Poor Awareness of Liver Disease Among Adults With NAFLD in the United States.

Population-based studies that estimate awareness of nonalcoholic fatty liver disease (NAFLD) in the United States are scant. We aimed to understand public awareness of NAFLD and its temporal trends. Our study included 11,700 adults (18+ years old) from five National Health and Nutrition Examination Surveys (2007-2016). NAFLD was determined by the improved Fatty Liver Index for the multiethnic U.S. population (US-FLI) in the absence of secondary causes of liver disease. Overall prevalence of NAFLD, hepatitis C virus, and hepatitis B virus were 36.6%, 1.02% and 0.35%, respectively. From 2007-2008 to 2015-2016, awareness of liver disease among adults with NAFLD improved from 4.4% to 6.3% (trend P = 0.026) but 4 to 10 times lower than awareness about viral hepatitis. In 2015-2016, among adults with NAFLD, awareness of liver disease was lower among young adults (aged 18-29 years) compared with those aged ≥ 30 years (0% vs. 6.9%) and lower among non-Hispanic Blacks compared with other races (0.7% vs. 6.6%) (all P < 0.001). In multivariable analysis, young adults (adjusted odds ratio [aOR] = 0.29; confidence interval [CI] 0.10-0.87) and non-Hispanic Blacks (aOR = 0.43; CI 0.20-0.96) were negatively associated with awareness of liver disease among adults with NAFLD, whereas diabetes (aOR = 2.22; CI 1.37-3.58), advanced fibrosis (aOR = 2.34; CI 1.17-4.68), and a higher number of health care visits (aOR = 1.33; CI 1.15-1.50) were positively associated with awareness of liver disease. Nearly 96% of adults with NAFLD in the United States were unaware they had liver disease, especially among young adults and non-Hispanic Blacks. Findings indicate efforts are needed to improve awareness of NAFLD.

Ethnic influence on nonalcoholic fatty liver disease prevalence and lack of disease awareness in the United States, 2011-2016.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a rising global disease associated with clinical and economic burdens. OBJECTIVES: We aimed to quantify NAFLD prevalence and awareness to provide stakeholders necessary information to combat NAFLD burden. METHODS: This study utilizes data from the National Health and Nutrition Examination Survey 2011-2016 and included 4538 adult participants who did not have heavy drinking or viral hepatitis history. The US fatty liver index defined NAFLD and NAFLD fibrosis score defined fibrosis. NAFLD awareness was captured by questionnaire. RESULTS: Amongst the study population of 4538 persons, NAFLD prevalence was 32.5%, lowest in non-Hispanic Blacks (18.0%) and Asians (18.1%), highest amongst Mexican Americans (48.4%). Within the NAFLD group, advanced fibrosis was highest in non-Hispanic Blacks (28.5%) and lowest amongst non-Hispanic Asians (2.7%). Of the 1473 (97.5%) NAFLD participants who answered NAFLD awareness question, 90% visited a healthcare centre at least once in the past year, but only 5.1% were aware of having NAFLD. On weighted population estimates, 77.33 million persons had NAFLD, 17.63 million had advanced fibrosis, and 73.39 million NAFLD participants were not aware of having NAFLD. CONCLUSIONS: Of 77.33 million people in the United States have NAFLD with 17.63 million having advanced fibrosis, with lowest prevalence in non-Hispanic Asians and highest in Mexican Americans. A conundrum exists amongst non-Hispanic Blacks who have low NAFLD prevalence but highest prevalence of advanced fibrosis. Awareness of NAFLD was low across all ethnicities. Effort is needed to improve disease awareness whilst addressing NAFLD clinical burden across ethnicities.

Quality of Life and Work Ability among Healthcare Personnel with Chronic Viral Hepatitis. Evaluation of the Inpatient Rehabilitation Program of the Wartenberg Clinic.

