Preventing Foodborne Illness At Home
Hepatitis A can have serious health consequences. The CDC advises the post-exposure prophylaxis described above for unvaccinated persons who have consumed any products contaminated by the hepatitis A virus.
To prevent hepatitis A contamination or transmission, consumers should always practice safe food handling and preparation measures by following the steps below:
- Wash hands with warm water and soap for at least 20 seconds before and after handling raw foods.
- Thoroughly wash hands after using the bathroom and changing diapers for protection against hepatitis A, as well as other foodborne diseases.
- Wash the inside walls and shelves of the refrigerator, cutting boards and countertops, and utensils that may have contacted contaminated foods then sanitize them with a solution of one tablespoon of chlorine bleach to one gallon of hot water dry with a clean cloth or paper towel that has not been previously used.
- Wash hands with warm water and soap following the cleaning and sanitation process.
- Consumers can also submit a voluntarily report, a complaint, or adverse event related to a food product.
The Role Of Primary Care Physicians And Psychiatrists In Screening For Hcv
Despite the association between HCV and psychiatric illness, screening for HCV has not been a routine practice in patients with psychiatric illness. These patients are at risk for contracting HCV by engaging in risky sexual behaviors and intranasal drug use but may not be forthcoming about these activities.65 Therefore, the only reliable way to rule out HCV infection would be to screen these at-risk populations. The CDC has recommended routine screening of incarcerated individuals in correctional facilities for HCV.66 Routine HCV screening is also recommended for all patients who are found to be infected with HIV.65 The Department of Veterans Affairs conducts routine HCV screening for all veterans being treated at Veterans Affairs hospitals.31,67,68
However, the US Preventive Services Task Force in 2004 recommended against routine screening for HCV in high-risk individuals because it found no data to support the efficacy of interferon alfa and ribavirin treatment in reducing morbidity and mortality from HCV infection despite 2 decades of research on the utility of interferon alfabased therapies in achieving viral clearance.69 Therefore, interferon alfa and ribavirin treatment for patients with HCV infection continues to be considered a therapeutic modality with an intuitive value but no evidence-based efficacy in reducing the overall morbidity and mortality associated with HCV.70
Extraction And Data Collection
A total of 613 abstracts were identified across each of the search libraries. After removal of duplicates and non-English publications, 230 articles remained. These were reviewed by M.R.B., with 48 relevant titles/abstracts identified. There were 45 full text articles available for analysis . An additional 4 relevant references were found in the citations from the above articles and assessed for inclusion. Of the 49 full texts, 13 publications did not meet inclusion criteria . This led to a total of 36 publications for analysis. Eligibility and inclusion criteria of full-text publications were verified by T.P. Key variables were recorded by M.R.B. and T.P., including study setting, recruitment strategy, participant demographics, SMI diagnosis, HCV risk factors, HCV screening modality, percentage of population screened, seroprevalence, and associations thereof. The quality of each study was recorded by M.B. and T.P. using the Quality Assessment Tool for Systematic Reviews of Observational Studies .18 Interuser concordance was very high, and third-party review was not required. An additional customized global assessment of study quality was performed based on 3 criteria, including study size cohort selection and reproducibility and risk factor evaluation . Scores were aggregated and assigned a ranking: 01=poor, 23=fair, and 46=good/excellent.
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Multivariable Stratified Analysis For Depression/anxiety
Multivariable stratified analyses were performed for subgroups of patients to determine the association of depression/anxiety with increased hepatitis B flare risk within subgroups . In the subgroup analyses, the risk of hepatitis B flares was higher in the patients with depression/anxiety than that in the control patients in the 1829-years age group, the 3039-years age group, males, females, patients with DM, patients without DM, patients with hypertension, patients without hypertension, patients with a history of stroke, patients without a history of stroke, patients with CKD, patients without CKD, and patients without underlying osteoporosis. Although patients with depression/anxiety had a higher risk of developing hepatitis B flares than patients without depression/anxiety in all of the subgroups analyzed, the HR was not statistically significant in several subgroups, including those with underlying osteoporosis, and in patients aged 4049 years, 5059 years, or 60 years and older.
