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1.
Medicine (Baltimore) ; 99(1): e18632, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895823

RESUMO

Health related quality of life (HRQOL) in chronic liver disease (CLD) patients has been attracting much attention these days because it is closely associated with clinical outcomes in CLD patients. HRQOL has become established as an important concept and target for research and practice in the fields of medicine. A critique of HRQOL research is the lack of conceptual clarity and a common definition of HRQOL. Using a clear definition of HRQOL may increase the conceptual understanding. In this study, we aimed to elucidate the association between serum zinc (Zn) level and HRQOL as assessed by the Beck Depression Inventory-2nd edition (BDI-II), Pittsburgh Sleep Quality Index Japanese version (PSQI-J) and the 36-Item Short Form Health Survey (SF-36) in CLD patients (n = 322, median age = 65 years, 121 liver cirrhosis (LC) patients (37.6%)). The median serum Zn level for all cases was 73.2 µg/dl. The median BDI-II score and PSQI-J score were 6 and 5, respectively. Patients with higher BDI-II score tended to have lower serum Zn level compared with those with lower BDI-II score. Similar tendencies were observed in patients with higher PSQI-J score. In the SF-36, physical functioning, role physical and physical component summary score significantly correlated with serum Zn level regardless of age, liver disease etiology and the LC status. While mental health and mental component summary score did not significantly correlate with serum Zn level regardless of age, liver disease etiology and the LC status. In conclusion, serum Zn level can be a useful marker for decreased HRQOL in patients with CLDs, especially for physical components.


Assuntos
Hepatopatias/sangue , Qualidade de Vida , Zinco/sangue , Idoso , Feminino , Humanos , Hepatopatias/psicologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
J Affect Disord ; 251: 180-185, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30927578

RESUMO

OBJECTIVE: This study investigated the prevalence and incidence of chronic liver disease in patients with major depressive disorder (MDD), and aimed to identify associated factors. METHODS: Data of 766,427 adult subjects aged ≥18 years were randomly selected from the National Health Research Institute database from the year 2005. The study first searched for subjects with at least one primary diagnosis of MDD in 2005, and then for those with a primary or secondary diagnosis of chronic liver disease were also identified. The differences in the prevalence of chronic liver disease and its associated factors between patients with MDD and the general population in 2005 were then analyzed. We also compared the incidence of chronic liver disease in patients with MDD and in the general population from 2006 to 2010. RESULTS: The prevalence of chronic liver disease in patients with MDD was 2.27 times as high as that of the general population in 2005 (12.4% vs. 5.8%; odds ratio (OR) = 2.27; 95% confidence interval (CI) = 2.07-2.48). The average annual incidence of chronic liver disease in patients with MDD during 2006-2010 was also higher than that of the general population (2.6% vs. 1.7%; risk ratio (RR) = 1.52; 95% CI = 1.37-1.7). CONCLUSIONS: Patients with MDD had a significantly higher prevalence and incidence of chronic liver disease than the general population. Among patients with MDD, an older age, the male sex, diabetes, hyperlipidemia and first-generation antipsychotic use were factors associated with chronic liver disease.


Assuntos
Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/epidemiologia , Hepatopatias/epidemiologia , Hepatopatias/psicologia , Adolescente , Adulto , Idoso , Antipsicóticos/uso terapêutico , Doença Crônica , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Adulto Jovem
3.
JAMA Netw Open ; 2(3): e190305, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30848805

