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Shiha G, Korenjak M, Eskridge W, Casanovas T, Velez-Moller P, Högström S, Richardson B, Munoz C, Sigurðardóttir S, Coulibaly A, Milan M, Bautista F, Leung NWY, Mooney V, Obekpa S, Bech E, Polavarapu N, Hamed AE, Radiani T, Purwanto E, Bright B, Ali M, Dovia CK, McColaugh L, Koulla Y, Dufour JF, Soliman R, Eslam M. Redefining fatty liver disease: an international patient perspective. Lancet Gastroenterol Hepatol 2020; 6:73-79. [PMID: 33031758 DOI: 10.1016/s2468-1253(20)30294-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
Despite its increased recognition as a major health threat, fatty liver disease associated with metabolic dysfunction remains largely underdiagnosed and undertreated. An international consensus panel has called for the disease to be renamed from non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) and has suggested how the disease should be diagnosed. This Viewpoint explores the call from the perspective of patient advocacy groups. Patients are well aware of the negative consequences of the NAFLD acronym. This advocacy group enthusiastically endorses the call to reframe the disease, which we believe will ultimately have a positive effect on patient care and quality of life and, through this effect, will reduce the burden on health-care systems. For patients, policy makers, health planners, donors, and non-hepatologists, the new acronym MAFLD is clear, squarely placing the disease as a manifestation of metabolic dysfunction and improving understanding at a public health and patient level. The authors from representative patient groups are supportive of this change, particularly as the new acronym is meaningful to all citizens as well as governments and policy makers, and, above all, is devoid of any stigma.
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Affiliation(s)
- Gamal Shiha
- European Liver Patients' Association (ELPA), Brussels, Belgium; World Hepatitis Alliance, London, UK; African Liver Patient Association (ALPA), Cairo, Egypt; Association of Liver Patients Care (ALPC), Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt.
| | - Marko Korenjak
- European Liver Patients' Association (ELPA), Brussels, Belgium; Association SLOVENIA HEP, Maribor, Slovenia
| | | | - Teresa Casanovas
- European Liver Patients' Association (ELPA), Brussels, Belgium; Asociación Catalana de Pacientes Hepáticos (ASSCAT), Barcelona, Spain
| | - Patricia Velez-Moller
- World Hepatitis Alliance, London, UK; Guatemala Liver Patients Association, Guatemala City, Guatemala
| | - Sari Högström
- European Liver Patients' Association (ELPA), Brussels, Belgium; Finnish Kidney and Liver Association, Helsinki, Finland
| | | | | | | | - Alioune Coulibaly
- World Hepatitis Alliance, London, UK; African Liver Patient Association (ALPA), Cairo, Egypt; Association for the Promotion of Health and Development in Mali (APSAD/MALI), Bamako, Mali; Association of the Malians of Washington DC (AMAW), Washington DC, USA
| | - Miskovikj Milan
- European Liver Patients' Association (ELPA), Brussels, Belgium; Hepar Centar, Bitola, North Macedonia
| | | | | | - Vicki Mooney
- The European Coalition for People Living with Obesity (EASO ECPO), Dublin, Ireland
| | - Solomon Obekpa
- African Liver Patient Association (ALPA), Cairo, Egypt; Advocacy for the Prevention of Hepatitis in Nigeria (APHIN), Benue State, Nigeria
| | - Eva Bech
- La Federación Nacional de Enfermos y Trasplantados Hepáticos (FNETH), Madrid, Spain
| | | | - Abd Elkhalek Hamed
- Arabic Association for the Study of Diabetes and Metabolism, Cairo, Egypt; Department of Internal Medicine, Hepatology, and Diabetes, Egyptian Military Medical Academy, Cairo, Egypt
| | - Temur Radiani
- European Liver Patients' Association (ELPA), Brussels, Belgium; Hepatitis C Cured Patient Association, Tbilisi, Georgia
| | | | | | - Mohammad Ali
- National Liver Foundation of Bangladesh, Dhaka, Bangladesh
| | - Cecil Kwaku Dovia
- World Hepatitis Alliance, London, UK; African Liver Patient Association (ALPA), Cairo, Egypt; Cedaku Foundation of Ghana, Ho, Ghana
| | | | | | - Jean-François Dufour
- Swiss NASH Foundation, Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, Bern, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Reham Soliman
- European Liver Patients' Association (ELPA), Brussels, Belgium; Association of Liver Patients Care (ALPC), Mansoura, Egypt; Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Department of Tropical Medicine, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, Australia.
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Abstract
This article explores mixed methods approaches with an illness called Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). Qualitative and Quantitative data were used to investigate the epidemiology of this illness, as well as explore attributions based on the name of the illness, and finally treatment approaches. In each of the domains within the ME and CFS research reviewed, our analyses were richer and our findings ultimately more impactful when we integrated qualitative and quantitative research methods. The use of a multiphase mixed methods research program provided our team unique vantage points for better understanding social and community issues involving this controversial chronic illness. Further, this approach allowed us to implement the insights gained through an advocacy lens to change policy, recommend and evaluate treatments, and amplify voices within the patient population. In this way, we believe that the practice of methodological pluralism is especially applicable and effective to the study of chronic illness, and believe other investigators will benefit from the use of these approaches with similar disenfranchised and unfairly treated populations.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, United States
| | - Jordan Reed
- Center for Community Research, DePaul University, Chicago, United States
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Jason LA, Holbert C, Torres-Harding S, Taylor RR, LeVasseur JJ, Breitinger P, LaBarbera D, Siegel L. Chronic Fatigue Syndrome versus Chronic Neuroendocrineimmune Dysfunction Syndrome. ACTA ACUST UNITED AC 2008; 18:43-55. [PMID: 15189800 DOI: 10.1300/j045v18n01_03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Since 1988, when the term chronic fatigue syndrome (CFS) was coined, considerable discussion has occurred about stigma associated with this diagnostic term. In particular, patients with CFS have felt that this term trivializes the serious nature of this disorder. A Name Change Work group, appointed by the CFS Coordinating Committee, developed an umbrella term: chronic neuroendocrineimmune dysfunction syndrome (CNDS), and proposed that there would be sub-types under this term, one being CFS. The present study examined attributions of this new umbrella term when compared with CFS. Nurses and physician assistants (PAs) were presented a case study of a patient with symptoms of CFS. They were told that the patient had either "chronic fatigue syndrome," "chronic neuroendocrineimmune dysfunction syndrome," or "chronic neuroendocrineimmune dysfunction syndrome, which had formerly been called chronic fatigue syndrome." The different terms led to different attributions, with PA respondents rating the "CNDS" label as more severe. Results suggest that a more medical sounding term (CNDS) may lead to attributions that this syndrome is a more serious, disabling illness. The policy implications of these findings are discussed.
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