Table 4 Influence of Demographic and Clinical Variables on the Risk of Hepatitis B Flares Determined by Cox Regression
Treatment Rates Of Hcv In Patients With Psychiatric Illness
The HCV clearance rates in response to antiviral treatment that are reported in the literature may not be applicable to the entire HCV-infected population because they were derived from clinical trials that excluded patients with preexisting psychiatric and substance use disorders.92,93 In contrast to these large pivotal HCV treatment trials, early reports detailing the clinical experience with HCV antiviral treatments describe reduced rates of patient engagement in the evaluation process leading to HCV treatment.92,93 These reports also cite psychiatric illness and substance use as reasons for HCV treatment ineligibility in at least half of the HCV patients being evaluated.92,93 Additionally, patients who were eligible for treatment had poorer HCV clearance rates .92,93
However, we and others reported more recently and in multiple populations with HCV and psychiatric disorders that HCV antiviral treatments can be safely completed and that compliance rates and viral clearance rates and outcomes in these patients are similar to those in patients with HCV infection but without psychiatric or substance abuse histories.31,85,89,94 These findings about improved compliance and safety of HCV antiviral treatment have led to an increase in the rates of initiating HCV antiviral treatment in patients with HCV and psychiatric disorders.18,95Figures 3 and and44 illustrate realistic rates of HCV treatment candidacy and HCV treatment outcomes.
aAll data are presented as %.
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Psychosocial And Neurocognitive Factors Associated With Hepatitis C Implications For Future Health And Wellbeing
- 1Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
- 2Faculdade de Medicina, Universidade de Lisboa, Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
- 3Laboratório de Genética, Faculdade de Medicina, Instituto de Saúde Ambiental, Universidade de Lisboa, Lisbon, Portugal
- 4Assertive Outreach Team, Sussex Partnership NHS Foundation Trust, Brighton and Hove, United Kingdom
- 5Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
Background: Hepatitis C virus infection involves changes not only from the point of view of physical health, but also emotional, and social that have a significant impact on the quality of life of these patients. According to the literature review, it seems that there is an important association between psychosocial factors, in particular on a cognitive level and disease progression. The aim of this mini-review is to summarize recent literature looking at the associations between psychosocial and neurocognitive factors and HCV.
Methods: PubMed/Medline was systematically searched for psychosocial and neurocognitive factors associated with hepatitis C, treatment adherence, and patient wellbeing.
Posttest Counseling Of Patients With Psychiatric Illness And Hcv Infection
Patients who are found to be infected with HCV should be counseled regarding prevention of the spread of the virus to others.19,76 HIV testing should be offered given the comorbidity of HIV/AIDS and HCV .77 HCV can be transmitted through shared use of common household objects such as toothbrushes, shaving utensils, and other personal items, and patient and family counseling should emphasize not sharing such personal items. Although HCV infection has a low rate of sexual transmission , patients should still be advised to practice safe sex and use barrier protection to further reduce transmission risks of HCV and other sexually transmitted diseases.
Recent emerging research suggests that the most important component of posttest counseling for a patient with newly diagnosed HCV infection should be a candid discussion about alcohol use. An accumulating body of evidence suggests that alcohol use even in moderation can accelerate the progression of HCV-induced liver disease78 consequently, HCV patients should be advised to eliminate all alcohol use.79,80
Research in veterans with HCV infection and alcohol use disorders suggests that candid counseling about the need to eliminate alcohol use may be a motivator toward improved rates of abstinence from alcohol use and actually may yield a better eligibility for interferon treatment and improved treatment outcomes.79,80
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How Hepatitis C Treatments Can Help Improve Your Mental Health
Learning more about the high success rate of treatments for the virus may help you better cope with anxiety. Medication can now cure more than 90 percent of people with hepatitis C, according to the Centers for Disease Control and Prevention .
A study published in October 2018 in the journal PLoS One found that when people with hepatitis C took direct-acting antiviral medication, they were not only cured of hepatitis C but also experienced reduced anxiety and depression and an improvement in overall quality of life.