RESUMO

Importance: Individually, higher body mass index (BMI) and alcohol consumption increase the risk of liver disease. Evidence of a joint association is mixed; however, previous studies have not used causal inference methods robust to confounding and reverse causation. Understanding any true effect is key to developing effective interventions to reduce liver disease. Objective: To investigate the joint association of BMI and alcohol consumption with liver injury biomarkers and incident liver disease using factorial mendelian randomization (MR). Design, Setting, and Participants: A population-based cohort study (Copenhagen General Population Study) recruited a random sample of Copenhagen, Denmark, residents aged 20 years or older of white, Danish descent (N = 98 643) between November 25, 2003, and July 1, 2014. Data were also obtained from ongoing links to national registers, and then analyzed from September 30, 2016, to April 23, 2018. Exposures: High and low BMI and alcohol consumption categories from baseline-measured or self-reported observational data and genetic variants predicting BMI and alcohol consumption. Main Outcomes and Measures: Plasma biomarkers of liver injury (alanine aminotransferase [ALT] and γ-glutamyltransferase [GGT]) and incident cases of liver disease from hospital records were the outcomes. Results: Of the 98 643 individuals recruited, 91 552 (54 299 [45.2%] women; mean [SD] age, 58 [13.05] years) with no baseline liver disease were included in main analyses. Individuals had a mean (SD) BMI of 26.2 (4.3) and consumed a mean (SD) of 10.6 (10.2) U/wk of alcohol. In factorial MR analyses, considering the high BMI/high alcohol group as the reference, mean circulating ALT and GGT levels were lowest in the low BMI/low alcohol group (ALT: -2.32%; 95% CI, -4.29% to -0.35%, and GGT: -3.56%; 95% CI, -5.88% to -1.24%). Individuals with low BMI/high alcohol use and high BMI/low alcohol use also had lower mean circulating ALT levels (low BMI/high alcohol use: -1.31%; 95% CI, -1.88% to -0.73%, and high BMI/low alcohol use: -0.81%; 95% CI, -2.86% to 1.22%) and GGT levels (low BMI/high alcohol use: -0.91%; 95% CI, -1.60% to -0.22%, and high BMI/low alcohol use: -1.13%; 95% CI, -3.55% to 1.30%) compared with the high BMI/high alcohol use reference group. These patterns were similar in multivariable factorial analyses. For incident liver disease (N = 580), factorial MR results were less conclusive (odds ratio of liver disease vs high BMI/high alcohol group: 1.01; 95% CI, 0.84 to 1.18, for the low BMI/high alcohol group, 1.22; 95% CI, 0.56 to 1.88 for the high BMI/low alcohol group, and 0.99 (95% CI, 0.41 to 1.56 for the low BMI/low alcohol group). Conclusions and Relevance: Interventions to reduce both BMI and alcohol consumption might reduce population levels of biomarkers of liver injury more than interventions aimed at either BMI or alcohol use alone. However, it is not clear whether this intervention will directly translate to a reduced risk of liver disease.


Assuntos
Alanina Transaminase/sangue , Consumo de Bebidas Alcoólicas , Índice de Massa Corporal , Hepatopatias , Sobrepeso , gama-Glutamiltransferase/sangue , Idoso , Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Biomarcadores/sangue , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Hepatopatias/sangue , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Hepatopatias/psicologia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Sobrepeso/sangue , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/prevenção & controle , Medição de Risco , Fatores de Risco
4.
Clin Sci (Lond) ; 133(3): 465-481, 2019 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-30755499

RESUMO

Skeletal muscle is a tissue that represents 30-40% of total body mass in healthy humans and contains up to 75% of total body proteins. It is thus the largest organ in non-obese subjects. The past few years have seen increasing awareness of the prognostic value of appreciating changes in skeletal muscle compartment in various chronic diseases. Hence, a low muscle mass, a low muscle function and muscle fatty infiltration are linked with poor outcomes in many pathological conditions. In particular, an affluent body of evidence links the severity, the complications and mortality of chronic liver disease (CLD) with skeletal muscle depletion. Yet it is still not clear whether low muscle mass is a cause, an aggravating factor, a consequence of the ongoing disease, or an epiphenomenon reflecting general alteration in the critically ill patient. The mechanisms by which the muscle compartment influences disease prognosis are still largely unknown. In addition, whether muscle alterations contribute to liver disease progression is an unanswered question. Here, we first review basic knowledge about muscle compartment to draw a conceptual framework for interpreting skeletal muscle alteration in CLD. We next describe recent literature on muscle wasting in cirrhosis and liver transplantation. We then discuss the implication of skeletal muscle compartment in non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH), focusing on plausible metabolic disruption in muscle compartment that might participate in NAFLD progression. Finally, we discuss shortcomings and challenges we need to address in the near future prior to designate the muscle compartment as a therapeutic target in CLD.


Assuntos
Hepatopatias/fisiopatologia , Músculo Esquelético/fisiopatologia , Animais , Progressão da Doença , Humanos , Hepatopatias/patologia , Hepatopatias/psicologia , Músculo Esquelético/crescimento & desenvolvimento , Músculo Esquelético/patologia
5.
Brain Behav ; 9(3): e01235, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30761781

