Social support for patients undergoing liver transplantation in a Public University Hospital.

BACKGROUND: Several diseases may lead to the need for liver transplantation due to progressive organ damage until the onset of cirrhosis, resulting in changes in interpersonal relationships. Social Support for transplant candidates is an important variable, providing them with psychological and social well-being. This study aims to assess social support in chronic hepatic patients, waiting for liver transplantation. METHODS: A cross-sectional study was conducted with 119 patients, for convenience sampling, from the liver transplant waiting list at a Brazilian University Hospital Outpatients. The information was collected through semistructured questionnaires, in four stages: 1) socioeconomic and demographic information 2) clinical aspects 3) feelings 4) Social Support Network Inventory (SSNI), to Brazilian Portuguese. The statistical analysis was conducted using ANOVA and multivariate linear regression analysis to evaluate the relationship between the scales of social support and the collected co-variables. RESULTS: Average age was 50.2 ± 11.6, and 87 (73.1%) were men. Patients with alcohol and virus liver disease etiology had the same frequency of 28%. The MELD, without extrapoints, was 16.7 ± 4.9. Global social support family score was 3.72 ± 0.39, and Cronbach's alpha = 0.79. The multivariate analysis presented the following associations, age = [- 0.010 (95% CI = - 0.010 - -0.010); P = 0.001], etiology of hepatic disease = [- 0.212 (95% CI = - 0.37 - -0.05); P = 0.009], happiness = [- 0.214(95% CI = - 0.33 - -0.09) P = 0.001) and aggressiveness = [0.172 (95% CI = 0.040-0.030); P = 0.010). CONCLUSIONS: The social support was greater when the patients were younger (18 to 30 years). Patients with alcoholic cirrhosis, regardless of whether or not they were associated with virus, had less social support. As for feelings, the absence of happiness and the presence of aggressiveness showed a negative effect on social support.

Essay on Being a Doctor: The Most Powerful Medicine.

Through the generosity of Charles R. Millikan, D. Min., vice president for Spiritual Care and Values Integration, an annual award competition was established at Houston Methodist Hospital among the resident staff. To enter the writing competition, residents must submit a poem or essay of 1,000 words or less on the topic, "On Being a Doctor." A committee of seven was selected from Houston Methodist Hospital Education Institute to establish the judging criteria and select the winning entries. The following is the third-place winning entry for 2017.

Infectious disease burden and cognitive function in young to middle-aged adults.

Prior research has suggested an association between exposure to infectious disease and neurocognitive function in humans. While most of these studies have explored individual viral, bacterial, and even parasitic sources of infection, few have considered the potential neurocognitive burden associated with multiple infections. In this study, we utilized publically available data from a large dataset produced by the Centers for Disease Control and Prevention that included measures of neurocognitive function, sociodemographic variables, and serum antibody data for several infectious diseases. Specifically, immunoglobulin G antibodies for toxocariasis, toxoplasmosis, hepatitis A, hepatitis B, and hepatitis C, cytomegalovirus, and herpes 1 and 2 were available in 5662 subjects. We calculated an overall index of infectious-disease burden to determine if an aggregate measure of exposure to infectious disease would be associated with neurocognitive function in adults aged 20-59 years. The index predicted processing speed and learning and memory but not reaction time after controlling for age, sex, race-ethnicity, immigration status, education, and the poverty-to-income ratio. Interactions between the infectious-disease index and some sociodemographic variables were also associated with neurocognitive function. In summary, an index aggregating exposure to several infectious diseases was associated with neurocognitive function in young- to middle-aged adults.

[Effect of hepatitis health promotion project in schools of Beijing and Gansu].

OBJECTIVE: To evaluate effect of health promotion project of element school students in Beijing and Gansu. METHODS: Evaluation field was conducted in 6 schools of hepatitis health promotion project. They were selected randomly from Beijing and Gansu, questionnaires were given to students and teachers for evaluating the awareness to hepatitis transmission and prevention, telephone interview was given to student's parents for awareness to hepatitis knowledge. RESULTS: Awareness to hepatitis was increased after health promotion, knowledge of hepatitis A and hepatitis B transmission among element school students were increased from 46.95%, 32.26% at baseline to 98.92%, 96.42% at middle-term respectively. Awareness rate of prevention of hepatitis A and hepatitis B were increased from 67.03%,67.38% at baseline to 98.21%, 99.64% at middle-term respectively. Immunization coverage of hepatitis A and hepatitis B was 29.75% at baseline, and reached 77.06% at middle-term after health promotion. The parent's awareness rate of hepatitis transmission and prevention also increased to 85% and 99% after intervention. CONCLUSION: It was very effective of health promotion project in two provinces, the improvement of awareness of hepatitis was not only for students, but also for parents as well.

