THE OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Hepatitis A: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83390-7 1. Hepatitis A-Popular works. I. Title.
iii
Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
iv
Dedication To the healthcare professionals dedicating their time and efforts to the study of hepatitis A.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to hepatitis A. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
v
About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
vi
About ICON Health Publications In addition to hepatitis A, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Appendicitis
·
The Official Patient's Sourcebook on Autoimmune Hepatitis
·
The Official Patient's Sourcebook on Bacteria and Foorborne Illness
·
The Official Patient's Sourcebook on Barrett's Esophagus
·
The Official Patient's Sourcebook on Celiac Disease
·
The Official Patient's Sourcebook on Cirrhosis of the Liver
·
The Official Patient's Sourcebook on Constipation
·
The Official Patient's Sourcebook on Crohn Disease
·
The Official Patient's Sourcebook on Cyclic Vomiting Syndrome
·
The Official Patient's Sourcebook on Diarrhea
·
The Official Patient's Sourcebook on Diverticular Disease
·
The Official Patient's Sourcebook on Fecal Incontinence
·
The Official Patient's Sourcebook on Gallstones
·
The Official Patient's Sourcebook on Gas
·
The Official Patient's Sourcebook on Gastritis
·
The Official Patient's Sourcebook on Gastroparesis
·
The Official Patient's Sourcebook on Hemolytic Uremic Syndrome
·
The Official Patient's Sourcebook on Hemorrhoids
·
The Official Patient's Sourcebook on Hepatitis B
·
The Official Patient's Sourcebook on Hepatitis C
·
The Official Patient's Sourcebook on Hiatal Hernia
·
The Official Patient's Sourcebook on Hirschsprung
·
The Official Patient's Sourcebook on Indigestion
·
The Official Patient's Sourcebook on Inguinal Hernia
·
The Official Patient's Sourcebook on Intestinal Pseudo-obstruction
·
The Official Patient's Sourcebook on Irritable Bowel Syndrome
·
The Official Patient's Sourcebook on Lactose Intolerance
·
The Official Patient's Sourcebook on Ménétrier
·
The Official Patient's Sourcebook on Pancreatitis
·
The Official Patient's Sourcebook on Peptic Ulcer
·
The Official Patient's Sourcebook on Porphyria
·
The Official Patient's Sourcebook on Primary Biliary Cirrhosis
·
The Official Patient's Sourcebook on Primary Sclerosing Cholangitis
·
The Official Patient's Sourcebook on Proctitis
·
The Official Patient's Sourcebook on Rapid Gastric Emptying
vii
·
The Official Patient's Sourcebook on Short Bowel Syndrome
·
The Official Patient's Sourcebook on Ulcerative Colitis
·
The Official Patient's Sourcebook on Whipple Disease
·
The Official Patient's Sourcebook on Wilson's Disease
·
The Official Patient's Sourcebook on Zollinger-ellison Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
ix
Table of Contents INTRODUCTION...................................................................................... 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7
CHAPTER 1. THE ESSENTIALS ON HEPATITIS A: GUIDELINES ............. 9 Overview ....................................................................................................................................... 9 What Is Hepatitis A?................................................................................................................... 11 What Causes Hepatitis A? .......................................................................................................... 11 How Could I Get Hepatitis A? .................................................................................................... 11 Who Can Get Hepatitis A?.......................................................................................................... 12 What Are the Symptoms? ........................................................................................................... 12 How Is Hepatitis A Treated?....................................................................................................... 13 How Can I Protect Myself?......................................................................................................... 14 For More Information.................................................................................................................. 15 More Guideline Sources .............................................................................................................. 15 Vocabulary Builder...................................................................................................................... 30
CHAPTER 2. SEEKING GUIDANCE ....................................................... 33 Overview ..................................................................................................................................... 33 Associations and Hepatitis A ...................................................................................................... 33 Finding More Associations ......................................................................................................... 39 Finding Doctors........................................................................................................................... 41 Selecting Your Doctor ................................................................................................................. 42 Working with Your Doctor ......................................................................................................... 43 Broader Health-Related Resources .............................................................................................. 44 Vocabulary Builder...................................................................................................................... 45
CHAPTER 3. CLINICAL TRIALS AND HEPATITIS A.............................. 47 Overview ..................................................................................................................................... 47 Recent Trials on Hepatitis A ....................................................................................................... 50 Benefits and Risks........................................................................................................................ 51 Keeping Current on Clinical Trials ............................................................................................. 54 General References....................................................................................................................... 55 Vocabulary Builder...................................................................................................................... 56 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 59
CHAPTER 4. STUDIES ON HEPATITIS A ............................................... 61 Overview ..................................................................................................................................... 61 The Combined Health Information Database .............................................................................. 61 Federally-Funded Research on Hepatitis A ................................................................................. 70 E-Journals: PubMed Central ....................................................................................................... 72 The National Library of Medicine: PubMed................................................................................ 73 Vocabulary Builder...................................................................................................................... 74
CHAPTER 5. BOOKS ON HEPATITIS A ................................................. 83 Overview ..................................................................................................................................... 83 Book Summaries: Federal Agencies ............................................................................................. 83 Book Summaries: Online Booksellers .......................................................................................... 85
x
Contents The National Library of Medicine Book Index............................................................................. 89 Chapters on Hepatitis A .............................................................................................................. 91 General Home References ............................................................................................................ 94 Vocabulary Builder...................................................................................................................... 95
CHAPTER 6. MULTIMEDIA ON HEPATITIS A....................................... 97 Overview ..................................................................................................................................... 97 Video Recordings......................................................................................................................... 97 Bibliography: Multimedia on Hepatitis A................................................................................... 99
CHAPTER 7. PERIODICALS AND NEWS ON HEPATITIS A.................. 103 Overview ................................................................................................................................... 103 News Services & Press Releases ................................................................................................ 103 Newsletter Articles .................................................................................................................... 112 Academic Periodicals covering Hepatitis A............................................................................... 114 Vocabulary Builder.................................................................................................................... 115
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ................... 117 Overview ................................................................................................................................... 117 NIH Guidelines ......................................................................................................................... 117 NIH Databases .......................................................................................................................... 118 Other Commercial Databases .................................................................................................... 125 The Genome Project and Hepatitis A ........................................................................................ 126 Specialized References ............................................................................................................... 130
CHAPTER 9. DISSERTATIONS ON HEPATITIS A ................................. 131 Overview ................................................................................................................................... 131 Dissertations on Hepatitis A ..................................................................................................... 131 Keeping Current ........................................................................................................................ 132 PART III. APPENDICES .............................................................................................................. 133
APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 135 Overview ................................................................................................................................... 135 Your Medications: The Basics ................................................................................................... 136 Learning More about Your Medications ................................................................................... 137 Commercial Databases............................................................................................................... 139 Contraindications and Interactions (Hidden Dangers)............................................................. 140 A Final Warning ....................................................................................................................... 141 General References..................................................................................................................... 142
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 143 Overview ................................................................................................................................... 143 What Is CAM? .......................................................................................................................... 143 What Are the Domains of Alternative Medicine? ..................................................................... 144 Can Alternatives Affect My Treatment?................................................................................... 147 Finding CAM References on Hepatitis A.................................................................................. 148 Additional Web Resources......................................................................................................... 151 General References..................................................................................................................... 157 Vocabulary Builder.................................................................................................................... 158
APPENDIX C. RESEARCHING NUTRITION ......................................... 161 Overview ................................................................................................................................... 161 Food and Nutrition: General Principles .................................................................................... 162 Finding Studies on Hepatitis A................................................................................................. 166 Federal Resources on Nutrition................................................................................................. 168 Additional Web Resources......................................................................................................... 168 Vocabulary Builder.................................................................................................................... 169
Contents
xi
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 171 Overview ................................................................................................................................... 171 Preparation ................................................................................................................................ 171 Finding a Local Medical Library ............................................................................................... 172 Medical Libraries Open to the Public ........................................................................................ 172
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 179 Overview ................................................................................................................................... 179 Your Rights as a Patient............................................................................................................ 179 Patient Responsibilities ............................................................................................................. 183 Choosing an Insurance Plan...................................................................................................... 184 Medicare and Medicaid ............................................................................................................. 186 NORD’s Medication Assistance Programs............................................................................... 189 Additional Resources................................................................................................................. 190 Vocabulary Builder.................................................................................................................... 191 ONLINE GLOSSARIES ............................................................................................................... 193 Online Dictionary Directories................................................................................................... 199 HEPATITIS A GLOSSARY ......................................................................................................... 201 General Dictionaries and Glossaries ......................................................................................... 216 INDEX.............................................................................................................................................. 218
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Hepatitis A
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Hepatitis A has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to hepatitis A, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on hepatitis A. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on hepatitis A should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching hepatitis A (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to hepatitis A. It also gives you sources of information that can help you find a doctor in your local area specializing in treating hepatitis A. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with hepatitis A. Part II moves on to advanced research dedicated to hepatitis A. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on hepatitis A. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with hepatitis A or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with hepatitis A. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with hepatitis A.
Scope While this sourcebook covers hepatitis A, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that hepatitis A is often considered a synonym or a condition closely related to the following: ·
Acute Viral Hepatitis a
·
Infectious Hepatitis
·
Viral Hepatitis
4
Hepatitis A
In addition to synonyms and related conditions, physicians may refer to hepatitis A using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for hepatitis A:4 ·
070.0 viral hepatitis a with hepatic coma
·
070.1 hepatitis a
·
070.1 viral hepatitis a without mention of hepatic coma
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to hepatitis A. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with hepatitis A will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
Since only the smallest fraction of information dealing with hepatitis A is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of hepatitis A, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on hepatitis A. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of hepatitis A to you or even given you a pamphlet or brochure describing hepatitis A. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. GUIDELINES
THE
ESSENTIALS
ON
HEPATITIS
9
A:
Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on hepatitis A. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on hepatitis A can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on hepatitis A. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Hepatitis A
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with hepatitis A and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on hepatitis A.
What Is Hepatitis A?7 Hepatitis A is a liver disease. Hepatitis (HEP-ah-TY-tis) makes your liver swell and stops it from working right. You need a healthy liver. The liver does many things to keep you alive. The liver fights infections and stops bleeding. It removes drugs and other poisons from your blood. The liver also stores energy for when you need it.
What Causes Hepatitis A? Hepatitis A is caused by a virus. A virus is a germ that causes sickness. (For example, the flu is caused by a virus.) People can pass viruses to each other. The virus that causes hepatitis A is called the hepatitis A virus.
How Could I Get Hepatitis A? Hepatitis A is spread by close personal contact with someone else who has the infection. Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/pubs/hep/hepa/hepa.htm. 7
12 Hepatitis A
You could also get hepatitis A by: ·
Eating food that has been prepared by someone with hepatitis A
·
Drinking water that has been contaminated by hepatitis A (in parts of the world with poor hygiene and sanitary conditions)
Wash your hands before fixing or eating food.
Who Can Get Hepatitis A? Anyone can get hepatitis A, but some people are more likely to than others, such as: ·
People who live with someone who has hepatitis A
·
Children who go to day care
·
People who work in a day care center
·
Men who have sex with men
·
People who travel to other countries where hepatitis A is common
What Are the Symptoms? Hepatitis A can make you feel like you have the flu. You might: ·
Feel tired
·
Feel sick to your stomach
·
Have a fever
·
Not want to eat
·
Have stomach pain
Guidelines 13
·
Have diarrhea
Some people have: ·
Dark yellow urine
·
Light-colored stools
·
Yellowish eyes and skin
Some people don’t have any symptoms. If you have symptoms, or think you might have hepatitis A, go to a doctor. The doctor will test your blood.
Bed rest and medicine will help you get better.
How Is Hepatitis A Treated? ·
Most people who have hepatitis A get well on their own after a few weeks.
·
You may need to rest in bed for several days or weeks, and you won’t be able to drink alcohol until you are well.
·
The doctor may give you medicine for your symptoms.
14 Hepatitis A
How Can I Protect Myself?
Vaccines protect you from getting hepatitis A.
You can get the hepatitis A vaccine. A vaccine is a drug that you take when you are healthy that keeps you from getting sick. Vaccines teach your body to attack certain viruses, like the hepatitis A virus. The hepatitis A vaccine is given through a shot. Children can get the vaccine after they turn 2 years old. Children aged 2 to 18 will need three shots. The shots are spread out over a year. Adults get two or three shots over 6 to 12 months. You need all of the shots to be protected. If you miss a shot, call your doctor or clinic right away to set up a new appointment.
You can protect yourself and others from hepatitis a in these ways, too: ·
Wash your hands to protect yourself.
·
Always wash your hands after using the toilet and before fixing food or eating.
Guidelines 15
·
Wear gloves if you have to touch other people’s stool. Wash your hands afterwards.
·
Drink bottled water when you are in another country. (And don’t use ice cubes or wash fruits and vegetables in tap water.)