RESUMO

INTRODUCTION: Experimental studies and clinical observations have shown that stress can damage hepatic tissue both directly and indirectly. Many studies have partially revealed the contributors of stress-induced liver injury; however, the whole process has not yet been uncovered. This review aims to summarize the mechanisms that have been proposed to be involved. METHODS: A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed) in its entirety up to March 2018, and analyzed the animal-derived mechanistic studies on stress-induced liver injury. RESULTS: The liver is the organ that meets and filters a mass of alien material, and then maintains immune tolerance under physiological conditions. Under stress conditions, however, immune tolerance is interrupted, which results in the induction of inflammation in the liver. Contributors to this process can be categorized as follows: hypoxia-reoxygenation, over-activation of Kupffer cells and oxidative stress, influx of gut-derived lipopolysaccharide and norepinephrine, and over-production of stress hormones and activation of the sympathetic nerve. CONCLUSIONS: Psychological stress is associated with a variety of pathological conditions resulting in liver injury through multiple systems, including the sympathetic nervous and adrenocortical system. Mechanistic understanding of this phenomenon is important for the clinical practice of managing patients with hepatic disorders and should be explored further in the future.


Assuntos
Hepatopatias , Estresse Psicológico , Animais , Humanos , Hepatopatias/etiologia , Hepatopatias/imunologia , Hepatopatias/psicologia , Estresse Psicológico/metabolismo , Estresse Psicológico/fisiopatologia
6.
Psychother Psychosom Med Psychol ; 69(1): 29-37, 2019 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-29439279

RESUMO

BACKGROUND: In the field of gastroenterology and hepatology, associations and interactions with comorbid mental disorders are often described, but there is currently a lack of methodologically high-quality studies on prevalence and the need for care. The aim of the study was to take account of this shortcoming. METHODS: Prospective, monocentric, cross-sectional study of a representative sample of inpatients at a university hospital. A total of 308 participants were examined for the presence of 8 frequent psychological syndromes with a validated questionnaire (PHQ-D). In addition, 63 participants were examined for the presence of mental disorders according to ICD-10 with a diagnostic interview (SKID-I) that covers a wider range of diagnoses. The need for psychosocial care was raised from the perspective of internal medicine practitioners and psychosomatic experts. RESULTS: The prevalence for at least 1 mental syndrome in the questionnaire sample (PHQ-D excl. PHQ-15) was 39.6%, in 23.8% of whom more than one syndrome was present. The most frequent were depressive and anxiety syndromes. There were significant differences in the various subgroups (sex, type and severity of the somatic disease). The 4-week prevalence for any mental disorder in the interview sample (SKID-I) was 52.4%. Affective and somatoform disorders as well as adaptation disorders were dominant. The need for psychosocial care was reported in 23.1% by the practitioners and in 30.2% by the experts. CONCLUSIONS: Patients with gastroenterological-hepatological tertiary care have a high prevalence of treatment-related psychological syndromes or disorders. In comparison with the reference data of the Robert Koch Institute on the 12-month prevalence of mental disorders among the general population in Germany, the proportion of current mental disorders is almost twice as high (52.7 vs. 27.1%, p<0.001). To cover the need for care, the provision of psychosomatic liaison services and the strengthening of psychosomatic basic care in gastroenterology/hepatology should be established.


Assuntos
Gastroenterologia , Gastroenteropatias/complicações , Gastroenteropatias/psicologia , Hepatopatias/complicações , Hepatopatias/psicologia , Transtornos Mentais/complicações , Transtornos Mentais/terapia , Sistemas de Apoio Psicossocial , Atenção Terciária à Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/complicações , Ansiedade/epidemiologia , Ansiedade/psicologia , Estudos Transversais , Depressão/complicações , Depressão/epidemiologia , Depressão/psicologia , Feminino , Gastroenteropatias/epidemiologia , Alemanha/epidemiologia , Humanos , Pacientes Internados , Classificação Internacional de Doenças , Hepatopatias/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
7.
Medicine (Baltimore) ; 97(42): e12890, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30335013

RESUMO

Dramatic lifestyle changes due to the Fukushima Daiichi Nuclear Power Plant accident increased the prevalence of hepatobiliary enzyme abnormalities (HEA). We aimed to evaluate associations of HEA with specific lifestyle- and disaster-related factors in residents who lived near the Fukushima Daiichi Nuclear Power Plant.This cross-sectional study included 22,246 residents who underwent a Comprehensive Health Check and the Mental Health and Lifestyle Survey from June 2011 to March 2012. Residents were divided into 2 groups based on residential area and housing status after the accident. Associations between HEA and lifestyle- and disaster-related factors, including psychological distress, were estimated using logistic regression analysis adjusted for demographic and lifestyle factors.HEA was present in 27.3% of subjects. The prevalence of HEA was significantly higher in evacuees than controls (29.5% vs 25.7%, P < .001). There were significant differences in various lifestyle characteristics and the prevalence of post-traumatic stress disorder between evacuees and controls. Multivariable logistic regression analysis showed that age, sex, moderate to heavy drinking, and low/no physical activity were significantly associated with HEA regardless of evacuation status. Changes in jobs and unemployment were significantly associated with HEA in controls and evacuees, respectively.Lifestyle and disaster-related factors, but not psychological distress, were associated with HEA among subjects who lived near the Fukushima Daiichi Nuclear Power Plant accident.


