Re: Co-morbid Medical and Psychiatric Illness and Substance Abuse in HCV-infected an

[Guest guest]

Please resend me the note about the speaker with

online feedback on Monday-I accidently deleted.

Thank you!

Kathy

--- wrote:

> Co-morbid Medical and Psychiatric Illness and

> Substance Abuse in HCV-

> infected and Uninfected Veterans

> Posted 01/24/2008

>

>

> Abstract and Introduction

> Abstract

> Summary: Comorbidities may affect the decision to

> treat chronic

> hepatitis C virus (HCV) infection. We undertook this

> study to

> determine the prevalence of these conditions in the

> HCV-infected

> persons compared with HCV-uninfected controls.

> Demographic and

> comorbidity data were retrieved for HCV-infected and

> -uninfected

> subjects from the VA National Patient Care Database

> using ICD-9

> codes. Logistic regression was used to determine the

> odds of comorbid

> conditions in the HCV-infected subjects.

> HCV-uninfected controls were

> identified matched on age, race/ethnicity and sex.

> We identified 126

> 926 HCV-infected subjects and 126 926 controls. The

> HCV-infected

> subjects had a higher prevalence of diabetes,

> anaemia, hypertension,

> chronic obstructive pulmonary disease (COPD)/asthma,

> cirrhosis,

> hepatitis B and cancer, but had a lower prevalence

> of coronary artery

> disease and stroke. The prevalence of all

> psychiatric comorbidities

> and substance abuse was higher in the HCV-infected

> subjects. In the

> HCV-infected persons, the odds of being diagnosed

> with congestive

> heart failure, diabetes, anaemia, hypertension,

> COPD/asthma,

> cirrhosis, hepatitis B and cancer were higher, but

> lower for coronary

> artery disease and stroke. After adjusting for

> alcohol and drug abuse

> and dependence, the odds of psychiatric illness were

> not higher in

> the HCV-infected persons. The prevalence and

> patterns of

> comorbidities in HCV-infected veterans are different

> from those in

> HCV-uninfected controls. The association between HCV

> and psychiatric

> diagnoses is at least partly attributable to alcohol

> and drug abuse

> and dependence. These factors should be taken into

> account when

> evaluating patients for treatment and designing new

> intervention

> strategies.

>

> Introduction

> Over 4 million persons in the USA are infected with

> hepatitis C virus

> (HCV) and over 170 million persons are infected

> globally. It is a

> major cause of end-stage liver disease and liver

> transplants in the

> USA.[1,2] While current treatment strategies lead to

> viral

> eradication in 54-56% of the treated persons

> overall,[3-9] not all

> patients infected with HCV are suitable candidates

> for treatment, and

> only a minority of the infected patients are ever

> prescribed

> treatment.[10-12] Reasons for nontreatment include

> nonadherence to

> follow-up visits, concurrent medical and psychiatric

> problems and

> substance abuse.[11,13] Medical comorbidities, such

> as advanced

> coronary artery disease and psychiatric

> comorbidities, such as

> depression and ongoing substance abuse, are relative

>

> contraindications to treatment. The prevalence of

> HCV, medical and

> psychiatric comorbidities and substance abuse is

> higher in the

> veterans of the United States armed forces who are

> in care in the

> Veterans' Affairs (VA) healthcare system compared

> with the general

> population.[14-19] The high prevalence of such

> contraindications may

> in part explain the relatively low rates of

> treatment for HCV in

> veterans in care. We conducted this study to

> quantify the burden of

> medical, psychiatric and substance abuse in

> HCV-infected veterans,

> and to compare them with matched HCV-uninfected

> persons. A thorough

> understanding of the magnitude of comorbid medical,

> as well as

> psychiatric and substance use conditions in

> HCV-infected persons may

> help develop strategies to address these conditions

> and lead to

> optimal management of HCV-infected persons.

>

> Discussion

> Treatment for HCV leads to improved outcomes

> including improved

> quality of life, improved survival, decreased

> progression of liver

> disease and decreased risk of hepatocellular

> carcinoma.[27-31] The

> potential benefits of treatment need to be balanced

> against the

> possible side effects and cost of therapy. Presence

> of multiple

> comorbidities may potentially influence providers

> towards

> nontreatment of HCV.

>

> We found that the prevalence of a range of comorbid

> medical

> comorbidities was higher in the HCV-infected persons

> and these

> patients were more likely to have multiple

> comorbidities. While the

> increased prevalence of conditions, such as

> cirrhosis and hepatitis B

> coinfection, is intuitive, the reason(s) for an

> increase in

> prevalence of other conditions is less clear. An

> association between

> diabetes and HCV has been reported in recent years,

> but the mechanism

> for the increased risk of diabetes in HCV infection

> is not known.

> [24,32-34] Increasing age and racial/ethnic minority

> status are

> important risk factors for the development of

> diabetes.[24] However,

> the odds of being diagnosed with diabetes in our

> study remained

> higher despite the fact that the groups were matched

> for age and

> race/ethnicity. Other important determinants of the

> risk of diabetes

> are body mass index and a family history of

> diabetes. We did not

> adjust for these factors, and they may have

> contributed to the

> differential prevalence and odds of diabetes.

> However, it is more

> plausible that HCV-infected persons would have a

> lower body mass

> index because of the presence of HCV and a larger

> number of medical,

> psychiatric and substance abuse comorbid diagnoses.

> If true, this

> would potentially bias the results towards a lower

> prevalence and

> odds of diabetes in the HCV-infected persons. We

> found the opposite,

> suggesting a true association. Future studies

> seeking to compare

> rates of medical comorbidities between patients with

> and without HCV

> may want to control for body mass index and, if

> available, family

> history of diabetes or other medical conditions.