For More Information You can also get information about hepatitis A from these groups: American Liver Foundation 75 Maiden Lane, Suite 603 New York, NY 10038 Phone: 1-800-465-4837 (This is a free call.) Email:
[email protected] Internet: www.liverfoundation.org Hepatitis Foundation International 30 Sunrise Terrace Cedar Grove, NJ 07009-1423 Phone: 1-800-891-0707 (This is a free call.) Email:
[email protected] Internet: www.hepfi.org
More Guideline Sources The guideline above on hepatitis A is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to hepatitis A. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with hepatitis A. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
16 Hepatitis A
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on hepatitis A and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
What I Need to Know About Hepatitis A. [Lo Que Necesito Saber Sobre la Hepatitis A] Source: Bethesda, MD: National Digestive Diseases Information Clearinghouse (NDDIC). 1999. 10 p. Contact: Available from National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389 or (301) 654-3810. Fax (301) 907-8906. E-mail:
[email protected]. Price: Single copy free; bulk copies available. Summary: This brochure provides basic information about hepatitis A. Written in nontechnical language, the brochure describes hepatitis A and the virus that causes it, explains how hepatitis A is transmitted, lists
Guidelines 17
groups of people who are more likely to get hepatitis A, lists the symptoms of the disease, describes the treatment, and focuses on preventing transmission of the disease through vaccination and proper hygiene. Hepatitis A, a liver disease caused by the hepatitis A virus (HAV) is spread by touching stool from a bowel movement of an infected person (for example, when changing an infected baby's diaper or when eating food made by someone who touched infected stool) and then eating or drinking without washing one's hands first. People who are at greater risk for getting hepatitis A include those who live with someone who has the disease, children who go to day care, people who work in a day care center, men who have sex with men, and people who travel to other countries. Bed rest and medication are prescribed for people who have hepatitis A. The brochure lists two resource organizations (the American Liver Foundation and the Hepatitis Foundation International) for readers who wish to obtain more information. In addition, the contact information for the National Digestive Diseases Information Clearinghouse (NDDIC) is provided. The brochure is illustrated with simple line drawings. ·
Hepatitis A: What You Should Know Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1999. 7 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $1.05 each; plus shipping and handling; quantity discounts available. Order number 74637 for English version; 74645 for Spanish version. Summary: Written in nontechnical language, this patient education booklet reviews hepatitis A, a liver disease caused by a virus in the blood. Hepatitis A virus (HAV) is easy to spread since the virus is sometimes found in feces (human waste). Many people with hepatitis A think they have the flu. Signs of infection with HAV may include flulike symptoms (fever, fatigue, upset stomach, vomiting), jaundice (yellow skin) and dark urine. Hepatitis A can spread quickly in group settings, such as group homes, prisons, military bases, nursing homes, and child care centers. The booklet reviews how hepatitis A is spread, including through touching feces (for example changing a baby's diaper), eating with soiled hands, drinking or swimming in polluted water, sharing needles (for drug use, tattooing, or piercing), participating in anal sex, and receiving a blood transfusion (a very rare way of getting hepatitis A now that blood tests are utilized extensively). Prevention strategies include washing one's hands, washing all eating utensils, avoiding raw or undercooked food, always using a latex condom for sexual encounters, and never sharing needles for any reason. A vaccine for hepatitis A is available and
18 Hepatitis A
may be useful for people who live with an infected person. The brochure concludes with a brief section on self care for people who have HAV; it focuses on the need to rest, avoid alcohol (to protect the liver), and eat healthy foods while recuperating. The booklet is illustrated with line drawings. ·
You Don't Have to Go All the Way to Get Hepatitis A: Get Vaccinated! Source: St. Paul, MN: Hepatitis B Coalition. 1997. 2 p. Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Fax (612) 647-9131. Price: $1.00. Summary: This brochure reminds readers of the risks associated with hepatitis A and the guidelines for vaccinations to prevent hepatitis A. Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus (HAV). The brochure discusses the complications of hepatitis A, risk factors for getting hepatitis A (including multiple sexual partners and certain sexual behaviors), how to protect oneself from getting hepatitis A (get vaccinated, use condoms for anal sexual activities), how hepatitis A is spread, the symptoms of hepatitis A, what to do after a potential exposure to hepatitis A, immune protection after having hepatitis A once, the specificity of the hepatitis A vaccine (it only protects against HAV, not against hepatitis B or C), where to receive hepatitis A shots, and how to get shots if one cannot afford them. The brochure contains slang terms for sexual activities and is illustrated with line drawings that suggest sexual activity between two men.
·
Hepatitis A Prevention Source: Atlanta, GA: Centers for Disease Control and Prevention (CDC). 1997. [4 p.]. Contact: Available from Centers for Disease Control and Prevention (CDC). 1600 Clifton Road, NE, Hepatitis Branch, MS G-37 Atlanta, GA 30333. (888) 443-7232 or (888) 4HEPCDC. Fax (404) 371-5488. Price: Single copy free. Summary: This brochure describes hepatitis A, a liver disease caused by the hepatitis A virus (HAV). Good personal hygiene and proper sanitation can help prevent hepatitis A. Vaccines are also available for long term prevention of HAV infection in persons 2 years of age and older. Immune globulin is available for short term prevention of hepatitis A virus infection in all ages. HAV is found in the stool (excrement) of persons with hepatitis A and is usually spread by putting something in the mouth that has been contaminated with that stool. For this reason, the virus is more easily spread in areas where there are poor sanitary
Guidelines 19
conditions or where good personal hygiene is not observed. Persons with hepatitis A can spread the virus to others who live in the same household or with whom they have sexual contact. The brochure reviews the risk factors for hepatitis A and lists the symptoms of the disease, which include yellowing of the eyes, dark urine, tiredness, loss of appetite, and flu like symptoms (nausea, vomiting, fever, stomach ache). The brochure reviews the recommendations for who should receive hepatitis A vaccination. In addition to getting hepatitis A directly from infected persons, the virus can be transmitted by swallowing contaminated water or ice, eating raw shellfish harvested from sewage contaminated water, and eating fruits, vegetables or other food that may have become contaminated during handling. The brochure offers the web site and Hepatitis Hotline (888-443-7232) information of the Centers for Disease Control and Prevention (CDC). ·
About Hepatitis A Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1996. 15 p. Contact: Available from Channing L. Bete Company, Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $1.25 each for 1-24 copies; discounts available for larger orders. Summary: This brochure provides an overview of hepatitis A, how it is transmitted, and how to prevent contracting the disease. The hepatitis A virus (HAV) is highly contagious and causes a flu-like illness. The brochure stresses that good hygiene and proper sanitation reduce the risk of getting hepatitis A. A vaccine is also recommended for some people. The brochure reviews how HAV is spread, including through touching, eating, polluted water, sex, blood, and sharing needles. The brochure also outlines the risks of HAV transmission in group-living situations. The remainder of the brochure emphasizes sanitary practices that can help prevent the spread of hepatitis A, including handwashing, thorough washing of dishes and utensils, and following proper hygienic precautions after changing a child's diaper or helping a child in the bathroom. The brochure provides specific suggestions for reducing the risks of spreading HAV through contaminated food, including the proper cooking of shellfish and the use of appropriate dishwashing and handwashing practices. The brochure concludes with a section of tips for travelers and recommendations for health care workers who need to help protect themselves and their patients from hepatitis A. Other sections in the brochure explain risk factors, the symptoms of hepatitis A, and the recommended patient care management for hepatitis A. The brochure is illustrated with cartoon-like drawings and numerous checklists and charts. The telephone numbers of the American Liver Foundation (800-
20 Hepatitis A
223-0179) and the Centers for Disease Control and Prevention Hepatitis Hotline (404-332-4555) are noted. ·
Simple Facts of CD: Hepatitis A Source: Portland, OR: Multnomah County Health Department. 1992. 2 p. Contact: Available from Multnomah County Health Department. Communicable Disease Office, 426 SW Stark Street, 3rd Floor, Portland, OR 97204. (503) 248-3406 or (503) 248-3417. Price: Single copy free. Summary: Hepatitis A is an infection of the liver, caused by the hepatitis A virus (HAV). This simple brochure outlines the symptoms, treatment, and prevention of hepatitis A. The symptoms of hepatitis A begin 2 to 6 weeks after a person is exposed to the virus and can include fever and chills, nausea, vomiting, fatigue, pain in the stomach area, dark colored urine, light colored bowel movements, and jaundice. Hepatitis A is spread through fecal contact: for example, eating foods handled by a sick person who failed to wash his or her hands after using the toilet. Hepatitis A can also be acquired by eating raw seafood (such as oysters) taken from fecal-contaminated water. There is no treatment for hepatitis A. Prevention measures for hepatitis A include immunization, good hand washing, and following safer sex measures. The brochure is written in nontechnical language and the information is provided in numbered list format for ease of understanding.
·
Hepatitis Basics Source: Kalamazoo, MI: Hope Publications. 200x. [4 p.]. Contact: Available from Hope Publications. 350 East Michigan Avenue, Suite 301, Kalamazoo, MI 49007-3851. (616) 343-0770. Website: hithope.com. Price: $0.59 each for 10-100 copies. Summary: This brochure, written in nontechnical language, offers a basic overview of human viral hepatitis, a disease that attacks the liver. The brochure describes the three main types: hepatitis A, hepatitis B, and hepatitis C. Hepatitis A infection is usually brief and causes no long term problems. However, hepatitis B and hepatitis C can lead to serious illness, including chronic (lifelong) infection, cirrhosis of the liver, liver cancer, liver failure, and death. The brochure emphasizes that the best way to deal with all three types of hepatitis is prevention. For each type, the brochure discusses risk factors, transmission, symptoms, and prevention strategies. Hepatitis A is transmitted through human feces, that is, in food or water that has been contaminated with feces. Raw foods such as fruits and vegetables pose the greatest risk (cooking kills the virus); but cooked foods can spread the disease if they're touched by
Guidelines 21
contaminated hands after cooking. Hepatitis B is spread primarily through sexual contact, shared drug injection equipment contaminated by blood, infected blood on razors or needles (used for ear piercing, tattooing), and infected blood and body fluids (health care workers are at risk). It is also passed from infected mother to her baby at birth. Hepatitis C is most commonly spread shared drug injection equipment contaminated with blood. The brochure reiterates prevention steps for each type of hepatitis C, particularly those related to good hygiene (handwashing). One sidebar reminds readers who have had hepatitis B or C that they should not donate blood or organs, should not share toothbrushes or other personal care items, should cover open sores and other breaks in the skin, and should use a latex condom during sex. One final section offers further information about the hepatitis A vaccine and the hepatitis B vaccine. ·
Hepatitis A: Viral Hepatitis Source: Santa Cruz, CA: ETR Associates. 1998. 4 p. Contact: Available from ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. Price: Single copy free; bulk copies available. Order number: R771. Summary: Hepatitis A is an infection of the liver. Symptoms improve gradually over time with plenty of rest and a good diet. This brochure describes hepatitis A in nontechnical language, focusing on transmission (how people get the disease), symptoms, and treatment options. The hepatitis A virus is passed in human feces. A common way for it to spread is from the hands of an infected person. People with hepatitis A may spread the virus by preparing or serving food; sharing dishes or eating utensils; sharing food, drinks, or cigarettes; and having sex, especially oral or anal sex. Hepatitis A symptoms include tiredness, fever, nausea, stomach pain or lack of appetite, dark tea-colored urine, light clay-colored stools, and yellow skin or eyes (jaundice). Most people with hepatitis A recover completely. It is very important to avoid alcohol during the recovery period, since the infected liver has trouble clearing alcohol from the body. A final section reminds readers how to prevent hepatitis A, including washing one's hands, preparing food carefully, and getting vaccinated, and what to do after being exposed. One sidebar describes the best way to wash one's hands; another discusses the indications for the hepatitis A vaccine.
·
About Viral Hepatitis Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1998. 15 p.
22 Hepatitis A
Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $0.95 each; plus shipping and handling; quantity discounts available. Summary: This booklet provides basic information about viral hepatitis. Illustrated with Scriptographic cartoon figures, the booklet defines the different types of hepatitis viruses (A, B, C, D, E) and how the viruses are transmitted. The booklet emphasizes that many people infected with viral hepatitis are unaware that they have a disease. Yet, they can still infect others and some can become long term carriers and or develop serious complications. The booklet reviews the functions and physiology of the liver and how it can be affected by a hepatitis infection. The booklet outlines how each type is transmitted and then notes the symptoms that are similar in each type of hepatitis. Treatment options are designed to ease the damaged liver's workload. These treatments include eating a varied, nutritional diet; getting plenty of rest; avoiding alcoholic beverages, nonessential medications, and large doses of vitamins; and avoiding infecting others. The booklet discusses the treatments that may be given immediately after exposure to hepatitis A or B, and then explores the preventive options, including the use of vaccines against hepatitis A or B. One section encourages health care workers to be extra careful to avoid viral hepatitis; the section describes how health care workers may be endangered at work and what safety precautions they should follow. The booklet concludes with a brief section of common questions and answers about viral hepatitis. ·
Meet Oliver: The Liver Mascot for Viral Hepatitis Source: Jenkintown, PA: Hepatitis B Foundation. 1997. 2 p. Contact: Available from Hepatitis B Foundation. 101 Greenwood Avenue, Suite 570, Jenkintown, PA 19046. (215) 884-8786. Fax (215) 887-1931. Email:
[email protected]. Website: http://www.hebp.org. Price: Single copy free. Summary: This brochure introduces readers to the basic functions of the liver and to problems encountered with viral hepatitis (inflammation of the liver). The liver stores sugar and iron to help provide energy for the body; detoxifies compounds that have been eaten, drunk, breathed or absorbed through the skin; produces proteins for healthy growth; makes clotting factors for the blood; and works with the immune system to fight off infection. The three most common liver viruses are hepatitis A, B, and C. Although people can recover from an infection with these viruses, many become chronic carriers of hepatitis B and hepatitis C, which can lead to more serious complications later in life. Typical symptoms of viral hepatitis range from mild flu-like symptoms to fatigue, weakness,
Guidelines 23
achiness, bloated stomach, and jaundice (yellow eyes and skin). Chronic hepatitis can result in cirrhosis, liver cancer, or liver failure. Certain behaviors and occupations may leave one at greater risk for contracting hepatitis. The brochure concludes with a brief list of recommendations for preventing viral hepatitis. The brochure is illustrated with a cartoon figure of a liver. The brochure includes the contact information for two nonprofit resource organizations: the Hepatitis B Foundation and the Hepatitis C Foundation. (AA-M). ·
Getting Hip to Hep: What You Should Know About Hepatitis A, B, and C. [Para estar al tanto con la hep: Lo que Usted debe de saber acerca de la hepatitis a, b, and c] Source: Cedar Grove, NJ: American Liver Foundation. 1996. 8 p. Contact: Available from American Liver Foundation. 1425 Pompton Avenue, Cedar Grove, NJ 07009. (800) 223-0179 or (201) 256-2550. Price: Single copy free. Summary: This brochure reviews the common types of viral hepatitis, including hepatitis A, hepatitis B, and hepatitis C. Topics include the complications of each type of hepatitis, risk factors, transmission, symptoms, diagnostic and screening tests, and preventive issues. The brochure concludes with a brief description of the American Liver Foundation, and a toll-free telephone number for additional information. 1 table. The brochure is available in English or Spanish.
·
Chronic Viral Hepatitis Source: Bethesda, MD: American Gastroenterological Association. 1996. 3 p. Contact: Available from GIDH-AGA Patient Education Center. P.O. Box 1274, West Caldwell, NJ 07007-9562. Price: 25 copies free to health care professionals for distribution to patients. Summary: This brochure provides patients with basic information about chronic viral hepatitis (CVH). Hepatitis is an inflammation of the liver that usually produces swelling, tenderness, and sometimes permanent damage. Hepatitis is caused by a number of things including alcohol, drugs, chemicals, and viral infections. If the inflammation of the liver continues at least 6 months, it is called chronic hepatitis. After a brief introduction that explains the role of the liver in managing the body's functions, the author describes the five different viruses known to cause viral hepatitis (hepatitis A, B, C, D, and E). Other topics include symptoms, the use of liver biopsy to confirm a diagnosis, the difference between acute and chronic hepatitis, carrier status for hepatitis, treatment
24 Hepatitis A
options, and prevention, notably the vaccines against hepatitis A and B and the blood screening procedures to protect against hepatitis C transmission through blood transfusions. The brochure notes that many cases of viral hepatitis are not diagnosed because the symptoms are vague and similar to a flu-like illness. The brochure concludes with a glossary of terms and the address and toll free telephone number (800223-0179) of the American Liver Foundation. 1 figure. (AA-M). ·
Viral Hepatitis: Everybody's Problem? Source: Cedar Grove, NJ: American Liver Foundation. 1994. 5 p. Contact: Available from American Liver Foundation. 1425 Pompton Avenue, Cedar Grove, NJ 07009. (800) 223-0179 or (201) 256-2550. Price: $0.50 each; $6 for 25 copies; $12 for 50 copies (as of 1995); discounts available for larger quantities. Summary: Written in a question-and-answer format, this brochure covers a broad range of topics, including a simple definition of the disease; a description of different types of viral hepatitis; transmission; symptoms; pregnancy and hepatitis; treatment; medication; exercise; diet; alcohol; food handling; possible complications; and prevention of hepatitis.
