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McCartney EM, Ralton L, Dawe J, Richmond J, Zobel J, Wigg A, Cock V, Tse EY, Rees T, Shaw D, Ferguson C. Point of care testing for hepatitis C in the priority settings of mental health, prisons and drug & alcohol facilities - the PROMPt Study. Clin Infect Dis 2024:ciae155. [PMID: 38513072 DOI: 10.1093/cid/ciae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 02/01/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND A barrier to hepatitis C virus (HCV) cure is conventional testing. The aim of this study was to evaluate the effect of HCV antibody and RNA point-of-care-testing (POCT) on testing rates, linkage to care, treatment and acceptability of testing in three priority settings in Australia. METHODS Participants were enrolled in an interventional cohort study at a reception prison, inpatient mental health service (MHS), and inpatient alcohol and other drug (AOD) unit-between October 2020 and December 2021. HCV POCT was performed using SD Bioline HCV antibody fingerstick test and a reflexive Xpert® HCV Viral Load Fingerstick test using capillary blood samples. A retrospective audit of HCV testing and treatment data was performed at each site for the preceding 12-month period to generate a historical control. RESULTS 1,549 participants received a HCV antibody test with 17% (264/1,549) receiving a positive result, of which 21% (55/264) tested HCV RNA positive. Across all settings the rate of testing per year significantly increased between the historical controls and the study intervention period by three-fold (RR:2.57 95% CI: 2.32, 2.85) for HCV antibody testing and four-fold (RR:1.62; 95% CI:1.31, 2.01) for RNA testing. Treatment uptake was higher during the POCT intervention (86%, 47/55; P=0.010) compared to the historical controls (61%, 27/44). CONCLUSIONS This study demonstrated across three settings that the use of HCV antibody and RNA POCT increased testing rates, treatment uptake linkage to care. The testing model was highly acceptable for most participants. CLINICAL TRIAL REGISTRATION ACTRN-12621001578897.
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Affiliation(s)
- Erin M McCartney
- Infectious Diseases Department, Royal Adelaide Hospital, South Australia, Australia
| | - Lucy Ralton
- Infectious Diseases Department, Royal Adelaide Hospital, South Australia, Australia
| | - Joshua Dawe
- Disease Elimination, Burnet Institute, Victoria, Australia
| | | | - Joshua Zobel
- Gastroenterolgy & Hepatology Department, Royal Adelaide Hospital, South Australia, Australia
| | - Alan Wigg
- Hepatology and Liver Transplantation Medicine Unit, Southern Adelaide Local Health Network, South Australia, Australia
| | - Victoria Cock
- Drug and Alcohol Services, South Australia, Australia
| | - Edmund Y Tse
- Gastroenterolgy & Hepatology Department, Royal Adelaide Hospital, South Australia, Australia
| | - Tom Rees
- Communicable Disease Control Branch, SA Health, South Australia, Australia
| | - David Shaw
- Infectious Diseases Department, Royal Adelaide Hospital, South Australia, Australia
| | - Catherine Ferguson
- Infectious Diseases Department, Royal Adelaide Hospital, South Australia, Australia
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Hayes MJ, Beavon E, Traeger MW, Dillon JF, Radley A, Nielsen S, Byrne CJ, Richmond J, Higgs P, Hellard ME, Doyle JS. Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102489. [PMID: 38440399 PMCID: PMC10909633 DOI: 10.1016/j.eclinm.2024.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Background The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Methods Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Findings Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%-23.0%; heterogeneity I2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. Interpretation These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. Funding None.
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Affiliation(s)
| | | | - Michael W. Traeger
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
| | - John F. Dillon
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | - Suzanne Nielsen
- Burnet Institute, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher J. Byrne
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | | | - Peter Higgs
- Burnet Institute, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
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Marukutira T, Barter R, Moore KP, Hellard ME, Richmond J, Turner K, Pedrana AE, Melody S, Johnston FH, Owen L, Boom WVD, Scott N, Thompson A, Iser DM, Spelman T, Veitch M, Stoové M, Doyle JS. Connecting patients notified with hepatitis C to treatment (CONNECT Study): A randomized controlled trial of active case management by a health department to support primary care practitioners. Int J Drug Policy 2023; 121:104184. [PMID: 37714008 DOI: 10.1016/j.drugpo.2023.104184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Despite subsidised access to direct-acting antivirals (DAAs), hepatitis C (HCV) treatment uptake in Australia is declining. Interventions are needed to link people living with HCV to care and treatment. We implemented and measured effectiveness of a state-wide, health department-led, enhanced case management through the primary care practitioner for all HCV notifications, aiming to encourage and support treatment commencement. METHODS A randomised controlled trial compared enhanced case management, delivered by the health department to diagnosing clinicians, with standard of care using notifiable disease systems in Tasmania, Australia (2020-21). The intervention involved a nurse specialist contacting and providing support by telephone to primary care practitioners making an HCV notification. The primary outcome was the proportion of cases notified with chronic hepatitis C who commenced treatment within 12 weeks of notification. We allowed a 12-week extended follow-up period at the end of the study for participants with no outcomes. RESULTS Eighty-five primary care practitioners randomised to the intervention and 86 to standard of care arms notified 111 and 115 HCV cases, respectively. The proportion of cases notified with chronic hepatitis (HCV RNA detected) commencing treatment within 12 weeks was similar between study arms (41% vs 33%; p=0·51) and after extended study follow-up (65% vs 48%; p=0·18). RNA test completion was higher in the intervention than in standard of care arm (89% vs. 78%; p=0·03), while completing pre-treatment workup for chronic patients (65% vs. 64%; p=0·93) was similar. CONCLUSION This was the first prospective randomised study of the utility of immediate HCV notification follow-up of primary care practitioners to enhance treatment uptake using disease notification surveillance data. We demonstrated improvement in HCV RNA testing and trend toward better engagement in care, but no significant increase in treatment uptake.
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Affiliation(s)
- Tafireyi Marukutira
- Public Health, Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | | | | | | | - Jacqui Richmond
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Kate Turner
- Department of Health, Hobart, Tasmania, Australia
| | - Alisa E Pedrana
- Public Health, Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shannon Melody
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | | | - Louise Owen
- Department of Health, Hobart, Tasmania, Australia
| | | | - Nick Scott
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David M Iser
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Timothy Spelman
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Mark Veitch
- Department of Health, Hobart, Tasmania, Australia
| | - Mark Stoové
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Public Health, Burnet Institute, Melbourne, Victoria, Australia; Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
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Mude WW, Fisher CM, Richmond J, Gautier RL, Wallace J. Social impacts of living with chronic hepatitis B in South Sudanese community in Australia. Ethn Health 2022; 27:529-541. [PMID: 32568555 DOI: 10.1080/13557858.2020.1782849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
Introduction: Chronic hepatitis B presents significant issues to public health and clinical practices. The infection requires lifelong clinical management and is a leading risk factor for liver cancer and liver cirrhosis. Limited studies currently exist on the social impacts of living with chronic hepatitis B, especially for people from Sub-Saharan Africa. The current study explored the experiences of South Sudanese people living with chronic hepatitis B in Australia.Methods: A qualitative inquiry using face-to-face interviews with fifteen South Sudanese people with chronic hepatitis B in Australia explored the social impacts of living with chronic hepatitis B. The study purposively sampled participants who self-identified as South Sudanese with hepatitis B and over 18 years of age. Interviews were coded and analysed using thematic analysis.Results: The study identified three themes relating to the experiences of living with chronic hepatitis B, and were grouped into psychological, interpersonal and healthcare system levels. Psychological level experiences related to the uncertainty of living with chronic hepatitis B and liver cancer risk, where participants expressed persistent fear of disease progression and anxiety around death related to the disease. Interpersonal level experiences involved the disclosure of hepatitis B and its social impacts including stigma, social distancing and isolation. Healthcare system level experiences included receiving mixed messages about hepatitis B, challenges with regular testing and difficulty receiving hepatitis B treatment.Conclusion: The findings provide valuable insights into the social impacts of hepatitis B. It underlines the importance of integrated public health interventions at the community level to improve knowledge and awareness of hepatitis B which address stigma in the South Sudanese community in Australia.
