD may have anxiety, depression, sleep disturbances and behavioural disorders as well as cognitive defects. Therefore, this study was designed to determine the frequency of major depression in patients diagnosed with chronic liver disease. METHODS: This descriptive cross-sectional study was conducted at the department of gastroenterology Ayub Teaching Hospital Abbottabad from January-July 2017. One hundred and eleven patients diagnosed with chronic liver disease were included in the study using consecutive non-probability sampling technique. A detailed medical history was taken and physical exam was conducted before the patients were asked to answer a questionnaire (HADS-D). The answers were marked to obtain a final score. Quantitative variables like age, HADS-D score, and duration of CLD were described in terms of mean and standard deviation. Categorical variables like gender and depression were described in terms of frequencies and percentages. Stratification was done on age, duration of CLD and gender to see the effect modifiers. Chi-Square test was used at 5% significance level for determining statistically significant difference. RESULTS: Out of 111 patients, 38 (34.2%) were found to have depression on the basis of their HADS-D score. When depression was stratified according to age, gender and duration of chronic liver disease, a strong statistical association was seen with duration of chronic liver disease and increased serum ALT levels (p<0.05). CONCLUSIONS: Depression is fairly common in patients with CLD and is significantly associated with the duration of CLD and derangement of liver enzymes.
Subject(s)
Depression/epidemiology , Liver Diseases/psychology , Adult , Aged , Alanine Transaminase/blood , Chronic Disease , Comorbidity , Cross-Sectional Studies , Female , Humans , Liver Diseases/blood , Male , Middle Aged , Pakistan/epidemiology , Prevalence , Surveys and Questionnaires , Time FactorsABSTRACT
BACKGROUND: Polycystic liver disease can cause severe symptomatic hepatomegaly. Combined partial hepatectomy and cyst fenestration can be performed to reduce liver volume and symptom burden. We aimed to assess change in symptom relief and quality of life 6 months after partial hepatectomy and cyst fenestration in polycystic liver disease patients. METHOD: We established a prospective cohort between 2014 and 2018 at a referral center in the United States. Patients who underwent partial hepatectomy and cyst fenestration for volume-related symptoms were included. Primary outcome was change in polycystic liver disease-related symptoms, measured with Polycystic Liver Disease Questionnaire. Secondary outcomes were change in liver volume (computed tomography/ magnetic resonance imaging) and change in quality of life, measured with the 12-Item Short Form Survey and the EuroQoL Visual Analogue Scale. Questionnaire scores range from 0 to 100 and were assessed before and 6 months after partial hepatectomy and cyst fenestration. Surgical complications were scored according to Clavien-Dindo (grade 1 to 5). RESULTS: We included 18 patients (mean age 52 years, 82% female). Partial hepatectomy and cyst fenestration reduced median liver volume (4,917 to 2,120 mL). Symptoms, measured with Polycystic Liver Disease Questionnaire, decreased (76.9 to 34.8 points; P < .001) 6 months after surgery; 15/16 symptoms declined after treatment, with the most impact seen on early satiety and dyspnea. Quality of life also improved after surgery: median physical and mental component scales of the 12-Item Short Form Survey and EuroQoL Visual Analog Scale increased (24.9 to 45.7, P = .004; 40.5 to 55.4, P = .02; and 40.0 to 72.5, P = .003). Major complications (grade 4) occurred in 2 patients. There was no procedure-related mortality. CONCLUSION: Partial hepatectomy and cyst fenestration substantially improves symptom burden and quality of life in highly symptomatic polycystic liver disease patients.
