Knowledge, attitudes and behaviors associated with Hep C care provision by family physicians
A study in the latest issue of the Journal of Viral Hepatitis investigates Knowledge, attitudes and behaviours associated with the provision of hepatitis C care by Canadian family physicians.
The role of primary care physicians in providing care for hepatitis C virus (HCV) infection is increasingly emphasized, but many gaps and challenges remain. This study explores family physicians’ knowledge, attitudes and practices associated with providing care for HCV infection.
Dr Cox and colleagues from Canada reported that 749 members of the College of Family Physicians of Canada (CFPC) completed a self-administered survey examining knowledge, attitudes and behaviours regarding HCV infection screening and care.
Multivariate analyses were performed using the outcome, HCV care provision, and variables based on a conceptual model of practice guideline adherence.
Educational programs should target physicians less likely to provide HCV care
Journal Viral Hepatitis
Family physicians providing basic–advanced HCV care were more likely to be older, practice in a rural setting, have injection drug users (IDU) in their practice and have higher levels of knowledge about the initial assessment and treatment of HCV.
The research team found that they were also less likely to believe that family physicians do not have a role in HCV care.
Educational programs should target physicians less likely to provide HCV care, namely family physicians practicing in urban areas and those who do not care for any IDU patients.
Dr Cox's team concluded, "Training and continuing medical education programmes that aim to shift family physicians’ attitudes about the provision of HCV care by promoting their roles as integral to HCV care could contribute to easing the burden on consultant physicians and lead to improved access to treatment for HCV infection
J Vir Hep 2011: 18(7): e332–e34011 July 2011
The effect of caffeine and alcohol consumption on liver fibrosis – a study of 1045 Asian hepatitis B patients using transient elastography
Arlinking Ong1,2, Vincent Wai-Sun Wong1, Grace Lai-Hung Wong1, Henry Lik-Yuen Chan1 Article first published online: 31 MAY 2011 DOI: 10.1111/j.1478-3231.2011.02555.x © 2011 John Wiley & Sons A/S
Issue Liver International Volume 31, Issue 7, pages 1047–1053, August 2011
Abstract Background:
Role of caffeine consumption in chronic hepatitis B virus (HBV)-infected patients and the interaction with alcohol consumption is unclear.
Aim: This study aimed to investigate the relationship between caffeine and alcohol consumption and liver stiffness in chronic HBV-infected patients.
Methods:
Chronic HBV-infected patients who underwent transient elastography examination in 2006–2008 were studied. Advanced fibrosis was defined as liver stiffness >9 kPa for patients with normal alanine aminotransferase (ALT) or >12 kPa for those with elevated ALT according to previous validation study. Caffeine and alcohol consumption was recorded using a standardized questionnaire. Excessive alcohol intake was defined as 30 g/day in men and 20 g/day in women. Results: The liver stiffness of 1045 patients who completed the questionnaire was 8.3 ± 6.2 kPa. Two hundred and sixteen (20.7%) patients had advanced fibrosis. Ninety-five (19.0%) patients who drank ≥1 cup of coffee had advanced fibrosis, compared with 121 (22.2%) patients who drank <1 cup (P=0.21). The amount of caffeine intake had positive correlation with the amount of alcohol intake (rs=0.167, P<0.001). Although 231 (22.1%) patients reported alcohol consumption, only 11 (1%) had excessive alcohol intake. The prevalence of advanced fibrosis among patients with mild to moderate alcohol intake (26, 18.8%) was comparable to that among non-drinkers (190, 21.0%) (P=0.57).
Conclusion:
Caffeine intake does not affect liver stiffness in chronic HBV-infected patients. Patients who drink coffee regularly tend to drink alcohol. Most chronic HBV-infected patients do not have excessive alcohol consumption. The prevalence of advanced fibrosis among mild to moderate alcohol drinkers was low in this population.
http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02555.x/abstract
Inverse association of IL28B genotype and liver mRNA expression of genes promoting or suppressing antiviral state†
Abstract
High intrahepatic expression levels of interferon stimulated genes (ISGs) in chronic hepatitis C patients are associated with poor response to interferon plus ribavirin combination therapy. Expression levels of 16 genes (OAS1, PKR, MxA, ISG15, RIG-I, TLR8, IRF7, IRF9, NFKBIA, IL28A/IL28B, IL29, IL28RA, IL10RB, IFNAR2, and STAT1) that promote antiviral state and 4 genes (SOCS1, SOCS3, Zc3h12a, and A20) that suppress antiviral state were analyzed using real-time PCR assays in 133 liver biopsy samples from patients infected with genotypes 1 or 2. Expression levels of genes promoting antiviral state were positively correlated with each other but were not correlated with those that suppress antiviral state.
Expression levels of some ISGs were inversely associated with common polymorphisms within the IL28B locus. Genes promoting antiviral state were expressed lower (e.g., ISG15, P = 1.42E-12 and MxA, P = 6.40E-11) in individuals with the protective rs12979860 CC genotype, and genes suppressing antiviral state were expressed higher (A20, P = 0.00107 and Zc3h12a, P = 0.00129, respectively), although some ISGs were not significant after the Bonferroni correction. The expression levels of both an antiviral (MxA) and a suppressor (SOCS1) ISG were independent predictors for non-response. These results suggest that rs12979860 genotype may be associated with response to combination therapy through an inverse relationship between antiviral and suppressor ISGs in the liver.