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Affiliation(s)
- William W Mude
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Christopher M Fisher
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Roslyn Le Gautier
- Palliative Medicine Research Group, The University of Melbourne & St Vincent's Hospital, Melbourne Australia
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5
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Marukutira T, Moore KP, Hellard M, Richmond J, Turner K, Pedrana AE, Melody S, Johnston FH, Owen L, Van Den Boom W, Scott N, Thompson A, Iser D, Spelman T, Veitch M, Stoové MA, Doyle J. Randomised controlled trial of active case management to link hepatitis C notifications to treatment in Tasmania, Australia: a study protocol. BMJ Open 2022; 12:e056120. [PMID: 35338062 PMCID: PMC8961121 DOI: 10.1136/bmjopen-2021-056120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION By subsidising access to direct acting antivirals (DAAs) for all people living with hepatitis C (HCV) in 2016, Australia is positioned to eliminate HCV as a public health threat. However, uptake of DAAs has declined over recent years and new initiatives are needed to engage people living with HCV in care. Active follow-up of HCV notifications by the health department to the notifying general practitioner (GP) may increase treatment uptake. In this study, we explore the impact of using hepatitis C notifications systems to engage diagnosing GPs and improve patient access to treatment. METHODS AND ANALYSIS This study is a randomised controlled trial comparing enhanced case management of HCV notifications with standard of care. The intervention includes phone calls from a department of health (DoH) specialist HCV nurse to notifying GPs and offering HCV management support. The level of support requested by the GP was graded in complexity: level 1: HCV information only; level 2: follow-up testing advice; level 3: prescription support including linkage to specialist clinicians and level 4: direct patient contact. The study population includes all GPs in Tasmania who notified HCV diagnosis to the DoH between September 2020 and December 2021. The primary outcome is proportion of HCV cases who initiate DAAs after 12 weeks of HCV notification to the health department. Secondary outcomes are proportion of HCV notifications that complete HCV RNA testing, treatment workup and treatment completion. Multiple logistic regression modelling will explore factors associated with the primary and secondary outcomes. The sample size required to detect a significant difference for the primary outcome is 85 GPs in each arm with a two-sided alpha of 0.05% and 80% power. ETHICS AND DISSEMINATION The study was approved by University of Tasmania's Human Research Ethics Committee (Protocol ID: 18418) on 17 December 2019. Results of the project will be presented in scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04510246. TRIAL PROGRESSION The study commenced recruitment in September 2020 and end of study expected December 2021.
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Affiliation(s)
- Tafireyi Marukutira
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiuology, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Karen P Moore
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | | | - Jacqui Richmond
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Kate Turner
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | - A E Pedrana
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Shannon Melody
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | - Fay H Johnston
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | - Louise Owen
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | | | - N Scott
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne Pvt Ltd, Fitzroy, Victoria, Australia
| | - David Iser
- Department of Gastroenterology, St Vincent's Hospital Melbourne Pvt Ltd, Fitzroy, Victoria, Australia
| | - Tim Spelman
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Mark Veitch
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | - Mark A Stoové
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Joseph Doyle
- Public Health, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
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6
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Wallace J, Xiao Y, Howell J, Thompson A, Allard N, Adamson E, Richmond J, Hajarizadeh B, Eagle M, Doyle J, Hellard M. Understanding how to live with hepatitis B: a qualitative investigation of peer advice for Chinese people living with hepatitis B in Australia. BMC Public Health 2022; 22:536. [PMID: 35303855 PMCID: PMC8932317 DOI: 10.1186/s12889-022-12907-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been diagnosed with hepatitis B, significant gaps remain in health care access and in accurate knowledge about hepatitis B. Most people with hepatitis B in Australia were born in China, where the infection has an intergenerational impact with significant social implications resulting from the infection. Understanding how people of Chinese ethnicity with hepatitis B understand and respond to hepatitis B is imperative for reducing morbidity, mortality, and the personal and social impact of the infection. METHODS Qualitative semi-structured interviews with people with hepatitis B of Chinese ethnicity recruited through a specialist service identified the advice people with hepatitis B thought was important enough to inform the experience of people newly diagnosed with hepatitis B. A thematic analysis of the data privileged the lived experience of participants and their personal, rather than clinical, explanations of the virus. RESULTS Hepatitis B infection had psychological and physical consequences that were informed by cultural norms, and to which people had responded to with significant behavioural change. Despite this cohort being engaged with specialist clinical services with access to the most recent, comprehensive, and expert information, much of the advice people with hepatitis B identified as important for living with hepatitis B was not based on biomedical understandings. Key suggestions from people with hepatitis B were to form sustainable clinical relationships, develop emotional resilience, make dietary changes, regulate energy, and issues related to disclosure. CONCLUSIONS The study highlights conflicts between biomedical and public health explanations and the lived experience of hepatitis B among people of Chinese ethnicity in Australia. Beliefs about hepatitis B are embedded within cultural understandings of health that can conflict with bio-medical explanations of the infection. Acknowledging these perspectives provides for insightful communication between health services and their clients, and the development of nuanced models of care informed by the experience of people with hepatitis B.
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Affiliation(s)
- Jack Wallace
- Burnet Institute, Melbourne, VIC, 3004, Australia. .,La Trobe University, Bundoora, VIC, 3086, Australia. .,Centre for Social Research in Health, University of New South Wales Sydney, Kensington, NSW, 2052, Australia.
| | - Yinzong Xiao
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jess Howell
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Alex Thompson
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia
| | - Nicole Allard
- World Health Organization Collaborating Centre for Viral Hepatitis, The Doherty Institute, Melbourne, VIC, 3004, Australia
| | | | - Jacqui Richmond
- Burnet Institute, Melbourne, VIC, 3004, Australia.,La Trobe University, Bundoora, VIC, 3086, Australia
| | - Behzad Hajarizadeh
- Kirby Institute, University of New South Wales Sydney, Kensington, NSW, 2052, Australia
| | | | - Joseph Doyle
- Burnet Institute, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, 3004, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, 3004, Australia.,University of Melbourne, Parkville, VIC, 3010, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, 3004, Australia
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7
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Xiao Y, Wallace J, Thompson A, Hellard M, van Gemert C, Holmes JA, Croagh C, Richmond J, Papaluca T, Hall S, Hong T, Demediuk B, Iser D, Ryan M, Desmond P, Visvanathan K, Howell J. A qualitative exploration of enablers for hepatitis B clinical management among ethnic Chinese in Australia. J Viral Hepat 2021; 28:925-933. [PMID: 33662159 DOI: 10.1111/jvh.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 12/09/2022]
Abstract
An estimated 18% of people living with chronic hepatitis B (CHB) in Australia were born in China. While guideline-based care, including regular clinical monitoring and timely treatment, prevent CHB-related cirrhosis, cancer and deaths, over three-quarters of people with CHB do not receive guideline-based care in Australia. This qualitative study aimed to identify enablers to engagement in CHB clinical management among ethnic Chinese people attending specialist care. Participants self-identified as of Chinese ethnicity and who attended specialist care for CHB clinical management were interviewed in Melbourne in 2019 (n = 30). Semi-structured interviews covered experiences of diagnosis and engagement in clinical management services, and advice for people living with CHB. Interviews were recorded with consent; data were transcribed verbatim and thematically analysed. Receiving clear information about the availability of treatment and/or the necessity of long-term clinical management were the main enablers for participants to engage in CHB clinical management. Additional enablers identified to maintain regular clinical monitoring included understanding CHB increases risks of cirrhosis and liver cancer, using viral load indicators to visualize disease status in patient-doctor communication; expectations from family, peer group and medical professionals; use of a patient recall system; availability of interpreters or multilingual doctors; and largely subsidized healthcare services. In conclusion, to support people attending clinical management for CHB, a holistic response from community, healthcare providers and the public health sector is required. There are needs for public health programmes directed to communicate (i) CHB-related complications; (ii) availability of effective and cheap treatment; and that (iii) long-term engagement with clinical management and its benefits.