Subject(s)
Cysts/surgery , Hepatectomy/psychology , Liver Diseases/surgery , Quality of Life/psychology , Adult , Cysts/psychology , Female , Hepatectomy/statistics & numerical data , Humans , Liver Diseases/psychology , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
BACKGROUND AND AIMS: Assessment is considered a duty, as well as a part of the tasks of social workers; in addition, they have an ethical commitment to improve their working tools. This study aimed at validating the Adapted Social Assessment Instrument used in a transplant center in the state of São Paulo, Brazil, for liver transplantation candidates, requiring its improvement and strengthening. METHODS: The methodology was based on both Marxian dialectics and the method of content validation. The content validation analysis was performed by 5 social workers from 3 Brazilian transplant centers. They evaluated the 5 domains of the instrument: identification, socio-demographic profile, eligibility criteria, evaluation, and social interventions. Descriptive statistics of data were performed, and qualitative analysis was associated to the participant observation. RESULTS: The 5 professionals (100%) assigned the scores 3 and 4, which have demonstrated clarity, relevance, and feasibility, pointing out suggestions for improvement, some of which were considered. CONCLUSIONS: The instrument was evaluated with an approval percentage of above 80%; therefore, the instrument is a valid measure.
Subject(s)
Liver Diseases/psychology , Liver Transplantation/psychology , Patient Selection , Psychological Tests/standards , Adult , Brazil , Female , Humans , Liver Diseases/surgery , Male , Preoperative Period , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
BACKGROUND: Because of high-risk behaviours, sedentary lifestyle and side effects of medications, psychiatric patients are at risk of viral hepatitis, alcohol-related liver disease and non-alcoholic fatty liver disease. We aimed to study the incidence of hepatocellular carcinoma (HCC) and cirrhotic complications in psychiatric patients. METHODS: We identified consecutive adult patients in all public hospitals and clinics in Hong Kong with psychiatric diagnoses between year 2003 and 2007 using the Clinical Data Analysis and Reporting System, which represents in-patient and out-patient data of approximately 80% of the 7.4-million local population. The patients were followed for liver-related events (HCC and cirrhotic complications) and deaths until December 2017. Age- and sex-standardized incidence ratio (SIR) of HCC in psychiatric patients to the general population was estimated by Poisson model. RESULTS: We included 105,763 psychiatric patients without prior liver-related events in the final analysis. During a median (interquartile range) follow-up of 12.4 (11.0-13.7) years, 1461 (1.4%) patients developed liver-related events; 472 (0.4%) patients developed HCC. Compared with the general population, psychiatric patients had increased incidence of HCC (SIR 1.42, 95% confidence interval [CI] 1.28-1.57, P < 0.001). The SIR was highest in patients with drug-induced (SIR 3.18, 95% CI 2.41-4.11, P < 0.001) and alcohol-induced mental disorders (SIR 2.98, 95% CI 2.30-3.81, P < 0.001), but was also increased in patients with psychotic disorders (SIR 1.39, 95% CI 1.16-1.65, P < 0.001) and mood disorders (SIR 1.16, 95% CI 1.00-1.34, P = 0.047). Liver disease was the fifth most common cause of death in this population, accounting for 595 of 10,614 (5.6%) deaths. Importantly, 569 (38.9%) patients were not known to have liver diseases at the time of liver-related events. The median age at HCC diagnosis (61 [range 26-83] years) was older and the median overall survival (8.0 [95% CI 5.0-10.9] months) after HCC diagnosis was shorter in this cohort of psychiatric patients than other reports from Hong Kong. CONCLUSIONS: HCC, cirrhotic complications, and liver-related deaths are common in psychiatric patients, but liver diseases are often undiagnosed. More efforts are needed to identify liver diseases in the psychiatric population so that treatments and screening for HCC and varices can be provided to patients in need.