Hepatitis support groups: meeting the information and support needs of hepatitis patients.

An estimated 5 million Americans are chronically infected with hepatitis B or C. They face socially and clinically significant reductions in mental and physical health. Improved coping and compliance with clinical therapies and harm-reducing behaviors can improve quality of life and, potentially, treatment outcomes. Motivation to join, participation, use, and usefulness of online and in-person hepatitis support groups was examined through observation and survey of group members and group leaders. Members joined primarily to get information particularly about treatments, diet, and treatment side effects. They also joined to get support. All received support that was often hard to get elsewhere. Healthcare providers were generally the most used source of information, yet support groups were the most useful source of information. Members used the information and support obtained to make treatment and lifestyle changes such as initiating or ceasing treatment, eliminating alcohol consumption, increasing openness with family and friends, and discussing side effects with healthcare providers. Providers caring for hepatitis patients should consider recommending support groups to their patients and also participate in the groups to ensure that valid and reliable information is provided.

Serum activity of prolyl endopeptidase, but not of dipeptidyl peptidase IV, is decreased by immunotherapy with IFN-alpha in high-risk melanoma patients.

Immunotherapy with interferon-alpha (IFN-alpha) induces neuropsychiatric side effects, most notably depression. In hepatitis patients treated with IFN-alpha, severity of depression correlates with a decrease in serum activity of dipeptidyl peptidase IV (DPP-IV, EC 3.4.14.5), a membrane-bound protease involved in the cleavage of cytokines and neuroactive peptides. Abnormal serum activity of the cytosolic peptidase prolyl endopeptidase (PEP, EC 3.4.21.26, postprolyl cleaving enzyme, prolyl oligopeptidase) has been documented in patients with a variety of psychiatric disorders, most consistently in mood disorders. The serum activity of PEP and DPP-IV was measured before and after 4 weeks of high-dose induction treatment with IFN-alpha in 18 patients with high-risk melanoma. In this exploratory study, we show a clear decrease in the serum activity of PEP after 4 weeks of treatment with IFN-alpha. This decrease was not related to changes in hematologic parameters. In contrast, serum activity of DPP-IV did not change. Further studies focusing on a possible role of PEP in the pathophysiology of IFN-alpha-induced depression are warranted.

[Child and adolescent quality of life: study analysis]. / La qualité de vie des enfants et des adolescents: analyse à partir d'enquêtes.

As with adults, the quality of life of children is a multi-dimensional concept, therefore, in theory, evaluations cannot be carried out except by the subject, given the very subjective nature of this procedure. There are obstacles in pediatrics with this postulate, as one would prefer to implement a procedure of evaluation regarding the child's own characteristics in order to determine the cognitive limits of his/her development. We have attempted to summarize this subjective aspect by adapting tools for evaluation suitable for both the child and adolescent. 1) The AUQUEL questionnaire. Targeted to nursery school or primary school children, it consists of a closed scale comprised of thirty-one items: the phases of satisfaction are presented with the use of four aspects which express different emotional conditions. It also includes an open question. 894 French children so far have filled out this questionnaire: 491 from the general population, 403 were evaluated under specific contexts, either organic illnesses, psychological problems, or in the context of social personalities. Differences can be observed, depending on the contexts, in a closed scale or an open question. We will look at the example of a kidney transplant to illustrate our point. 2) The "OKadolescent" questionnaire Similar in structure to an adult questionnaire; it differs, however, by the themes that are adopted to the life and preoccupations of an adolescent. It is made up, as with the questionnaire for children, of a closed scale (26 items), and an open question. Here, 268 adolescents from the general population can be compared with adolescents evaluated in either a somatic or war-zone context. We will take as an example adolescents who have undergone kidney transplants or have suffered from hepatitis, to demonstrate the paradoxical characteristics of the evaluation of the adolescents quality of life. 3) Conclusion Our experience in this domain of the evaluation of a child's quality of life enables us to confirm its feasibility, on the condition of using specific tools, for the clinician (the best representation for the impact of pathology on a child's quality of life), and its relevance as an element for evaluating the needs linked with the health of the given population.

[The evaluation of the psychosomatic development in children after infectious and idiopathic cholestatic jaundice in neonatal and infantile period]. / Ocena rozowju psychosomatycznego dzieci po przebytych zóltaczkach cholestatycznych o podlozu infekcyjnym i idiopatycznych okresu noworodkowego i wczesnoniemowlecego.