Its important to keep in mind that the new DAAs have some side effects but are far more tolerable than the older injections of interferon, Graham notes. People living with hepatitis C shouldnt be fearful of seeking treatment.
The side effects from antiviral medications tend to be mild and include nausea, fatigue, and insomnia. Keep in mind, too, that the treatment lasts only 8 to 12 weeks, so any side effects are likely temporary, she says.
Looking To Other Models Of Care
Mental health has lagged other high-prevalence HCV populations in terms of decentralization of screening programs,8,69 although some data exist regarding intensified support within traditional outpatient models.70 In other high-risk settings, such as the prison and opioid-substitution contexts, decentralized models of HCV care service delivery augmented by community nurse engagement, case management, and enhanced motivational support have demonstrated efficacy in engaging and improving HCV treatment access when compared to traditional health care models.17 People with SMI are often integrated within community mental health services, and a remodeling of the current care paradigm bolstered by enhanced clinician education could translate to effective BBV screening and treatment.35,7072 These pathways could be supported through point-of-care HCV antigen assays, integration of nurse practitioners, improved clinician education, streamlined screening strategies, and horizontal integration of specialists, through either visiting sites or telehealth platforms.70,73 Notwithstanding potential barriers in the SMI setting, decentralization of traditional models of care could yield markedly improved access to highly tolerable curative therapies.58,59,74
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What Causes Hepatic Encephalopathy
The exact cause of hepatic encephalopathy is unknown. However, its usually triggered by a buildup of toxins in the bloodstream. This occurs when your liver fails to break down toxins properly.
Your liver removes toxic chemicals such as ammonia from your body. These toxins are left over when proteins are metabolized or broken down for use by various organs in your body. Your kidneys change these toxins into safer substances that are then removed through urination.
When your liver is damaged, its unable to filter out all the toxins. Toxins can then build up in your bloodstream and potentially get into your brain. Toxic buildup can also damage other organs and nerves.
Hepatic encephalopathy may be triggered by:
- infections such as pneumonia
Several tests are used to diagnose hepatic encephalopathy.
Factors Associated With New Onset Of Major Psychiatric Disorders Affective Psychoses And Schizophrenia Among Patients With Chronic Hepatitis C Who Received Antiviral Therapy
In univariate analysis, older age and advanced hepatic fibrosis were significantly associated with a lower risk of new-onset major psychiatric disorders . After adjustment for age and sex, older age and advanced hepatic fibrosis remained associated with lower risk of new-onset major psychiatric disorders . Female patients with CHC patients had a significantly higher risk of new-onset major psychiatric disorders after anti-HCV therapy when compared with male patients . Similar results also were observed on affective psychoses. Being a woman was the only factor predictive of affective psychoses after adjustment for age .
Cox Subdistribution Hazards Model for Risk Factors of Major Psychiatric Disorders Among Patients With CHC Who Achieved Antiviral Therapy
Ten-year cumulative incidence and Cox subdistribution hazards model of major psychoses, schizophrenia, and affective psychoses between sustained virological response and non-SVR hepatitis C virus patients among subgroups of age and gender with death as competing risk. HR, hazard ratio N.S., not significant SVR, sustained virological response.
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Hcv Transmission And Risk Factors
Well-established HCV risk factors include intravenous drug use, blood or blood product transfusions prior to 1992, and hemodialysis.19 Targeted screening for HCV infection in patients with 1 or more of these risk factors has been recommended by the Centers for Disease Control and is clearly warranted.20 However, evidence is beginning to emerge that other patient groups also may be at a higher risk for HCV infection when compared with the general US population.21 These groups include non-IV drug users,22,23,24 patients with high-risk sexual practices , and patients admitted to psychiatric hospitals.2527 Two distinct demographic groups that have an elevated prevalence of HCV infection include patients followed at the Department of Veterans Affairs hospitals 28,29 and incarcerated individuals .30 HCV is not considered a sexually transmitted disease however, having multiple sexual partners is a risk factor.19 The potential transmission of HCV infection through tattooing and body piercing remains a controversial issue there are insufficient data to consider patients with tattoos and body piercing at an elevated risk for HCV infection.19
Liver Function Tests And Hcv
Few prevalence studies analyzed liver function test derangement. Freudenreich et al36 reported an elevated alanine aminotransferase in 25% HCV seropositive individuals, while Hung et al47 reported 72.7% and Dinwiddie et al27 reported 39.4% . In each study, a statistically significant increase in ALT was noted among HCV seropositive individuals compared to HCV seronegative individuals. However, these data indicate that liver function tests alone are incompletely sensitive as a screening tool for HCV screening in SMI. Beyond liver function tests, severity and staging of liver disease have not been prospectively assessed in the SMI context despite the high prevalence of HCV.