·
Questions and Answers: Dr. Dan Talks to You About the ABC's of Viral Hepatitis A, B and C. [Preguntas and Respuestas: Dr. Dan Habla Sobre la Hepatitis A, B y C] Source: Bethesda, MD: American Digestive Health Foundation. 199x. 8 p. Contact: American Digestive Health Foundation (ADHF). 7910 Woodmont Avenue, Seventh Floor, Bethesda, MD 20814. (800) 668-5237 or (301) 654-2055. Fax (301) 652-3890. Website: www.ADHF.org. Price: Single copy free; bulk copies available. Summary: This brochure offers answers to common questions about viral hepatitis (liver infection), including types A, B, and C. Viral hepatitis is a disease caused by viruses that damage the liver; this damage can make the liver inflamed, swollen, and tender. Hepatitis A does not cause long lasting infections; hepatitis B and C can cause infections lasting longer than 6 months. Hepatitis A is transmitted through fecal contact (the stool) with a person who is infected with the virus; the virus can be transmitted when a person eats food or drinks water contaminated with infected human waste. Hepatitis B is transmitted through direct contact with the blood or body fluids of an infected person. The most common causes of hepatitis C are sharing needles and equipment when using intravenous drugs, receiving blood transfusions before 1992, having unprotected sex with multiple partners, and during childbirth from mother to baby (this
Guidelines 25
is a rare form of transmission). The brochure notes that a viral hepatitis infection can be hard to detect because there often are no visible signs or symptoms. Most often, viral hepatitis is discovered through routine blood tests conducted during an evaluation. Vaccines are available to prevent hepatitis A and hepatitis B; all types of hepatitis can be prevented by avoiding risky behaviors. There are some treatment options for hepatitis, but prevention is preferable. The brochure concludes with a description of the American Digestive Health Foundation (ADHF), a cooperative effort of a group of professional organizations in gastroenterology and liver disease. The ADHF and the American Liver Foundation (ALF) are working together to educate Americans about viral hepatitis. The brochure includes the toll free information line of ADHF (800-668-5237) and the ALF (888-4HEP-ABC), along with their websites. The brochure is available in either English or Spanish. 1 figure. 2 tables. ·
Hepatitis A, B, and C: What You Should Know About These Serious Liver Diseases Source: Cedar Grove, NJ: American Liver Foundation. [6 p.]. Contact: Available from American Liver Foundation. 1425 Pompton Avenue, Cedar Grove, NJ 07009-1000. (201) 256-2550 or (800) 223- 0179; FAX (201) 256-3214. Price: $0.50. Also available in Spanish (see MG0001412). Summary: This brochure presents information about viral hepatitis A, B, and C. The spread of viral hepatitis, its symptoms, and transmission are explained. A spanish version of this brochure is also available (see MG0001412).
·
[Hepatatis Foundation International Packet] Source: Cedar Grove, NJ: Hepatitis Foundation International. 199x. [40 p.]. Contact: Available from Hepatitis Foundation International. 30 Sunrise Terrace, Cedar Grove, NJ 07009. (800) 891-0707 or (201) 239-1035. Fax (201) 857-5044. Price: $10.00 each; discounts available for larger orders. Free with membership. Summary: This information packet provides a wealth of information to support educational programs about hepatitis and its prevention. The packet was created by the Hepatitis Foundation International, a group that provides updated information on new diagnostic measures and treatments, referral to physicians, and access to a telecommunications network of patients with similar ailments. The information stresses that understanding the disease process of viral hepatitis and its impact on the
26 Hepatitis A
liver, and encouraging individuals to actively participate in their health care is vital. The packet includes fact sheets on hepatitis A, hepatitis B, vaccination, hepatitis C, diagnosis and treatment options, and liver care; copies of the foundation's newsletter; a curriculum for teachers on liver wellness, hepatitis B, and substance abuse prevention; information about the foundation; display information (miniposters) on preventing the sexual transmission of hepatitis B; and brochures on hepatitis B in children and on the physiology and role of the liver. The materials are compiled into a folder.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “hepatitis A” or synonyms. The following was recently posted: ·
Prevention of Hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). Source: Centers for Disease Control and Prevention.; 1999 October 1; 39 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1365&sSearch_string=hepatitis+A
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
FAQs: Viral Hepatitis B Summary: Answers to questions about hepatitis B risk factors, transmission, prevention, vaccination, and treatment. Source: National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6448
Guidelines 27
·
Hepatitis A Virus (HAV) Summary: Written for clinicians, this hepatitis A virus (HAV) fact sheet presents basic information about the disorder that includes diagnosis, epidemiology, disease management guidelines, and information Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5317
·
Model Programs for Hepatitis A, B, and C Prevention Summary: This web site presents programs across the United States that work to prevent hepatitis A, B, or C in people who are at risk for infection -- especially adults and adolescents. Source: Immunization Action Coalition http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6273
·
Prevention of Hepatitis A Virus (HAV) Infection - Vaccination Questions and Answers Summary: Guidelines for immunization against hepatitis A virus (HAV) infection. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5318
·
Slide Set Presentation and Technical Notes: Hepatitis A to E Summary: At this web site users can view or download slide set presentations and technical notes for hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E. Source: Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5313
28 Hepatitis A
·
The Johns Hopkins Center for Viral Hepatitis Website Summary: This web site links users to: a an interactive, question-andanswer forum where Viral Hepatitis specialists at the Johns Hopkins Center for Viral Hepatitis will respond to questions posted on the Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4717
·
Vaccine Information Statements - Centers for Disease Control and Prevention Summary: This web site provides links to general information on a variety of vaccines for the general public including chickenpox, diphtheria, HIB, measles, mumps, pertussis, polio, rubella, hepatitis and Source: National Immunization Program, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=366
·
Vaccines for Children Program Summary: The Vaccines for Children (VFC) program provides vaccines free of charge to eligible children, including hepatitis A and hepatitis B vaccines. The VFC Web site provides specifics. Source: National Immunization Program, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6272
·
Viral Hepatitis - Resource Center Summary: This web site is a one-stop shopping center for information about Hepatitis, from A to E. Source: Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3819
Guidelines 29
·
Viral Hepatitis A - Information Summary: This web site provides access to information about Hepatitis A for both health professionals and the lay public. Source: Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3813
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to hepatitis A. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To access the database, which is more oriented to researchers than patients, you can view the current list of conditions covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
30 Hepatitis A
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria,
Guidelines 31
cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Handwashing: The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Intravenous: Within a vein or veins. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Prisons: Penal institutions, or places of confinement for war prisoners. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU]
32 Hepatitis A
Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
Seeking Guidance 33
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with hepatitis A. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with hepatitis A. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Hepatitis A As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
34 Hepatitis A
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
British Liver Trust Address: British Liver Trust Ransomes Europark, Ipswich, Suffolk, 1P3 9QG, United Kingdom Telephone: 01473 276326 Toll-free: 0808 800 1000 Fax: 01473 276327 Web Site: http://www.britishlivertrust.org.u Background: The British Liver Trust is a nonprofit organization in the United Kingdom that is dedicated to helping adults with all forms of liver disease. The Trust is committed to promoting and funding liver disease research, publishing current information for affected individuals and family members, and supporting all individuals affected by liver disease and those who care for them. To fulfill its mission and objectives, the British Liver Trust offers a variety of programs and services including confidential telephone helplines, a nationwide network of support groups, annual national support group conferences, a web site on the Internet, and several publications, including informational leaflets and a regular newsletter entitled 'Liver Focus.' The Trust also supports training conferences for managers and health and safety officers concerning employee protection against infection from bloodborne viruses (i.e., including those that cause different forms of hepatitis) and has promoted the development of the British Liver Trust Liver Nurses' Forum, a national organization open to any nurse who works with liver patients or who has a special interest in liver disease. The Nurses' Forum is committed to conducting biannual meetings, offering an annual conference where nurses are encouraged to present their own research and to discuss issues of special relevance to liver nurses, promoting informal links between members, and publishing a regular newsletter. The British Liver Trust's web site discusses the organization's mission, goals, and services; offers news updates and access to research
Seeking Guidance 35
information; posts recent editions of its newsletter; and provides understandable information on different forms of liver disease. Relevant area(s) of interest: Hepatitis A, Hepatitis B, Hepatitis C ·
Canadian Liver Foundation Address: Canadian Liver Foundation 365 Bloor Street, Suite 200, Toronto, Ontario, M4W 3L4, Canada Telephone: (416) 964-4935 Toll-free: (800) 563-5483 Fax: (416) 964-0024 Email:
[email protected] Web Site: http://www.liver.c Background: The Canadian Liver Foundation (CLF) is a not-for-profit health organization committed to reducing the incidence and impact of liver disease by providing support for research and education into the causes, diagnosis, prevention and treatment of more than 100 diseases of the liver. Established in 1969, the CLF has established 30 chapters across Canada and provides information in both English and French. Some of the liver diseases discussed in brochures and medical information sheets available from CLF include gallstones, hemochromatosis, primary biliary cirrhosis, several forms of hepatitis, porphyria, fatty liver, and liver cancer. Further information is provided on liver transplantation, the effects of sodium, and management of variceal bleeding. The Foundation also produces a newsletter and maintains World Wide Web site at http://www.liver.ca. Relevant area(s) of interest: Cirrhosis of the Liver, Gallstones, Hepatitis A, Hepatitis B, Hepatitis C, Porphyria
·
Children's Liver Disease Foundation Address: Children's Liver Disease Foundation AXA Equity and Law House, 35-37 Great Charles Street Queensway, Birmingham, B3 3JY, United Kingdom Telephone: 0121-212-3839 Toll-free: (800) 652-4372 Fax: 0121-212-4300 Web Site: http://www.childliverdisease.or Background: The Children's Liver Disease Foundation (CLDF) is a voluntary organization dedicated to caring for children and families around the world who are affected by liver disease. Established in 1980 and consisting of 30 chapters, CLDF is dedicated to educating the
36 Hepatitis A
medical profession and the general public about childhood liver disease; promoting research into early diagnosis, treatments, and cure; providing new facilities and trained staffs; and giving emotional support to children and families affected by pediatric liver disease. CLDF also publishes a newsletter, reports, and brochures; offers a referral service, a database, and a directory; and offers translations of various educational materials. Relevant area(s) of interest: Hepatitis A ·
Children's Liver Disease Foundation (UK) Address: Children's Liver Disease Foundation (UK) AXA Equity and Law House, 35-37 Great Charles Street Queensway, Birmingham, B3 3JY, United Kingdom Telephone: 0121 212 3839 Toll-free: (800) 652-4372 Fax: 0121 212 4300 EWeb Site: http://www.childliverdisease.or Background: The Children's Liver Disease Foundation (UK) is a voluntary not- for-profit organization in the United Kingdom that was established in 1980. The Foundation is committed to providing emotional support to children, adolescents, and families affected by liver disease; promoting research into the causes of pediatric liver disease; creating a greater awareness of such disorders and conditions in the health care communities and the public; and promoting the development of means of early diagnosis and cure. The Children's Liver Disease Foundation is also dedicated to providing understandable information on pediatric liver disease through general informational brochures including 'A Guide to the Liver' and 'Signs and Symptoms of Liver Disease' as well as a leaflet series on specific pediatric liver diseases and conditions, such as Alagille syndrome; neonatal hepatitis; hepatitis A, B, C, and E; biliary atresia; and others. The Foundation's web site on the Internet discusses the organization's mission, goals, and services; enables interested individuals, family members, and health care professionals to make specific inquiries; and provides access to the Foundation's publication series. Relevant area(s) of interest: Hepatitis A, Hepatitis B, Hepatitis C, Wilson's Disease
·
Hepatitis C Society of Canada Address: Hepatitis C Society of Canada 383 Huron Street, Toronto, Ontario, M5S 2G5, Canada Telephone: (416) 979-5855 Toll-free: (800) 652-4372
Seeking Guidance 37
Fax: (416) 979-5856 Email:
[email protected] Web Site: http://web.idirect.com/~hepc Background: The Hepatitis C Society of Canada (HeCSC) is a national voluntary nonprofit organization dedicated to providing comfort and support to those infected with the hepatitis C virus, their family members, and other concerned individuals; promoting public awareness of hepatitis C and its transmission, care, and prevention; seeking fair treatment of all people living with and affected by hepatitis C; and promoting research that will help to prevent, treat, and cure hepatitis C. Viral hepatitis is inflammatory liver disease caused by viral infection. There are several forms of viral hepatitis that may be caused by different viruses. The virus responsible for hepatitis C, known as HCV, travels in the blood to the liver where it invades liver cells, multiples, and damages or destroys liver cells. Symptoms, which may range from mild to severe, may include fatigue, abdominal pain, nausea with or without vomiting, fever, itchy skin, and yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice). The Hepatitis C Society of Canada was established in 1994 and currently has a network of over 20 support groups across Canada to promote mutual support and networking among affected individuals and family members. The Society also compiles and distributes information about hepatitis C to affected individuals and family members, the general public, the medical community, and policymakers and has established an ongoing dialogue with public health officials and government representatives to advocate for equality of access to disability pension plans, fair treatment from employers, and improvements in the security of Canada's blood supply. The Hepatitis C Society of Canada also offers local counseling, support, and referral services for affected individuals, family members, and friends via its 800 line; communicates on behalf of employees for fair treatment in the workplace; assists affected individuals in obtaining benefits from the disability pension plan; and provides representation at the Krever Commission Blood Inquiry on behalf of transfused carriers of hepatitis C. In addition, the Society conducts educational seminars, publishes a bimonthly newsletter, and maintains a web site on the Internet. Relevant area(s) of interest: Hepatitis C ·
Hepatitis Foundation International Address: Hepatitis Foundation International 30 Sunrise Terrace, Cedar Grove, NJ 07009-1423
38 Hepatitis A
Telephone: (973) 239-1035 Toll-free: (800) 891-0707 Fax: (973) 857-5044 Email:
[email protected] Web Site: http://www.hepFI.or Background: Hepatitis Foundation International (HFI) is a voluntary notfor- profit membership organization dedicated to increasing awareness of the worldwide problem of viral hepatitis and educating the public and health care providers about its prevention, diagnosis, and treatment. Viral hepatitis is inflammatory liver disease caused by viral infection. There are several different forms of viral hepatitis that may be caused by different viruses. Such forms of hepatitis include hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. Depending upon the specific form of the disease and other factors, viral hepatitis may cause liver cell damage, associated scarring of the liver (cirrhosis), and, in some cases, an increased risk of liver cancer. In some cases, affected individuals may have no apparent symptoms. In other cases, some adults with hepatitis A may have dark urine and light stools and may experience fatigue, nausea, vomiting, fever, abdominal pain, and/or abnormal yellowing of the skin and the whites of the eyes (jaundice). Some individuals with hepatitis B, C, D, or E may have dark urine and light stools and experience mild flulike symptoms, fatigue, fever, and/or jaundice. Hepatitis Foundation International was established in 1995 and currently consists of approximately 35,000 members. The Foundation focuses exclusively on bringing viral hepatitis under control by supporting research to find cures; providing educational programs and materials to inform health professionals, affected individuals, family members, and the public concerning new diagnostic and treatment methods; and offering a support network for those who are affected by viral hepatitis. Hepatitis Foundation International also engages in patient advocacy and lobbying, provides appropriate referrals, and has a registry. The Foundation offers a wide range of educational materials including brochures, posters, information sheets, booklets, a primer for teachers concerning hepatitis B and substance abuse prevention, a coloring book for children, and a regular newsletter entitled 'Hepatitis Alert.' In addition, Hepatitis Foundation International has a web site on the Internet. Relevant area(s) of interest: Hepatitis A, Hepatitis B, Hepatitis C ·
Immunization Action Coalition/Hepatitis B Coalition Address: Immunization Action Coalition/Hepatitis B Coalition 1573 Selby Avenue, St. Paul, MN 55104 Telephone: (651) 647- 9009 Toll-free: (800) 652-4372
Seeking Guidance 39
Fax: (651) 647-9131 Email:
[email protected] Web Site: http://www.immunize.or Background: The Immunization Action Coalition/Hepatitis B Coalition (IAC) is a nonprofit organization dedicated to boosting immunization rates and promoting Hepatitis B vaccinations. Established in 1990, the Immunization Action Coalition promotes physician, community, and family awareness of and responsibility for appropriate immunization of all people of all ages against all vaccine-preventable diseases. The Hepatitis B Coalition, a program of the Immunization Action Coalition, promotes Hepatitis B vaccination for all infants, children, and adolescents. Hepatitis B is one of several viral agents that cause inflammation of the liver known as 'hepatitis' or 'diffuse hepatocellular inflammatory disease.' Hepatitis B is characterized by fever, nausea, vomiting, and persistent yellowing of the skin, mucous membranes, and whites of the eyes (jaundice). The IAC's educational materials include a newsletter, brochures, and audiovisual aids. IAC also maintains a web site on the Internet at http://www.immunize.org. Relevant area(s) of interest: Hepatitis A, Hepatitis B
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about hepatitis A. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
40 Hepatitis A
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “hepatitis A” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “hepatitis A”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “hepatitis A” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with hepatitis A. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “hepatitis A” (or a synonym) in the search box. Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site:
Seeking Guidance 41
http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following INternet sites may be of particular interest: ·
Hepatitis Education Project http://www.scn.org/health/hepatitis/supportg.htm
·
Hepatitis Central http://hepatitis-central.com/hcv/support/toc.html
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with hepatitis A must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
42 Hepatitis A
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about hepatitis A?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 11
Seeking Guidance 43
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for hepatitis A?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
13
44 Hepatitis A
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
Seeking Guidance 45
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Translations: Products resulting from the conversion of one language to another. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU]
Clinical Trials 47
CHAPTER 3. CLINICAL TRIALS AND HEPATITIS A Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning hepatitis A.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for hepatitis A is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
48 Hepatitis A
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on hepatitis A.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for hepatitis A compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on hepatitis A carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on hepatitis A. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
Clinical Trials 49
treatment, like a placebo, has no effect on hepatitis A and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how hepatitis A develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for hepatitis A. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
50 Hepatitis A
surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Hepatitis A The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to hepatitis A.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Delta Hepatitis and Liver Disease in Hemophiliacs Condition(s): Blood Disease; Hepatitis, Viral, Human; Hemophilia A; Liver Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the prevalence of hepatitis delta virus (HDV) in a large cohort of hemophiliacs and to elucidate the role of HDV in the development and progression of liver disease in this population. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005304;jsessionid=8365106 344858744A1239558A8C7F4C3
16
These are listed at www.ClinicalTrials.gov.