>

> The prevalence of coronary artery disease and stroke

> was lower in the

> HCV-infected persons. This is an interesting and

> novel observation. A

> protective effect of HCV upon these diagnoses was

> observed despite

> the groups being matched for age, sex and

> race/ethnicity. We

> separately ran a multivariable logistic regression

> model adjusting

> for demographic factors as well as other

> comorbidities and found

> similar results (data not shown). While we have

> found the same

> association in HCV-infected persons on

> dialysis,[35,36] the reason

> for this observation is not clear. As persons with

> such acute and

> life threatening events (such as myocardial

> infarction and stroke)

> are usually rushed to the nearest medical facility,

> it is possible

> that these events were not recorded in the VA

> facility

=== message truncated ===

________________________________________________________________________________\

____

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Re: Co-morbid Medical and Psychiatric Illness and Substance Abuse in HCV-infected an

Please resend me the note about the speaker withonline feedback on Monday-I accidently deleted.Thank you!Kathy--- <elizabethnv1earthlink (DOT) net> wrote:> Co-morbid Medical and Psychiatric Illness and> Substance Abuse in HCV-> infected and Uninfected Veterans> Posted 01/24/2008> > > Abstract and Introduction> Abstract> Summary: Comorbidities may affect the decision to> treat chronic > hepatitis C virus (HCV) infection. We undertook this> study to > determine the prevalence of these conditions in the> HCV-infected > persons compared with HCV-uninfected controls.> Demographic and > comorbidity data were retrieved for HCV-infected and> -uninfected > subjects from the VA National Patient Care Database> using ICD-9 > codes. Logistic regression was used to determine the> odds of comorbid > conditions in the HCV-infected subjects.> HCV-uninfected controls were > identified matched on age, race/ethnicity and sex.> We identified 126 > 926 HCV-infected subjects and 126 926 controls. The> HCV-infected > subjects had a higher prevalence of diabetes,> anaemia, hypertension, > chronic obstructive pulmonary disease (COPD)/asthma,> cirrhosis, > hepatitis B and cancer, but had a lower prevalence> of coronary artery > disease and stroke. The prevalence of all> psychiatric comorbidities > and substance abuse was higher in the HCV-infected> subjects. In the > HCV-infected persons, the odds of being diagnosed> with congestive > heart failure, diabetes, anaemia, hypertension,> COPD/asthma, > cirrhosis, hepatitis B and cancer were higher, but> lower for coronary > artery disease and stroke. After adjusting for> alcohol and drug abuse > and dependence, the odds of psychiatric illness were> not higher in > the HCV-infected persons. The prevalence and> patterns of > comorbidities in HCV-infected veterans are different> from those in > HCV-uninfected controls. The association between HCV> and psychiatric > diagnoses is at least partly attributable to alcohol> and drug abuse > and dependence. These factors should be taken into> account when > evaluating patients for treatment and designing new> intervention > strategies.> > Introduction> Over 4 million persons in the USA are infected with> hepatitis C virus > (HCV) and over 170 million persons are infected> globally. It is a > major cause of end-stage liver disease and liver> transplants in the > USA.[1,2] While current treatment strategies lead to> viral > eradication in 54-56% of the treated persons> overall,[3-9] not all > patients infected with HCV are suitable candidates> for treatment, and > only a minority of the infected patients are ever> prescribed > treatment.[10-12] Reasons for nontreatment include> nonadherence to > follow-up visits, concurrent medical and psychiatric> problems and > substance abuse.[11,13] Medical comorbidities, such> as advanced > coronary artery disease and psychiatric> comorbidities, such as > depression and ongoing substance abuse, are relative> > contraindications to treatment. The prevalence of> HCV, medical and > psychiatric comorbidities and substance abuse is> higher in the > veterans of the United States armed forces who are> in care in the > Veterans' Affairs (VA) healthcare system compared> with the general > population.[14-19] The high prevalence of such> contraindications may > in part explain the relatively low rates of> treatment for HCV in > veterans in care. We conducted this study to> quantify the burden of > medical, psychiatric and substance abuse in> HCV-infected veterans, > and to compare them with matched HCV-uninfected> persons. A thorough > understanding of the magnitude of comorbid medical,> as well as > psychiatric and substance use conditions in> HCV-infected persons may > help develop strategies to address these conditions> and lead to > optimal management of HCV-infected persons.> > Discussion> Treatment for HCV leads to improved outcomes> including improved > quality of life, improved survival, decreased> progression of liver > disease and decreased risk of hepatocellular> carcinoma.[27-31] The > potential benefits of treatment need to be balanced> against the > possible side effects and cost of therapy. Presence> of multiple > comorbidities may potentially influence providers> towards > nontreatment of HCV.> > We found that the prevalence of a range of comorbid> medical > comorbidities was higher in the HCV-infected persons> and these > patients were more likely to have multiple> comorbidities. While the > increased prevalence of conditions, such as> cirrhosis and hepatitis B > coinfection, is intuitive, the reason(s) for an> increase in > prevalence of other conditions is less clear. An> association between > diabetes and HCV has been reported in recent years,> but the mechanism > for the increased risk of diabetes in HCV infection> is not known.> [24,32-34] Increasing age and racial/ethnic minority> status are > important risk factors for the development of> diabetes.[24] However, > the odds of being diagnosed with diabetes in our> study remained > higher despite the fact that the groups were matched> for age and > race/ethnicity. Other important determinants of the> risk of diabetes > are body mass index and a family history of> diabetes. We did not > adjust for these factors, and they may have> contributed to the > differential prevalence and odds of diabetes.> However, it is more > plausible that HCV-infected persons would have a> lower body mass > index because of the presence of HCV and a larger> number of medical, > psychiatric and substance abuse comorbid diagnoses.> If true, this > would potentially bias the results towards a lower> prevalence and > odds of diabetes in the HCV-infected persons. We> found the opposite, > suggesting a true association. Future studies> seeking to compare > rates of medical comorbidities between patients with> and without HCV > may want to control for body mass index and, if> available, family > history of diabetes or other medical conditions.> > The prevalence of coronary artery disease and stroke> was lower in the > HCV-infected persons. This is an interesting and> novel observation. A > protective effect of HCV upon these diagnoses was> observed despite > the groups being matched for age, sex and> race/ethnicity. We > separately ran a multivariable logistic regression> model adjusting > for demographic factors as well as other> comorbidities and found > similar results (data not shown). While we have> found the same > association in HCV-infected persons on> dialysis,[35,36] the reason > for this observation is not clear. As persons with> such acute and > life threatening events (such as myocardial> infarction and stroke) > are usually rushed to the nearest medical facility,> it is possible > that these events were not recorded in the VA> facility === message truncated ===__________________________________________________________Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