We carried out the analysis of psychomotoric and somatic development of 38 children after the period of 6--12 months since suffering from neonatal and infantile jaundice (infectious and idiopathic). We did not confirm retardation of the psychomotoric development in the examined group, however we confirmed deficiency of body mass in 45% of patients. Cholestatic jaundice in this group did not influence the children's. psychomotoric development significantly in the following years. It seems, that deficiency of the body mass of examined children after cholestatic jaundice is mostly dependent on the gestational and labour risk factors or small birth weight rather than on clinical course of disease and etiological factors of jaundice.

Use of universal precautions in interventional radiology: results of a national survey.

OBJECTIVE: To determine current use of universal precautions by practicing interventional radiologists in the United States. METHODS: National survey mailed to interventional radiologists, conducted anonymously in November 1991. Of 1530 survey forms mailed to practicing interventional radiologists, 817 (53%) were returned and 804 (52%) were completed and evaluable. Both academic and private practice settings were represented. RESULTS: Eighty-five percent of respondents had changed their use of infection control measures in the previous 10 years. Of these, 96% cited personal concerns about AIDS as a reason for making changes. Sixty-two percent made changes in response to Centers for Disease Control and Prevention and Occupational Safety and Health Administration recommendations as well. Use of barrier precautions was quite variable. Although 86% of respondents always wore a sterile gown during procedures, only 32% routinely wore a face mask or shield and only 29% of those who did not wear corrective glasses routinely wore protective eye gear during procedures. Seven percent of respondents routinely double gloved for procedures. Twenty percent of reported percutaneous injuries occurred during recapping of used sharps; an additional 6% were related to improper disposal of used sharps. CONCLUSIONS: We conclude that use of universal precautions by interventional radiologists in the United States is variable. Some practices that may lead to preventable injury to health care workers remain common.

Reactions to AIDS and other illnesses: reported interactions in the workplace.

Previous research on the public's response to AIDS has been concerned with attitudes and knowledge in relation to the disease itself. The present study investigated American students' willingness to interact in the workplace with AIDS patients and compared this with their reactions to cancer and hepatitis patients. The effects of perceived control over the cause of the disease were also examined. Exposure to the diseases was manipulated with written scenarios. Results demonstrated that the type of illness affected a willingness to interact with individuals--AIDS patients were reacted to least positively, followed by hepatitis, and cancer patients. Perceived control over the cause of the disease did not affect reactions.

[Initial neuropsychiatric disorders in children with hepatitis and the effect of microsocial-psychological factors on their development]. / Initsial'nye nervno-psikhicheskie rasstroistva pri gepatitakh u detei i vliianie mikrosotsial'no-psikhologicheskikh faktorov na ikh vozniknovenie.

The psychic hepatitis-associated disorders in children with different biological and microsocial influences were studied. The development of mental disturbances correlated with the severity of hepatitis. It is concluded that identification of aggravating factors of the microsocial environment is necessary for timely conduction of prophylactic measures.

[Studies on the function of maintaining concentration (TAF)--evaluation of clinical symptoms (author's transl)].

The function of maintaining concentrations (TAF) test was performed in patients with schizophrenia and hepatitis, and subjects with sleep deprivation. The results obtained are as follows: 1) Schizophrenia: It was suggested that TAF provided a reliable index of the effect and the amount of medicine as well as remissive condition. 2) Hepatitis: TAF tended to parallel the conditions of both acute and chronic hepatitis. A positive correlation was found between TAF-deviation (D) and gamma-glutamyl transpeptidase as well as lactate dehydrogenase (r = 0.682, 0.535, respectively). No significant correlation was found between TAF-level (L) and hepatic enzymes. 3) TAF-D of a 4-hour sleep group decreased significantly compared with that of a 8-hour sleep group. The lapse phenomenon of TAF curved line was observed in a 4-hour sleep group after 49 hours of sleep deprivation. It was considered that TAF was an objective index of pathological or physiological conditions.

On transference in the treatment of organic diseases.

The term 'transference' paraphrases the irrational factor in medicine. Physicians feel disturbed by this factor. However, medicine is not only the application of rational data but also dealing with the patient. Transference is a prerequisite of perception and therapy. Analytic therapy aims at converting transference as repetition of behaviour into recollection. Transference thus reveals the hidden needs of human rights. It means communication, justification, satisfaction. Experience in clinic and practice shows that this applies not only to neurotics but also to patients with organic diseases, and especially to the latter where it is matter of life or death.