The aim of this study was to research the impact of inpatient rehabilitation on work ability and health-related quality of life factors for healthcare personnel (HP) with chronic hepatitis B and C virus (HBV and HCV) infection. A prospective evaluation study with three data collection times without an external control group was conducted. HP (n = 163) with an occupational acquired chronic hepatitis B/C infection who participated in an inpatient rehabilitation program were surveyed. Information was collected on work ability (WAI-Work Ability Index), quality of life (SF-36-Short Form-36 Health Survey), and anxiety and depression-related symptoms (HADS-D-Hospital Anxiety and Depression Scale). The majority of participants had HCV infection. Work ability was poor, improved significantly until the end of treatment, and remained at a moderate level six months later. The SF-36 showed no change in physical health over the study period, the results regarding mental health were in the average range with a significant improvement directly after intervention. The HADS-D results indicate noteworthy anxiety and depression symptoms during the study period. The inpatient rehabilitation program proved to be effective in the short term regarding mental health (SF-36) and WAI. To ensure long lasting positive results, services aimed at enhancing physical and mental health should be provided as early as possible and on a recurring basis.

Epidemiology of HIV, Sexually Transmitted Infections, Viral Hepatitis, and Tuberculosis Among Incarcerated Transgender People: A Case of Limited Data.

Transgender people experience a disproportionate burden of human immunodeficiency virus (HIV) and incarceration. Discrimination, victimization, poverty, and poor mental health drive vulnerability to HIV and related infections, as well as risk of arrest, detention, and incarceration. In this paper, we systematically review published data on HIV, sexually transmitted infections, viral hepatitis, and tuberculosis among incarcerated transgender people; describe potential structural determinants of HIV risk and transmission; identify gaps in the literature; and make recommendations for research and interventions to address this neglected population. We found that HIV and related infections among incarcerated transgender people have received little attention in the epidemiologic literature. The limited data available, which date from 1992, demonstrate high prevalence of HIV and sexually transmitted infections in this population internationally. Transgender people who had not had genital surgery were typically placed in jails and prisons corresponding to birth-assigned sex rather than gender identity. Once incarcerated, they routinely faced harassment, physical abuse, and sexual violence from inmates and staff and denial of access to medically necessary gender-affirming therapies. More HIV research with incarcerated transgender populations is urgently needed to inform correctional policy change that centers human rights and structural interventions, such as stigma reduction, pre-arrest diversion, and access to HIV prevention methods and gender-affirming care during incarceration.

Impact of nursing intervention on improving HIV, hepatitis knowledge and mental health among homeless young adults.

In a prospective two-group pilot study of a convenient sample of 156 young adults, we assessed improvement in HIV cognitive and transmission knowledge, hepatitis knowledge, and mental health at six-month follow-up. Multiple linear regression analysis revealed higher six-month scores in total HIV/AIDS knowledge, HIV/AIDS cognitive knowledge, HIV transmission knowledge and HBV and HCV knowledge at 6 months in the Hepatitis Health Promotion (HHP) group compared to the Art Messaging (AM) group. Moreover, homeless young participants who reported having significant others in their lives, and excellent or very good health did better than their counterparts. Youth who were attempting to get their lives together had higher scores for all types of knowledge except HBV. Hallucinogen users had significantly worse scores on all knowledge measures than non-users. Lastly, the HHP group revealed an improvement in psychological well-being compared to the AM group.

Predictors of mental and physical health in non-cirrhotic patients with viral hepatitis: a case control study.