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Re: Co-morbid Medical and Psychiatric Illness and Substance Abuse in HCV-infected an

Please resend me the note about the speaker withonline feedback on Monday-I accidently deleted.Thank you!Kathy--- <elizabethnv1earthlink (DOT) net> wrote:> Co-morbid Medical and Psychiatric Illness and> Substance Abuse in HCV-> infected and Uninfected Veterans> Posted 01/24/2008> > > Abstract and Introduction> Abstract> Summary: Comorbidities may affect the decision to> treat chronic > hepatitis C virus (HCV) infection. We undertook this> study to > determine the prevalence of these conditions in the> HCV-infected > persons compared with HCV-uninfected controls.> Demographic and > comorbidity data were retrieved for HCV-infected and> -uninfected > subjects from the VA National Patient Care Database> using ICD-9 > codes. Logistic regression was used to determine the> odds of comorbid > conditions in the HCV-infected subjects.> HCV-uninfected controls were > identified matched on age, race/ethnicity and sex.> We identified 126 > 926 HCV-infected subjects and 126 926 controls. The> HCV-infected > subjects had a higher prevalence of diabetes,> anaemia, hypertension, > chronic obstructive pulmonary disease (COPD)/asthma,> cirrhosis, > hepatitis B and cancer, but had a lower prevalence> of coronary artery > disease and stroke. The prevalence of all> psychiatric comorbidities > and substance abuse was higher in the HCV-infected> subjects. In the > HCV-infected persons, the odds of being diagnosed> with congestive > heart failure, diabetes, anaemia, hypertension,> COPD/asthma, > cirrhosis, hepatitis B and cancer were higher, but> lower for coronary > artery disease and stroke. After adjusting for> alcohol and drug abuse > and dependence, the odds of psychiatric illness were> not higher in > the HCV-infected persons. The prevalence and> patterns of > comorbidities in HCV-infected veterans are different> from those in > HCV-uninfected controls. The association between HCV> and psychiatric > diagnoses is at least partly attributable to alcohol> and drug abuse > and dependence. These factors should be taken into> account when > evaluating patients for treatment and designing new> intervention > strategies.> > Introduction> Over 4 million persons in the USA are infected with> hepatitis C virus > (HCV) and over 170 million persons are infected> globally. It is a > major cause of end-stage liver disease and liver> transplants in the > USA.[1,2] While current treatment strategies lead to> viral > eradication in 54-56% of the treated persons> overall,[3-9] not all > patients infected with HCV are suitable candidates> for treatment, and > only a minority of the infected patients are ever> prescribed > treatment.[10-12] Reasons for nontreatment include> nonadherence to > follow-up visits, concurrent medical and psychiatric> problems and > substance abuse.[11,13] Medical comorbidities, such> as advanced > coronary artery disease and psychiatric> comorbidities, such as > depression and ongoing substance abuse, are relative> > contraindications to treatment. The prevalence of> HCV, medical and > psychiatric comorbidities and substance abuse is> higher in the > veterans of the United States armed forces who are> in care in the > Veterans' Affairs (VA) healthcare system compared> with the general > population.[14-19] The high prevalence of such> contraindications may > in part explain the relatively low rates of> treatment for HCV in > veterans in care. We conducted this study to> quantify the burden of > medical, psychiatric and substance abuse in> HCV-infected veterans, > and to compare them with matched HCV-uninfected> persons. A thorough > understanding of the magnitude of comorbid medical,> as well as > psychiatric and substance use conditions in> HCV-infected persons may > help develop strategies to address these conditions> and lead to > optimal management of HCV-infected persons.> > Discussion> Treatment for HCV leads to improved outcomes> including improved > quality of life, improved survival, decreased> progression of liver > disease and decreased risk of hepatocellular> carcinoma.[27-31] The > potential benefits of treatment need to be balanced> against the > possible side effects and cost of therapy. Presence> of multiple > comorbidities may potentially influence providers> towards > nontreatment of HCV.> > We found that the prevalence of a range of comorbid> medical > comorbidities was higher in the HCV-infected persons> and these > patients were more likely to have multiple> comorbidities. While the > increased prevalence of conditions, such as> cirrhosis and hepatitis B > coinfection, is intuitive, the reason(s) for an> increase in > prevalence of other conditions is less clear. An> association between > diabetes and HCV has been reported in recent years,> but the mechanism > for the increased risk of diabetes in HCV infection> is not known.> [24,32-34] Increasing age and racial/ethnic minority> status are > important risk factors for the development of> diabetes.[24] However, > the odds of being diagnosed with diabetes in our> study remained > higher despite the fact that the groups were matched> for age and > race/ethnicity. Other important determinants of the> risk of diabetes > are body mass index and a family history of> diabetes. We did not > adjust for these factors, and they may have> contributed to the > differential prevalence and odds of diabetes.> However, it is more > plausible that HCV-infected persons would have a> lower body mass > index because of the presence of HCV and a larger> number of medical, > psychiatric and substance abuse comorbid diagnoses.> If true, this > would potentially bias the results towards a lower> prevalence and > odds of diabetes in the HCV-infected persons. We> found the opposite, > suggesting a true association. Future studies> seeking to compare > rates of medical comorbidities between patients with> and without HCV > may want to control for body mass index and, if> available, family > history of diabetes or other medical conditions.> > The prevalence of coronary artery disease and stroke> was lower in the > HCV-infected persons. This is an interesting and> novel observation. A > protective effect of HCV upon these diagnoses was> observed despite > the groups being matched for age, sex and> race/ethnicity. We > separately ran a multivariable logistic regression> model adjusting > for demographic factors as well as other> comorbidities and found > similar results (data not shown). While we have> found the same > association in HCV-infected persons on> dialysis,[35,36] the reason > for this observation is not clear. As persons with> such acute and > life threatening events (such as myocardial> infarction and stroke) > are usually rushed to the nearest medical facility,> it is possible > that these events were not recorded in the VA> facility === message truncated ===__________________________________________________________Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

[Guest guest]

Thanks!