Assuntos
Doenças Biliares/psicologia , Acidente Nuclear de Fukushima , Estilo de Vida , Hepatopatias/psicologia , Transtornos de Estresse Pós-Traumáticos/complicações , Adulto , Idoso , Sistema Biliar/enzimologia , Doenças Biliares/epidemiologia , Doenças Biliares/etiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Eliminação Hepatobiliar , Humanos , Japão/epidemiologia , Fígado/enzimologia , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos de Estresse Pós-Traumáticos/epidemiologia
8.
Dig Dis Sci ; 63(12): 3290-3296, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30178285

RESUMO

BACKGROUND: Impaired physical capacity increases peri-liver transplant complications. Patient perceptions regarding exercise prior to transplantation are not known. AIMS: This study aimed to assess patient and caregiver activity levels, perceptions of willingness to exercise, and of provider advice. METHODS: Consecutive patients listed for liver transplant and caregivers presenting for routine outpatient visits were evaluated over a 3-month interval. Anonymous surveys adapted to patients and caregivers addressed the importance and safety of exercise, type and duration of exercise performed, barriers, willingness to wear a monitoring device, and perceived provider recommendations. Responses were logged on a Likert scale from 1 to 5. RESULTS: Three hundred and sixty-eight responses were received. Most participants perceived exercise as important. Patients exercised three times per week for 30 min. Eighty percent endorsed walking (median response: 2-agree; IQR 1-2). Most did not jog, swim, cycle, or strength train. Fatigue, reported by 70%, was the major barrier (2, IQR 1-3). Over 90% of caregivers endorsed exercise as important (1-strongly agree, IQR 1-2) and encouraged exercise (median response 2, IQR 1-2). Over 60% of patients (median response 2, IQR 1-3) and caregivers (median response 2, IQR 2-3) felt providers encouraged exercise. CONCLUSIONS: Patients and caregivers are willing to exercise to optimize physical fitness prior to liver transplantation.


Assuntos
Exercício , Fadiga , Hepatopatias , Transplante de Fígado/psicologia , Aptidão Física , Atitude Frente a Saúde , Cuidadores/psicologia , Exercício/fisiologia , Exercício/psicologia , Tolerância ao Exercício/fisiologia , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Inquéritos Epidemiológicos , Humanos , Hepatopatias/fisiopatologia , Hepatopatias/psicologia , Hepatopatias/cirurgia , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Aptidão Física/fisiologia , Aptidão Física/psicologia , Período Pré-Operatório , Estados Unidos
9.
Health Qual Life Outcomes ; 16(1): 142, 2018 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-30021601

RESUMO

BACKGROUND: The objective of this study was to determine health-related quality of life (HRQoL) among chronic liver disease (CLD) subjects in South Korea using EuroQol five-dimension questionnaire (EQ-5D). METHOD: The sample consisted of 139 subjects with CLD from the sixth Korean National Health and Nutrition Examination Survey (KNHNES VI). Data were analyzed using SPSS program for descriptive statistics, t-test, ANOVA, Scheffe's test and hierarchical multiple regression. RESULTS: Results indicated that marital status (P < 0.01), occupation (P < 0.01), basic livelihood security recipient status (P < 0.05), hepatocellular carcinoma (P < 0.05), subjective health status (P < 0.01), and depression (P < 0.001) were significant predictors of HRQoL. Health behaviors (alcohol intake, sleep duration) variables were insignificant. CONCLUSION: In conclusion, marital status, occupation, basic livelihood security recipient status (BLSRS), hepatocellular carcinoma (HCC), subjective health status (SHS), and depression were confirmed to be factors affecting the HRQoL. We should be provide to continuous monitoring and education of adequate alcohol intake for patients with CLD. Findings of this study might be used to develop community based health programs and policies for CLD.