OBJECTIVE: To identify independent predictors of mental and physical health in patients with viral hepatitis. METHODS: Hepatitis C (HCV) and hepatitis B (HBV) infected patients, and community control subjects with equal age and sex distribution were recruited. All subjects filled in personal characteristics questionnaire, Hospital Anxiety and Depression Scale (HADS), Iowa Fatigue Scale (IFS), and Medical Outcomes Survey Short Form-12 (SF-12). All patients had measurement of routine laboratory values, and some had recent liver biopsy. Regression analyses were used to identify predictors of physical and mental health. RESULTS: One hundred eighty nine subjects (162 males, 27 females, for each group N=63) with mean (±SD) age of 39±11years were included. Anxiety and depression were important predictors of SF-12 (and its subscales MCS and PCS) and IFS scores, whereas IFS scores independently predicted HADS, PCS, MCS, and SF-12 scores. After controlling for confounders, HCV infection was independently associated with impairment of physical health. Moreover, creatinine showed an inverse strong relation with fatigue. Genotype 3a of HCV was independently associated with depressed and anxious states, whereas higher inflammation grade was significantly related to depression. Marital status, non-psychiatric comorbidities, and history of alcohol abuse also predicted health scores in the patients. Adjusted R(2)s for linear models were 0.571 to 0.709, whereas areas under the receiver operating characteristic (ROC) curve for logistic models were 0.90 to 0.93. CONCLUSION: In viral hepatitis patients, besides mental and medical comorbidities, marital status, and alcohol abuse, HCV infection itself is associated with impaired physical and possibly mental health.

Preferences and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis.

OBJECTIVES: The objectives of this study were to measure the preferences for and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis and to explore the factors that may influence patients' preferences. The study also aimed to analyze patients' satisfaction with decision and information provision and their relationships with the decisional role. METHODS: Semistructured interviews were performed with 178 chronic hepatitis patients. The Control Preferences Scale was translated into Chinese from English and adopted to measure patients' preferred and perceived decisional role. Patients' satisfaction with decision and information provision was also investigated by a 5-point Likert-type scale. RESULTS: Patients with chronic hepatitis in the study generally preferred a collaborative role (45%) or passive role (44%); only 11% of patients preferred an active role in treatment decision making. The agreement between patients' perceived and preferred role was not perfect (Bowker's S = 33.8, P < 0.001). Age and education level were significantly associated with patients' preferences: Younger, better educated patients tended to prefer more active roles. A total of 54% of patients felt satisfied with treatment decisions, whereas 39% of patients felt satisfied with information provision. Patients' levels of satisfaction with their treatment decisions were correlated not only with the perceived role itself but also with its agreement with the preferred role. Patients' satisfaction with information provision was significantly correlated with patients' preferred role. Moreover, there was a significant correlation between patients' satisfaction with the treatment decision and information provision. CONCLUSIONS: Patients' preferences for participation in treatment decision making should be considered seriously by doctors during the encounter. Health providers should make a greater effort to improve doctor-patient communication and decrease the mismatch between patients' perceived and preferred decisional role.

[Somatopsychic manifestations in patients with chronic viral hepatitis].

The aim of the work was to study somatopsychic manifestations in patients with chronic viral hepatitis (CVH). MMPI profiles, state and trait anxiety were assessed in 110 patients. Boundary psychic problems were evaluated using the Beck scale. It was shown that mean MMPI T-score in patients with CVH was above 50; half of them developed "neurotic triad"; hypochondria occurred in 37.3%, depression in 42.7%, and hysteria in 37.1%. The highest level of state anxiety was documented in patients with HCV infection and isolated HBCor At. The CVH-1b genotype was associated with enhanced occurrence of depression in patients having virus-positive blood for 1-5 years. The level of state and trait anxiety in them was lower than in patients with duration of viremia over 5 years.

[Perceptions, knowledge and attitudes about liver disease in healthy adults attending health facilities in stratum A, B and C]. / Percepciones, conocimientos y actitudes sobre enfermedad hepática en adultos sanos que acuden a instituciones de salud de estrato A, B y C.