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Affiliation(s)
- Yinzong Xiao
- Burnet Institute, Melbourne, VIC, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, VIC, Australia.,La Trobe University, Bundoora, VIC, Australia
| | - Alex Thompson
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Caroline van Gemert
- Burnet Institute, Melbourne, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Jacinta A Holmes
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Catherine Croagh
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | | | - Tim Papaluca
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Samuel Hall
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Thai Hong
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Barbara Demediuk
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - David Iser
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Marno Ryan
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Paul Desmond
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Kumar Visvanathan
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Jess Howell
- Burnet Institute, Melbourne, VIC, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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8
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Raef H, Wong L, Garelli C, Kim E, Ahmed M, Pike K, Moses S, Harris J, Marshak-Rothstein A, Rashighi M, Richmond J. 041 CXCR3 blockade reduces skin germinal center B cells and autoantibody titers in murine cutaneous lupus erythematosus. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Olayinka J, Garelli C, Wong N, Piedra-Mora C, David C, Robinson N, Richmond J. 074 Cutaneous T-cell lymphoma and canine epitheliotropic lymphoma: A comparative analysis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Flanagan EK, Richmond J, Thompson AJ, Desmond PV, Bell SJ. Addressing pregnancy-related concerns in women with inflammatory bowel disease: Insights from the patient's perspective. JGH Open 2021; 5:28-33. [PMID: 33490610 PMCID: PMC7812482 DOI: 10.1002/jgh3.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 12/17/2022]
Abstract
Background and Aim Therapeutic options for inflammatory bowel disease (IBD) have expanded, as has the use of IBD medications in women during the reproductive period. However, no qualitative data exist that examine the pregnancy‐related concerns of women with IBD in the current era of widespread immunomodulator and biologic use. Hence, we aimed to explore in detail the impact of IBD on pregnancy from the patient's perspective. Methods This qualitative study used semistructured interviews to explore participants' experiences regarding IBD and pregnancy until no new themes emerged. Key themes were identified using thematic analysis. Results Fifteen women with IBD were interviewed. The majority of participants reported lingering concerns regarding their IBD medications, despite advice from their gastroenterologist that the drugs were considered safe in pregnancy. Participants more often reported medication‐related fears, such as potential negative effects on their child's immune system, than concerns regarding the effect of the disease itself on their pregnancy outcomes. A common theme was a perceived lack of knowledge among non‐IBD clinicians regarding IBD medications during pregnancy, which augmented pre‐existing anxiety. Conclusions This study is the first of its kind to provide an in‐depth assessment of female patients' perspectives of IBD in relation to conception, pregnancy, and caring for offspring. In particular, this research characterizes the unique fears and persisting anxieties regarding IBD medications in pregnancy. The study has unearthed important insights into the specific concerns and support needs of women with IBD in order to facilitate nonjudgmental counseling designed around patient concerns and beliefs.
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Affiliation(s)
- Emma K Flanagan
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia
| | - Jacqui Richmond
- Disease Elimination The Burnet Institute Melbourne Victoria Australia.,The Australian Research Centre in Sex, Health and Society La Trobe University Melbourne Victoria Australia
| | - Alexander J Thompson
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia
| | - Paul V Desmond
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia
| | - Sally J Bell
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Gastroenterology, Monash Health Melbourne Victoria Australia
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Sheahen B, Brillante D, Richmond J. 421a Thoracic Aortic Dilatation: A general Cardiology Practice Experience. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Tran S, Bennett G, Richmond J, Nguyen T, Ryan M, Hong T, Howell J, Demediuk B, Desmond P, Bell S, Thompson A. 'Teach-back' is a simple communication tool that improves disease knowledge in people with chronic hepatitis B - a pilot randomized controlled study. BMC Public Health 2019; 19:1355. [PMID: 31647001 PMCID: PMC6813056 DOI: 10.1186/s12889-019-7658-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The low diagnosis rate and poor access to clinical care among people with CHB is a major barrier to reducing HBV-related morbidity and mortality in Australia. One explanation for this is a lack of disease-specific knowledge among people living with CHB. Health literacy has been shown to be important for maximising engagement with medical care and adherence to recommended management. The 'teach-back' communication strategy has been shown to improve patient understanding in other clinical areas. This study aims to assess disease-specific knowledge; and evaluate the efficacy of the teach-back strategy for improving HBV knowledge, compared to a standard medical consultation. METHOD A randomized pilot study was conducted between February and June 2017. Participants were recruited from the liver clinic at an inner-city tertiary hospital. English-speaking patients aged ≥18 years and diagnosed with CHB were eligible for the study. Participants were randomised to a control group (medical specialist appointment) and intervention group (teach-back). Knowledge was assessed at baseline, immediately post-intervention and at one month using a validated questionnaire. Participants in the intervention group received a one-on-one teach-back session about CHB. The main outcome measure was a combined knowledge score of the domains assessed - transmission, natural history, epidemiology and prevention and clinical management. RESULTS Seventy participants were recruited (control n = 32, teach-back n = 38). Mean baseline knowledge score was 19.1 out of 23 with 55 (79%) participants scoring ≥17.3 (defined as high knowledge) (7). Sub-analysis of CHB knowledge domains identified focal deficits concerning transmission and whether HBV is curable. Knowledge scores were found to be positively associated with English proficiency and antiviral treatment experience (p < 0.05). Teach-back was associated with a significant increase in CHB knowledge at early recall (22.5 vs 18.7, p < 0.001) and at 1-month follow-up (21.9 vs 18.7, p < 0.001); there was no improvement in CHB knowledge associated with standard clinical consultant (early recall: 19.6 vs 19.4, p = 0.49, one-month follow-up: 19.5 vs 19.4, p = 0.94). CONCLUSION In a tertiary hospital liver clinic population, baseline knowledge about CHB was good, but there were focal deficits concerning transmission and potential for cure. Teach-back was associated with improvement in CHB knowledge and it is a simple communication tool suitable for incorporation into a standard medical consultation.
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Affiliation(s)
- Sophie Tran
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Gabrielle Bennett
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Jacqui Richmond
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
- The Burnet Institute, Disease Elimination, 85 Commercial Road, Prahran, Melbourne, 3004 Australia
| | - Tin Nguyen
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Marno Ryan
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Thai Hong
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Jessica Howell
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Barbara Demediuk
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Paul Desmond
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Sally Bell
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Alexander Thompson
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
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Kelly M, Richmond J, Singaroyan N, Kerr T, O’Donnell A, Masterson E, Haughey C, Harney O, Walsh J, Groarke J. A pilot trial to investigate the impact of a personalised self-management lifestyle programme using mobile technology on the health and wellbeing of cancer survivors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz275.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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DOWNE K, Richmond J, Sharma S. MON-094 EXTENDED HOURS IN-CENTRE NOCTURNAL HAEMODIALYSIS, A REGIONAL AUSTRALIAN PERSPECTIVE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Mude W, Fisher C, Richmond J, Wallace J, Le Gautier R. A qualitative investigation of barriers, support-seeking and coping among South Sudanese people with chronic hepatitis B in Australia. Aust J Prim Health 2019; 25:264-274. [PMID: 31213224 DOI: 10.1071/py19015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
This inquiry examines health-seeking practices and challenges among South Sudanese people from refugee backgrounds with chronic hepatitis B in Australia. Fifteen semi-structured interviews were conducted. Using interpretative thematic analysis, the results revealed four themes, consisting of barriers and facilitators to clinical follow up, treatment and support-seeking practices and coping responses. Time constraints, having divergent views about treatment decisions and perceived inadequate clinical support were also identified as barriers. Being referred to a specialist, being aware of the risk associated with liver cancer and sending reminders about appointments were identified as facilitators to clinical follow up. Treatment-seeking practices involved both biomedical and alternative therapies. Participants mainly drew on their social networks and supports, religious beliefs and individual resilience as coping strategies. The findings are important for improving access to treatment and care and support for people with chronic hepatitis B from the South Sudanese community.
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Affiliation(s)
- William Mude
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia; and Corresponding author
| | - Christopher Fisher
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
| | - Jacqui Richmond
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
| | - Roslyn Le Gautier
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
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16
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Patel D, Mande P, Moses S, Harris J, Rothstein A, Richmond J. 095 Targeting CXCR3 in a mouse model of cutaneous lupus Eeythematosus. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Azzolino V, Grag M, Zapata L, Richmond J, Riding R, Strassner J. 029 JAK inhibitors prevent and reverse vitiligo in mice, but do not eliminate established autoreactive T cells in the skin. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Power J, Westle A, Dowsett GW, Lucke J, Tucker JD, Sugarman J, Lewin SR, Hill S, Brown G, Wallace J, Richmond J. Perceptions of HIV cure research among people living with HIV in Australia. PLoS One 2018; 13:e0202647. [PMID: 30142171 PMCID: PMC6108463 DOI: 10.1371/journal.pone.0202647] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Abstract
Participation in HIV cure-related clinical trials that involve antiretroviral treatment (ART) interruption may pose substantial individual risks for people living with HIV (PLHIV) without any therapeutic benefit. As such, it is important that the views of PLHIV are considered in the design of HIV cure research trials. Examining the lived experience of PLHIV provides unique and valuable perspectives on the risks and benefits of HIV cure research. In this study, we interviewed 20 PLHIV in Australia about their knowledge and attitudes toward clinical HIV cure research and explored their views regarding participation in HIV cure clinical trials, including those that involve ART interruption. Data were analysed thematically, using both inductive and deductive coding techniques, to identity themes related to perceptions of HIV cure research and PLHIV's assessment of the possible risks and benefits of trial participation. Study findings revealed interviewees were willing to consider participation in HIV cure research for social reasons, most notably the opportunity to help others. Concerns raised about ART interruption related to the social and emotional impact of viral rebound, including fear of onward HIV transmission and anxiety about losing control. These findings reveal the ways in which PLHIV perspectives deepen our understanding of HIV cure research, moving beyond a purely clinical assessment of risks and benefits in order to consider the social context.