--- elizabethnv1 wrote:

> Are you talking about Saturday night chat's ? Here

> is the link

> http://forums.delphiforums.com/hephelp/start

> Re: Co-morbid

> Medical and Psychiatric Illness and Substance Abuse

> in HCV-infected an

>

>

> Please resend me the note about the speaker with

> online feedback on Monday-I accidently deleted.

>

> Thank you!

> Kathy

> --- wrote:

>

> > Co-morbid Medical and Psychiatric Illness and

> > Substance Abuse in HCV-

> > infected and Uninfected Veterans

> > Posted 01/24/2008

> >

> >

> > Abstract and Introduction

> > Abstract

> > Summary: Comorbidities may affect the decision

> to

> > treat chronic

> > hepatitis C virus (HCV) infection. We undertook

> this

> > study to

> > determine the prevalence of these conditions in

> the

> > HCV-infected

> > persons compared with HCV-uninfected controls.

> > Demographic and

> > comorbidity data were retrieved for HCV-infected

> and

> > -uninfected

> > subjects from the VA National Patient Care

> Database

> > using ICD-9

> > codes. Logistic regression was used to determine

> the

> > odds of comorbid

> > conditions in the HCV-infected subjects.

> > HCV-uninfected controls were

> > identified matched on age, race/ethnicity and

> sex.

> > We identified 126

> > 926 HCV-infected subjects and 126 926 controls.

> The

> > HCV-infected

> > subjects had a higher prevalence of diabetes,

> > anaemia, hypertension,

> > chronic obstructive pulmonary disease

> (COPD)/asthma,

> > cirrhosis,

> > hepatitis B and cancer, but had a lower

> prevalence

> > of coronary artery

> > disease and stroke. The prevalence of all

> > psychiatric comorbidities

> > and substance abuse was higher in the

> HCV-infected

> > subjects. In the

> > HCV-infected persons, the odds of being

> diagnosed

> > with congestive

> > heart failure, diabetes, anaemia, hypertension,

> > COPD/asthma,

> > cirrhosis, hepatitis B and cancer were higher,

> but

> > lower for coronary

> > artery disease and stroke. After adjusting for

> > alcohol and drug abuse

> > and dependence, the odds of psychiatric illness

> were

> > not higher in

> > the HCV-infected persons. The prevalence and

> > patterns of

> > comorbidities in HCV-infected veterans are

> different

> > from those in

> > HCV-uninfected controls. The association between

> HCV

> > and psychiatric

> > diagnoses is at least partly attributable to

> alcohol

> > and drug abuse

> > and dependence. These factors should be taken

> into

> > account when

> > evaluating patients for treatment and designing

> new

> > intervention

> > strategies.

> >

> > Introduction

> > Over 4 million persons in the USA are infected

> with

> > hepatitis C virus

> > (HCV) and over 170 million persons are infected

> > globally. It is a

> > major cause of end-stage liver disease and liver

> > transplants in the

> > USA.[1,2] While current treatment strategies

> lead to

> > viral

> > eradication in 54-56% of the treated persons

> > overall,[3-9] not all

> > patients infected with HCV are suitable

> candidates

> > for treatment, and

> > only a minority of the infected patients are

> ever

> > prescribed

> > treatment.[10-12] Reasons for nontreatment

> include

> > nonadherence to

> > follow-up visits, concurrent medical and

> psychiatric

> > problems and

> > substance abuse.[11,13] Medical comorbidities,

> such

> > as advanced

> > coronary artery disease and psychiatric

> > comorbidities, such as

> > depression and ongoing substance abuse, are

> relative

> >

> > contraindications to treatment. The prevalence

> of

> > HCV, medical and

> > psychiatric comorbidities and substance abuse is

> > higher in the

> > veterans of the United States armed forces who

> are

> > in care in the

> > Veterans' Affairs (VA) healthcare system

> compared

> > with the general

> > population.[14-19] The high prevalence of such

> > contraindications may

> > in part explain the relatively low rates of

> > treatment for HCV in

> > veterans in care. We conducted this study to

> > quantify the burden of

> > medical, psychiatric and substance abuse in

> > HCV-infected veterans,

> > and to compare them with matched HCV-uninfected

> > persons. A thorough

> > understanding of the magnitude of comorbid

> medical,

> > as well as

> > psychiatric and substance use conditions in

> > HCV-infected persons may

> > help develop strategies to address these

> conditions

> > and lead to

> > optimal management of HCV-infected persons.

> >

> > Discussion

> > Treatment for HCV leads to improved outcomes

> > including improved

> > quality of life, improved survival, decreased

> > progression of liver

> > disease and decreased risk of hepatocellular

> > carcinoma.[27-31] The

> > potential benefits of treatment need to be

> balanced

> > against the

> > possible side effects and cost of therapy.

> Presence

> > of multiple

> > comorbidities may potentially influence

> providers

> > towards

> > nontreatment of HCV.