OBJECTIVE: To find and describe perceptions, beliefs, knowledge and attitudes adopted by healthy people regarding liver disease, who attend at three medical institutions. To estimate how the academic and socioeconomic level operate as determinant factors. MATERIAL AND METHODS: Descriptive transversal study that includes a 31 question-questionnaire made in a group of 390 healthy people who were in the waiting rooms at Hospital Cayetano Heredia (HNCH), Policlinico Peruano Japones (PPJ) and Clinica Angloamericana (CAA), reflecting low, medium and medium-high socio economic status respectively. Data was processed with SPSS software. RESULTS: We found that 218/390 (56%) people had higher education level, and 64% were women. "Eating high-fat meals" had the highest percentage (91%) among perceptions of liver disease. "Bad breath" and "heartburn" were referred as symptoms of liver disease, among people with a higher education level. Less than 50% of people knew about routes of transmission of hepatitis B, associated with its prevention and treatment. CONCLUSIONS: Beliefs and wrong perceptions about liver disease are prevalent among people; dyspepsia was inaccurately associated. There is an inappropriate knowledge about routes of transmission, preventive measures and treatment, which was reflected in people with lower education level as well as in those with higher education and socioeconomic level.

Dietary alterations due to perceptions in acute viral hepatitis lead to sub-optimal calorie intake and increased length of hospitalization.

Although there are no dietary restrictions recommended in acute viral hepatitis (AVH), there is an altered food intake, probably because of perceptions and traditional nutritional practices, leading to sub-optimal intake and poorer clinical outcome. Therefore, we aimed to determine nutritional intake of AVH patients before and after disease onset and to investigate if optimal intake following nutrition education shortened the length of hospitalization (LOH). Seventy-five patients with AVH were interviewed for foods consumed and avoided because of perceptions during illness. Nutrition education was given to all patients with meal plan. In-patients were monitored for their nutritional intake until discharge. All patients were followed up after 2 weeks to assess compliance to the plan. There was a statistically significant decrease in mean calorie and protein intake in AVH patients during illness [1314 kcal (standard deviation, SD 291) and 27.5 g (SD 8.84)] when compared with that before onset of the disease [1873 kcal (SD 246) and 51.5 g (SD 8.03); P < 0.0001]. Mean LOH in patients consuming a high calorie diet [6.28 days (SD 2.91)] was significantly lower than those consuming low calories [8.36 days (SD 2.59), P = 0.024]. Two-week follow up revealed that 70% of patients modified their diet to a balanced normal diet as per the given plan. Our study showed that AVH patients consumed sub-optimal calories because of perceptions and traditional nutritional practices. Nutrition education played a major role in achieving overall nutritional goals and in decreasing the LOH.

HIV, STD, and hepatitis risk behaviors of young men before and after incarceration.

High rates of HIV, STD and hepatitis and associated risk behaviors have been documented among persons entering correctional facilities. However, there is a paucity of data on risk behaviors after release from custody. This study documents risk behaviors and informs intervention development targeting young men leaving incarcerated settings. We enrolled and interviewed 106 men from five prisons up to 60 days prior to their release from prison and interviewed them again four times after their release (at 1-week, 1-, 3- and 6-months). At enrollment, men were 18-29 years of age. Nearly 54% identified as African American, while 27% identified as White, 10% identified as Hispanic/Latino and 10% identified as "other". Approximately 83% had been incarcerated multiple times, 37% reported a prior STD diagnosis and their mean lifetime number of sex partners was 36 (median = 20). Many reported multiple sex partners and inconsistent condom use after release. A significant decrease in condom use during vaginal sex with primary committed female partners and in oral sex with both committed and casual female partners after release from prison were reported from 1-6 months. These young men are at sexual risk of HIV, STD and hepatitis infection after release from prison. Interventions are needed to prevent this population from acquiring and transmitting HIV, STD and hepatitis.

[Study on depression in 212 patients with viral hepatitis].