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Affiliation(s)
- Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- * E-mail:
| | - Andrew Westle
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Gary W. Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Centre for Social Research in Health, University of NSW, Sydney, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Joseph D. Tucker
- UNC Project-China, University of North Carolina, Guangzhou, China
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sharon R. Lewin
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Centre for Social Research in Health, University of NSW, Sydney, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Jacqui Richmond
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
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O'Leary DA, Cropp E, Isaac D, Desmond PV, Bell S, Nguyen T, Wong D, Howell J, Richmond J, O'Neill J, Thompson AJ. "B in IT" - a community-based model for the management of hepatitis B patients in primary care clinics using a novel web-based clinical tool. Hepatol Med Policy 2018; 3:1. [PMID: 30288324 PMCID: PMC5918916 DOI: 10.1186/s41124-017-0031-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/19/2017] [Indexed: 12/25/2022]
Abstract
Background The current model of care for the treatment of chronic hepatitis B (CHB) in Australia is through specialist Hepatology or Infectious Diseases clinics, and limited accredited primary care practices. Capacity is limited, and less than 5% of Australians living with CHB currently access therapy. Increasing treatment uptake is an urgent area of clinical need. Nucleos(t)ide analogue therapy is safe and effective treatment for CHB that is suitable for community prescribing. We have evaluated the success of a community-based model for the management of CHB in primary care clinics using a novel web-based clinical tool. Methods Using guidelines set out by the Gastroenterological Society of Australia, we developed an interactive online clinical management tool for the shared care of patients with CHB in primary care clinics, with remote oversight from tertiary hospital-based hepatologists and a project officer. We call this model of care the “B in IT” program. Suitable patients were referred from the specialist liver clinic back to primary care for ongoing management. Compliance with recommended appointments, pathology tests and ultrasounds of patients enrolled in “B in IT” was assessed and compared to that of the same patients prior to community discharge, as well as a matched control group of CHB outpatients continuing to attend a specialist clinic. Results Thirty patients with CHB were enrolled in the “B in IT” program. Compliance with attending scheduled appointments within 1 month of the suggested date was 87% across all 115 visits scheduled. Compliance with completing recommended pathology within 1 month of the suggested date was 94% and compliance with completing recommended liver ultrasounds for cancer screening within 1 month of the suggested date was 89%. The compliance rates for visit attendance and ultrasound completion were significantly higher than the control patient group (p < 0.0001) and the “B in IT” patients prior to community discharge (p = 0.002 and p = 0.039, respectively). Conclusions The “B in IT” program’s novel web-based clinical tool supports primary care physicians to treat and monitor patients with CHB. This program promotes community-based care and increases system capacity for the clinical care of people living with CHB.
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Affiliation(s)
- Debra A O'Leary
- 1Gastroenterology Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - Eleanor Cropp
- 1Gastroenterology Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - David Isaac
- 2GP Liaison Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia.,North Richmond Community Health, 23 Lennox Street, Richmond, VIC 3121 Australia
| | - Paul V Desmond
- 1Gastroenterology Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - Sally Bell
- 1Gastroenterology Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - Tin Nguyen
- 1Gastroenterology Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - Darren Wong
- 1Gastroenterology Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - Jessica Howell
- 1Gastroenterology Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - Jacqui Richmond
- 4Victorian Infectious Diseases Service, The Royal Melbourne Hospital, 300 Gratten Street, Parkville, Melbourne, VIC 3000 Australia.,5La Trobe University, The Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, VIC 3000 Australia.,6Department of General Practice, The University of Melbourne, 200 Berkeley Street, Parkville, Melbourne, VIC 3000 Australia
| | - Jenny O'Neill
- EpiSoft Pty Ltd, Suite 216, 20 Dale Street, Brookvale, NSW 2100 Australia
| | - Alexander J Thompson
- 1Gastroenterology Department, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065 Australia
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20
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Allard N, Cabrie T, Wheeler E, Richmond J, MacLachlan J, Emery J, Furler J, Cowie B. The challenge of liver cancer surveillance in general practice: Do recall and reminder systems hold the answer? Aust Fam Physician 2017; 46:859-864. [PMID: 29101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) surveillance reduces mortality in at-risk people living with chronic hepatitis B (CHB), but is difficult to achieve in practice. The objective of this study was to measure participation and adherence to liver cancer HCC surveillance in eligible patients in a community health centre, following support from the Integrated Hepatitis B Service (IHBS). METHODS A retrospective analysis of the medical records of patients with CHB who met the indications for HCC surveillance over a 4.5-year period of IHBS involvement was conducted. Data collected included the date of ultrasound examinations and HBV DNA viral load tests. RESULTS Sixty-seven patients underwent HCC surveillance, representing 213 person years. The participation rate was 75%. Adherence to surveillance was considered good in 18 (27%) patients, suboptimal in 29 (43%) patients and poor in 20 (30%) patients. A greater proportion of patients were receiving HCC surveillance at the final audit (56%) than at baseline (10%; P DISCUSSION: It is difficult to achieve optimal adherence to HCC surveillance, even with additional support.
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21
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Wallace J, Pitts M, Liu C, Lin V, Hajarizadeh B, Richmond J, Locarnini S. More than a virus: a qualitative study of the social implications of hepatitis B infection in China. Int J Equity Health 2017; 16:137. [PMID: 28764768 PMCID: PMC5540563 DOI: 10.1186/s12939-017-0637-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/26/2017] [Indexed: 02/08/2023] Open
Abstract
Background China has the largest absolute number of people living with hepatitis B with up to 300,000 people estimated to die each year from hepatitis B related diseases. Despite advances in immunisation, clinical management, and health policy, there is still a lack of accessible and affordable health care for people with hepatitis B. Through in-depth interviews, this study identifies the personal, social and economic impact of living with hepatitis B and considers the role of stigma and discrimination as barriers to effective clinical management of the disease. Methods Semi-structured qualitative interviews were held with 41 people living with hepatitis B in five Chinese cities. Participants were recruited through clinical and non-government organisations providing services to people with hepatitis B, with most (n = 32) being under the age of 35 years. Results People living with hepatitis B experience the disease as a transformative intergenerational chronic infection with multiple personal and social impacts. These include education and employment choices, economic opportunities, and the development of intimate relationships. While regulations reducing access to employment and education for people with hepatitis B have been repealed, stigma and discrimination continue to marginalise people with hepatitis B. Conclusions Effective public policy to reduce morbidity and mortality associated with hepatitis B needs to address the lived impact of hepatitis B on families, employment and educational choices, finances, and social marginalisation.