Assuntos
Nível de Saúde , Hepatopatias/psicologia , Qualidade de Vida , Adulto , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/psicologia , Doença Crônica , Estudos Transversais , Depressão/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Hepatopatias/classificação , Masculino , Pessoa de Meia-Idade , República da Coreia , Fatores Socioeconômicos
10.
J Surg Res ; 228: 290-298, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29907224

RESUMO

BACKGROUND: The patient-provider relationship (PPR) is an important element of health care delivery and may influence patient outcomes. The objective of the present study was to identify clinical predictors of PPR among patients with hepatopancreatobiliary (HPB) diseases and assess the association of PPR and health care utilization. MATERIALS AND METHODS: The Medical Expenditure Panel Survey database from 2008-2014 was used to identify adult patients with HPB diagnoses. A PPR score of "poor," "average," and "optimal" was calculated from the Consumer Assessment of Healthcare Providers and Systems Survey. Predictors of poor PPR and the association of PPR and health care utilization were assessed. RESULTS: Among 592 patients, PPR was optimal (210, 35.4%), average (270, 45.5%), or poor (114, 19.2%). Patients without insurance (36.3%) or with Medicaid (28.8%) were more likely to report poor PPR versus patients with private insurance (14.0%) or Medicare (15.4%) (P = 0.03). Poor (24.3%)- and low (21.5%)-income patients were more likely to report poor PPR versus middle (12.8%)- or high-income (14.0%) patients (P = 0.03). Poor mental health was also more common among patients with poor PPR (13.4%) versus average (5.4%) or optimal (3.7%) PPR (P = 0.02), and this association between poor PPR and poor mental health remained significant on multivariable analysis (odds ratio [OR] 2.43, 95% confidence interval [CI] 1.20-4.92). Poor PPR was associated with increased emergency room utilization on univariate (OR 2.50, 95% CI 1.21-5.14), but not multivariate (OR 2.18, 95% CI 0.92-5.15) analysis. CONCLUSIONS: Among patients with HPB diseases, PPR was associated with insurance type, socioeconomic status, and mental health scores. Patients reporting poor PPR were more likely to be high utilizers of the emergency room. Efforts to improve the PPR are needed and should be focused on these high-risk populations.


Assuntos
Doenças Biliares/terapia , Hepatopatias/terapia , Pancreatopatias/terapia , Medidas de Resultados Relatados pelo Paciente , Relações Médico-Paciente , Adulto , Idoso , Doenças Biliares/economia , Doenças Biliares/psicologia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Hepatopatias/economia , Hepatopatias/psicologia , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Pancreatopatias/economia , Pancreatopatias/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Classe Social , Estados Unidos , Adulto Jovem
12.
Palliat Med ; 32(5): 908-918, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29393806

RESUMO

BACKGROUND: Liver disease represents the third commonest cause of death in adults of working age and is associated with an extensive illness burden towards the end of life. Despite this, patients rarely receive palliative care and are unlikely to be involved in advance care planning discussions. Evidence addressing how existing services meet end-of-life needs, and exploring attitudes of patients and carers towards palliative care, is lacking. AIM: To explore the needs of patients and carers with liver disease towards the end of life, evaluate how existing services meet need, and examine patient and carer attitudes towards palliative care. DESIGN: Qualitative study - semi-structured interviews analysed using thematic analysis. Settings/participants: A total of 17 participants (12 patients, 5 bereaved carers) recruited from University Hospitals Bristol. RESULTS: Participants described escalating physical, psychological and social needs as liver disease progressed, including disabling symptoms, emotional distress and uncertainty, addiction, financial hardship and social isolation. End-of-life needs were incompatible with the healthcare services available to address them; these were heavily centred in secondary care, focussed on disease modification at the expense of symptom control and provided limited support after curative options were exhausted. Attitudes towards palliative care were mixed, however, participants valued opportunities to express future care preferences (particularly relating to avoidance of hospital admission towards the end of life) and an increased focus on symptomatic and logistical aspects of care. CONCLUSION: The needs of patients with liver disease and their carers are frequently incompatible with the healthcare services available to them towards the end of life. Novel strategies, which recognise the life-limiting nature of liver disease explicitly and improve coordination with community services, are required if end-of-life care is to improve.