OBJECTIVE: To investigate the symptoms on depression in patients with viral hepatitis. METHODS: A cross-sectional study was conducted among the patients with viral hepatitis in infectious diseases Hospital of Taiyuan. The questionnaire included a Eysenck Personality Questionnaire, self-rating depression scale (SDS), and a self-designed one related to information regarding general conditions of the disease and social support. RESULTS: (1) Depression symptom prevalence rate among chronic viral hepatitis patients was 54.7% (116/212). (2) Factors as age, occupation, education, confirmed time, number of recurrence and anti-virus treatment, self-confidence on recovery, satisfaction on the surrounding environment etc. that might be associated with depression. (3) The severity of depression was significantly negative correlation with social support scores, objective support scores, subjective support scores (r = -0.262, P = 0.000; r = -0.228, P = 0.001; r = -0.270, P = 0.000). (4) There was positive correlation noticed between severity of the depressive disorder and Eysenck Personality two dimensions scores, while the scores of introversion and extroversion scores were negatively correlated (r = -0.330, P = 0.000) but positively correlated to the emotional stability scores (r = 0.309, P = 0.000). CONCLUSION: (1) Patients with hepatitis showed symptoms of depression to a certain degree. (2) Factors as age, occupation, education, economic situation, confirmed time of diagnosis, number of recurrence and anti-virus treatments, confidence on recovery, satisfaction on the surrounding environment might be associated with symptoms of depression. (3) There was positive correlation between severity of depressive and Eysenck Personality two dimensions scores but the scores of introversion and extroversion scores were negatively correlated.

[Assessing knowledge, attitude, and practice on occupational blood exposure in caregiving facilities, in Morocco]. / Evaluation des connaissances, attitudes et pratiques sur les accidents d'exposition au sang en milieu de soins au Maroc.

OBJECTIVE: This study had for aim to evaluate practices and knowledge of infectious hazards, to determine the prevalence of viral infections related to occupational blood exposure among health care workers, and to propose a preventive policy. DESIGN: This descriptive multicentric and transversal epidemiological survey was carried out from 2003 to 2004 in 10 Moroccan cities. Two thousand eight hundred and forty four persons were contacted and 2086 accepted to answer the questionnaire (73.3 %). RESULTS: The mean age was 40.8+/-7.8 years and seniority 15.6+/-7.4 years. Blood was the most incriminated product (96.1%), followed by dirty linen and hospital waste. Instruments most often mentioned as dangerous were hollow needles (80.3%). The most feared infections were viral hepatitis (77.5%) and HIV (89.3%). Only 40.6% of the personnel were adequately vaccinated against hepatitis B. Post-vaccine serology was performed on only 1.8% of the vaccinated staff. During the last 12 months, 58.9% of the personnel underwent at least one occupational blood exposure 5.8% of which was reported. Universal precautions appeared poorly used as only 65.6% wore gloves for invasive acts and 61.5% correctly disinfected their hands. Re-sheathing used needles was frequent (51.2%). CONCLUSIONS: Infectious hazards in healthcare facilities are not sufficiently taken into account: the recent creation of occupational health services in hospital facilities should contribute to improve working conditions, make hepatitis B vaccination available and mandatory, and lead to more information and education on hazards related to occupational blood exposure for healthcare personnel.

Generic and disease-specific health related quality of life of liver patients with various aetiologies: a survey.

Most studies on health related quality of life (HRQoL) of chronic liver patients were done in small clinical populations or restricted to one aetiology or disease stage. There is still a need for a study in a large liver patient population with various aetiologies and disease stages, approaching a population-based study. We evaluated the impact of liver disease aetiology on generic HRQoL, disease-specific HRQoL and fatigue and we compared HRQoL and fatigue between aetiological groups and healthy Dutch controls. Members of the Dutch liver patient association completed the Liver Disease Symptom Index, Short Form-36, and Multidimensional Fatigue Index-20. We compared the HRQoL between patients with viral hepatitis, autoimmune hepatitis, cholestatic diseases, hemochromatosis and other liver diseases by linear, ordinal and logistic regression, corrected for disease stage and other significant factors. Viral hepatitis patients showed a worse mental health than other aetiological groups. Hemochromatosis patients demonstrated 17% more bodily pain than viral hepatitis patients and the strongest decrease in role emotional health with increasing age. Aetiological groups showed a worse generic HRQoL and more fatigue than controls. In conclusion, viral hepatitis and hemochromatosis patients have a more impaired HRQoL than patients of other liver disease aetiological groups.