J. Med. Virol. 83:1597–1607, 2011. © 2011 Wiley-Liss, Inc.
Entire UPMC transplant team missed hepatitis alert
By Sean D. Hamill, Pittsburgh Post-Gazette
The positive hepatitis C test that was missed at UPMC, leading to the shutdown of its living donor kidney transplant program, was not noticed by its entire transplant team despite a highlighted alert in the hospital's electronic records system.
"Everyone just missed it," a source with knowledge of the case said.
The alert was missed by as many as a half dozen people on the transplant team who typically would have reviewed such a test result, according to interviews with several current or former UPMC employees. A number of those interviewed said the problem lies more with the larger system of ensuring that medical errors are caught than with the individuals involved in the incident.
Because of the missed positive test result, a kidney from a living donor, who did not know she was infected with the disease, was transplanted into a man who did not have hepatitis C, leading to two ongoing federal investigations.
Read more:
http://www.post-gazette.com/pg/11191/1159219-455.stm#ixzz1RnjxwEUi
Pharmaceutical
In China, Some Doctors Are Becoming Sales Reps
Amid growing frustration with insurers and paperwork, it is not unusual to hear doctors in the US complain about their chosen profession and look elsewhere to make a living. But in China, doctors are crossing over to the other side of the sample box - and as many as 14,000 physicians will join foreign drugmakers over the next five years, according to Bloomberg News.
Healthy You
Vitamin D insufficiency prevalent among psoriatic arthritis suffers
Disease activity not affected by vitamin D levels
New research reports a high prevalence of vitamin D insufficiency and deficiency among patients with psoriatic arthritis. Seasonal variation in vitamin D levels was not observed in patients in southern or northern locations. The findings published today in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR), also show no association between disease activity and vitamin D level.
Psoriasis is a common chronic skin disorder, likely caused by an autoimmune response, and is characterized by red scaly patches on the surface of the skin. When accompanied by inflammatory arthritis the condition is known as psoriatic arthritis (PsA)—a disease gaining public attention with the recent diagnosis of professional golfer, Phil Mickelson. Studies suggest that psoriasis occurs in up to 3% of the world population and roughly one third of these patients have PsA with prevalence estimates ranging from 6% to 42%.
"Vitamin D deficiency is a widespread concern," explains lead study author Dafna Gladman, MD, FRCPC, Director of the University of Toronto Psoriatic Arthritis Clinic in Canada. "And it is more common to see individuals living in Northern regions with a deficiency in vitamin D than in those who reside in Southern areas." Medical evidence shows that vitamin D deficiency is more common in individuals living at higher latitudes during the winter, suggesting the deficiency is a result of reduced sun exposure. Furthermore, several studies have reported reduced levels of vitamin D in patients with autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, and scleroderma.
The Canadian and Israeli teams set out to determine the prevalence of vitamin D deficiency in PsA patients, seasonal and geographical variants, and associations with disease activity by evaluating 302 patients with PsA from March to August 2009. There were 258 patients evaluated during the winter and 214 patients during the summer. This cross-sectional study was conducted at two geographically diverse locations; the arthritis clinic in Toronto, Canada was designated the northern site and medical centers in Haifa, Israel were selected for their subtropical southern location.
Vitamin D levels in the blood, known as 25-hydroxyvitman D [25 (OH) D], were used as the primary measure as this takes into account vitamin D synthesized from sunlight as well as from ingested foods. At the northern site, the 25 (OH) D level was insufficient in 56% of PsA patients in the winter and in 59% during the summer. Approximately 51% of patients at the southern location had insufficient 25 (OH) D levels in winter and 62% of patients had insufficient levels in the summer. The level of vitamin D was deficient in 3% of patients at the northern location only in winter; at the southern site vitamin D deficiency was reported in 4% of patients in the winter and in 1% during the summer.
Differences in patient vitamin D levels regarding seasonal or geographical variations were not statistically significant. Levels of vitamin D were not found to affect disease activity in PsA patients. However, Dr. Gladman added, "Additional research is needed to determine if PsA patients require a greater vitamin D intake to maintain healthy levels than that recommended for the general population."
###
This study is published in Arthritis Care & Research. Media wishing to receive a PDF of this article may contact healthnews@wiley.com.
Full citation: Seasonal Variation in Vitamin D Levels in Psoriatic Arthritis Patients from Different Latitudes and its Association with Clinical Outcomes." Zahi Touma, Lihi Eder, Devy Zisman, Joy Feld, Vinod Chandran, Cheryl F. Rosen, Hua Shen, Richard J. Cook and Dafna D. Gladman. Arthritis Care and Research; Published Online: July 11, 2011 (DOI: 10.1002/acr.20530). http://doi.wiley.com/10.1002/acr.20530.
About the Journal
Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed research publication that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. For details, please visit Arthritis Care & Research.
About Wiley-Blackwell
Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or our new online platform, Wiley Online Library (wileyonlinelibrary.com), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.
http://www.eurekalert.org/pub_releases/2011-07/w-vdi070711.php
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