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Risk Factors For Hcv In Smi
Given the increased prevalence of HCV in people with SMI, risk factor data were appraised. Lifetime IDU was reported in 10 studies, each prospective, with a pooled size of 4,541 individuals. A wide range of whole population IDU was noted across these studies . Studies that subanalyzed IDU among people with seropositive HCV found that 50.0%78.6% of people with HCV had IDU as a risk factor, although it is notable that these data were drawn from US and Australian cohorts .22,25,37,46,54 The apparent heterogeneity in HCV seroprevalence in PWID therefore likely reflects the nature and demographic of the sample cohorts as well as the methodology of data recording and reporting. Illicit substance abuse and/or history of general substance abuse disorder was more widely reported across included studies and, for the most part, mirrored HCV seroprevalence . Other reported HCV risk factors included high-risk sexual encounters, shared skin piercing equipment, transfusions, health care work exposures, and shared razor blades in institutions.24,37,39 Depression was more strongly associated with HCV compared to other primary mental health conditions based on multivariable analysis in 3 out of 4 studies that evaluated this.26,34,55,56 Quantitative analysis of risk factors relative to pooled seroprevalence was precluded by variable and lack of standardized reporting between individual studies.
Inclusion And Exclusion Criteria
Prospective observational and retrospective cross-sectional studies that assessed HCV prevalence in adults with SMI aged18 years were systematically reviewed. HCV prevalence was determined based on International Classification of Diseases, Ninth Revision coded data as well as seroprevalence data. Many of the extracted articles did not elucidate a specific definition for SMI in the recruitment strategy however, data were included if SMI, severe psychiatric illnesses, or an enduring mental illness with functional impairment was clearly stipulated as an inclusion criterion.
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Rationale For Bbv Screening In Smi And Barriers To Care
We show that BBV screening delivered through population-based programs has high acceptability among people with SMI. Nonetheless, real-world data suggest that people within mental health services are underserved from an HCV screening perspective. In a cross-sectional analysis of 57,170 SMI outpatients, 4.7% were screened for HCV over a 12-month period as compared to 12.4% in a general population comparator cohort, with the strongest predictor of HCV screening in the SMI group being non-psychiatric health care utilization.64 Importantly, person-centered blood-borne virus screening delivered through collocated specialist services has been shown to significantly bolster HCV screening rates in community-managed individuals with SMI.65 However, even with positive case identification, significant attrition in follow-up and treatment is commonly encountered.6567 Few publications in this systematic review addressed linkage to care in HCV-positive individuals however, known barriers exist as a composite of complex patient-related, clinician, and health system factors.8,10,66 For example, issues pertaining to access and retention within traditional specialist health care models may be experienced at a patient level. This may be compounded by perceived or actual stigma.66 From a clinician perspective, legacy concerns stemming from interferon-era therapies coupled with competing mental health care priorities may hinder advocacy and referral to HCV treatment services.66,68
Cumulative Incidence Of Hepatitis B Flares
The cumulative incidence of hepatitis B flares is shown in Figure 2. In the depression/anxiety cohort, the median duration of follow-up and the time to hepatitis B flares was 5.3 and 1.3 years, respectively. The Kaplan-Meier analysis indicated that in the first year, the incidence of hepatitis B flares was higher in the depression/anxiety cohort than in the control cohort, and this increased incidence persisted throughout the follow-up period .
Figure 2 Kaplan-Meier analysis of the cumulative risk of hepatitis B flares according to depression/anxiety status.
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