Hepatitis B Surface Antigen Levels Are Related to Spontaneous Hepatitis B Surface Antigen Seroconversion in Inactive Hepatitis B Carriers.

BACKGROUND: The cure for hepatitis B is defined as the hepatitis B surface antigen (HBsAg) seroclearance and/or seroconversion. Predictors of spontaneous seroconversion are not well described. The objective of this study is to identify predictors of spontaneous HBsAg seroconversion from community practice. METHODS: We performed a matched analysis of patients who HBsAg seroconverted (cases) and patients who did not HBsAg seroconvert (control) in a 1:5 ratio according to date of clinic visit between 2014 and 2019 in a large community practice situated in Los Angeles area. Baseline laboratory and clinical data were collected. Univariate analysis and 2-sided t tests were performed, χ test for proportions, and logistic regression. RESULTS: We identified 14 cases and 70 controls. The mean (±SD) ages of the cases and controls were 53.6 (±12.2) and 49.5 (±13.1), respectively (P=0.45). Most patients were women, and all patients were of Asian descent. There were statistically significant mean (±SD) baseline differences between cases and controls in HBsAg titers (459.8±311.0 and 782.0±393.3 IU/mL, P=0.01) and alanine aminotransferase (ALT) values (17.6±4.4 and 25.1±16.7 IU/mL, P<0.01), respectively. Baseline hepatitis B virus DNA and other pertinent laboratory values did not differ between cases and controls. Eleven of 14 cases (79%) and 11 of 70 controls (16%) baseline HBsAg titers were <1000 IU/mL (P<0.01). The results of a logistic regression demonstrated that HBsAg titers and ALT values were predictor variables for HBsAg seroconversion (P=0.01 and <0.01, respectively). CONCLUSIONS: Spontaneous HBsAg seroclearance and seroconversion is an uncommon event in patients with chronic hepatitis B. The most important predictors of seroconversion are HBsAg titers<1000 IU/mL and low baseline ALT values.

Quality of life of mental health consumers in Hong Kong: Analysis of service perceptions.

OBJECTIVES: Successful psychiatric rehabilitation entails fostering overall quality of life of individuals recovering from severe mental illnesses. Understanding how service-related perceptions may be related to quality of life can be useful in improving the effectiveness of community-based care. This study investigated the quality of life of mental health consumers using a service-oriented paradigm. METHODS: 162 mental health consumers from community-based psychiatric rehabilitation centers were interviewed. Analyses were conducted to investigate the relationships between service perceptions (perceived treatment coercion, rehabilitation needs, and continuity of care) and quality of life. RESULTS: Physical health quality was negatively related to rehabilitation needs. Mental health quality was negatively related to both rehabilitation needs and poorer continuity of service. Life satisfaction was negatively related to poorer continuity of service and higher perceived treatment coercion. CONCLUSIONS: This study highlighted the significance of service perceptions in the well-being of individuals with severe mental illness.

Cognitive insight and causal attribution in the development of self-stigma among individuals with schizophrenia.

OBJECTIVE: Stigma has dampening effects on the overall rehabilitation of individuals given a diagnosis of schizophrenia. This study was an initial attempt to understand the relationship between cognitive insight and attribution in the development of self-stigma among this group of mental health consumers. METHODS: In a cross-sectional design, the investigators interviewed 162 mental health consumers with broad diagnoses of schizophrenia from 15 community-based psychiatric rehabilitation centers in Hong Kong. After controlling for the effects of demographic and illness-related factors, the authors used hierarchical multiple regression analysis to investigate the effects of cognitive insight and causal attribution on self-stigma. RESULTS: Better cognitive insight and attribution of personal responsibility to the cause of the illness were significantly associated with higher levels of self-stigma. CONCLUSIONS: Given that awareness and interpretation of participants' illness were related to self-stigma, cognitive restructuring is needed to alleviate self-stigma among individuals with schizophrenia.