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Affiliation(s)
- J Wallace
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Victoria, 3000, Australia.
| | - M Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Victoria, 3000, Australia
| | - C Liu
- China Health Program, La Trobe University, Melbourne, Australia
| | - V Lin
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - B Hajarizadeh
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Victoria, 3000, Australia.,The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, Australia
| | - J Richmond
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Victoria, 3000, Australia
| | - S Locarnini
- Victorian Infectious Diseases Reference Laboratory, Director, WHO Regional Reference Laboratory for Hepatitis B, Doherty Institute, Melbourne, Australia
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Wong E, Pedrana A, Draper B, Gold J, Richmond J, Stoove M, Doyle J, Thompson A, Hellard M. O17 Eliminate Hepatitis C Partnership: clinical site scoping. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Bennett G, Tran S, Richmond J, Thompson A. P8 Using ‘teach-back’ with clients who live with chronic hepatitis B: does it improve understanding? J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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24
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Jones L, Carol H, Evans K, Richmond J, Houghton PJ, Smith MA, Lock RB. A review of new agents evaluated against pediatric acute lymphoblastic leukemia by the Pediatric Preclinical Testing Program. Leukemia 2016; 30:2133-2141. [PMID: 27416986 DOI: 10.1038/leu.2016.192] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 05/31/2016] [Accepted: 07/04/2016] [Indexed: 02/07/2023]
Abstract
Acute lymphoblastic leukemia (ALL) in children exemplifies how multi-agent chemotherapy has improved the outcome for patients. Refinements in treatment protocols and improvements in supportive care for this most common pediatric malignancy have led to a cure rate that now approaches 90%. However, certain pediatric ALL subgroups remain relatively intractable to treatment and many patients who relapse face a similarly dismal outcome. Moreover, survivors of pediatric ALL suffer the long-term sequelae of their intensive treatment throughout their lives. Therefore, the development of drugs to treat relapsed/refractory pediatric ALL, as well as those that more specifically target leukemia cells, remains a high priority. As pediatric malignancies represent a minority of the overall cancer burden, it is not surprising that they are generally underrepresented in drug development efforts. The identification of novel therapies relies largely on the reappropriation of drugs developed for adult malignancies. However, despite the large number of experimental agents available, clinical evaluation of novel drugs for pediatric ALL is hindered by limited patient numbers and the availability of effective established drugs. The Pediatric Preclinical Testing Program (PPTP) was established in 2005 to provide a mechanism by which novel therapeutics could be evaluated against xenograft and cell line models of the most common childhood malignancies, including ALL, to prioritize those with the greatest activity for clinical evaluation. In this article, we review the results of >50 novel agents and combinations tested against the PPTP ALL xenografts, highlighting comparisons between PPTP results and clinical data where possible.
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Affiliation(s)
- L Jones
- Leukaemia Biology Program, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, New South Wales, Australia
| | - H Carol
- Leukaemia Biology Program, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, New South Wales, Australia
| | - K Evans
- Leukaemia Biology Program, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, New South Wales, Australia
| | - J Richmond
- Leukaemia Biology Program, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, New South Wales, Australia
| | - P J Houghton
- Molecular Medicine, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - M A Smith
- Cancer Therapy Evaluation Program, NCI, Bethesda, MD, USA
| | - R B Lock
- Leukaemia Biology Program, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, New South Wales, Australia
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Hajarizadeh B, Richmond J, Ngo N, Lucke J, Wallace J. Hepatitis B-Related Concerns and Anxieties Among People With Chronic Hepatitis B in Australia. Hepat Mon 2016; 16:e35566. [PMID: 27630722 PMCID: PMC5010884 DOI: 10.5812/hepatmon.35566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/02/2016] [Accepted: 04/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The psychological wellbeing of people with chronic hepatitis B (CHB) may be negatively affected due to the chronic and transmissible nature of the disease, and possible serious complications (e.g. cirrhosis and liver cancer). There are limited data investigating concerns and anxieties among people living with CHB. OBJECTIVES This study examined feelings about having hepatitis B among people with CHB, including hepatitis B-related concerns and anxieties. PATIENTS AND METHODS Using convenience sampling, people with CHB attending four public liver clinics and one general practice in three Australian jurisdictions between April and September 2013 completed a self-administered questionnaire about their feelings about having hepatitis B. RESULTS Ninety-three people completed the survey. Mean age was 45 years, 57% were men, and 93% were born overseas (75% from Asia). Seventy-six percent of participants reported having hepatitis B-related concerns and anxieties. The most common concerns were of developing liver cancer (57%), and infecting other people (53%). Thirty-five percent of participants were unwilling to talk to anyone about their hepatitis B while 25% changed how they lived as a result of having hepatitis B. Lower educational level was associated with feeling scared of hepatitis B (adjusted Odds Ratio [OR]: 4.04; 95%CI: 1.09, 14.90; P = 0.04), and an unwillingness to talk to anyone about hepatitis B (adjusted OR: 4.41; 95%CI: 1.09, 17.83; P = 0.04). Very good English proficiency was associated with a higher likelihood of participants changing how they lived (adjusted OR: 12.66; 95%CI: 2.21, 72.42; P < 0.01), and seeing life differently as a result of having hepatitis B (adjusted OR: 21.10; 95%CI: 3.70, 120.19; P < 0.01). Health professionals were the key person for 34% of participants in helping them cope with having hepatitis B, while 18% reported that no one supported them. CONCLUSIONS Hepatitis B-related concerns and anxieties are prevalent among people with CHB. Clinical management of people with CHB must address their psychological support needs as an essential component of comprehensive care.
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Affiliation(s)
- Behzad Hajarizadeh
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, Australia
- Corresponding Author: Behzad Hajarizadeh, Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia. Tel: +61-394798736, Fax: +61-392855220, E-mail:
| | - Jacqui Richmond
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Naomi Ngo
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
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Hajarizadeh B, Wallace J, Richmond J, Ngo N, Enright C. Hepatitis B knowledge and associated factors among people with chronic hepatitis B. Aust N Z J Public Health 2015; 39:563-8. [PMID: 26095536 DOI: 10.1111/1753-6405.12378] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/01/2014] [Accepted: 01/01/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess hepatitis B knowledge among people with chronic hepatitis B (CHB) in Australia. METHODS People with CHB in three Australian jurisdictions completed a self-administered questionaire, including 24 hepatitis B knowledge questions across four domains: transmission; natural history; epidemiology and prevention; and clinical management. RESULTS Ninety-three people completed the survey. Mean age was 45 years, 43% were women and 93% were born overseas (75% from Asia). Mean total knowledge score was 55 out of 100 with 17 participants (18%) scoring ≥75 (defined as a high knowledge). Clinical management scored the lowest (median: 25) and natural history scored the highest (median: 80). In adjusted linear regression, tertiary education (vs. secondary and under) was associated with higher knowledge score (β: 11.95; 95%CI: 2.45, 21.44; p=0.01). In adjusted logistic regression, very good English proficiency (vs. limited/no proficiency) was associated with high knowledge (OR: 7.65; 95%CI: 1.94, 30.19; p<0.01). Participants reporting hepatitis B-related anxiety demonstrated a significantly higher knowledge score compared to those reporting no such anxiety (β: 15.11; 95%CI: 4.40, 25.81; p<0.01). CONCLUSIONS AND IMPLICATIONS Hepatitis B-related knowledge gaps were identified among people with CHB. Interventions to improve knowledge should focus on people with low levels of academic education and limited English proficiency.
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Affiliation(s)
- Behzad Hajarizadeh
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Victoria.,The Kirby Institute, UNSW Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Victoria
| | - Jacqui Richmond
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Victoria
| | - Naomi Ngo
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Victoria
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Wallace J, Hajarizadeh B, Richmond J, McNally S. Challenges in managing patients in Australia with chronic hepatitis B: the General Practitioners' perspective. Aust N Z J Public Health 2014; 37:405-10. [PMID: 24090321 DOI: 10.1111/1753-6405.12127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE General Practitioners (GPs) are essential to reducing the impact of chronic hepatitis B (CHB) given their clinical management role where only 56% of people with the infection in Australia have been diagnosed. This qualitative study aimed to identify the challenges GPs face in effectively responding to CHB. METHODS Semi-structured interviews were conducted with 26 GPs self-identifying as having a 'high caseload' of patients and/or a particular interest in CHB. Participants were recruited from five jurisdictions and came from diverse ethnicities, clinical experience and practice profile. Interview data were analysed according to the principles of grounded theory. RESULTS Patient and GP knowledge, a lack of community awareness, and language and cultural diversity impeded the GP response to CHB. Communication with specialists was reported as challenging with unclear referral pathways, limited feedback from specialists after referral, and poor liaison and support for managing people living with CHB. Regulations restricting GPs capacity to respond included the lack of prescribing opportunities, fear of Medicare auditing for screening the populations most at risk, and inadequate financial support given the complexity of CHB and the communities most affected by the infection. CONCLUSIONS General Practitioners require additional skills and resources to support the effective management of people with CHB. These include improved awareness and knowledge about the infection, adequate financial resources to support patient management, and effective referral pathways and support.