Clinical Trials 51
Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for hepatitis A. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
·
If the treatment is effective, then it may improve health or prevent diseases or disorders.
·
Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
·
People who take part in trials contribute to scientific discoveries that may help other people with hepatitis A. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 17
52 Hepatitis A
How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
·
Know how the researchers plan to carry out the study, for how long, and where.
·
Know what is expected of you.
·
Know any costs involved for you or your insurance provider.
·
Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
·
Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
·
Receive any new information about the new treatment.
·
Continue to ask questions and get answers.
·
Maintain your privacy. Your name will not appear in any reports based on the study.
Clinical Trials 53
·
Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
·
What are the standard treatments for hepatitis A? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
·
What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
·
How long will the treatment last? How often will I have to come back for follow-up exams?
·
What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
·
Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
·
How will my health be monitored?
·
Where will I need to go for the clinical trial? How will I get there?
·
How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
·
Will I be able to see my own doctor? Who will be in charge of my care?
54 Hepatitis A
·
Will taking part in the study affect my daily life? Do I have time to participate?
·
How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “hepatitis A” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
·
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
·
For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
Clinical Trials 55
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
·
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
·
The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
·
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
·
Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
·
Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
56 Hepatitis A
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Caspases: A family of intracellular cysteine endopeptidases. They play a key role in inflammation and mammalian apoptosis. They are specific for aspartic acid at the P1 position. They are divided into two classes based on the lengths of their N-terminal prodomains. Caspases-1,-2,-4,-5,-8, and -10 have long prodomains and -3,-6,-7,-9 have short prodomains. EC 3.4.22.-. [NIH]
Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Interferons: Proteins secreted by vertebrate cells in response to a wide variety of inducers. They confer resistance against many different viruses, inhibit proliferation of normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other immunomodulatory functions. [NIH] Leukapheresis: The preparation of leukocyte concentrates with the return of red cells and leukocyte-poor plasma to the donor. [NIH]
Clinical Trials 57
Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Varicella: Chicken pox. [EU]
59
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on hepatitis A. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on hepatitis A. In Part II, as in Part I, our objective is not to interpret the latest advances on hepatitis A or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with hepatitis A is suggested.
Studies 61
CHAPTER 4. STUDIES ON HEPATITIS A Overview Every year, academic studies are published on hepatitis A or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on hepatitis A. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on hepatitis A and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and hepatitis A, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
62 Hepatitis A
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “hepatitis A” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Cost-Effectiveness of Hepatitis A Vaccination in Patients with Chronic Hepatitis C Source: Hepatology. 31(4): 834-839. April 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: Infection with hepatitis A virus (HAV) occasionally leads to acute liver failure and has a higher fatality rate in patients with chronic hepatitis C virus (HCV). Vaccination of patients with HCV against HAV is effective and well tolerated. This article reports on a study that examined the cost effectiveness of HAV vaccination in North American patients with HCV. The authors constructed a decision analysis model to compare three HAV vaccination strategies in adult patients with chronic HCV over a period of 5 years: vaccinate no patients (treat none); vaccinate only susceptible (anti HAV negative) patients (selective); or vaccinate all patients without prior testing of immune status (universal). Probabilities and direct costs were estimated from hospital data and the literature. The cost per patient for the three vaccination strategies were: treat none, $2.00; selective, $56.00; and universal, $82.00. For every 1 million patients with HCV vaccinated over a 5 year period, the selective strategy prevented 128 symptomatic cases of HAV, 3 liver transplantations, and 3 deaths owing directly to HAV compared with the treat none strategy. In addition, the selective strategy costs an additional $427,000 per patient with HAV prevented, and $23 million per HAV related death averted, compared with the treat none strategy. The results were most sensitive to the incidence of HAV infection; vaccination increased costs if the annual rate of infection was less than 0.56 percent. The authors conclude that vaccination of North American patients with chronic HCV against HAV infection is not a cost effective therapy. 3 figures. 3 tables. 35 references.
Studies 63
·
ACIP Recommendations for the Prevention of Hepatitis A Through Immunization Source: American Family Physician. 61(7): 2246-2248, 2255-2256. April 1, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention has developed recommendations for the prevention of hepatitis A infection through active or passive immunization. This article offers practice guidelines that have been extracted from the original report. The ACIP recommendations are an updated version of a 1996 ACIP report on the prevention of hepatitis A through immunization. The new report includes new data on the epidemiology of hepatitis A; recent findings about the effectiveness of community based hepatitis A vaccination programs; and recommendations for the routine vaccination of children living in areas with rates of hepatitis that are at least twice the national average from 1987 through 1997. The author first describes the rationale for the prevention of hepatitis A through routine active immunization. Vaccination is recommended for persons who travel to or work in countries that have high or intermediate presence of hepatitis A virus (HAV) infection; for men who have sex with men; for persons who use injecting or noninjecting illegal drugs; persons who have occupational risk for infection with HAV; persons who have clotting factor disorders; and persons who have chronic liver disease. The author notes that when deciding to vaccinate for outbreak control, the characteristics of hepatitis A epidemiology in the community and existing hepatitis A vaccination programs should be considered. The author briefly discusses outbreaks in communities that have high, intermediate, or low rates of HAV infection, and outbreaks in other settings, such as day care centers, hospitals, institutions, and schools. The article concludes with information for readers who wish to obtain copies of the complete ACIP statement ($5.00 from Massachusetts Medical Society, C.S.P.O. Box 9120, Waltham, MA 02254-9120). 1 table.
·
Identifying Target Groups for a Potential Vaccination Program During a Hepatitis A Communitywide Outbreak Source: American Journal of Public Health. 89(6): 918-921. June 1999. Summary: This article reports on a study undertaken to identify groups for targeted vaccination during a community wide hepatitis A outbreak
64 Hepatitis A
in 1996. Residents of the Sioux City, Iowa, metropolitan area reported with hepatitis A between September 1995 and August 1996 were sampled and compared with population based controls. In comparison with 51 controls, the 40 case patients were more likely to inject methamphetamine, to attend emergency rooms more often than other health care facilities, and to have a family member who used the Special Supplemental Nutrition Program for Women, Infants, and Children. The authors conclude that groups at increased risk of hepatitis A can be identified and access for vaccination during community wide outbreaks of the disease. The authors contend that implementing a vaccination program should be considered early in the outbreak, when transmission may be more localized to selected groups at increased risk of disease and when a smaller number of cases have occurred. However, even when implemented promptly and appropriately, these efforts will be limited in scope. To achieve a sustained reduction in hepatitis A incidence nationwide, a more comprehensive strategy is necessary, including ongoing routine vaccination of young children. 1 figure. 2 tables. 19 references. ·
Serological and Molecular Testing in Viral Hepatitis: An Update Source: Canadian Journal of Gastroenterology. 15(3): 177-184. March 2001. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail:
[email protected]. Summary: The routine serological (by blood test) diagnoses of the three major forms of viral hepatitis (A, B, C, and also delta hepatitis) are important in the evaluation of acute and chronic viral hepatitis (liver inflammation). This article updates readers on serological and molecular virological tests that are used to evaluate patients with chronic hepatitis C. The authors focus on the use of genotype and viral load testing to plan individualized patient treatment approaches. Despite the increasing sophistication of these diagnostic techniques, the initial approach to the patient with suspected viral hepatitis is still determined by the clinical impression of whether infection is acute or chronic. For suspected acute viral hepatitis, hepatitis A and B remain the major differentials because acute hepatitis C is usually subclinical, whereas hepatitis C has become the major cause of chronic hepatitis. The authors discuss the possible role of genotyping to help determine which patients may respond to interferon monotherapy. 4 tables. 63 references.
Studies 65
·
Tests for Acute and Chronic Viral Hepatitis: Finding Your Way Through the Alphabet Soup of Infection and Superinfection Source: Postgraduate Medicine. 107(2): 123-126, 129-130. February 2000. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: This article is the second in a four article symposium that provides a practical approach to the diagnosis and management of common hepatic disorders encountered by primary care physicians. In this article, the authors review the serologic (blood) and molecular diagnosis of viral hepatitis. The authors note that viral causes of hepatitis are clinically indistinguishable from one another. This can be a problem because appropriate management often depends on the specific virus involved. The authors discuss five hepatitis viruses (A through E) and explain which tests are most helpful for deciding on management for each type. Diagnosis of acute hepatitis A virus (HAV) is made by detection of hepatitis A IgM antibody. IgG antiHAV develops after natural infection and provides lifelong immunity. Neither reinfection nor chronicity occurs with HAV. The hepatitis B virus (HBV) produces a number of proteins with corresponding antibodies that enable accurate diagnostic evaluation of the patient with suspected HBV infection. Hepatitis B surface antigen (HBsAg) is almost always detectable when the disease is first seen, and disappears in acute HBV infection after clearance of the virus. Acute hepatitis C virus (HCV) is usually subclinical (without apparent symptoms), but the likelihood of chronicity is high. The routine diagnosis of HCV is by antibody testing with an ELISA. Hepatitis D virus (HDV) is unable to replicate on its own and requires HBV; thus, it can cause disease only in patients with HBV infection. Diagnosis of HDV infection revolves around the identification of antibodies; however, these antibodies are detectable in only one third of HDV infections. Hepatitis E virus (HEV) is a very unusual cause of acute hepatitis in the United States. 7 tables. 10 references.
