The Negative Impact of Hepatitis C - Term Paper Example

INVESTIGATIVE REPORT OF A FAMILY HEALTH ISSUE Abstract Hepatitis C is a common viral disease of the liver, with an estimated 4.5 million infected individuals in the United States (Zickmund, Brown & Bielefeldt, 2007). Today, it s considered a major public health concern which is largely an asymptomatic disease that lies dormant for years but explodes when least expected. It is symptomatic in 25–35% of cases, and the clinical features resemble those of other forms of acute viral hepatitis such as malaise, nausea, abdominal discomfort, pale stools, dark urine and jaundice. These symptoms are usually mild, but this can be variable. (Farrell G. 2002) Many studies have documented that this chronic disease has impacted and impaired health – related quality of life (HRQL). However, there is a lot of ongoing research on the subject and self administered tools have been developed and upgraded to assist the health care professionals in assessing and estimating the impact of hepatitis C on the patient’s quality of life. This study is going to investigate about the negative impact of Hepatitis C not only on the patient but on the family of the patient. Introduction “Health is Wealth” is one good saying that no human being can get away from and as it is rightly said- “If you have health you have everything! But if you don’t have health you have nothing!”(reference with page number).(This is only an old saying and there is no ref. for it.) Especially in these modern days with widespread diseases that were not even thought of a few centuries ago, health issues has become a major challenge for the medical fraternity. The prevalence of HCV infection in some countries in Africa, the Eastern Mediterranean, South-East Asia and the Western Pacific is high compared to some countries in North America and Europe (World Health Organization (WHO), 2000). Some of the very prominent issues facing them are diseases such as Aids, Cancer and other Coronary Heart Diseases (CHD) Hepatitis C also poses a challenge as research is being carried out on a large scale in the field. In 2004, it was estimated that approximately 194,260 people living in Australia had been exposed to the virus and that 13,028 new diagnoses were reported in 2004 (Annual Surveillance Report, 2005). Hepatitis C is primarily transmitted via the parenteral route – approximately 80% of Australian-born people with hepatitis C were exposed to the virus through unsterile injecting drug use. (Crofts N, Dore G, 2001) There is also evidence to suggest that transmission rates may be higher if the patient is co-infected with HIV or other sexually transmitted diseases. (MacDonald M, Wodak A. 2003) Hepatitis C is transmitted by reusing syringes and needles, and contact with other injecting equipment such as tourniquets, spoons, water, surfaces and fingers contaminated with blood. Blood contact may also take place with reused snorting devices. (Hepatitis C Sub Committee of the Australian National Council, 1998) The government has committed its efforts in improving community awareness of this deadly disease. This study is going to make an investigation of how Hepatitis C affects not only the patient but has a great impact on the family as well. Hepatitis C:Hepatitis C is a ribonucleic acid (RNA) virus belonging “to the flavivirus family” (ASHM, 2004, p.10). Genetically distinct viral groups have evolved, with nine different genotypes of hepatitis C identified and approximately 40 different subtypes (Dev, McCaw, Sundararajan, Bowden & Sievert, 2002). Hepatitis C continues to pose a major public health concern around the world as it affects people in many different ways. Though no symptoms are reported for this disease, yet the initial stages of the disease are acute with about 10% of those affected lying sick for several weeks and sometimes even months (reference? No reference given- taken from- “Nurses and Hepatitis C” 1st page – paragraph on the right)). The recently published AASLD ( American Association for the study of Liver Diseases) guidelines suggest that obesity can affect the natural history of chronic hepatitis C, but no specific foods to avoid are mentioned (Strader, Wright, Thomas & Seeff, 2004). In the course of the acute stage, the virus levels dramatically shoot up in the blood, till anti-bodies are produced to the body’s immune response (reference – no ref.) Chronic HCV infection leads to a wide spectrum of liver disease ranging from minimal damage (even after 30 years) through chronic hepatitis (mild, moderate, severe) to cirrhosis, liver cell cancer and liver failure. (Batey, RG., 2003) It is reported that the most common cause of liver transplants is Hepatitis C. Considering the fact that the number of chronic infections has escalated to a high level with it being transmitted to others in addition to people not seeking treatment during the early stages, Hepatitis C seems to be a burgeoning factor where the health care system is concerned. The recently published AASLD guidelines suggest that obesity can affect the natural history of chronic hepatitis C, but no specific foods to avoid are mentioned. Strader DB, Wright T, Thomas DL, Seeff LB.