Subject(s)
Carcinoma, Hepatocellular/epidemiology , Liver Cirrhosis/epidemiology , Liver Neoplasms/epidemiology , Mental Disorders/epidemiology , Adult , Carcinoma, Hepatocellular/psychology , Chronic Disease/epidemiology , Chronic Disease/psychology , Female , Hong Kong/epidemiology , Humans , Incidence , Liver Cirrhosis/psychology , Liver Diseases/epidemiology , Liver Diseases/psychology , Liver Neoplasms/psychology , Male , Mental Disorders/psychology , Middle Aged , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCTION: Among patients with Hepatic Encephalopathy, prevalence of Minimal HE varies between 30-50%. Identifying patients with MHE has been shown to improve with medications and delay development of Overt HE, however only limited clinicians screen for MHE in patients due to time consuming neuropsychological and neurophysiological tests. The Number Connection Test is an easy way to evaluate patients to diagnose MHE. The aim of this study is to find out the prevalence of covert hepatic encephalopathy. METHODS: The descriptive cross-sectional study was done to find out the prevalence of covert hepatic encephalopathy among patients with chronic liver disease. To diagnose Covert HE which included MHE as well, NCT was used in Devanagari script. RESULTS: The prevalence of covert hepatic encephalopathy is found to be 56 (58.3%) at 90% confidence interval (58.23-58.37%). A total of 96 patients (71.9% male) were diagnosed as HE, with mean age of 49.6+11.8 years. The cause of CLD in 85 (88.5%) of these patients was alcohol, of which 76 (79.2%) consumed locally brewed alcohol. Of these 96 patients with HE, only 40 (41.7%) had overt HE. Among all these, maximum patients had MHE (37.5%). CONCLUSIONS: Our study showed that although the prevalence of minimal HE is quite high among cirrhotics, they are usually missed in clinical practice due to absence of symptoms. Active screening with easy-to-administer tests, like Number Connection tests, can help identify patients with minimal HE and hence treat them early.
Subject(s)
Alcohol Drinking , Hepatic Encephalopathy , Liver Diseases , Neuropsychological Tests/statistics & numerical data , Alcohol Drinking/adverse effects , Alcohol Drinking/epidemiology , Cross-Sectional Studies , Early Diagnosis , Female , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/epidemiology , Humans , Liver Diseases/epidemiology , Liver Diseases/etiology , Liver Diseases/psychology , Male , Mass Screening/methods , Middle Aged , Nepal/epidemiology , Practice Patterns, Physicians'/standards , Severity of Illness Index , Time-to-TreatmentABSTRACT
Prior research indicates that couples who cope with chronic illness from a relational "we" orientation experience more positive outcomes than couples that cope individually; however, little prior research identifies clinical processes that promote reciprocity or how societal gender processes are involved. This grounded theory analysis of 25 videotaped therapy sessions with six heterosexual couples coping with chronic liver disease (LD) used a feminist-informed relational lens to focus on the clinical processes involved in shifting from an individual to a relational orientation. Findings identified three contextual barriers to attaining a "we orientation": (a) autonomy discourse, (b) illness-related power, and (c) gendered power. Analysis detailed therapist actions that decreased the impact of barriers to reciprocity and fostered relational coping. Clinical implications attend to complex intersections among gender, caregiving, and contextual barriers to reciprocity.
Investigaciones anteriores indican que las parejas que hacen frente a una enfermedad crónica desde una orientación relacional basada en el "nosotros" tienen resultados más positivos que las parejas que la enfrentan individualmente; sin embargo, existen escasas investigaciones previas que identifiquen los procesos clínicos que promueven la reciprocidad o la manera en la que están implicados los procesos de género social. Este análisis de teoría fundamentada de 25 sesiones de terapia videograbadas con seis parejas heterosexuales que enfrentan una enfermedad hepática crónica utilizó una óptica relacional fundamentada en el feminismo para centrarse en los procesos clínicos relacionados con el paso de una orientación individual a una relacional. Los hallazgos identificaron tres obstáculos contextuales para lograr una "orientación basada en el nosotros": (a) el discurso de autonomía, (b) el poder relacionado con la enfermedad, y (c) el poder asociado al género. El análisis detalló las medidas del terapeuta que redujeron el efecto de los obstáculos para la reciprocidad y fomentaron el afrontamiento relacional. Las implicancias clínicas tratan de las intersecciones complejas entre el género, el cuidado y los obstáculos contextuales para la reciprocidad.