Assuntos
Cuidadores/psicologia , Hepatopatias/patologia , Hepatopatias/psicologia , Determinação de Necessidades de Cuidados de Saúde , Cuidados Paliativos , Assistência Terminal , Adulto , Idoso , Luto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
14.
BMC Gastroenterol ; 17(1): 103, 2017 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-28870162

RESUMO

BACKGROUND: The global burden of liver diseases, such as hepatocellular carcinoma and liver cirrhosis, is substantial. In this study, we estimated utility weights of liver disease-related health states in the general population using a visual analogue scale (VAS) and the standard gamble (SG) method. METHODS: Depictions of standardized health states related to major liver diseases were developed based on patient education materials and previous publications. To fully reflect disease progression from diagnosis to prognosis, each health state comprised four parts: diagnosis, symptoms, treatment, and progression and prognosis. A total of 407 participants from the Korean general population evaluated the health states using the VAS and SG methods in computer-assisted personal interviews. After excluding illogical responses, mean utility weights were calculated for each health state. RESULTS: The utility weights for health states were significantly different according to the existence of inconsistency in general. According to the VAS results, the health state with the highest utility was 'Chronic hepatitis B virus infection' (0.64), whereas the health state with the lowest utility was 'Hepatocellular carcinoma that requires palliative therapy' (0.17). Similarly, the SG results revealed that the health state with the highest utility was 'Chronic hepatitis B virus infection' (0.85), and the health state with the lowest utility was 'Hepatocellular carcinoma that requires palliative therapy' (0.40). CONCLUSIONS: The estimated utility weights in this study will be useful to measure the burden of liver diseases and evaluate cost-utility of programs for reducing the burden of liver diseases.


Assuntos
Efeitos Psicossociais da Doença , Nível de Saúde , Hepatopatias/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Índice de Gravidade de Doença , Adulto , Carcinoma Hepatocelular/psicologia , Feminino , Hepatite B Crônica/psicologia , Humanos , Neoplasias Hepáticas/psicologia , Masculino , Pessoa de Meia-Idade , República da Coreia , Estatística como Assunto , Adulto Jovem
15.
Int J Drug Policy ; 47: 153-160, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28673437

RESUMO

BACKGROUND: An open cohort study (LiveRLife) evaluating an intervention integrating non-invasive liver disease assessment via transient elastography (TE) among people who inject drugs (PWID) was conducted in New South Wales, Australia. Participant follow-up occurred 2-16 weeks post-enrolment. It is imperative that PWID understand liver assessment results in order to make informed decisions about their health. The aim of this study was to evaluate the decisions and experiences of participants who received a liver disease assessment, including interpretation of TE score and subsequent health behaviours, using a health literacy framework. METHODS: Participants who had participated in LiveRLife were recruited from two opioid substitution treatment clinics and one medically supervised injecting centre between November 2015 and February 2016. The four recruitment categories were: (a) high TE score (≥9.5kPa)/attended follow-up, n=12; (b) high score/did not attend follow-up, n=2; (c) low score (<9.5kPa)/attended follow-up, n=11; and (d) low score/did not attend follow-up, n=8. Participants were not reminded of their category during recruitment. Inclusion criteria were: participants who received a TE score and informed consent. RESULTS: Of 33 semi-structured interviews, reasons for receiving a TE assessment were varied. Most participants interpreted level of liver disease correctly based on their TE score. Participants with higher TE scores frequently described feeling surprised by their result and also, often incorrectly identified drug use as a cause of advanced liver disease. In contrast, persons with lower TE scores felt encouraged by their result and spoke more to maintenance of healthy behaviours. When applicable, participants spoke of HCV therapy. CONCLUSION: Findings highlight some positive health changes made by PWID following liver disease assessment as well as ongoing misunderstandings of chronic liver disease in relation to illicit drug use. Results will inform strategies for targeted liver health education and 'linkage to care' for PWID with, and at-risk of, advanced liver disease.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Hepatopatias/diagnóstico por imagem , Hepatopatias/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Tomada de Decisões , Técnicas de Imagem por Elasticidade , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade
16.
Indian J Gastroenterol ; 36(3): 217-226, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28608324