(2004) The dreaded Hepatitis C is essentially hereditary that “is primarily transmitted via the parenteral route – approximately 80% of Australian-born people with hepatitis C were exposed to the virus through unsterile injecting drug use.” (Crofts , Dore, Locarnini, 2001. It direct codes please provide the page??nothing given.). The virus is not capable of being transmitted through kissing, hugging or touching but through blood-to-blood-contact by using the same syringes and needles used on infected people (Australian National Council (ANC), 1998). People could also be infected by coming into contact with other injecting equipment such as tourniquets, spoons, water, surfaces and fingers contaminated with blood ( (ANC), 1998). Blood contact may also take place with reused snorting devices (ANC, 1998). Breast milk of women who have tested positive with Hepatitis C has not been found to contain the virus, however, “All babies born to women who are hepatitis C positive will test antibody positive at birth because they inherit their mother’s antibodies. By the age of 18 months, 92–95% of babies will have cleared their mother’s antibodies and test negative for hepatitis C.” (Australian Institute for Primary Care, 2001, p. 16). The Impact on the Family: Being a victim of Hepatitis C is by no means a laughing matter because of the drastic impact it has not only on the infected person but also the family. Those infected with this virus are shocked and powerless at their next course of action. The person becomes listless with absolutely no zest for life (reference-no ref). They are confused and feel a lot of guilt and shame to think that they have to live a life of disability and illness (reference-no ref). They also feel lonely and internalize all their feelings and feel “victimized.” (reference -no ref). There is also the social stigma of having to disclose about the disease in the community and thereby either leaving their jobs or having to reduce their number of working hours (reference- no ref). The family is thrown off balance if any of their members are inflicted with Hepatitis C. There are many factors that contribute to this. Firstly, the sadness they feel at seeing one of their loved ones trying to cope with all the difficulties that arise (reference- no ref). The person many also face stigmatization or marginalization at times even from their own family members and circle of friends (reference- no ref). On the medical side, the family plays a major role in looking after their loved one infected with Hepatitis C. The first step towards caring for them would be to be properly educated on all aspects of the virus so that they would be in a better position to deal with the patient (reference-no ref). For example during the anti-viral treatment of the patient if interferon is administered the patient experiences heavy mood swings and becomes extremely irritable (reference- no ref). So if the family knows about the side effects of different drugs, it would help them to be more understanding and caring. Other side-effects reported in 10-20% of treated patients may include anorexia, malaise, alopecia, neutropenia, thrombocytopenia, irritability, diarrhoea and weight loss (Sievert, 2003). On the emotional side it is very important for the family to lend their full support by understanding the patient’s feelings (reference-no ref). The family members have to fully understand that the patient is always in the throes of guilt because of their disability and also not being able to support the family in the regular and normal way (reference- no ref). Besides this, the patient feels concern over the possibility of a somewhat premature death or about the restrictive limitations on their lifestyle (reference-no ref). This sort of negative psychological impact was especially prevalent in women. They were mostly concerned about the ability to fulfill expected gender roles, such as pregnancy and childcare (Grundy & Beeching, 2004.) The family has to meticulously see that their loved one has regular balanced diets, proper rest and exercise, change in sexual habits and reduced alcohol intake in order to be in a better position to manage stress, or else it might lead to depression and other psychological disorders (reference- no ref. taken from Nurses and Hepatitis C – Personal perspective – Jeff Ward)). Advice on adhering to the patient’s sexual habits is a must. According to the 2002 NIH guidelines, specific precautions (i.e. use of condoms) are recommended only for patients with multiple partners (National Institute of Health, 2002). It has been estimated that about 170 million people have hepatitis C virus (HCV) worldwide (Alter, Kruszon-Moram & Naina, 1999, WHO and Viral Hepatitis Prevention Board, 1999). Therefore it is vital that a family is advised on the importance of taking care to see that the disease is not transmitted to the other members in the family. Even though educating both the patient and family members on the various aspects of the disease is not only time-consuming and expensive, yet this would prove to have a very favorable impact on the patient’s lifestyle (reference).no ref. Several studies have indicated that cirrhosis develops in 10–30% of people with chronic HCV over a period of 20–30 years (Alter, Margolis, Krawezynsky, 1992, Seef, Buskell-Balcs, Wright, 1992, Tong, El-Harra, Reikes AR, 1995). This proves that most patients are asymptomatic for a very long period of time and may rarely develop progressive or symptomatic liver disease. However, the majority of infected patients are not administered any anti-viral treatment because of the many adverse side effects and therefore have to live their whole life with the infection (reference-no ref). Many recent studies have demonstrated the fact that patients lack vital knowledge about the disease and moreover have many misconceptions about the nature of the disease, the risks involved of passing it on to others and the various treatment options available (reference- no ref). In fact, the most important and potent tool for prevention of this disease is in the effective detection, diagnosis and treatment right from its initial stages (reference- no ref). Very limited insight of the nature, prevention and cure of Hepatitis C is because of inadequate or inappropriate information of this disease (reference- no ref.). Hepatitis C patients encounter blatant stigmatization not only from the society but also from the healthcare environment (reference-no ref.). Therefore it is almost crucial that Healthcare providers and other helpers receive proper guidance and understanding of the infection of HCV, in order to treat the patient in