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Affiliation(s)
- Jack Wallace
- Australian Research Centre in Sex, Health and Society, Latrobe University, Victoria Australian Research Centre in Sex, Health and Society, Latrobe University, Victoria; Viral Hepatitis Clinical Research Program, The Kirby Institute, The University of New South Wales Australian Research Centre in Sex, Health and Society, Latrobe University, Victoria
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Affiliation(s)
- J. Richmond
- Cancer and Palliative Care Services; Toowoomba Health Service; Toowoomba Queensland Australia
| | - P. Gilbar
- Cancer and Palliative Care Services; Toowoomba Health Service; Toowoomba Queensland Australia
- School of Medicine (Rural Clinical School); University of Queensland; Toowoomba Queensland Australia
| | - E. Abro
- Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
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Wallace J, McNally S, Richmond J, Hajarizadeh B, Pitts M. Challenges to the effective delivery of health care to people with chronic hepatitis B in Australia. Sex Health 2012; 9:131-7. [DOI: 10.1071/sh10137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 05/02/2011] [Indexed: 11/23/2022]
Abstract
Background
The complexity of the hepatitis B natural history and its prevalence in specific populations in Australia challenges the capacity of the health system to deliver health care effectively to affected people. This study explores the challenges in delivering health care to people with chronic hepatitis B (CHB) in Australia. Methods: We conducted a grounded theory based qualitative study in which data were gathered from 70 in-depth interviews with government program officers, clinicians and health and community workers across Australia, and four focus group discussions with 40 health and community workers from the communities most at risk of CHB. Results: A systematic approach to screening populations at risk, including people born in countries with intermediate or high prevalence of CHB; consensus on clinical guidelines; development of a shared care framework for CHB involving general practitioners; and effective communication between patients and health professionals were identified as essential. Workforce development, particularly for primary health care professionals, and developing the knowledge and capacity of health professionals to communicate effectively with people with HBV were described as other major factors in reducing the barriers to CHB treatment in Australia. Conclusion: To improve the clinical management of people with CHB in Australia, the health system needs to encourage the screening of people at risk, improve access to clinical services, and the knowledge and communication skills of primary health care and community health service providers. This study supported developing a shared care model and related infrastructures including training programs, referral pathways and clinical guidelines.
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Wallace J, McNally S, Richmond J, Hajarizadeh B, Pitts M. Managing chronic hepatitis B: A qualitative study exploring the perspectives of people living with chronic hepatitis B in Australia. BMC Res Notes 2011; 4:45. [PMID: 21371332 PMCID: PMC3060129 DOI: 10.1186/1756-0500-4-45] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 03/03/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of a comprehensive public health response to hepatitis B in Australia is urgently required to reduce the increasing burden of hepatitis B infection on the health system and the community. A significant gap in the public health response to hepatitis B is an understanding of how people with chronic hepatitis B (CHB) respond to CHB. FINDINGS A qualitative study involving semi-structured interviews and focus group discussions was conducted. Interviews were held with 20 people with CHB from three states of Australia. In addition, four focus group discussions were held with a total of 40 community and health workers from culturally and linguistically diverse communities in four Australian states.People with CHB reported no formal or informal pre or post test discussion with little information about hepatitis B provided at the point of diagnosis. Knowledge deficits about hepatitis B were found among most participants. Few resources are available for people with CHB or their families to assist them in understanding the infection and promoting their health and well-being. A lack of confidence in the professional knowledge of service providers was noted throughout interviews. CONCLUSIONS People with CHB need culturally and linguistically appropriate education and information, particularly at the point of diagnosis. Primary health care professionals need the knowledge, skills and motivation to provide appropriate information to people with CHB, to ensure they have the capacity to better manage their infection.
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Affiliation(s)
- Jack Wallace
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne VIC, Australia
| | - Stephen McNally
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne VIC, Australia
| | - Jacqui Richmond
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy VIC, Australia
| | - Behzad Hajarizadeh
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne VIC, Australia
| | - Marian Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne VIC, Australia
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Bailey DE, Barroso J, Muir AJ, Sloane R, Richmond J, McHutchison J, Patel K, Landerman L, Mishel MH. Patients with chronic hepatitis C undergoing watchful waiting: Exploring trajectories of illness uncertainty and fatigue. Res Nurs Health 2010; 33:465-73. [PMID: 20730869 PMCID: PMC3525323 DOI: 10.1002/nur.20397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We identified trajectories of illness uncertainty in chronic hepatitis C patients and examined their association with fatigue levels during 12 months of disease monitoring without treatment (watchful waiting). Sixty-two men and 63 women completed uncertainty and fatigue measures. Groups were formed by uncertainty scores (high, medium, and low) at baseline. Baseline fatigue levels were higher in the high uncertainty group than in the medium and low groups. Over time, uncertainty levels did not change. Fatigue levels in the low uncertainty group remained constant, increased in the medium, and decreased in the high groups. Findings suggest that uncertainty and fatigue do not remit spontaneously. Being aware of this may help nurses identify those patients needing support for these two concerns.
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Affiliation(s)
| | - Julie Barroso
- Duke University School of Nursing, Durham, North Carolina
| | - Andrew J. Muir
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Richard Sloane
- Duke University Center for Aging, Duke University, Durham, North Carolina
| | - Jacqui Richmond
- Department of Gastroenterology, St. Vincent’s Hospital, Melbourne PO Box 2900, Fitzroy, Victoria 3065, Australia
| | - John McHutchison
- Duke Clinical Research Institute, and Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Keyur Patel
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University, Durham, North Carolina
| | | | - Merle H. Mishel
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Richmond J, Gao F, Wood L, Bulanhagui CA, Penny M. Pharmacogenetic analysis of CTLA4 gene polymorphisms and response to tremelimumab in patients with advanced melanoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.14003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kabanov VA, Aliev KV, Richmond J. The Polymerization of Propargyl Chloride Activated by Interaction with Poly(4-vinylpyridine). ACTA ACUST UNITED AC 2006. [DOI: 10.1080/00222337508068662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Calle R, McCarthy MI, Banerjee P, Zeggini E, Cull CA, Thorne KI, Wiltshire S, Terra S, Meyer D, Richmond J, Mancuso J, Milos P, Fryburg D, Holman RR. Paraoxonase 2 (PON2) polymorphisms and development of renal dysfunction in type 2 diabetes: UKPDS 76. Diabetologia 2006; 49:2892-9. [PMID: 17096118 DOI: 10.1007/s00125-006-0436-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 07/21/2006] [Indexed: 10/24/2022]
Abstract
AIMS/HYPOTHESIS Identification of variants predicting development of renal dysfunction would offer substantial clinical benefits. There is evidence that coding non-synonymous variants in the gene encoding paraoxonase 2 (PON2) are associated with nephropathy in both type 1 and type 2 diabetes. METHODS We examined the relationship between variation at the C311S and A148G polymorphisms (together with PON2 intronic variant rs12704795) and indices of renal dysfunction (progression to micro- and macroalbuminuria, plasma creatinine increases) in 3,374 newly diagnosed type 2 diabetic subjects from the UK Prospective Diabetes Study followed prospectively (median 14.0 years), using proportional hazards models, adjusted for sex, ethnicity and other known or putative risk factors. RESULTS rs12704795 genotypes were associated with differing rates of development of microalbuminuria (relative risk [RR] for CC vs AA homozygotes 0.68 [95% CI 0.54-0.87], p=0.002) but not other measures of worsening renal function. Heterozygotes for C311S were more likely to develop microalbuminuria (RR=1.31 [95% CI 1.11-1.54], p=0.001) but less likely to double creatinine levels during follow-up (RR=0.49 [95% CI 0.27-0.89], p=0.02). There was no corroboration of this latter association for related outcomes and no prior evidence supports heterosis effects at this locus. CONCLUSIONS/INTERPRETATION We conclude that the PON2 variants typed in this study have, at best, a small effect on the risk of renal dysfunction in type 2 diabetes.
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Affiliation(s)
- R Calle
- Pfizer Global Research & Development, Groton, CT, USA
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Abstract
OBJECTIVE To review the evidence available on best practice care of people with both hepatitis C and mental illness and its application in a mental health service. METHODS A literature search was conducted for publications dealing with screening, referral for specialist review and antiviral treatment for this population group. RESULTS A small number of studies was identified that specifically dealt with screening and treatment for hepatitis C in people with mental illness. CONCLUSIONS Screening, referral and treatment for hepatitis C in people with mental illness is worthwhile and achievable.
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Affiliation(s)
- Alison Seccull
- Victorian Public Health Training Scheme, Department of Human Services, Melbourne, Vic, Australia.
