Background & Aims: As many as 70% of individuals with chronic hepatitis C (CHC) are managed solely in primary care. The aims of this study were to determine the prevalence of elevated liver stiffness measurement (LSM) in a cohort of community managed patients with CHC and to evaluate predictors of advanced liver disease and liver-related events.
Methods: A prospective cohort of adult patients with CHC were recruited from 21 primary care practices throughout Victoria, Australia. Inclusion criteria included the presence of CHC for >6 months, no recent (<18 months) specialist input and no history of hepatocellular carcinoma. Clinical assessment, LSM and phlebotomy were carried out in primary care. A hospital cohort was recruited for comparison. Participants were followed longitudinally and monitored for liver-related events.
Results: Over 26 months, 780 community patients were recruited and included in the analysis. The median LSM was 6.9 kPa in the community, with 16.5% of patients at risk of advanced fibrosis (LSM ≥12.5 kPa); of these 8.5% had no laboratory features of advanced liver disease. The proportion at risk of cirrhosis was no different between the community and hospital cohorts (p = 0.169). At-risk alcohol consumption, advancing age, elevated body mass index and alanine aminotransferase were independent predictors of elevated LSM. Over a median follow-up of 15.2 months, liver-related events occurred in 9.3% of those with an LSM ≥12.5 kPa. An LSM of 24 kPa had the highest predictive power for liver-related events (hazard ratio152; p <0.001).
Conclusion: The prevalence of advanced fibrosis, as determined by LSM, in primary care managed CHC is significant and comparable to a hospital cohort. Furthermore, this study supports the use of LSM as a community screening tool in a CHC population and indicates a possible role in predicting liver-related events.
Lay Summary: The prevalence of advanced liver disease in primary care managed hepatitis C is unknown. Our data suggests that rates of advanced fibrosis in the community are significant (16.5%), often underdiagnosed and comparable to rates seen in specialist referral centres. Liver stiffness measurement is a feasible community screening tool prior to hepatitis C therapy and can predict liver-related adverse events.
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http://dx.doi.org/10.1016/j.jhep.2018.04.013 | DOI Listing |
Scand J Prim Health Care
January 2025
Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Research has shown that physical activity on prescription (PAP), used in Swedish healthcare, increases patients' physical activity, but data are lacking regarding the long-term effects of PAP on exercise capacity. Therefor exercise capacity was evaluated in patients with metabolic risk factors, after 4.5 years of PAP treatment provided by physiotherapists in primary healthcare.
View Article and Find Full Text PDFJ Health Organ Manag
January 2025
Amrita School of Business - Amritapuri Kollam Campus, Kollam, India.
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Design/methodology/approach: The study leverages the renowned Carter's 7 C model as a foundational framework for supplier assessment, supplemented by insights gathered from interviews with experts in the New Product Introduction, Purchasing and Procurement departments of a leading hospital in India.
Eur J Pediatr
January 2025
Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisbon, Portugal.
Purpose: Under-five mortality is a key public health indicator, highly responsive to preventive interventions. While global efforts have made strides in reducing mortality rates in this age group, significant disparities persist, particularly in Sub-Saharan Africa. This study aimed to systematically review the factors influencing under-five mortality in Africa, focusing on sociodemographic factors and health-related determinants.
View Article and Find Full Text PDFDiscov Ment Health
January 2025
Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Smoking is highly prevalent and persistent among people with mental illness, but implementation of smoking cessation care by mental healthcare professionals (MHCPs) is lagging behind. This study took a broad approach to understanding implementation of stop smoking support (SSS) by MHCPs (N = 220 for main analyses), incorporating background characteristics, psychosocial factors, client factors, and organizational/environmental factors. Variable selection was based on previous work and the Consolidated Framework for Implementation Research.
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