RESUMO

BACKGROUND: Chronic liver disease questionnaire (CLDQ), a self-administered quality-of-life (QOL) instrument for chronic liver disease (CLD) patients, was originally developed in English language. We aimed to translate and validate CLDQ in Tamil language (CLDQ-T). METHODS: CLDQ-T, prepared by two forward and two backward independent translations by four bilingual (Tamil and English) persons, and repeated iterative modifications, was validated in adult, native-Tamil patients with CLD. CLDQ-T was re-tested in some patients 2 weeks later. Convergent validity was assessed using Spearman's correlation, and discriminant validity by comparison with World Health Organization's brief QOL tool (WHOQOL-BREF). Reliability was assessed through internal consistency (Cronbach's alpha) and test-retest reliability (intra-class correlation). Cutoff used for statistical significance was p<0.05. RESULTS: The study included 126 patients (age: mean [SD] 46 years [12.5]; male 104; cause: alcohol 42%, HBV 25%, HCV 4%, cryptogenic 29%; CTP class A 47%, B 37%, and C 16%). In convergent validity, all domains except the "abdominal domain" showed significant correlation between CLDQ-T and WHOQOL-BREF. Patients with severe disease had lower scores for all domains of CLDQ-T except the "abdominal" domain, but not for any of the domains for WHOQOL-BREF. Overall Cronbach's alpha was 0.942, and more than 0.7 for all the individual domains except the "activity" domain. On retesting in 44 (35%) patients, intraclass correlation coefficient was 0.879 for the overall CLDQ-T score and >0.700 for individual domains. CONCLUSION: CLDQ-T was easily understood and showed good performance characteristics in assessing QOL in Tamil-speaking patients with CLD.


Assuntos
Linguagem , Hepatopatias/psicologia , Qualidade de Vida , Inquéritos e Questionários , Tradução , Adulto , Doença Crônica , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sri Lanka
17.
BMJ Open ; 7(5): e013873, 2017 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-28550020

RESUMO

OBJECTIVE: We aimed to adapt, translate and validate the Chronic Liver Disease Questionnaire (CLDQ) in Malaysian patients with chronic liver diseases of various aetiologies. SETTING: Tertiary level teaching institution in Malaysia. PARTICIPANTS: The validation process involved 211 adult patients (English language n=101, Malay language n=110) with chronic liver disease. Characteristics of the study subjects were as follows: mean (SD) age was 56 (12.8) years, 58.3% were male and 41.7% female. The inclusion criteria were patients 18 years or older with chronic hepatitis and/or liver cirrhosis of any aetiology. The exclusion criteria were as follows: presence of hepatic encephalopathy, ongoing treatment with interferon and presence of other chronic conditions that have an impact on health-related quality of life (HRQOL). METHODS: A cross-sectional study was conducted. Cultural adaptation of the English version of the CLDQ was performed, and a Malay version was developed following standard forward-backward translation by independent native speakers. Psychometric properties of both versions were determined by assessing their internal consistency, test-retest reliability and discriminant and convergent validity. RESULTS: Cronbach's alpha for internal consistency across the various domains of the CLDQ was 0.95 for the English version and 0.92 for the Malay version. Test-retest analysis showed excellent reliability with an intraclass correlation coefficient of 0.89 for the English version and 0.93 for the Malay version. The average scores of both the English and Malay versions of the CLDQ demonstrated adequate discriminant validity by differentiating between non-cirrhosis (English 6.3, Malay 6.1), compensated cirrhosis (English 5.6, Malay 6.0) and decompensated cirrhosis (English 5.1, Malay 4.9) (p<0.001). Convergent validity showed that correlation was fair between the English (ρ=0.59) and Malay (p=0.47) CLDQ versions with the EQ-5D, a generic HRQOL instrument. CONCLUSION: The English and Malay versions of the CLDQ are reliable and valid disease-specific instruments for assessing HRQOL in Malaysian patients with chronic liver disease.


Assuntos
Hepatopatias , Multilinguismo , Inquéritos e Questionários/normas , Traduções , Doença Crônica/psicologia , Estudos Transversais , Feminino , Humanos , Hepatopatias/diagnóstico , Hepatopatias/psicologia , Malásia , Masculino , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
18.
Drug Alcohol Depend ; 176: 28-32, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28514693

RESUMO

BACKGROUND: Heavy drinking is harmful for individuals with liver disease. However, some of these individuals drink despite knowledge of the risks. The current study aims to identify factors underlying drinking despite health problems among individuals with liver disease. METHODS: The current study utilizes a subsample of individuals reporting past-year liver disease and at least one drink in the past year (n=331), taken from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a large nationally representative survey of the United States. Participants reported on drinking despite health problems, symptoms of psychopathology, and family history of alcohol problems in a cross-sectional survey. RESULTS: Drug use disorders (Adjusted Odds Ratio [AOR]=2.68), as well as borderline, antisocial, and schizotypal personality disorders (AORs=2.50-4.10), were associated with increased likelihood of drinking despite health problems among individuals with liver disease, all ps<0.05. Any anxiety disorder trended toward significance (AOR=2.22), p=0.06, but major depressive disorder was not associated with increased risk, (AOR=0.99), ps=0.97. Individuals with a family history of alcohol problems were also more likely to drink despite health problems (AOR=2.79), p<0.05. CONCLUSIONS: Several types of psychopathology, as well as a family history of alcohol problems, increased the likelihood of drinking despite health problems among individuals with liver disease. These findings highlight the need to intervene with heavily drinking individuals with liver disease, who may be drinking due to familial risk and/or comorbid psychopathology.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Hepatopatias/epidemiologia , Hepatopatias/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno da Personalidade Antissocial/psicologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
19.
Rom J Intern Med ; 55(3): 129-137, 2017 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-28323622