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Ainsworth R, Bartlett JMS, Going JJ, Mallon EA, Forsyth A, Richmond J, Angerson W, Watters A, Dunne B. IHC for Her2 with CBE356 antibody is a more accurate predictor of Her2 gene amplification by FISH than HercepTest in breast carcinoma. J Clin Pathol 2005; 58:1086-90. [PMID: 16189156 PMCID: PMC1770743 DOI: 10.1136/jcp.2004.021576] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Her2 (c-erbB-2/neu) overexpression in breast carcinoma predicts response to the anti-Her2 monoclonal antibody, trastuzumab, and is associated with a poor prognosis. When considering patients for trastuzumab treatment, Her2 protein expression is measured by imunohistochemistry (IHC) and, where staining is equivocal, by fluorescence in situ hybridisation (FISH) detection of Her2 gene amplification. AIMS To compare IHC using CBE356 with IHC using the Food and Drug Administration approved HercepTesttrade mark. METHODS CBE356 and HercepTest were analysed using 167 FISH characterised breast carcinomas. Immunohistochemical expression of Her2 was measured semiquantitatively. Sensitivity, specificity, predictive values, and overall accuracy were calculated for both IHC methods using gene amplification by FISH as the end point, and IHC and FISH assays were tested in Kaplan-Meier survival analysis. RESULTS The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CBE356 positive (2+ and 3+) cases were 94%, 89%, 95%, 84%, and 97%, respectively, and of HercepTest positive (2+ and 3+) cases were 91%, 66%, 98%, 92%, and 91%, respectively. A positive result with CBE356, HercepTest, or FISH was associated with significantly decreased overall survival (log rank p = 0.005, p = 0.0017, and p = 0.0005, respectively). CONCLUSIONS Positive IHC staining for Her2 using CBE356 is 3% more accurate and 23% more sensitive at predicting Her2 gene amplification by FISH than positive staining with HercepTest. Negative IHC using CBE356 antibody is 6% more likely to represent a truly negative result than negative staining with HercepTest. Overall, CBE356 was a more accurate predictor of Her2 gene amplification by FISH than HercepTest.
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Affiliation(s)
- R Ainsworth
- Department of Pathology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
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Richmond J, Dunning P, Desmond P. Hepatitis C: a medical and social diagnosis. Aust Nurs J 2004; 12:23-25. [PMID: 19149457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hepatitis C has reached epidemic proportions in Australia. Because of its association with injecting drug use, which is a main transmission mode, hepatitis C is a highly stigmatising health condition. In fact, the stigma attached to hepatitis C means hepatitis C is not just a medical diagnosis, but also a social diagnosis. The limited available research indicates hepatitis C-related discrimination is most likely to occur in health care settings. A strategic and evidenced-based approach is required to combat the social impact of hepatitis C.
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Affiliation(s)
- Jacqui Richmond
- Gastroenterology Department, St. Vincent's Hospital, Melbourne, Victoria
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Abstract
Of the various growth factors involved in the healing response after a fracture, bone morphogenetic proteins (BMPs) are emerging as key modulators. BMPs exert their effects by binding to a complex of type I and type II receptors leading to the phosphorylation of specific downstream effector proteins called Smads. The current study examined the presence of BMP signaling components in human callus obtained from five nascent malunions undergoing fracture fixation. These callus samples represented various stages of bone healing and a mixture of endochondral and intramembraneous bone healing. We performed immunohistochemistry on the callus, using antibodies for BMP (BMP-2,-3,-4,-7), their receptors (BMPR-IA, -IB, -II), and phosphorylated BMP receptor-regulated Smads (pBMP-R-Smads). Active osteoblasts showed fairly consistent positive staining for all BMPs that were examined, with the immunoreactivity most intense for BMP-7 and BMP-3. Immunostaining for BMPs in osteoblasts appeared to colocalize with the expression of BMPR-IA, -IB, and -II. Positive immunostaining for pBMP-R-Smads suggests that the BMP receptors expressed in these cells are activated. Staining for BMPs in cartilage cells was variable. The immunostaining appeared stronger in more mature cells, whereas staining for BMP receptors in cartilage cells was less ubiquitous. However, the expression of pBMP-R-Smads in cartilage cells suggests active signal transduction. Fibroblast-like cells also had a variable staining pattern. Overall, our findings indicate the presence of BMPs, their various receptors, and activated forms of receptor-regulated Smads in human fracture callus. To the best of our knowledge, this is the first study that documents the expression of these proteins in human fracture tissue. Complete elucidation of the roles of BMP in bone formation will hopefully lead to improved fracture healing care.
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Affiliation(s)
- P Kloen
- Hospital for Special Surgery, New York, NY 10021, USA.
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Richmond J, Egol KA, Koval KJ. Management of orthopaedic injuries in polytrauma patients. Bull Hosp Jt Dis 2003; 60:162-7. [PMID: 12102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- J Richmond
- NYU-Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, New York 10003, USA
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Bartlett JM, Going JJ, Mallon EA, Watters AD, Reeves JR, Stanton P, Richmond J, Donald B, Ferrier R, Cooke TG. Evaluating HER2 amplification and overexpression in breast cancer. J Pathol 2001; 195:422-8. [PMID: 11745673 DOI: 10.1002/path.971] [Citation(s) in RCA: 186] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development of Herceptin (Trazumatab) makes testing for HER2 status important for choosing optimal therapy in breast cancer. This study addresses the precision, accuracy, and reproducibility of HER2 assays. HER2 was assessed retrospectively by immunohistochemistry (IHC) with Dako 'Herceptest', by IHC with the monoclonal antibody CB11, and by fluorescence in situ hybridization (FISH, PathVysion), in a series of 216 formalin-fixed breast carcinomas including 191 for which quantitative HER2 data from radioimmunohistochemistry (Q-IHC) were available. All tests were scored independently by two observers. Positivity rates varied between Herceptest (12.6%), FISH (19.4%), and CB11 IHC (28.5%). Kappa values showed that IHC-based tests were more susceptible to inter-observer variation (kappa=0.67 and 0.74 for Herceptest and CB11, respectively) than FISH (kappa=0.973). Overall test accuracy (see the Materials and methods section) for CB11 IHC (83.8%) was lower than Herceptest (87.4%) or FISH (93.2%). FISH predicted p185 HER2 overexpression (determined by Q-IHC) better (concordance index C.Ind. 0.90) than CB11 IHC (C.Ind.=0.85) or Herceptest (C.Ind.=0.81). Of 42 cases with gene amplification by FISH, 67% were positive in the Herceptest (2+ or 3+) vs. 83% with CB11. Of 174 cases negative by FISH, 96% were negative in the Herceptest and 68% with CB11. In conclusion, FISH is the most accurate, reproducible, and precise predictor of HER2 overexpression in routine diagnostic laboratories.
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Affiliation(s)
- J M Bartlett
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
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Chun HJ, Doty JR, Salazar JD, Richmond J, Fonger JD. Noninvasive graft flow and patency assessment following minimally invasive direct coronary artery bypass (MIDCAB) grafting. Heart Surg Forum 2001; 2:230-4. [PMID: 11276481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/1999] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Assessment of graft patency following minimally invasive direct coronary artery bypass (MIDCAB) surgery is essential in order to determine the efficacy of this technique. This study was conducted to evaluate the role of intraoperative and postoperative noninvasive flow and velocity measurements to follow and predict graft performance. METHODS Between April 1996 and July 1997, 130 patients had 133 grafts placed using MIDCAB techniques. Intraoperative transit-time ultrasound was used to assess graft patency and flow prior to wound closure. Also, serial transcutaneous doppler examinations were performed to evaluate graft patency on the first postoperative day, at two weeks, and at three months. Peak values for systolic and diastolic waveforms were measured for both flow and velocity, and the diastolic-to-systolic ratio was calculated at each time interval. Recatheterization was performed selectively for inadequate ultrasound flow or doppler velocity, or for patient symptoms. RESULTS Seven (5.3 %) grafts developed stenosis or occlusion. When compared to normal grafts, mean intraoperative flows, flow ratios, and velocity ratios were lower. Mean postoperative diastolic peak velocity (DPV) to systolic peak velocity (SPV) ratio remained stable over time for normal grafts; however, grafts with stenosis or occlusion demonstrated a diminished DPV/SPV ratio. CONCLUSIONS Intraoperative transit-time ultrasound and outpatient transcutaneous doppler examinations did not reach a predictive value for graft stenosis or occlusion following MIDCAB surgery in this series of patients. However, these data demonstrate trends that may help identify patients at an increased risk for unfavorable events, guiding the use of postoperative recatheterization in such patients.