·
Viral Hepatitis and Exercise Source: Medicine and Science in Sports and Exercise. 32(7 Supplement): S422-S430. July 2000. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax: (301) 2232365. Website: www.lww.com. Summary: Increased awareness and publicity of human immunodeficiency virus (HIV) has fostered a heightened sense of concern regarding the transmission of infectious agents during sports
66 Hepatitis A
and athletic competition. Although the potential risk is low, there are other unanswered questions and issues regarding infectious disease and sports. Viral hepatitis is a common infection and predominantly affects the young who are most likely to lead active lives and engage in both amateur and competitive sport related activity. This article summarizes the common forms of viral hepatitis and the associated clinical syndromes. In addition, the author presents a review of the literature addressing the effect of exercise and the various states of liver disease. The author finally addresses the question regarding participation and return to physical activity following acute viral hepatitis, as well as during chronic hepatitis. Athletes are likely to acquire viral hepatitis as a result of their off the field activity and not from on the field or locker room contact. Teenaged and college aged youth at risk are those who are sexually active, share personal items, use intravenous drugs, or get tattoos or body piercings. In addition, competitive athletes may be exposed to enteric pathogens by consumption of infected food material, especially during travel. Persons with acute viral hepatitis may continue physical activity and mild to moderate training as tolerated by overall well being and clinical condition, but should not participate in strenuous activity or competitive sports until liver function tests have returned to normal. Persons with chronic persistent hepatitis should be allowed to participate in moderate physical activity. Persons with chronic active hepatitis and cirrhosis (liver scarring) should not participate in strenuous competitive sports but should be encouraged to partake in a low level and graduated training program under the supervision of an experienced physician. 4 figures. 4 tables. 27 references. ·
Sources of Viral Hepatitis in Children Source: Viral Hepatitis Review. 6(1-4): 47-64. 2000. Contact: Available from Harcourt Brace and Company Ltd. Journals Subscriptions Department, High Street, Foots Cray, Sidcup, Kent DA14 5HP UK. Telephone +181 300 3322. Summary: This article reviews the epidemiological features of viral hepatitis (including types A, B, and C) in children. The clinical presentation of viral hepatitis varies from mild subclinical infection with nonspecific symptoms to overwhelming fulminant multisystem disease with high mortality. Some agents cause only a self limited acute infection, whereas others can lead to chronic infection that may be associated with asymptomatic chronic carrier state, progression to cirrhosis (liver scarring), or development of hepatocellular carcinoma (HCC, liver cancer). The authors stress that although the prevalence of infectious hepatitis is higher in adults, there are specific issues regarding
Studies 67
epidemiology, modes of transmission, and immunization strategies that are unique to the pediatric population. The authors focus on the identification, prophylaxis (prevention), and elimination of these diseases. With respect to HAV, children often have subclinical infections (no obvious symptoms) and act as reservoirs for transmission to adults who have more severe disease. Perinatal (during birth) HBV transmission is critical in maintaining the endemicity of HBV in a population. Horizontal transmission of HBV occurs almost exclusively in childhood, but the mechanisms are not clear. The goal of elimination of HBV infection has become a real possibility, through the immunoprophylaxis of infants and children. For HCV infection, perinatal transmission has become the major route of infection for children, and interruption of this cycle can have a significant impact on new cases. 7 tables. 154 references. ·
Viral Hepatitis in Pregnancy Source: Viral Hepatitis Review. 6(1-4): 205-215. 2000. Contact: Available from Harcourt Brace and Company Ltd. Journals Subscriptions Department, Foots Cray, Sidcup, Kent DA14 5HP UK. Telephone +181 300 3322. Summary: The association of viral hepatitis (liver infection) and pregnancy goes beyond recognition and management of the individual patients with acute or chronic hepatitis. Public health measures directed at the entire pregnant population provide an excellent opportunity for implementation of widespread screening and primary and secondary prophylaxis, particularly with regard to hepatitis B and the subsequent development of hepatocellular carcinoma (HCC, liver cancer). This review article discusses important epidemiological features of viral hepatitis in the pregnant population; clinical features and diagnosis of acute viral hepatitis, fulminant hepatitis, and chronic viral hepatitis in the pregnant patient; management of viral hepatitis in pregnancy; and preventive measures for mothers and babies. Acute viral hepatitis is the most common cause of jaundice in pregnancy and in most cases neither the liver disease nor the pregnancy (mother or fetus) is affected by the presence of the other. The most important epidemiological association of pregnancy and viral hepatitis is chronic hepatitis B where pregnancy perpetuates the prevalence of HBV by its high rate of vertical transmission (mother to fetus) with resulting chronic hepatitis B, cirrhosis, and hepatocellular carcinoma. This vertical transmission is preventable in 85 percent of cases by screening all pregnancy women for hepatitis B and by subsequent immunoprophylaxis of the babies. Vertical transmission of HCV is much less than HBV and chronic hepatitis C and pregnancy appear to have little effect on one another. Hepatitis E and
68 Hepatitis A
herpes simplex hepatitis are rare in developed countries but are frequently fulminant (rapid and severe) in pregnancy with resulting high maternal and fetal mortality (death). 2 tables. 53 references. ·
Viral Hepatitis Source: Current Opinion in Gastroenterology. 15(3): 234-239. May 1999. Contact: Available from Lippincott Williams and Wilkins Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Summary: Viral hepatitis is still one of the most common causes of acute and chronic liver disease worldwide. This article reviews the major advances that have been made in this area during this past year. Molecular biology and clinical studies have improved the understanding of the mechanisms of antiviral drugs, as well as viral resistance to therapy. The risks of hepatitis A in patients with chronic liver disease have been confirmed, and the efficacy of hepatitis A vaccines in these patients has been proven. Aggressive combination therapy has emerged as a promising strategy for chronic hepatitis B and C, and techniques for immune prophylaxis for hepatitis B are being improved. Liver transplantation has become routine for end stage hepatitis B liver disease, and new strategies to prevent and treat recurrence are being explored. 71 references (15 annotated).
·
Viral Hepatitis in Latin America Source: Viral Hepatitis. 5(1): 45-61. March 1999. Contact: Available from W.B. Saunders Company, Ltd. Journal Subscriptions Department, Harcourt Brace and Company, Ltd., High Street, Foots Cray, Sidcup, Kent DA 14 5HP, U.K. (887) 784-6463. Summary: This article discusses viral hepatitis in Latin America. Viral hepatitis is more often than not a subclinical disease, and thus has no pathognomonic diagnostic features and is not a reportable disease in Latin America. The authors discuss information on the extent of viral hepatitis that was compiled from data published in the World Health Organization (WHO) and Panamerican Health Association (PHO) statistical reports, national and international journals, material provided by Health Ministries, blood banks, scientific societies, and professional medical associations of the region. Although National Hepatitis Committees have been established to facilitate the gathering of valuable local data, only limited information has been reported with regard to the prevalence of viral hepatitis markers according to age, race and socioeconomic level. In Latin America, different types of viral hepatitis
Studies 69
have been described, but the persistence of isolated areas and the existence of small groups of aboriginal Indians settled in the Central and Northern regions of South America give rise to a heterogeneous epidemiological pattern. The article covers hepatitis A, hepatitis B, hepatitis C, delta hepatitis, and hepatitis E. The authors consider clinical features, prevention, epidemiology, acute versus chronic disease, transmission, immunization, fulminant hepatitis, risk factors, perinatal exposure, hemodialysis, and transplantation issues. 150 references. ·
Hepatitis A, B, and D Source: Gastroenterology Nursing. 22(6): 236-244. November-December 1999. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555. Summary: Hepatitis is defined as inflammation of the liver. This article reviews three types of hepatitis: A, B, and D. Six or seven viruses, labeled as hepatitis A through G, are responsible for the majority of cases of viral hepatitis. All types of hepatitis present with the same flulike symptoms. In this first of a series of three articles, current knowledge regarding hepatitis A, B, and D is reviewed. Fifty percent of hepatitis cases are hepatitis A. Hepatitis A virus (HAV) is a single stranded RNA virus that has a vary stable capsid and whose proteins are derived from a single polyprotein. Hepatitis B is considered a sexually transmitted disease, and the hepatitis B virus (HBV) is a DNA virus that replicates through an RNA intermediate. HBV can integrate into the host chromosomes. Hepatitis D is an incomplete virus found accompanying Hepatitis B. Chronic HBV infections are associated with hepatocellular carcinoma (liver cancer). All three of these viruses cause an identical acute clinical syndrome after a variable incubation period. Patients present with muscle and joint pain, anorexia (no appetite), nausea, and abdominal tenderness. In the more severe cases, jaundice with dark urine and light colored stools develops. The author stresses that every phase of care for the hepatitis patient improves when health care professionals are knowledgeable about the different types of hepatitis, especially about the appropriate patient care management and educational strategies for each. 1 table. 87 references.
70 Hepatitis A
Federally-Funded Research on Hepatitis A The U.S. Government supports a variety of research studies relating to hepatitis A and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to hepatitis A and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore hepatitis A and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for hepatitis A: ·
Project Title: Hepatitis A Vaccine--Interleukin 4 Antibody Levels Principal Investigator & Institution: Haynet, Mary S.; University of Wisconsin Madison 500 Lincoln Dr Madison, Wi 53706 Timing: Fiscal Year 2000 Summary: The hepatitis A vaccines are highly immunogenic and without serious adverse effects. Therefore, the interaction between the antigen and the immune system must be very efficient. This study proposes to examine the cytokine response as an immune mechanism driving the antibody response to hepatitis A immunization and model the pharmacodynamics of this response. Our primary hypothesis is that the interleukin-4 (IL-4) production stimulated by hepatitis A immunization will predict the height of the antibody levels to hepatitis A immunization. To substantiate this hypothesis, we will immunize 25 hepatitis A seronegative subjects who will be followed for two weeks with serial blood draws to determine IL-4 production using three different strategies. Peripheral blood mononuclear cells (PBMC) will be cultured
18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
Studies 71
and spontaneous IL-4 production will be measured by ELISA in the supernatant of the cell cultures. IL-4 gene expression will be measured by extracting mRNA from PBMC. The mRNA will be probed with an IL-4 specific DNA probe and the amount of hybridized mRNA will be measured by capillary electrophoresis. Finally, we will measure IL-4 levels in the serum obtained from subjects. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Safety and Immunogenicity of Hepatitis A Vaccine in Hemophilia Principal Investigator & Institution: Koerper, Marion A.; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2000 Summary: This abstract is not available. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
·
Project Title: Regulation of Adenovirus Proteinase by a Peptide and DNA Principal Investigator & Institution: Mangel, Walter F.; Brookhaven Science Assoc-Brookhaven Lab Brookhaven National Lab Upton, Ny 11973 Timing: Fiscal Year 2000; Project Start 1-JUL-1997; Project End 8-FEB-2002 Summary: Among potential targets for antiviral therapy that arise during certain viral infections are the virus-coded proteinases. These enzymes, essential for the synthesis of infectious virus, are required to process virus-specific precursor proteins involved in the maturation, assembly and replication of such pathogenic human viruses as adenovirus, poliovirus, encephalitis virus, hepatitis A and C viruses, cytomegalovirus, and human immunodeficiency virus. virus-coded proteinases are highly specific for their virus-coded substrates. If equally specific inhibitors can be developed and targeted to infected cells, they should interfere with virus replication and not with normal cellular metabolism. Our model system is the infection of HeLa cells in culture by human adenovirus serotype 2 (Ad2). We showed for maximal Ad2 proteinase activity in vitro, three components are required- the protein product of the adenovirus L3 23K gene, an 11 amino acid peptide (pVlc) that originates from the C-terminus of virion precursor protein pvI, and the viral DNA. The cofactors increase k(cat), 300-fold with pVlc and 6000fold with Ad2 DNA as well. We solved the three-dimensional structure of the proteinase complexed with pVlc at 2.6 Angstrom resolution. The fold of the protein is unique. A putative active site contains a Cys-His-
72 Hepatitis A
Glu triplet and oxyanion hole in an arrangement similar to that in papain. If that is the active site, this protein would represent a new class of cysteine proteinases and a new, fifth group of enzymes that contain catalytic triads. Here we propose to understand at the biochemical and structural levels how the activity of the adenovirus proteinase is regulated. We shall locate and characterize the active site, elucidate the mechanisms by which the two cofactors stimulate proteinase activity and characterize the enzyme during different times after infection. We have just shown that beta-actin can serve as a cofactor and will characterize that interaction with the enzyme in vitro and in vivo. Although important in themselves, the results of these experiments will also be used in a subsequent grant to design different types of proteinase inhibitors to act as antiviral agents. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “hepatitis A” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for hepatitis A in the PubMed Central database: ·
A new G-tailing method for the determination of the poly(A) tail length applied to hepatitis A virus RNA by Yuri Yu. Kusov, Gocha Shatirishvili, Georgy Dzagurov, and Verena Gauss-Muller; 2001 June 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=55756&ren dertype=external
·
A Rapid Method for Determination of Endoproteinase Substrate Specificity: Specificity of the 3C Proteinase from Hepatitis A Virus by
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 19
Studies 73
JR Petithory, FR Masiarz, JF Kirsch, DV Santi, and BA Malcolm; 1991 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53165 ·
Amplification of the Full-Length Hepatitis A Virus Genome by Long Reverse Transcription-PCR and Transcription of Infectious RNA Directly from the Amplicon by R Tellier, J Bukh, SU Emerson, and RH Purcell; 1996 April 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39544
·
Excretion of Hepatitis A Virus (HAV) in Adults: Comparison of Immunologic and Molecular Detection Methods and Relationship between HAV Positivity and Infectivity in Tamarins by Louis B. Polish, Betty H. Robertson, Bhawna Khanna, Krzysztof Krawczynski, John Spelbring, Fred Olson, and Craig N. Shapiro; 1999 November http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85708&ren dertype=external
·
Molecular Epidemiology of Human Hepatitis A Virus Defined by an Antigen-Capture Polymerase Chain Reaction Method by RW Jansen, G Siegl, and SM Lemon; 1990 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53794
·
Past infection with hepatitis A virus among Vancouver street youth, injection drug users and men who have sex with men: implications for vaccination programs by Jan J. Ochnio, David Patrick, Margaret Ho, Douglas N. Talling, and Simon R. Dobson; 2001 August 7 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81329
·
Seroepidemiology of Water-Borne Hepatitis in India and Evidence for a Third Enterically-Transmitted Hepatitis Agent by VA Arankalle, MS Chadha, SA Tsarev, SU Emerson, AR Risbud, K Banerjee, and RH Purcell; 1994 April 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43590
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign
74 Hepatitis A
references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with hepatitis A, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “hepatitis A” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “hepatitis A” (hyperlinks lead to article summaries): ·
An outbreak of hepatitis A among homosexual men in Amsterdam, 1991-1993. Author(s): Leentvaar-Kuijpers A, Kool JL, Veugelers PJ, Coutinho RA, van Griensven GJ. Source: International Journal of Epidemiology. 1995 February; 24(1): 21822. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7797346&dopt=Abstract
·
Hepatitis A, B, C and D in a community in Italy of immigrants from NE Africa. Author(s): Faustini A, Franco E, Saitto C, Cauletti M, Zaratti L, Papini P, Ali' Ahmed S, Zampieri F, Ierussi A, Pana A, et al. Source: Journal of Public Health Medicine. 1994 March; 16(1): 71-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8037956&dopt=Abstract
Vocabulary Builder Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
22
Studies 75
against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigens: Substances that cause an immune response in the body. The body "sees" the antigens as harmful or foreign. To fight them, the body produces antibodies, which attack and try to eliminate the antigens. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Artery: A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astrovirus: A genus of small, circular RNA viruses in the family astroviridae. They cause gastroenteritis and are found in the stools of several vertebrates including humans. Transmission is by the fecal-oral route. There are at least seven human serotypes and the type species is human astrovirus 1. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU]
Capsid: The outer protein protective shell of a virus, which protects the viral nucleic acid. [NIH] Carcinoma: A malignant new growth made up of epithelial cells tending to
76 Hepatitis A
infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dermatitis: Inflammation of the skin. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Encephalitis: Inflammation of the brain. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Epidemic:
Occurring suddenly in numbers clearly in excess of normal
Studies 77
expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH] Hepatic: Pertaining to the liver. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunogenic: Producing immunity; evoking an immune response. [EU] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of
78 Hepatitis A
anaesthesia or unconsciousness by use of appropriate agents. [EU] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Mebendazole: A nematocide in humans and animals. It acts by interfering with the carbohydrate metabolism and associated energy production of the parasite. [NIH] Methamphetamine: A central nervous system stimulant and sympathomimetic with actions and uses similar to dextroamphetamine. The smokable form is a drug of abuse and is referred to as crank, crystal, crystal meth, ice, and speed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Papain: A proteolytic enzyme obtained from Carica papaya. It is also the name used for a purified mixture of papain and chymopapain that is used as a topical enzymatic debriding agent. EC 3.4.22.2. [NIH] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle
Studies 79
specially affected. [EU] Pathogen: Any disease-producing microorganism. [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Plasminogen: The inactive precursor of plasmin (=enzyme that catalyses the hydrolysis of peptide bonds at the carbonyl end of lysine or arginine residues). [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Psychoneuroimmunology: The field concerned with the interrelationship between the brain, behavior and the immune system. Neuropsychologic, neuroanatomic and psychosocial studies have demonstrated their role in accentuating or diminishing immune/allergic responses. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid
80 Hepatitis A
hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Reconstitution: 1. a type of regeneration in which a new organ forms by the rearrangement of tissues rather than from new formation at an injured surface. 2. the restoration to original form of a substance previously altered for preservation and storage, as the restoration to a liquid state of blood serum or plasma that has been dried and stored. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Respiratory: Pertaining to respiration. [EU] Rhinovirus: A genus of picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [NIH] Rotavirus: A genus of reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU]
Studies 81
Substrate: A substance upon which an enzyme acts. [EU] Superinfection: A new infection complicating the course of antimicrobial therapy of an existing infectious process, and resulting from invasion by bacteria or fungi resistant to the drug(s) in use. It may occur at the site of the original infection or at a remote site. [EU] Transgenes: Genes that are introduced into an organism using gene transfer techniques. [NIH] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Virion: The infective system of a virus, composed of the viral genome, a protein core, and a protein coat called a capsid, which may be naked or enclosed in a lipoprotein envelope called the peplos. [NIH]
Books 83
CHAPTER 5. BOOKS ON HEPATITIS A Overview This chapter provides bibliographic book references relating to hepatitis A. You have many options to locate books on hepatitis A. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on hepatitis A include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “hepatitis A” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on hepatitis A: ·
Viral Hepatitis: Diagnosis, Treatment, Prevention Source: New York, NY: Marcel Dekker, Inc. 1997. 532 p.