RESUMO

INTRODUCTION: Chronic liver diseases (CLD) are an important cause of morbidity and mortality in general population. The aim of this study was to analyze potential differences between patients with CLD and healthy control group, and to estimate the severity of CLD by using simple questionnaires: general health questionnaire (GHQ-12) and chronic liver disease questionnaire (CLDQ). METHODS: A cross-sectional pilot study was performed in Zemun Clinical Hospital during years 2014 and 2015. Sixty participants were divided into 4 groups (15 per group): chronic alcoholic hepatitis, other chronic hepatitis, liver cirrhosis, and healthy control group. Entire study population chose one of four offered answers of structured questionnaires GHQ-12 and CLDQ, based on which mean model of end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores were calculated. RESULTS: Mean GHQ12 and CLDQ scores were 10.5 and 5.21 ± 1.11 respectively. Regarding certain CLDQ domain scores, a significant difference between alcoholic and non-alcoholic hepatitis groups in the worry domain was observed. Mean MELD score was 7.42 ± 2.89 and did not differ between chronic hepatitis groups, while mean CTP score was 5.73 ± 0.88. A statistically significant correlation was observed between GHQ12 and CLDQ scores (ρ = -0.404, p < 0.01), but not between subjective and objective scores. CONCLUSIONS: Mean GHQ12 and CLDQ scores pointed out to general psychological no-distress condition of the studied participants, as well as scarcely expressed CLD-specific complaints. Mean MELD and CTP scores indicated stable chronic liver diseases, with low three-month mortality rates in the cases of chronic hepatitis, as well as determination to Child A group in the case of liver cirrhosis.


Assuntos
Hepatopatias/psicologia , Pacientes Ambulatoriais , Qualidade de Vida , Inquéritos e Questionários , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Índice de Gravidade de Doença
20.
J Pediatr Gastroenterol Nutr ; 64(4): 528-532, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27673709

RESUMO

OBJECTIVES: Research is lacking into the emotional effects on families of serious chronic illness in infants. We examined the effect of the diagnosis of serious liver disease in infants upon parent psychological symptoms and family functioning. We hypothesized that parent psychological symptoms, family functioning, and father engagement will predict infant emotional outcomes. METHODS: Parents of infants recently diagnosed with serious liver disease completed validated questionnaires about parent stress, family function, impact of the illness on the family, and father engagement. The measures were repeated after 1 year, with the addition of the Child Behavior Checklist (CBCL). RESULTS: Parents of 37 infants participated. Parent stress and family functioning scores were not elevated. Parent psychological symptoms, family function, and father engagement did not predict infant outcome. For mothers, infant diagnosis other than biliary atresia, number of outpatient visits, and impact of the illness on the family explained 32% of the variation in CBCL (P = 0.001). For fathers, socioeconomic status, infant diagnosis other than biliary atresia, whether the infant had had a transplant, and impact of the illness on the family explained 44% of the variation in CBCL (P < 0.001). CONCLUSIONS: Parents and families appear to be resilient in coping with serious infant illness. Infant diagnosis other than biliary atresia and parental perceptions of high impact of the illness on the family are indicators of negative emotional outcomes for infants with serious liver disease. Psychosocial interventions for infants with chronic illness should target reducing the impact of illness on the family.


Assuntos
Adaptação Psicológica , Relações Familiares/psicologia , Comportamento do Lactente/psicologia , Hepatopatias/psicologia , Transplante de Fígado/psicologia , Estresse Psicológico/etiologia , Atresia Biliar/diagnóstico , Atresia Biliar/psicologia , Atresia Biliar/cirurgia , Pré-Escolar , Doença Crônica , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Hepatopatias/diagnóstico , Hepatopatias/cirurgia , Masculino , Pais/psicologia , Resiliência Psicológica , Inquéritos e Questionários
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