> >

> > We found that the prevalence of a range of

> comorbid

> > medical

> > comorbidities was higher in the HCV-infected

> persons

> > and these

> > patients were more likely to have multiple

> > comorbidities. While the

> > increased prevalence of conditions, such as

> > cirrhosis and hepatitis B

> > coinfection, is intuitive, the reason(s) for an

> > increase in

> > prevalence of other conditions is less clear. An

> > association between

> > diabetes and HCV has been reported in recent

> years,

> > but the mechanism

> > for the increased risk of diabetes in HCV

> infection

>

=== message truncated ===

________________________________________________________________________________\

____

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[Guest guest]

Thanks!

--- elizabethnv1 wrote:

> Are you talking about Saturday night chat's ? Here

> is the link

> http://forums.delphiforums.com/hephelp/start

> Re: Co-morbid

> Medical and Psychiatric Illness and Substance Abuse

> in HCV-infected an

>

>

> Please resend me the note about the speaker with

> online feedback on Monday-I accidently deleted.

>

> Thank you!

> Kathy

> --- wrote:

>

> > Co-morbid Medical and Psychiatric Illness and

> > Substance Abuse in HCV-

> > infected and Uninfected Veterans

> > Posted 01/24/2008

> >

> >

> > Abstract and Introduction

> > Abstract

> > Summary: Comorbidities may affect the decision

> to

> > treat chronic

> > hepatitis C virus (HCV) infection. We undertook

> this

> > study to

> > determine the prevalence of these conditions in

> the

> > HCV-infected

> > persons compared with HCV-uninfected controls.

> > Demographic and

> > comorbidity data were retrieved for HCV-infected

> and

> > -uninfected

> > subjects from the VA National Patient Care

> Database

> > using ICD-9

> > codes. Logistic regression was used to determine

> the

> > odds of comorbid

> > conditions in the HCV-infected subjects.

> > HCV-uninfected controls were

> > identified matched on age, race/ethnicity and

> sex.

> > We identified 126

> > 926 HCV-infected subjects and 126 926 controls.

> The

> > HCV-infected

> > subjects had a higher prevalence of diabetes,

> > anaemia, hypertension,

> > chronic obstructive pulmonary disease

> (COPD)/asthma,

> > cirrhosis,

> > hepatitis B and cancer, but had a lower

> prevalence

> > of coronary artery

> > disease and stroke. The prevalence of all

> > psychiatric comorbidities

> > and substance abuse was higher in the

> HCV-infected

> > subjects. In the

> > HCV-infected persons, the odds of being

> diagnosed

> > with congestive

> > heart failure, diabetes, anaemia, hypertension,

> > COPD/asthma,

> > cirrhosis, hepatitis B and cancer were higher,

> but

> > lower for coronary

> > artery disease and stroke. After adjusting for

> > alcohol and drug abuse

> > and dependence, the odds of psychiatric illness

> were

> > not higher in

> > the HCV-infected persons. The prevalence and

> > patterns of

> > comorbidities in HCV-infected veterans are

> different

> > from those in

> > HCV-uninfected controls. The association between

> HCV

> > and psychiatric

> > diagnoses is at least partly attributable to

> alcohol

> > and drug abuse

> > and dependence. These factors should be taken

> into

> > account when

> > evaluating patients for treatment and designing

> new

> > intervention

> > strategies.

> >

> > Introduction

> > Over 4 million persons in the USA are infected

> with

> > hepatitis C virus

> > (HCV) and over 170 million persons are infected

> > globally. It is a

> > major cause of end-stage liver disease and liver

> > transplants in the

> > USA.[1,2] While current treatment strategies

> lead to

> > viral

> > eradication in 54-56% of the treated persons

> > overall,[3-9] not all

> > patients infected with HCV are suitable

> candidates

> > for treatment, and

> > only a minority of the infected patients are

> ever

> > prescribed

> > treatment.[10-12] Reasons for nontreatment

> include

> > nonadherence to

> > follow-up visits, concurrent medical and

> psychiatric

> > problems and

> > substance abuse.[11,13] Medical comorbidities,

> such

> > as advanced

> > coronary artery disease and psychiatric

> > comorbidities, such as

> > depression and ongoing substance abuse, are

> relative

> >

> > contraindications to treatment. The prevalence

> of

> > HCV, medical and

> > psychiatric comorbidities and substance abuse is

> > higher in the

> > veterans of the United States armed forces who

> are

> > in care in the

> > Veterans' Affairs (VA) healthcare system

> compared

> > with the general

> > population.[14-19] The high prevalence of such

> > contraindications may

> > in part explain the relatively low rates of

> > treatment for HCV in

> > veterans in care. We conducted this study to

> > quantify the burden of

> > medical, psychiatric and substance abuse in

> > HCV-infected veterans,

> > and to compare them with matched HCV-uninfected

> > persons. A thorough

> > understanding of the magnitude of comorbid

> medical,

> > as well as

> > psychiatric and substance use conditions in

> > HCV-infected persons may

> > help develop strategies to address these

> conditions

> > and lead to

> > optimal management of HCV-infected persons.

> >

> > Discussion

> > Treatment for HCV leads to improved outcomes

> > including improved

> > quality of life, improved survival, decreased

> > progression of liver

> > disease and decreased risk of hepatocellular

> > carcinoma.[27-31] The

> > potential benefits of treatment need to be

> balanced

> > against the

> > possible side effects and cost of therapy.

> Presence

> > of multiple

> > comorbidities may potentially influence

> providers

> > towards

> > nontreatment of HCV.