84 Hepatitis A
Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Price: $175.00. ISBN: 0824794168. Summary: This text familiarizes readers with current methods of diagnosis, treatment, and prevention of human viral hepatitis. Sixteen chapters cover: methods and applications of molecular diagnostic testing for viral hepatitis; the hepatitis A virus; the molecular biology and immunopathology of the hepatitis B virus; the prevention and therapy of clinical disease arising from the hepatitis B virus; the hepatitis C virus; the hepatitis D virus; the epidemiology and biology of the hepatitis E virus; other hepatitis viruses including the hepatitis G virus; the role of hepatitis viruses in acute liver failure; hepatocellular carcinoma and viral hepatitis; extrahepatic manifestations of chronic viral hepatitis; the overlap of chronic viral hepatitis and autoimmune hepatitis; liver transplantation and viral hepatitis B, D, and C; viral hepatitis in marrow and stem-cell transplant patients; viral hepatitis in the immunocompromised host; and the role of iron in chronic viral hepatitis. The authors evaluate diagnostic serological techniques such as ELISAs and PCRs; highlight nonhuman primate and transgenically created animal models used in disease transmission studies, virus isolation, and serological assays and vaccine development; review the management of fulminant hepatic failure and hepatitis in the immunocompromised patient; discuss how diagnosis may be complicated by predominant extrahepatic manifestations; assess various vaccines recent licensing and future prospects; and appraise the cost effectiveness of medical treatments with antiviral agents, the role of liver transplantation, and preventive measures. Each chapter includes extensive references, and a subject index concludes the volume. ·
Viral Hepatitis: Practical Evaluation and Treatment Source: Kirkland, WA: Hogrefe and Huber Publishers. 1995. 248 p. Contact: Available from Hogrefe and Huber Publishers. Seattle Main Office, P.O. Box 2487, Kirkland, WA 98083-2487. (800) 228-3749 or (206) 820-1500. Fax (206) 823-8324. Price: $49 plus shipping (as of 1995). ISBN: 0889371334. Summary: This book provides up to date practical information on the diagnosis, treatment, and prevention of the viral hepatitis. Designed for a broad based audience of primary care providers, the book includes 15 chapters on the following topics: an overview of viral hepatitis; hepatitis A; hepatitis A vaccine; acute hepatitis B; chronic hepatitis B; special circumstances with HBV; prevention of hepatitis B; treatment of hepatitis B; diagnosis and transmission of hepatitis C; clinical features of hepatitis
Books 85
C; special topics in hepatitis C; treatment of hepatitis C; delta hepatitis; hepatitis E; and fulminant hepatic failure. The book explains diagnosis, clinical features, epidemiology and transmission, natural history, prevention, and treatment for each form of hepatitis. Each chapter includes an outline and summary of approach. A subject index concludes the volume. (AA-M).
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to hepatitis A (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Australia Antigen and Viral Hepatitis by W. T. London (Editor), J. Desmyter (Editor) (1973); ISBN: 3805516118; http://www.amazon.com/exec/obidos/ASIN/3805516118/icongroupin terna
·
Blood Transfusion Id Card and Book: For Safer Blood at the Time of Aids, Hepatitis, Vds, Etc by Antun Murkovic (1989); ISBN: 0929602005; http://www.amazon.com/exec/obidos/ASIN/0929602005/icongroupin terna
·
Chronic Active Hepatitis: The Mayo Clinic Experience (Gastroenterology Series, Vol 2) by Albert J. Czaja, E. Rolland Dickson (Editor) (1986); ISBN: 0824776151; http://www.amazon.com/exec/obidos/ASIN/0824776151/icongroupin terna
·
Chronic Active Liver Disease: Contemporary Issues in Gastroentrology by Sidney Cohen (Editor) (1983); ISBN: 0443082235; http://www.amazon.com/exec/obidos/ASIN/0443082235/icongroupin terna
·
Chronic Hepatitis: Proceedings of the International Symposium on Problems of Chronic Hepatitis, Montecatini by International Symposium on Problems of Chronic Hepatitis Montecatini t, Paolo Gentilini (Editor) (1976); ISBN: 3805523211; http://www.amazon.com/exec/obidos/ASIN/3805523211/icongroupin terna
86 Hepatitis A
·
Guidance for Clinical Health Care Workers: Protection Against Hiv and Hepatitis (1990); ISBN: 0113212496; http://www.amazon.com/exec/obidos/ASIN/0113212496/icongroupin terna
·
Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public Safety Workers Response to p (1989); ISBN: 9990470073; http://www.amazon.com/exec/obidos/ASIN/9990470073/icongroupin terna
·
Hepatitis A by Ian D. Gust, Stephen M. Feinstone (1988); ISBN: 0849357675; http://www.amazon.com/exec/obidos/ASIN/0849357675/icongroupin terna
·
Hepatitis Market by Biotechnology News Staff (1990); ISBN: 0962339121; http://www.amazon.com/exec/obidos/ASIN/0962339121/icongroupin terna
·
Immunological Aspects of Liver Disease by H. C. Thomas (1982); ISBN: 038711310X; http://www.amazon.com/exec/obidos/ASIN/038711310X/icongroupi nterna
·
Infectious Diseases of the Liver (Falk Symposium, Vol 54) by L. Bianchi, et al (1990); ISBN: 0792389026; http://www.amazon.com/exec/obidos/ASIN/0792389026/icongroupin terna
·
Laboratory Diagnosis of Hepatitis Viruses: 18a (Cumitech Ser.) by Max A. Chernesky, et al (1984); ISBN: 9990058156; http://www.amazon.com/exec/obidos/ASIN/9990058156/icongroupin terna
·
Modern Concepts of Acute and Chronic Hepatitis by Gary Gitnick (Editor) (1989); ISBN: 0306428954; http://www.amazon.com/exec/obidos/ASIN/0306428954/icongroupin terna
·
Molecular Components of Hepatitis B Virus (Developments in Molecular Virology : 6) by Mark Feitelson (1985); ISBN: 0898386969; http://www.amazon.com/exec/obidos/ASIN/0898386969/icongroupin terna
·
Pathogenesis of Liver Diseases (International Academy of Pathology Monograph, No 28) by Emmmanuel Farber, et al (1987); ISBN: 0683030388;
Books 87
http://www.amazon.com/exec/obidos/ASIN/0683030388/icongroupin terna ·
Proceedings of the European Symposium on Hepatitis B by Saul Krugman, Sheila Sherlock (1981); ISBN: 0865550085; http://www.amazon.com/exec/obidos/ASIN/0865550085/icongroupin terna
·
Tumorigenic DNA Viruses (Advances in Viral Oncology, Vol 8) by George Klein (Editor) (1989); ISBN: 0881674958; http://www.amazon.com/exec/obidos/ASIN/0881674958/icongroupin terna
·
Viral and Autoimmune Hepatitis: Morphologic and Pathogenetic Aspects of Cell Damage in Hepatitis With Potential Chronicity (Progress in Pathology) by Hans Peter, Dr. Dienes (1989); ISBN: 0895742802; http://www.amazon.com/exec/obidos/ASIN/0895742802/icongroupin terna
·
Viral Hepatitis (1978); ISBN: 0891680136; http://www.amazon.com/exec/obidos/ASIN/0891680136/icongroupin terna
·
Viral Hepatitis (Proceedings in Life Sciences) by F. Callea, et al (1986); ISBN: 0387167307; http://www.amazon.com/exec/obidos/ASIN/0387167307/icongroupin terna
·
Viral Hepatitis and Liver Disease by Girish Vyas, et al (1985); ISBN: 0808916785; http://www.amazon.com/exec/obidos/ASIN/0808916785/icongroupin terna
·
Viral Hepatitis and Liver Disease (1988); ISBN: 084514247X; http://www.amazon.com/exec/obidos/ASIN/084514247X/icongroupi nterna
·
Viral Hepatitis and Liver Disease: Proceedings by A.J. Zuckerman (Editor) (1988); ISBN: 0471612707; http://www.amazon.com/exec/obidos/ASIN/0471612707/icongroupin terna
·
Viral Hepatitis B Infection in the Western Pacific Region: Vaccine and Control by S.K. Lam, et al (1984); ISBN: 9971950804; http://www.amazon.com/exec/obidos/ASIN/9971950804/icongroupin terna
88 Hepatitis A
·
Viral Hepatitis Report (Technical Report No 512) by Who (1973); ISBN: 9241205121; http://www.amazon.com/exec/obidos/ASIN/9241205121/icongroupin terna
·
Viral Hepatitis: 1981 International Symposium by Wolf Szmuness, et al (1982); ISBN: 0898597374; http://www.amazon.com/exec/obidos/ASIN/0898597374/icongroupin terna
·
Viral Hepatitis: A Contemporary Assessment of Etiology, Epidemiostributors to the Book Trade, Doubleday, by 2D, University of California San francis Symposium on Viral Hepatitis (1978); ISBN: 0898597382; http://www.amazon.com/exec/obidos/ASIN/0898597382/icongroupin terna
·
Viral Hepatitis: Biological and Clinical Features, Specific Diagnosis and Prophylaxis by F. Blaine Hollinger, et al (1990); ISBN: 0881677272; http://www.amazon.com/exec/obidos/ASIN/0881677272/icongroupin terna
·
Viral Hepatitis: Second International Max V. Pettenkofer Symposium (Infectious Diseases and Antimicrobial Agents, 4) by Germany) International Max Von Pettenkofer Symposium 1982 Munich (1983); ISBN: 0824770463; http://www.amazon.com/exec/obidos/ASIN/0824770463/icongroupin terna
·
Viral Hepatitis: Standardization in Immuniprophylaxis of Infections by Hepatitis Viruses by G. Papavangelou, W. Hennessen (1983); ISBN: 380553826X; http://www.amazon.com/exec/obidos/ASIN/380553826X/icongroupi nterna
·
Virus Hepatitis and Its Control by Yvonne Cossart (1982); ISBN: 0721607144; http://www.amazon.com/exec/obidos/ASIN/0721607144/icongroupin terna
·
Virus Infections: Modern Concepts and Status by Lloyd C. Olson (Editor) (1982); ISBN: 0824718593; http://www.amazon.com/exec/obidos/ASIN/0824718593/icongroupin terna
Books 89
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “hepatitis A” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:23 ·
Application of elisa for the diagnosis and epidemiology of hepatitis A. Author: Willem Duermeyer; Year: 1980; Amsterdam: Rodopi, 1980
·
Australia antigen and viral hepatitis. Editors: J. Desmyter and W. Thomas London. Associate editor: C. Vermylen. Author: International Symposium on Basic Progress in Blood Transfusion (6th: 1972: Brussels); Year: 1973; Basel, New York, Karger, 1973; ISBN: 3805516118 http://www.amazon.com/exec/obidos/ASIN/3805516118/icongroupin terna
·
Experimental viral hepatitis. Author: Piazza, Marcello; Year: 1969; Springfield, Ill., Thomas [c1969]
·
Hepatic circulation in hepatitis A; a study in young males at rest and during and after supine leg exercise. Author: Lundbergh, Per; Year: 1974; Stockholm [Distributed by the Almqvist & Wiksell Periodical Co.] 1974
·
Hepatitis A: aspects on prophylaxis and a comparison with hepatitis B and hepatitis non-A, non-B on epidemiology and prognosis. Author: by Ola Weiland; Year: 1981; Stockholm: Distributed by Almqvist & Wiksell Periodical Co., 1981
·
Hepatitis A. Author: edited by Robert J. Gerety; Year: 1984; Orlando: Academic Press, 1984; ISBN: 0122806700 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0122806700/icongroupin terna
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
23
90 Hepatitis A
·
Hepatitis A. Author: authors, Ian D. Gust, Stephen M. Feinstone; Year: 1988; Boca Raton, Fla.: CRC Press, c1988; ISBN: 0849357675 http://www.amazon.com/exec/obidos/ASIN/0849357675/icongroupin terna
·
Hepatitis frontiers. Editors: Frank W. Hartman [et al. Author: Hartman, Frank W. (Frank Wilbur), 1890-; Year: 1957; Boston, Little, Brown [c1957]
·
Hepatitis virus infections. Author: onder redactie van W.J.M. Spaan ... [et al.]; Year: 1995; [Leiden ]: Boerhaave Commissie voor Postacademisch Onderwijs in de Geneeskunde, Rijksuniversiteit Leiden, [1995]; ISBN: 9067672629
·
Hepatitis, a technical workshop. Author: editors, Louise J. Keating, Arthur J. Silvergleid; presented by the Committee on Technical Workshops, American Association of Blood Banks, Chicago, Illinois, 1981; Year: 1981; Washington, D.C.: AABB, c1981; ISBN: 0914404652
·
Human viral hepatitis; hepatitis-associated antigen and viruses. Author: Zuckerman, Arie J; Year: 1975; Amsterdam, North-Holland Pub. Co.; New York, American Elsevier Pub. Co., 1975; ISBN: 0720445132
·
Infectious diseases in sport: an information booklet prepared on behalf of Sports Focus on the incidence and implications of infectious diseases in sport, with particular reference to HIV and hepatitis A, B & C. Author: written and compiled by Jamie Turner & St; Year: 1994; Bendigo, Vic.: Sports Focus, 1994; ISBN: 0646222503
·
Infectious hepatitis, 1961. Author: Canada. Dominion Bureau of Statistics; Year: 1962; Ottawa, Dominion Bureau of Statistics, Health and Welfare Division, Public Health Section, 1962
·
Infective hepatitis; studies in East Anglia during the period 1943-47, by F. O. MacCallum [and others]. Author: MacCallum, F. O; Year: 1951; London, H. M. Stationery Off., 1951
·
Investigation of an epidemic of hepatitis A in Palau, January-June 1985: report. Author: by Richard Taylor ... [et al.]; Year: 1986; Noumea, New Caledonia: South Pacific Commission, [1986]; ISBN: 9822030215 http://www.amazon.com/exec/obidos/ASIN/9822030215/icongroupin terna
·
Report of informal consultation on the public health control of hepatitis A: WHO headquarters, Geneva, 5-6 October 1992. Author: International Symposium on Enterically-Transmitted Hepatitis Viruses (1995: Paris, France); Year: 1992; Geneva: World Health Organization, [1992]
Books 91
Chapters on Hepatitis A Frequently, hepatitis A will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with hepatitis A, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and hepatitis A using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “hepatitis A” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on hepatitis A: ·
Hepatitis and Renal Disease Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E., eds. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 574-606. Contact: Available from Appleton and Lange. 25 Van Zant Street, P.O. Box 5630, Norwalk, CT 06856. (800) 423-1359 or (203) 838-4400. Price: $175.00. ISBN: 0838513794. Summary: This chapter from a textbook of clinical dialysis covers hepatitis and renal disease. The author first provides an overview of hepatitis, including related definitions, terms, and concepts; the serology and epidemiology; the clinical course; and prophylaxis and treatment methods. The author then addresses the renal implications of hepatitis, including nephrologic complications, the influence of hepatitis on renal disorders, hepatitis in dialysis units, diagnostic considerations, and the prevention of hepatitis transmission in dialysis settings. One section also discusses the risk factors to health care workers of hepatitis B exposure. 12 tables. 577 references.