[Lack of knowledge among blood donors in Burkina Faso (West Africa); potential obstacle to transfusion security]. / Faible niveau de connaissances des donneurs de sang au Burkina Faso; une entrave potentielle à la sécurité transfusionnelle.

BACKGROUND: The measures recommended to reduce TTD include clinical selection of donors, based on a standardized questionnaire which aims to find out antecedents and behaviours predicting transmitted diseases within donors. The effectiveness of this measure is well established in the industrialized countries where the level of education of the population may support a greater receptivity of donors about this procedure. What is happening in developing one? AIM: This study was carried out to assess knowledge attitude and behaviours among blood donors regarding blood and transfusion safety in Burkina Faso. METHODS: A cross sectional study was carried out in the blood bank of the teaching hospital of Ouagadougou. In addition to the routine questionnaire, 544 included blood donors were subjected to additional questions seeking to specify their behaviours, knowledge and attitude towards TTD diseases and screening. RESULTS: Donors were from 16 to 57 years of age (mean age : 28+/-7.9 years). The majority of donors were male (71.2%). Family donors represent 52% and first time donors 55%. About 30.8% were illiterate or of primary school level. A percentage of 14.4 donate to access HIV testing and 30.7% will donate blood immediately to check any contamination in case of exposure. There was no difference between donors having been informed about their HIV status in the past and the other donors regarding HIV, HBs Ag and VHC results. CONCLUSIONS: This study suggests that there is some great need for donors' education on transfusion safety. There is also need for staff training in donors' management.

Predictors of relapse to harmful alcohol after orthotopic liver transplantation.

BACKGROUND: End-stage alcoholic liver disease (ALD) is a common indication for liver transplantation. Outcomes may be limited by return to harmful drinking. Previous studies have identified few predictors of drinking relapse. AIM: This study examined novel postulated predictors of relapse to drinking. METHOD: The case notes of all patients transplanted for ALD at the Royal Prince Alfred Hospital from 1987-2004 were reviewed. Pre-transplant characteristics were rated by a psychiatrist independent of the transplant team, blind to the outcome. Outcomes were rated by a second independent alcohol treatment specialist also blind to the pre-transplant ratings. RESULTS: Of 100 patients, 6 died before discharge from hospital, 4 had <6 months follow-up, 18 relapsed to harmful drinking, 10 drank below harmful levels, and 62 remained abstinent after a mean of 5.6 years follow-up. Univariate analyses identified six potential pre-transplant predictors of return to harmful drinking. These were a diagnosis of mental illness (of which all cases were of depression), the lack of a stable partner, grams per day consumed in the years before assessment for transplant, reliance on 'family or friends' for post-transplant support, tobacco consumption at time of assessment, and lack of insight into the alcohol aetiology. Duration of pre-transplant abstinence and social class by occupation did not predict relapse. A multivariate model based on the above characteristics correctly predicted 89% of the outcomes. CONCLUSION: A model based on readily defined behaviours and psychosocial factors predicted relapse to harmful drinking after transplant for ALD. This model may improve assessment and post-transplant management of patients with advanced ALD.

A national survey of dental hygienists' infection control attitudes and practices.