> >

> > We found that the prevalence of a range of

> comorbid

> > medical

> > comorbidities was higher in the HCV-infected

> persons

> > and these

> > patients were more likely to have multiple

> > comorbidities. While the

> > increased prevalence of conditions, such as

> > cirrhosis and hepatitis B

> > coinfection, is intuitive, the reason(s) for an

> > increase in

> > prevalence of other conditions is less clear. An

> > association between

> > diabetes and HCV has been reported in recent

> years,

> > but the mechanism

> > for the increased risk of diabetes in HCV

> infection

>

=== message truncated ===

________________________________________________________________________________\

____

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Re: Co-morbid> Medical and Psychiatric Illness and Substance Abuse> in HCV-infected an> > > Please resend me the note about the speaker with> online feedback on Monday-I accidently deleted.> > Thank you!> Kathy> --- <elizabethnv1earthlink (DOT) net> wrote:> > > Co-morbid Medical and Psychiatric Illness and> > Substance Abuse in HCV-> > infected and Uninfected Veterans> > Posted 01/24/2008> > > > > > Abstract and Introduction> > Abstract> > Summary: Comorbidities may affect the decision> to> > treat chronic > > hepatitis C virus (HCV) infection. We undertook> this> > study to > > determine the prevalence of these conditions in> the> > HCV-infected > > persons compared with HCV-uninfected controls.> > Demographic and > > comorbidity data were retrieved for HCV-infected> and> > -uninfected > > subjects from the VA National Patient Care> Database> > using ICD-9 > > codes. Logistic regression was used to determine> the> > odds of comorbid > > conditions in the HCV-infected subjects.> > HCV-uninfected controls were > > identified matched on age, race/ethnicity and> sex.> > We identified 126 > > 926 HCV-infected subjects and 126 926 controls.> The> > HCV-infected > > subjects had a higher prevalence of diabetes,> > anaemia, hypertension, > > chronic obstructive pulmonary disease> (COPD)/asthma,> > cirrhosis, > > hepatitis B and cancer, but had a lower> prevalence> > of coronary artery > > disease and stroke. The prevalence of all> > psychiatric comorbidities > > and substance abuse was higher in the> HCV-infected> > subjects. In the > > HCV-infected persons, the odds of being> diagnosed> > with congestive > > heart failure, diabetes, anaemia, hypertension,> > COPD/asthma, > > cirrhosis, hepatitis B and cancer were higher,> but> > lower for coronary > > artery disease and stroke. After adjusting for> > alcohol and drug abuse > > and dependence, the odds of psychiatric illness> were> > not higher in > > the HCV-infected persons. The prevalence and> > patterns of > > comorbidities in HCV-infected veterans are> different> > from those in > > HCV-uninfected controls. The association between> HCV> > and psychiatric > > diagnoses is at least partly attributable to> alcohol> > and drug abuse > > and dependence. These factors should be taken> into> > account when > > evaluating patients for treatment and designing> new> > intervention > > strategies.> > > > Introduction> > Over 4 million persons in the USA are infected> with> > hepatitis C virus > > (HCV) and over 170 million persons are infected> > globally. It is a > > major cause of end-stage liver disease and liver> > transplants in the > > USA.[1,2] While current treatment strategies> lead to> > viral > > eradication in 54-56% of the treated persons> > overall,[3-9] not all > > patients infected with HCV are suitable> candidates> > for treatment, and > > only a minority of the infected patients are> ever> > prescribed > > treatment.[10-12] Reasons for nontreatment> include> > nonadherence to > > follow-up visits, concurrent medical and> psychiatric> > problems and > > substance abuse.[11,13] Medical comorbidities,> such> > as advanced > > coronary artery disease and psychiatric> > comorbidities, such as > > depression and ongoing substance abuse, are> relative> > > > contraindications to treatment. The prevalence> of> > HCV, medical and > > psychiatric comorbidities and substance abuse is> > higher in the > > veterans of the United States armed forces who> are> > in care in the > > Veterans' Affairs (VA) healthcare system> compared> > with the general > > population.[14-19] The high prevalence of such> > contraindications may > > in part explain the relatively low rates of> > treatment for HCV in > > veterans in care. We conducted this study to> > quantify the burden of > > medical, psychiatric and substance abuse in> > HCV-infected veterans, > > and to compare them with matched HCV-uninfected> > persons. A thorough > > understanding of the magnitude of comorbid> medical,> > as well as > > psychiatric and substance use conditions in> > HCV-infected persons may > > help develop strategies to address these> conditions> > and lead to > > optimal management of HCV-infected persons.> > > > Discussion> > Treatment for HCV leads to improved outcomes> > including improved > > quality of life, improved survival, decreased> > progression of liver > > disease and decreased risk of hepatocellular> > carcinoma.[27-31] The > > potential benefits of treatment need to be> balanced> > against the > > possible side effects and cost of therapy.> Presence> > of multiple > > comorbidities may potentially influence> providers> > towards > > nontreatment of HCV.> > > > We found that the prevalence of a range of> comorbid> > medical > > comorbidities was higher in the HCV-infected> persons> > and these > > patients were more likely to have multiple> > comorbidities. While the > > increased prevalence of conditions, such as> > cirrhosis and hepatitis B > > coinfection, is intuitive, the reason(s) for an> > increase in > > prevalence of other conditions is less clear. An> > association between > > diabetes and HCV has been reported in recent> years,> > but the mechanism > > for the increased risk of diabetes in HCV> infection> === message truncated ===__________________________________________________________Looking for last minute shopping deals? Find them fast with Yahoo! Search. http://tools.search.yahoo.com/newsearch/category.php?category=shopping

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Liz, I could be wrong, but she might be referring to the live chat Ill be having with Dr. Haas who is an MD and specializes in alternative care as well. The topic of this chat will be detoxification.. This was the only chat that was scheduled on a monday,, I think,, lol elizabethnv1 wrote: Are you talking about Saturday night chat's ? Here is the link http://forums.delphiforums.com/hephelp/start Re: Co-morbid Medical and Psychiatric Illness and Substance Abuse in HCV-infected an Please resend me the note about the speaker withonline feedback on Monday-I accidently deleted.Thank you!Kathy--- <elizabethnv1earthlink (DOT) net> wrote:> Co-morbid Medical and Psychiatric Illness and> Substance Abuse in HCV-> infected and Uninfected Veterans> Posted 01/24/2008> > > Abstract and Introduction> Abstract> Summary: Comorbidities may affect the decision to> treat chronic > hepatitis C virus (HCV) infection. We undertook this> study to > determine the prevalence of these conditions in the>