·
Gastrointestinal Disease and Hepatitis Source: in Andersen, R.D., et al. Infections in Children: A Sourcebook for Educators and Child Care Providers. Aspen Publishers, Inc. 1994. p. 137146. Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21701. (800) 638-8437 or (301) 417-7500. Price: $36. ISBN: 0834203871. Summary: This chapter, from a handbook for educators and child care providers on infections in children, addresses gastrointestinal disease and
92 Hepatitis A
hepatitis. The chapter covers vomiting; diarrhea; common causes of infectious diarrhea, including rotavirus, Escherichia coli, campylobacter species, salmonella, and shigella; hepatitis A; hepatitis B; and hepatitis C. In each section, the authors review the illness and its symptoms, consider etiology, review transmission and its prevention, and remind readers of the situations in which consultation of a health care provider is indicated. 3 references. ·
Acute Viral Hepatitis Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume Two. Philadelphia, PA: Current Medicine. 1999. p. 831-839. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. Price: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Viral infection is the most common cause of acute and chronic liver disease in the world. This chapter on acute viral hepatitis (liver infection) is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. The author notes that the spectrum of clinical illness due to hepatitis infection is extraordinarily broad. In many patients, infection is asymptomatic and entirely subclinical; in others, acute, life threatening liver failure may occur. At present, there is no specific, effective treatment for acute viral hepatitis with the exception of liver transplant for patients with acute irreversible liver failure. Hepatitis viruses are classified into two distinct groups: the enterically transmitted (through the digestive tract), nonenveloped agents, including hepatitis A virus (HAV) and hepatitis E virus (HEV); and the bloodborne, enveloped agents, including hepatitis B virus (HBV), hepatitis D virus (HDV), and hepatitis C virus (HCV). A fourth bloodborne agent, the hepatitis G virus (HGV) appears unlikely to be a true hepatitis virus and is not covered in this chapter. The enterically transmitted hepatitis viruses survive exposure to bile, are shed in feces, and produce infections that are generally self limited although they may cause severe hepatitis and acute liver failure; chronic disease is not seen. In contrast, the bloodborne enveloped hepatitis viruses are disrupted by exposure to bile or detergents, are not shed in feces, and may be associated with prolonged viremia (presence of the virus in the blood), persistent infectivity, and progression to chronic liver disease. Effective and safe vaccines are available for immunoprophylaxis against HAV and HBV infections (the latter vaccine also prevents HDV infection). Immunoprophylaxis against
Books 93
infection with other hepatitis viruses is not currently available. 10 figures. 4 tables. 21 references. ·
Therapy of Acute and Chronic Viral Hepatitis Source: in Schrier, R.W., et al., eds. Advances in Internal Medicine. Vol 39. St. Louis, MO: Mosby-Year Book, Inc. 1994. p. 241-275. Contact: Available from Mosby Year-Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545. Fax (800) 535-9935. E-mail:
[email protected]. Price: $72.95. ISBN: 0815183127. ISSN: 00652822. Summary: This entry, from a yearbook of advances in internal medicine, outlines the therapy of acute and chronic viral hepatitis. Viral hepatitis comprises at least five different diseases caused by five different viruses: hepatitis A, B, C, D or delta, and E. All five viruses can cause acute hepatitis; types B, C, and D can also cause persistent infection and chronic hepatitis. Acute viral hepatitis is probably the most common cause of jaundice and acute liver failure worldwide. Similarly, chronic viral hepatitis is probably the most common cause of cirrhosis and hepatocellular carcinoma. Therapy of acute and chronic viral hepatitis has recently been advanced by breakthroughs in the understanding of the hepatitis viruses and by development of several safe and potent antiviral substances. This review focuses largely on alpha interferon, with a few comments relating to other antiviral and immunomodulatory agents that have been found promising in early studies. Despite the benefits of alpha interferon therapy in many patients with chronic viral hepatitis, several shortcomings of this therapy are evident: less than 50 percent of patients respond, side effects can be problematic, and some patients are not appropriate for therapy. 5 figures. 4 tables. 151 references.
·
Diagnosis and Treatment of Viral Hepatitis Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 119-142. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 193559725. (215) 251-2230. Price: $39.50. ISBN: 0812114361. Summary: This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses the diagnosis and treatment of viral hepatitis. The author discusses five forms of hepatitis virus, but notes that the signs and symptoms of the different types are generally not distinctive enough to separate them clinically. The author discusses the epidemiology, manifestations, diagnosis, prognosis, treatment, complications, and prevention for each
94 Hepatitis A
of the following: hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. The author also details the complications of hepatitis B such as chronic hepatitis, primary hepatocellular carcinoma, and extrahepatic immune disease; and co-infection with hepatitis D. ·
Hepatitis A Virus Source: in Hollinger, F.B., et al. Viral Hepatitis: Biological and Clinical Features, Specific Diagnosis, and Prophylaxis. 2nd ed. New York, NY: Raven Press, Ltd. 1991. p. 1-37. Contact: Available from Raven Press. 1185 Avenue of the Americas, Dept. 5B, New York, NY 10036. (800) 777-2836 or (212) 930-9500. Fax (212) 8693495. Price: $91.50 plus shipping (as of 1995). ISBN: 0881677272. Summary: This chapter, from a book that examines the fundamental aspects of viral hepatitis, discusses the hepatitis A virus (HAV). Topics covered include the history of this disease; the infectious agent itself, including its biological characteristics, morphology and physicochemical properties, propagation and assay in cell culture, and antigenic composition and determinants; the pathogenesis and pathology of HAV; the clinical signs and symptoms and laboratory diagnosis used to confirm HAV; immunodiagnosis; the management of acute viral hepatitis; epidemiology; and prevention and control issues, including guidelines for immune globulin prophylaxis, vaccines, and molecular approaches to vaccine development and to understanding replication. 9 figures. 8 tables. 489 references.
General Home References In addition to references for hepatitis A, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom
Books 95
edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
Vocabulary Builder Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous sysTEM. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Campylobacter:
A genus of bacteria found in the reproductive organs,
96 Hepatitis A
intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU]
Multimedia 97
CHAPTER 6. MULTIMEDIA ON HEPATITIS A Overview Information on hepatitis A can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on hepatitis A. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on hepatitis A is the Combined Health Information Database. You will need to limit your search to “video recording” and “hepatitis A” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “hepatitis A” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on hepatitis A:
98 Hepatitis A
·
Hepatitis A Source: Princeton, NJ: Films for the Humanities and Sciences. 1997. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail:
[email protected]. Website: www.films.com. Price: $99.00; plus shipping and handling. Order number BXA7388. Summary: Hepatitis A, a viral infection of the liver, was once thought to be a problem of developing countries, where water supplies are often contaminated and sewage facilities may be inadequate. But in the past 15 years, more than 30 outbreaks have occurred in the United States. This program, hosted by Nancy Duerr and featuring Dr. Harold Margolis of the Centers for Disease Control and Prevention, explains current knowledge about this strain of the hepatitis virus and its causes, treatment, and prevention. The program is designed like a news report and begins with an overview of the role and functions of the liver. The program then reviews the various forms of the hepatitis virus, noting that all forms cause liver inflammation and cirrhosis and can cause symptoms like the flu, dark urine, or jaundice (yellowing of the skin). The narrators review the way each type is transmitted, the symptoms, the treatment and side effects, the prognostic factors, the availability of immunization, and the risk factors. The program goes into more depth on hepatitis A, interviewing patients and health care providers. Topics discussed are risk groups, including children in day care and people living in institutions or in crowded housing units; transmission; the geography of recent U.S. outbreaks; the symptoms of the disease; and treatment options, which are available only for the symptoms, since there is no treatment against the virus itself. The program notes that about 1 percent of people with hepatitis A develop fulminant hepatitis, which may need to be treated with liver transplantation. Another section reminds viewers of the risks of international travel and the importance of pretravel immunization. The program concludes with information about the American Liver Foundation (888-443-7222) and a brief interview with Thelma King Theil, the chair of the Hepatitis Foundation International.
·
Hepatitis A, B, C, D and E Source: Atlanta, GA: Emory University School of Medicine. 1990. Contact: Available from Emory University School of Medicine. Lynne Wise, Department of Medical Education, 69 Butler Street, SE, Atlanta, GA 30303. (404) 616-3556. Price: $100 plus $5 shipping and handling. (rental $45 for 2 weeks). Order Number 90-01.
Multimedia 99
Summary: This videotape covers all of the known types of viral hepatitis, but concentrates on Hepatitis B. The tape opens with a discussion of the mechanisms of injury to the liver and continues with a detailed look at the prevalence of hepatitis B (200,000 cases per year in the U.S.) and the various known risk factors. Extensive coverage is given to the serologic findings in both acute and chronic disease. Finally, the author outlines the current treatment with interferon and the use of vaccines. (AA).