a much better manner. They also need to have knowledge about the history of the patient, the right diagnosis, different approaches as well as the current trends in treatment (reference).no ref) The National Hepatitis C Strategy group of 2005 – 2008, has highlighted 7 key areas for its treatment to be effective – These strategies include – 1) Prevention and education, 2) Treatment and diagnosis, 3) surveillance, 4) research, 5) health maintenance, 6) care and support, and 7) workforce development and addressing discrimination and stigma. All the different strategies have one main goal of early interventions and preventions. Those groups that are at high risk such as Aboriginal and Torres Strait Islander people should take advantage of early interventions and treatment programs and other support services or youth services in the community (reference- no ref). It is the responsibility of the Local Government for proper urban planning and development because it directly affects the operations and locations of the various NSP’s (National Student Partnerships) The key principles of the National Hepatitis C Strategy should be clearly reflected in the planning procedures. Reference: Alter, M. J., Kruszon-Moram, D., Naina, O.V. (1999). The prevalence of hepatitis C infection in the United States, 1998 through 1994. New England Journal of Medical, 341, 556–62. Alter, M. J., Margolis, H. S., & Krawezynsky, K. (1992). The natural history of Community acquired hepatitis C in the United States. New England Journal of Medical, 327, 1899–905. Annual Surveillance Report, (2005). HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia, edited by National Centre in HIV Epidemiology and Clinical Research 2005. Retrieved September 11, 2008 from (website) Batey, RG. Chronic Hepatitis C. Hepatitis C Update: A management guide for general practitioners. AFP 2003;32(Oct)4:17. ASHM(what is this stand for?).(Australian Society for HIV Medicine) (2004). HIV/Viral Hepatitis: a guide for primary care. Adelaide: ASHM. Retrieved September 5, 2008 from (website) Australian Instititue for Primary Care. (2001). National Hepatitis C Resource Manual. La Trobe University, Melbourne: AIPC, 16. Retrieved September 5, 2008 from (website) Crofts, N., Dore, G., & Locarnini, S. (2001). Hepatitis C: An Australian Perspective. Melbourne: IP Communications. Retrieved September 5, 2008 from (website) Dev, A., McCaw, R., Sundararajan, V., Bowden, S., & Sievert, W. (2002). Southeast Asian patients with chronic hepatitis C: The impact of novel genotypes and race on treatment outcome. Hepatology, 36, 1259-1264. Grundy, G., & Beeching, N. (2004). Understanding social stigma in women with hepatitis C. Nursing Standard, 19, 35–39. Hepatitis C Sub Committee of the Australian National Council on AIDS and Related Diseases. Estimates and projections of the hepatitis C virus epidemic in Australia. Sydney 1998;Aug. Australian National Council. (1998). Hepatitis C Sub- Committee of the Australian National Council on AIDS and Related Diseases: Estimates and projections of the hepatitis C virus epidemic in Australia. Retrieved September 5, 2008 from (website) Farrell G. Hepatitis C other liver disorders and liver health: a practical guide. Sydney: MacLennan and Petty, 2002:47. K. Bielefeldt Department of Medicine, (year??) University of Pittsburgh School of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh, Pennsylvania, USA (Taken from A systematic Review………) Retrieved September 8, 2008 from (website) Brown, K. E. (year). Iowa City Veterans Administration Medical Center and Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA (Taken from A systematic Review………) Retrieved September 8, 2008 from (website) MacDonald M, Wodak A. Preventing transmission of hepatitis C.Hepatitis C Update: A management guide for general practitioners. AFP 2003;28(Dec):10. National Institute of Health. (2002). Consensus development conference statement: management of Hepatitis C. Hepatology, 36, 3–20. Commonwealth of Australia (2005). National Hepatitis C Strategy 2005 – 2008. ISBN: 0 642 82656 0. Retrieved September 10, 2008 from (website) Seef, L.B., Buskell-Balcs, Z., & Wright, E.C. (1992). Long-term mortality after transfusion- associated non-A, non-B hepatitis. New England Journal of Medicine, 327, 1906–1911. Sievert, W. (2003). Antiviral therapy for chronic hepatitis C. Hepatitis C Update: A management guide for general practitioners. AFP 10(Oct) 829-30. Retrieved September 10, 2008 from (website) S L. Zickmund VA (2007) Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Published online: 4 April 2007, Springer Science+Business Media, LLC 2007 (Taken from A systematic Review………) Retrieved September 10, 2008 from (website) A Systematic Review of Provider Knowledge of Hepatitis C: Is it Enough for a Complex Disease? Susan L. Zickmund · Kyle E. Brown · Klaus Bielefeldt (from material you sent me.) Strader, D.B., Wright, T., Thomas, D.L., & Seeff, L.B. (2004). American Association for the Study of Liver Diseases. Diagnosis, management and treatment of hepatitis C. Hepatology, 39, 1141–1147. Tong, M.J., El-Harra, N.S., & Reikes, A.R. (1995). Clinical outcomes after transfusion associated hepatitis C. New England Journal of Medical, 332,1463–1466. WHO and Viral Hepatitis Prevention Board. (1999). Global Surveillance and Control of Hepatitis C. Journal of Viral Hepatitis, 6, 35 – 47. World Health Organization (WHO). (2000). Hepatitis C [Factsheet]. Retrieved September 24, 2008 from http://www.who.int/mediacentre/factsheets/fs164/en/ Dear customer, All the places you have asked for websites I can’t give you because I did not use any. Everything is from the material you provided. I had removed a few bits and added ones with references. Where there are no references we don’t have ref. because I wrote everything in my own words taking bits from here and there. I have also done the expansion of the words you asked. Thanks Georgina Read More