HCV-infected > persons compared with HCV-uninfected controls.> Demographic and > comorbidity data were retrieved for HCV-infected and> -uninfected > subjects from the VA National Patient Care Database> using ICD-9 > codes. Logistic regression was used to determine the> odds of comorbid > conditions in the HCV-infected subjects.> HCV-uninfected controls were > identified matched on age, race/ethnicity and sex.> We identified 126 > 926 HCV-infected subjects and 126 926 controls. The> HCV-infected > subjects had a higher prevalence of diabetes,> anaemia, hypertension, > chronic obstructive pulmonary disease (COPD)/asthma,> cirrhosis, > hepatitis B and cancer, but had a lower prevalence> of coronary artery > disease and stroke. The prevalence of all> psychiatric comorbidities > and substance abuse was higher in the

HCV-infected> subjects. In the > HCV-infected persons, the odds of being diagnosed> with congestive > heart failure, diabetes, anaemia, hypertension,> COPD/asthma, > cirrhosis, hepatitis B and cancer were higher, but> lower for coronary > artery disease and stroke. After adjusting for> alcohol and drug abuse > and dependence, the odds of psychiatric illness were> not higher in > the HCV-infected persons. The prevalence and> patterns of > comorbidities in HCV-infected veterans are different> from those in > HCV-uninfected controls. The association between HCV> and psychiatric > diagnoses is at least partly attributable to alcohol> and drug abuse > and dependence. These factors should be taken into> account when > evaluating patients for treatment and designing new> intervention > strategies.> >

Introduction> Over 4 million persons in the USA are infected with> hepatitis C virus > (HCV) and over 170 million persons are infected> globally. It is a > major cause of end-stage liver disease and liver> transplants in the > USA.[1,2] While current treatment strategies lead to> viral > eradication in 54-56% of the treated persons> overall,[3-9] not all > patients infected with HCV are suitable candidates> for treatment, and > only a minority of the infected patients are ever> prescribed > treatment.[10-12] Reasons for nontreatment include> nonadherence to > follow-up visits, concurrent medical and psychiatric> problems and > substance abuse.[11,13] Medical comorbidities, such> as advanced > coronary artery disease and psychiatric> comorbidities, such as > depression and ongoing substance abuse, are

relative> > contraindications to treatment. The prevalence of> HCV, medical and > psychiatric comorbidities and substance abuse is> higher in the > veterans of the United States armed forces who are> in care in the > Veterans' Affairs (VA) healthcare system compared> with the general > population.[14-19] The high prevalence of such> contraindications may > in part explain the relatively low rates of> treatment for HCV in > veterans in care. We conducted this study to> quantify the burden of > medical, psychiatric and substance abuse in> HCV-infected veterans, > and to compare them with matched HCV-uninfected> persons. A thorough > understanding of the magnitude of comorbid medical,> as well as > psychiatric and substance use conditions in> HCV-infected persons may > help develop strategies to address

these conditions> and lead to > optimal management of HCV-infected persons.> > Discussion> Treatment for HCV leads to improved outcomes> including improved > quality of life, improved survival, decreased> progression of liver > disease and decreased risk of hepatocellular> carcinoma.[27-31] The > potential benefits of treatment need to be balanced> against the > possible side effects and cost of therapy. Presence> of multiple > comorbidities may potentially influence providers> towards > nontreatment of HCV.> > We found that the prevalence of a range of comorbid> medical > comorbidities was higher in the HCV-infected persons> and these > patients were more likely to have multiple> comorbidities. While the > increased prevalence of conditions, such as> cirrhosis and hepatitis B >

coinfection, is intuitive, the reason(s) for an> increase in > prevalence of other conditions is less clear. An> association between > diabetes and HCV has been reported in recent years,> but the mechanism > for the increased risk of diabetes in HCV infection> is not known.> [24,32-34] Increasing age and racial/ethnic minority> status are > important risk factors for the development of> diabetes.[24] However, > the odds of being diagnosed with diabetes in our> study remained > higher despite the fact that the groups were matched> for age and > race/ethnicity. Other important determinants of the> risk of diabetes > are body mass index and a family history of> diabetes. We did not > adjust for these factors, and they may have> contributed to the > differential prevalence and odds of diabetes.> However, it is more

> plausible that HCV-infected persons would have a> lower body mass > index because of the presence of HCV and a larger> number of medical, > psychiatric and substance abuse comorbid diagnoses.> If true, this > would potentially bias the results towards a lower> prevalence and > odds of diabetes in the HCV-infected persons. We> found the opposite, > suggesting a true association. Future studies> seeking to compare > rates of medical comorbidities between patients with> and without HCV > may want to control for body mass index and, if> available, family > history of diabetes or other medical conditions.> > The prevalence of coronary artery disease and stroke> was lower in the > HCV-infected persons. This is an interesting and> novel observation. A > protective effect of HCV upon these diagnoses was> observed

despite > the groups being matched for age, sex and> race/ethnicity. We > separately ran a multivariable logistic regression> model adjusting > for demographic factors as well as other> comorbidities and found > similar results (data not shown). While we have> found the same > association in HCV-infected persons on> dialysis,[35,36] the reason > for this observation is not clear. As persons with> such acute and > life threatening events (such as myocardial> infarction and stroke) > are usually rushed to the nearest medical facility,> it is possible > that these events were not recorded in the VA> facility === message truncated ===__________________________________________________________Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ Jackie

[Guest guest]

Ahhh I wasn't sure .