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Affiliation(s)
- H J Chun
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Richmond J, Grainger J, Taylor V, Critchlow F. Scoring for success. Prof Nurse 2001; 16:1266-7. [PMID: 12029918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- J Richmond
- Rehabilitation Ward, University Hospitals Coventry
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Abstract
It is an honour to have been asked to follow in the footsteps of Professor Russell (1) and deliver the FRAME Annual Lecture. In doing so, I am not speaking in any official capacity. I am speaking as myself: someone who has had a 30-year association with medicine and the biological sciences, who has had more time and reason than most to reflect upon the changes that have taken place during that period, and to think about how things may develop in the future. The views expressed tonight are based upon, and represent, my personal experience, expectations and aspirations.
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Affiliation(s)
- J Richmond
- Home Office, P.O. Box 6779, Dundee DD1 9WN, UK
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Richmond J. Women with hepatitis C--facts and figures. Aust Nurs J 2000; 8:32. [PMID: 11894460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Brewer JM, Tetley L, Richmond J, Liew FY, Alexander J. Lipid vesicle size determines the Th1 or Th2 response to entrapped antigen. J Immunol 1998; 161:4000-7. [PMID: 9780169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Understanding the factors that control the differential induction of Th1 and Th2 responses is a key immunologic objective with profound implications for vaccination and immunotherapy of infectious and autoimmune diseases. Using Ag formulated in lipid vesicles prepared from nonionic surfactants, we describe a novel mechanism influencing the balance of the Th1 or Th2 response. Our results indicate that inoculation of BALB/c mice with vesicles with a mean diameter > or = 225 nm preferentially induces Th1 responses, as characterized by increased titers of IgG2a in plasma and elevated IFN-gamma production by lymph node cells. However, preparation of the same quantity of Ag in vesicles with mean diameter of < or = 155 nm induces a Th2 response, as identified by IgG1 in the absence of IgG2a production and increased lymph node IL-5 production. Although large (> or = 225 nm) vesicles could induce IL-12 production, smaller vesicles (< or = 155 nm) could not. However, small vesicles did induce higher levels of IL-1beta production by macrophages than larger vesicles. The role of IL-12 in this response was confirmed in IL-12-deficient mice, whose spleen cells failed to produce IFN-gamma following in vivo priming with Ag prepared in large vesicles. Our results therefore indicate that macrophages respond to endocytosis of large or small vesicles by producing different patterns of cytokines that can subsequently direct the immune response toward a Th1 or a Th2 phenotype.
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Affiliation(s)
- J M Brewer
- Department of Immunology, University of Strathclyde, Glasgow, Scotland.
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Abstract
The assessment of lymphoproliferative disorders using fine-needle aspiration (FNA) cytology may be problematic particularly when organs other than lymph node are involved. In this report we have reviewed 26 consecutive FNA specimens from superficial extranodal sites which were reported as diagnostic or suggestive of malignant lymphoma. The aspirates were obtained from skin or subcutaneous tissue (ten cases), thyroid (five cases), salivary gland (five cases), breast (four cases), neck, and pharynx (one case each). Ancillary studies including immunocytochemistry, in situ hybridisation to detect immunoglobulin light chain mRNA expression, and polymerase chain reaction for analysis of immunoglobulin heavy chain gene rearrangement were performed in 20, 12, and 7 cases, respectively. Clinicopathologic correlation confirmed the diagnosis of lymphoma in 25/26 aspirates. Nine of the 14 patients whose initial presentation was with an extranodal mass were considered to have primary lymphomas of mucosa-associated lymphoid tissue (MALT) type. In contrast, ten of 11 patients with recurrent extranodal disease had primary nodal type lymphomas. There was one false-positive diagnosis, a neck mass misinterpreted cytologically as B-cell lymphoma which was ultimately shown to be a branchial cyst. FNA cytology supported by appropriate ancillary investigations provides accurate diagnosis in most cases of extranodal lymphoma.
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Affiliation(s)
- C J Stewart
- Department of Pathology, Glasgow Royal Infirmary, Scotland, United Kingdom
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O'Donohoe J, Chalkley S, Richmond J, Barltrop D. Blood lead in U.K. children--time for a lower action level? Clin Sci (Lond) 1998; 95:219-23. [PMID: 9680505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
1. Blood lead measurements in samples collected from 660 London schoolchildren during 1991 to 1992 suggest that the blood lead values in children in the U.K. are decreasing. 2. Geometric mean values for blood lead were 0.18 (range 0.05-0.71) micromol/l [3.7 (1. 0-15.0) microgram/dl]. Analysis of variance showed differences between ethnic groups, sex and schools. An age-matched subset of 148 children was compared with 136 children from an earlier study in 1986 and 1987. Trend analysis of the geometric mean lead values showed a negative slope (b=-0.484, P<0.0001), with maximum values of 0.81, 1.00, 0.71 and 0.43 micromol/l (17, 21, 15 and 9 microgram/dl) for the years 1986, 1987, 1991 and 1992 respectively. 3. It is recommended that children in the U.K. being investigated for anaemia, pica, recurrent abdominal pain or a high-risk environment should have blood lead values measured and that the action level for blood lead in children should be decreased from 1.19 micromol/l to 0.48 micromol/l (from 25 microgram/dl to 10 microgram/dl). 4. Guidance is offered to clinicians and other health professionals investigating excessive lead exposure.
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Affiliation(s)
- J O'Donohoe
- Academic Department of Child Health, Imperial College School of Medicine, Chelsea and Westminster Hospital, London SW10 9NH, U.K
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50
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Abstract
OBJECTIVES To investigate the effects of lead and cadmium on the metabolic pathway of vitamin D3. METHODS Blood and urinary cadmium and urinary total proteins were measured in 59 smelter workers occupationally exposed to lead and cadmium. In 19 of these workers, the plasma vitamin D3 metabolites, (25-hydroxycholecalciferol (25 OHD3), 24R, 25-dihydroxycholecalciferol (24R,25(OH)2D3) and 1 alpha,25-dihydroxycholecalciferol (1 alpha, 25(OH)2D3)) were measured together with blood lead. Vitamin D3 metabolites were measured by radioimmunoassay, (RIA), lead and cadmium by atomic absorption spectrophotometry, and total proteins with a test kit. RESULTS Ranges for plasma 25(OH)D3, 24R,25(OH)2D3 and 1 alpha,25(OH)2D3 were 1.0-51.9 ng/ml, 0.6-5.8 ng/ml, and 0.1-75.7 pg/ml, respectively. Ranges for blood lead were 1-3.7 mumol/l, (21-76 micrograms/dl), blood cadmium 6-145 nmol/l, and urinary cadmium 3-161 nmol/l. Total proteins in random urine samples were 2.1-32.6 mg/dl. Concentrations of lead and cadmium in blood showed no correlation (correlation coefficient -0.265) but there was a highly significant correlation between blood and urinary cadmium. Concentrations for 24R,25(OH)2D3 were depressed below the normal range as blood and urinary cadmium increased, irrespective of lead concentrations. High cadmium concentrations were associated with decreased plasma 1 alpha,25(OH)2D3 when lead concentrations were < 1.9 mumol/l and with above normal plasma 1 alpha,25(OH)2D3 when lead concentrations were > 1.9 mumol/l, Kruskal-Wallis analysis of variance (K-W ANOVA) chi 2 = 10.3, p = 0.006. Plasma 25(OH)D3 was negatively correlated with both urinary total proteins and urinary cadmium, but showed no correlation with plasma 24R,25(OH)2D3, 1 alpha,25(OH)2D3, blood lead, or blood cadmium. CONCLUSION Continuous long term exposure to cadmium may result in a state of equilibrium between blood and urinary cadmium. Cadmium concentrations in blood could be predicted from the cadmium concentration of the urine, (regression coefficient +0.35 SE 0.077). Exposure to cadmium alone decreased the concentrations of 1 alpha,25(OH)2D3 and 24R,25(OH)2D3, whereas exposure to both cadmium and lead increased the concentrations of 1 alpha,25(OH)2D3. It has been suggested that cadmium and lead interact with renal mitochondrial hydroxylases of the vitamin D3 endocrine complex. Perturbation of the vitamin D metabolic pathway by cadmium may result in health effect, such as osteoporosis or osteomalacia, risks which are possibly increased in the presence of lead.
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Affiliation(s)
- S R Chalkley
- Department of Academic Child Health, Imperial College School of Medicine, Chelsea
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