PURPOSE: The objectives of this study were to: 1) investigate the infection control practices of practicing dental hygienists, 2) document the attitudes and practices of dental hygienists toward patients with infectious diseases, and 3) determine if professional affiliation affected the attitudes and/or practices of the respondents. METHODS: A 49-item survey consisting of eight demographic, nine attitudinal, and 32 practice questions was used for this study. A stratified sampling method was used, in which the United States was divided into four regions. Three states were selected from each region according to geographic location and population. Five percent of registered dental hygienists within each selected state were randomly selected for inclusion in the study. All analyses were conducted using the Statistical Package for Social Scientists (SPSS v.10, Chicago, IL). RESULTS: Of the 2,009 surveys mailed, 104 were undeliverable. A total of 856 completed surveys were returned from practicing dental hygienists for a response rate of 44.9%. Overall, this study found an increased use of barriers and personal protective equipment in comparison to previous studies. A majority of respondents (53.9%) felt that treating patients with HIV or AIDS increased their personal risk for contracting the disease. The majority of respondents also reported always using extra precautions with HIV/AIDS patients (63.5%) and hepatitis patients (60.1%). In addition, most respondents reported they would not use an ultrasonic scaler when treating HIV/AIDS (65.8%) or hepatitis (58.9%) patients, indicating an alteration in clinical practice habits. CONCLUSION: The majority of dental hygienists surveyed reported altering infection control practices and treatment techniques when treating HIV/AIDS or hepatitis patients. While there has been an improvement in compliance with recommended infection control guidelines, practitioners still have misconceptions, and possibly fear, regarding infectious diseases and disease transmission.

[Anxiety and depression in patients with viral hepatitis].

OBJECTIVE: To investigate the anxiety and depression in patients with viral hepatitis. METHODS: A retrospective survey was conducted among 118 patients with viral hepatitis hospitalized in Renmin Hospital, Wuhan University, from 1999 to 2000 using self-rating anxiety scale (SAS) and self-rating depression scale (SDS). RESULTS: The average SAS score in patients with viral hepatitis was 44 +/- 10, significantly higher than the norm (34 +/- 6, P < 0.01). The average SDS score in patients with viral hepatitis was 44 +/- 10, significantly higher than the norm (42 +/- 11, P < 0.025). The average SDS in patients with chronic viral hepatitis was 45 +/- 10, significantly higher than that in patients with acute viral hepatitis (42 +/- 11, P < 0.05). The average SAS in female patients with viral hepatitis was 47 +/- 11, significantly higher than that in male patients (43 +/- 7, P < 0.05). CONCLUSION: Patients with hepatitis have symptoms of anxiety and depression to a certain degree.

A survey on community perceptions of jaundice in east Delhi: implications for the prevention and control of viral hepatitis.

Using senior health professionals as interviewers, a 30-cluster sampling survey was carried out to investigate community perceptions of pilia (the local word for jaundice) in east Delhi (India). Of 416 persons (mostly mothers of children aged < 2 years) interviewed, 339 (81%) were aware of pilia as an illness. Only 322 (77%), 164 (39%), 73 (18%) and 71 (17%) people knew about correct symptoms, dangers, causes and prevention of pilia. Most of the correct responses were related to the faeco-orally transmitted viral hepatitis. Literate respondents were significantly more aware of pilia (chi 2 52.81, P < 0.0001), its symptoms (chi 2 48.88, P < 0.0001), causes (chi 2 39.34, P < 0.0001), dangers (chi 2 19.3, P = 0.0007), and prevention (chi 2 60.8, P < 0.0001). However, age of the respondents had no significant bearing (P > or = 0.05) on the correctness of responses. About 293 (70%) subjects considered pilia as a treatable illness; of them, 193 (66%) and 77 (26%) respectively expressed their preference for the 'modern' and indigenous systems of medicine for its treatment. In contrast, 110 (38%) respondents said that they would prefer faith healers for the treatment of pilia. Although only 31 (7%) persons were aware of a vaccine against pilia (hepatitis B vaccine), virtually all agreed to have their children immunized if such a vaccine were made available. The study underscores the usefulness of pilia in lay-reporting of viral hepatitis and epidemiological studies on jaundice-associated illnesses and the need for educating the community about its causes and prevention to increase people's participation in controlling viral hepatitis and other diseases that mainly manifest as jaundice.