Re: Co-morbid Medical and Psychiatric Illness and Substance Abuse in HCV-infected an

Please resend me the note about the speaker withonline feedback on Monday-I accidently deleted.Thank you!Kathy--- <elizabethnv1earthlink (DOT) net> wrote:> Co-morbid Medical and Psychiatric Illness and> Substance Abuse in HCV-> infected and Uninfected Veterans> Posted 01/24/2008> > > Abstract and Introduction> Abstract> Summary: Comorbidities may affect the decision to> treat chronic > hepatitis C virus (HCV) infection. We undertook this> study to > determine the prevalence of these conditions in the> HCV-infected > persons compared with HCV-uninfected controls.> Demographic and > comorbidity data were retrieved for HCV-infected and> -uninfected > subjects from the VA National Patient Care Database> using ICD-9 > codes. Logistic regression was used to determine the> odds of comorbid > conditions in the HCV-infected subjects.> HCV-uninfected controls were > identified matched on age, race/ethnicity and sex.> We identified 126 > 926 HCV-infected subjects and 126 926 controls. The> HCV-infected > subjects had a higher prevalence of diabetes,> anaemia, hypertension, > chronic obstructive pulmonary disease (COPD)/asthma,> cirrhosis, > hepatitis B and cancer, but had a lower prevalence> of coronary artery > disease and stroke. The prevalence of all> psychiatric comorbidities > and substance abuse was higher in the HCV-infected> subjects. In the > HCV-infected persons, the odds of being diagnosed> with congestive > heart failure, diabetes, anaemia, hypertension,> COPD/asthma, > cirrhosis, hepatitis B and cancer were higher, but> lower for coronary > artery disease and stroke. After adjusting for> alcohol and drug abuse > and dependence, the odds of psychiatric illness were> not higher in > the HCV-infected persons. The prevalence and> patterns of > comorbidities in HCV-infected veterans are different> from those in > HCV-uninfected controls. The association between HCV> and psychiatric > diagnoses is at least partly attributable to alcohol> and drug abuse > and dependence. These factors should be taken into> account when > evaluating patients for treatment and designing new> intervention > strategies.> > Introduction> Over 4 million persons in the USA are infected with> hepatitis C virus > (HCV) and over 170 million persons are infected> globally. It is a > major cause of end-stage liver disease and liver> transplants in the > USA.[1,2] While current treatment strategies lead to> viral > eradication in 54-56% of the treated persons> overall,[3-9] not all > patients infected with HCV are suitable candidates> for treatment, and > only a minority of the infected patients are ever> prescribed > treatment.[10-12] Reasons for nontreatment include> nonadherence to > follow-up visits, concurrent medical and psychiatric> problems and > substance abuse.[11,13] Medical comorbidities, such> as advanced > coronary artery disease and psychiatric> comorbidities, such as > depression and ongoing substance abuse, are relative> > contraindications to treatment. The prevalence of> HCV, medical and > psychiatric comorbidities and substance abuse is> higher in the > veterans of the United States armed forces who are> in care in the > Veterans' Affairs (VA) healthcare system compared> with the general > population.[14-19] The high prevalence of such> contraindications may > in part explain the relatively low rates of> treatment for HCV in > veterans in care. We conducted this study to> quantify the burden of > medical, psychiatric and substance abuse in> HCV-infected veterans, > and to compare them with matched HCV-uninfected> persons. A thorough > understanding of the magnitude of comorbid medical,> as well as > psychiatric and substance use conditions in> HCV-infected persons may > help develop strategies to address these conditions> and lead to > optimal management of HCV-infected persons.> > Discussion> Treatment for HCV leads to improved outcomes> including improved > quality of life, improved survival, decreased> progression of liver > disease and decreased risk of hepatocellular> carcinoma.[27-31] The > potential benefits of treatment need to be balanced> against the > possible side effects and cost of therapy. Presence> of multiple > comorbidities may potentially influence providers> towards > nontreatment of HCV.> > We found that the prevalence of a range of comorbid> medical > comorbidities was higher in the HCV-infected persons> and these > patients were more likely to have multiple> comorbidities. While the > increased prevalence of conditions, such as> cirrhosis and hepatitis B > coinfection, is intuitive, the reason(s) for an> increase in > prevalence of other conditions is less clear. An> association between > diabetes and HCV has been reported in recent years,> but the mechanism > for the increased risk of diabetes in HCV infection> is not known.> [24,32-34] Increasing age and racial/ethnic minority> status are > important risk factors for the development of> diabetes.[24] However, > the odds of being diagnosed with diabetes in our> study remained > higher despite the fact that the groups were matched> for age and > race/ethnicity. Other important determinants of the> risk of diabetes > are body mass index and a family history of> diabetes. We did not > adjust for these factors, and they may have> contributed to the > differential prevalence and odds of diabetes.> However, it is more > plausible that HCV-infected persons would have a> lower body mass > index because of the presence of HCV and a larger> number of medical, > psychiatric and substance abuse comorbid diagnoses.> If true, this > would potentially bias the results towards a lower> prevalence and > odds of diabetes in the HCV-infected persons. We> found the opposite, > suggesting a true association. Future studies> seeking to compare > rates of medical comorbidities between patients with> and without HCV > may want to control for body mass index and, if> available, family > history of diabetes or other medical conditions.> > The prevalence of coronary artery disease and stroke> was lower in the > HCV-infected persons. This is an interesting and> novel observation. A > protective effect of HCV upon these diagnoses was> observed despite > the groups being matched for age, sex and> race/ethnicity. We > separately ran a multivariable logistic regression> model adjusting > for demographic factors as well as other> comorbidities and found > similar results (data not shown). While we have> found the same > association in HCV-infected persons on> dialysis,[35,36] the reason > for this observation is not clear. As persons with> such acute and > life threatening events (such as myocardial> infarction and stroke) > are usually rushed to the nearest medical facility,> it is possible > that these events were not recorded in the VA> facility === message truncated ===__________________________________________________________Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

Jackie