Bibliography: Multimedia on Hepatitis A The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in hepatitis A (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on hepatitis A. For more information, follow the hyperlink indicated: ·
Case studies in clinical infection : hepatitis. Source: a presentation of Films for the Humanities & Sciences; Sheffield University Television; produced for the Department of Medical Microbiology, University of Sheffield; Year: 2001; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2001
·
Epidemiology and prevention of viral hepatitis A, B, C, D, E : an overview. Source: CDC, Centers for Disease Control and Prevention; Year: 1996; Format: Slide; [Atlanta, Ga.: The Centers, 1996]
·
Ethical issues and considerations surrounding genetics ; Polymerase chain reaction (PCR): technology in infectious diseases. Source: HSTN; Year: 2002; Format: Videorecording; Carrollton, TX: Primedia Workplace Learning, c2002
·
Expert opinions on contemporary clinical issues in hepatitis C. Source: Willis C. Maddrey, Eugene R. Schiff; Year: 1999; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1999
·
Functional dichotomy in the CD4 positive T cell response to parasites; Hepatitis A virus, molecular approaches to vaccine development. . Year: 1991; Format: Videorecording; [Bethesda, Md.: NIAID, 1991]
·
Gastroenterology . Year: 1999; Format: Electronic resource; Newton, MA: HealthStream, 1999
100 Hepatitis A
·
Gastroenterology . Year: 2001; Format: Electronic resource; Nashville, TN: HealthStream, 2001
·
Gastroenterology section. Source: American Medical Association; Year: 1994; Format: Electronic resource; Norwood, MA: SilverPlatter Education, c1994
·
Hepatitis & you as a healthcare worker. Part 1 : hepatitis A & E. Year: 2000; Format: Videorecording; Carrollton, TX: HSTN, c2000
·
Hepatitis & you as a healthcare worker. Part 2 : hepatitis B & C. Year: 2001; Format: Videorecording; Carrollton, TX: HSTN, c2001
·
Hepatitis A, B, & C : viruses and their detection. Source: presented by Department of Medicine, Emory University, School of Medicine; Year: 1980; Format: Videorecording; Atlanta: Emory Medical Television Network, 1980
·
Hepatitis A, B, C, D, and E. Source: [presented by] the Emory Medical Television Network and the Emory University School of Medicine; Year: 1990; Format: Videorecording; Atlanta, Ga.: The University, c1990
·
Hepatitis A. Source: a presentation of Films for the Humanities & Sciences; Information Television Network; Year: 1997; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1997
·
Management of viral hepatitis. Source: University of Michigan, Medical Center, Independent Study Unit, Department of Postgraduate Medicine and Health Professions Education; Year: 1974; Format: Slide; Ann Arbor: The University: [for loan or sale by its Medical Center Media Library], c1974
·
New look at hepatitis. Source: by Sandra Fessia, Mary Griffin, Patrick Scollin; John E. Lawe, editor; Year: 1994; Format: Electronic resource; Hanover, N.H.: Warlock Productions, c1994
·
Update on non-A, non-B hepatitis. Source: with Richard D. Aach; Year: 1990; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1990
·
Viral hepatitis : etiology, diagnosis, treatment. Source: Brooke Army Medical Center; Year: 1970; Format: Videorecording; Fort Sam Houston, Tex.: Academy of Health Sciences, 1970
·
Viral hepatitis: epidemiology, prevention, control. Source: Brooke Army Medical Center; Year: 1970; Format: Videorecording; Fort Sam Houston, Tex.: Academy of Health Sciences, 1970
·
Viral hepatitis. Source: Inge Gurevich, Burke A. Cunha; Year: 1985; Format: Slide; Garden Grove, Calif.: Medcom, c1985
Multimedia 101
Periodicals and News 103
CHAPTER 7. PERIODICALS AND NEWS ON HEPATITIS A Overview Keeping up on the news relating to hepatitis A can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on hepatitis A. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover hepatitis A beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on hepatitis A is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
104 Hepatitis A
PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “hepatitis A” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to hepatitis A. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “hepatitis A” (or synonyms). The following was recently listed in this archive for hepatitis A: ·
Hepatitis A much more common in US than thought Source: Reuters Health eLine Date: May 06, 2002 http://www.reuters.gov/archive/2002/05/06/eline/links/20020506elin 020.html
·
Hepatitis A infection rate in children higher than previous estimates Source: Reuters Medical News Date: May 06, 2002 http://www.reuters.gov/archive/2002/05/06/professional/links/20020 506publ002.html
·
GSK's Havrix hepatitis A vaccine may protect up to 30 years Source: Reuters Industry Breifing Date: March 14, 2002 http://www.reuters.gov/archive/2002/03/14/business/links/20020314 clin001.html
·
HIV infection prolongs course of acute hepatitis A Source: Reuters Medical News Date: February 25, 2002 http://www.reuters.gov/archive/2002/02/25/professional/links/20020 225clin010.html
Periodicals and News 105
·
Vaccinating children against hepatitis A reduces disease rate in community Source: Reuters Industry Breifing Date: December 19, 2001 http://www.reuters.gov/archive/2001/12/19/business/links/20011219 publ001.html
·
Childhood hepatitis A shots prevent disease Source: Reuters Health eLine Date: December 18, 2001 http://www.reuters.gov/archive/2001/12/18/eline/links/20011218elin 004.html
·
Aventis offers free testing to recipients of recalled hepatitis A vaccine Source: Reuters Medical News Date: December 14, 2001 http://www.reuters.gov/archive/2001/12/14/professional/links/20011 214publ001.html
·
Hepatitis A and B immunization rates continue to rise among US gay men Source: Reuters Medical News Date: September 12, 2001 http://www.reuters.gov/archive/2001/09/12/professional/links/20010 912publ010.html
·
Combined hepatitis A/B vaccine provides long-term immunity Source: Reuters Industry Breifing Date: September 05, 2001 http://www.reuters.gov/archive/2001/09/05/business/links/20010905 clin006.html
·
Young adults in India becoming more susceptible to hepatitis A Source: Reuters Medical News Date: August 21, 2001 http://www.reuters.gov/archive/2001/08/21/professional/links/20010 821epid003.html
·
Self-referral hepatitis A vaccination strategy ineffective in Canada Source: Reuters Medical News Date: April 23, 2001 http://www.reuters.gov/archive/2001/04/23/professional/links/20010 423publ008.html
106 Hepatitis A
·
Moderate HIV infection has little effect on course of hepatitis A Source: Reuters Medical News Date: February 01, 2001 http://www.reuters.gov/archive/2001/02/01/professional/links/20010 201clin015.html
·
Hepatitis A linked to coronary artery disease Source: Reuters Health eLine Date: January 01, 2001 http://www.reuters.gov/archive/2001/01/01/eline/links/20010101elin 003.html
·
Asialoglycoprotein receptor largely responsible for hepatitis A uptake by the liver Source: Reuters Industry Breifing Date: January 01, 2001 http://www.reuters.gov/archive/2001/01/01/business/links/20010101 scie001.html
·
Maternal hepatitis A antibody interference with vaccination can be overcome Source: Reuters Medical News Date: December 21, 2000 http://www.reuters.gov/archive/2000/12/21/professional/links/20001 221clin011.html
·
Most gay and bisexual men have not been vaccinated against hepatitis A or B Source: Reuters Medical News Date: October 17, 2000 http://www.reuters.gov/archive/2000/10/17/professional/links/20001 017publ002.html
·
Hepatitis A immunization for teens is cost-effective in states with high rates Source: Reuters Medical News Date: August 16, 2000 http://www.reuters.gov/archive/2000/08/16/professional/links/20000 816econ001.html
·
Hepatitis A viremia lasts longer than expected Source: Reuters Medical News Date: August 04, 2000 http://www.reuters.gov/archive/2000/08/04/professional/links/20000 804scie006.html
Periodicals and News 107
·
Chronic liver disease may indicate need for hepatitis A vaccination Source: Reuters Medical News Date: April 17, 2000 http://www.reuters.gov/archive/2000/04/17/professional/links/20000 417clin016.html
·
SmithKline's hepatitis A, B vaccine to receive FDA approval in next few weeks Source: Reuters Industry Breifing Date: April 12, 2000 http://www.reuters.gov/archive/2000/04/12/business/links/20000412 rglt005.html
·
Combined hepatitis A/B vaccine offers fast protection Source: Reuters Health eLine Date: April 12, 2000 http://www.reuters.gov/archive/2000/04/12/eline/links/20000412elin 014.html
·
Cases of hepatitis A infection underreported in US Source: Reuters Medical News Date: April 12, 2000 http://www.reuters.gov/archive/2000/04/12/professional/links/20000 412epid005.html
·
Accelerated hepatitis A/B vaccination effective Source: Reuters Medical News Date: April 12, 2000 http://www.reuters.gov/archive/2000/04/12/professional/links/20000 412clin002.html
·
New hepatitis A, B vaccine perfect for travelers Source: Reuters Health eLine Date: April 11, 2000 http://www.reuters.gov/archive/2000/04/11/eline/links/20000411elin 020.html
·
Hepatitis A may be more common than thought Source: Reuters Health eLine Date: April 11, 2000 http://www.reuters.gov/archive/2000/04/11/eline/links/20000411elin 037.html
108 Hepatitis A
·
Some states flunk vaccinating kids against hepatitis A Source: Reuters Health eLine Date: February 28, 2000 http://www.reuters.gov/archive/2000/02/28/eline/links/20000228elin 012.html
·
Combination hepatitis A/B vaccine ineffective against hepatitis B Source: Reuters Medical News Date: December 27, 1999 http://www.reuters.gov/archive/1999/12/27/professional/links/19991 227clin008.html
·
Hepatitis A vaccine immunogenic in liver and renal transplant patients Source: Reuters Medical News Date: December 21, 1999 http://www.reuters.gov/archive/1999/12/21/professional/links/19991 221clin007.html
·
Hepatitis A vaccine effective in chronic patients with hepatitis B Source: Reuters Medical News Date: December 17, 1999 http://www.reuters.gov/archive/1999/12/17/professional/links/19991 217clin010.html
·
High prevalence of hepatitis A spurs CDC to update US hepatitis A vaccination guidelines Source: Reuters Medical News Date: October 20, 1999 http://www.reuters.gov/archive/1999/10/20/professional/links/19991 020publ004.html
·
Combination hepatitis A and B vaccine immunogenic Source: Reuters Medical News Date: September 29, 1999 http://www.reuters.gov/archive/1999/09/29/professional/links/19990 929drgd002.html
·
Combination hepatitis A and B vaccine effective Source: Reuters Health eLine Date: September 28, 1999 http://www.reuters.gov/archive/1999/09/28/eline/links/19990928elin 006.html
Periodicals and News 109
·
Combined hepatitis A and B vaccine safe, "highly immunogenic" Source: Reuters Medical News Date: August 18, 1999 http://www.reuters.gov/archive/1999/08/18/professional/links/19990 818clin006.html
·
Hepatitis A cases often incorrectly identified as secondary Source: Reuters Medical News Date: July 23, 1999 http://www.reuters.gov/archive/1999/07/23/professional/links/19990 723epid006.html
·
Most homosexual, bisexual men not immunized against hepatitis A and B Source: Reuters Medical News Date: June 22, 1999 http://www.reuters.gov/archive/1999/06/22/professional/links/19990 622epid005.html
·
Hepatitis A vaccine prevents secondary HAV infection Source: Reuters Medical News Date: April 02, 1999 http://www.reuters.gov/archive/1999/04/02/professional/links/19990 402clin002.html
·
Call for routine hepatitis A vaccination Source: Reuters Health eLine Date: February 24, 1999 http://www.reuters.gov/archive/1999/02/24/eline/links/19990224elin 008.html
·
Routine hepatitis A vaccination of selected children recommended Source: Reuters Medical News Date: February 19, 1999 http://www.reuters.gov/archive/1999/02/19/professional/links/19990 219plcy001.html
·
Hepatitis A vaccine for children in 11 states Source: Reuters Health eLine Date: February 18, 1999 http://www.reuters.gov/archive/1999/02/18/eline/links/19990218elin 011.html
110 Hepatitis A
·
Hepatitis A virus remains after standard purification measures of factor VIII Source: Reuters Medical News Date: January 22, 1999 http://www.reuters.gov/archive/1999/01/22/professional/links/19990 122publ005.html
·
Routine vaccination of US children and adults for hepatitis A recommended Source: Reuters Medical News Date: December 22, 1998 http://www.reuters.gov/archive/1998/12/22/professional/links/19981 222epid001.html
·
Three dosage levels of hepatitis A vaccine safe and well tolerated Source: Reuters Medical News Date: November 26, 1998 http://www.reuters.gov/archive/1998/11/26/professional/links/19981 126drgd001.html
·
Routine childhood vaccination against hepatitis A may be advisable Source: Reuters Medical News Date: October 26, 1998 http://www.reuters.gov/archive/1998/10/26/professional/links/19981 026plcy002.html
·
[CLIN- Hepatitis A infection associated with HIV disease progression Source: Reuters Medical News Date: September 29, 1998 http://www.reuters.gov/archive/1998/09/29/professional/links/19980 929clin016.html
·
Men who have sex with men should be vaccinated against hepatitis A Source: Reuters Medical News Date: September 04, 1998 http://www.reuters.gov/archive/1998/09/04/professional/links/19980 904epid007.html
·
Hepatitis A vaccine advised for gay men Source: Reuters Health eLine Date: September 04, 1998 http://www.reuters.gov/archive/1998/09/04/eline/links/19980904elin 005.html
Periodicals and News 111
·
Spokane Residents Urged To Get Hepatitis A Vaccinations Source: Reuters Medical News Date: March 16, 1998 http://www.reuters.gov/archive/1998/03/16/professional/links/19980 316publ005.html
·
Campaign Launched To Increase Awareness Of Viral Hepatitis Source: Reuters Medical News Date: February 25, 1998 http://www.reuters.gov/archive/1998/02/25/professional/links/19980 225publ002.html
·
Hepatitis A Shot For Hep C Patients Source: Reuters Health eLine Date: February 02, 1998 http://www.reuters.gov/archive/1998/02/02/eline/links/19980202elin 007.html
·
Severe Disease Seen With Hepatitis A Superimposed On Hepatitis C Source: Reuters Medical News Date: January 29, 1998 http://www.reuters.gov/archive/1998/01/29/professional/links/19980 129clin005.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
112 Hepatitis A
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “hepatitis A” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “hepatitis A” (or synonyms). If you know the name of a company that is relevant to hepatitis A, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “hepatitis A” (or synonyms).
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “hepatitis A” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is
Periodicals and News 113
updated every 3 months. The following is a typical result when searching for newsletter articles on hepatitis A: ·
Assault on Your Liver: Inside the ABCs (and DEFGs) of Viral Hepatitis Source: Mayo Clinic Women's Healthsource. 3(7): 4, 5. July 1999. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This health newsletter article describes the different strains of viral hepatitis and their impact on the liver. The liver is a noncomplaining organ, which functions to filter out harmful chemicals, fight infection, and convert energy for the body's use. When hepatitis hits, however, illnesses can range from mild to potentially life threatening. The author describes how to tell the difference between each type of hepatitis, whether risk factors are present or not, and what happens after infection. Blood tests are used to diagnose hepatitis. Some tests detect specific antibodies the body produces in response to infection with a particular hepatitis virus; others measure how well the liver is functioning; others actually test for the virus itself. The author lists the epidemiology and incubation of each type (hepatitis A through E), then reminds readers of the transmission of each type. Treatment, vaccination options, risk factors, and preventive measures are then noted. Hepatitis A is spread through the fecal oral route (not washing hands properly after contact with infected feces), ingestion of contaminated food and water, or close personal contact with an infected person (anal or oral). Hepatitis B is transmitted through contact with body fluids containing HBV, sexual contact, or sharing contaminated needles. Hepatitis E is associated with contaminated water. Vaccinations are available for hepatitis A, B, and D (hepatitis B vaccine prevents hepatitis D infection); no vaccine is available for hepatitis C or E. One sidebar reviews strategies for optimum liver care, with or without the presence of hepatitis.
·
Viral Hepatitis: A Decade of Discovery and Progress in Prevention Source: Mayo Clinic Health Letter. 13(8): 4-5. August 1995. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This newsletter article familiarizes readers with recent advances in the prevention and treatment of viral hepatitis. Topics covered include the causes of hepatitis; the viruses that cause hepatitis; acute versus chronic hepatitis; treatment options, based on the severity of the hepatitis; prevention, notably minimizing lifestyle risk factors; and research avenues yet to be explored. One sidebar in the article lists the
114 Hepatitis A
indications for the hepatitis A or B vaccine and one summarizes the five types of viral hepatitis (A, B, C, D, and E), transmission, and the severity of illness associated with each.
Academic Periodicals covering Hepatitis A Academic periodicals can be a highly technical yet valuable source of information on hepatitis A. We have compiled the following list of periodicals known to publish articles relating to hepatitis A and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on hepatitis A published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on hepatitis A: ·
American Journal of Epidemiology. (Am J Epidemiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Journal+of+Epidemiology&dispmax=20&dispstart=0
·
International Journal of Epidemiology. (Int J Epidemiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Int ernational+Journal+of+Epidemiology&dispmax=20&dispstart=0
·
Journal of Psychosomatic Research. (J Psychosom Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Psychosomatic+Research&dispmax=20&dispstart=0
Periodicals and News 115
·
Journal of Public Health Medicine. (J Public Health Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Public+Health+Medicine&dispmax=20&dispstart=0
·
The Indian Journal of Medical Research. (Indian J Med Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Indian+Journal+of+Medical+Research&dispmax=20&dispstart=0
Vocabulary Builder Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Cyclospora: A genus of coccidian parasites in the family eimeriidae. Cyclospora cayetanensis is pathogenic in humans, probably transmitted via the fecal-oral route, and causes nausea and diarrhea. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Listeria: A genus of bacteria which may be found in the feces of animals and man, on vegetation, and in silage. Its species are parasitic on cold-blooded and warm-blooded animals, including man. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Vibrio: A genus of vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH]
Physician Guidelines and Databases 117
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
118 Hepatitis A
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.24 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:25 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
·
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
·
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
·
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
·
Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 25 See http://www.nlm.nih.gov/databases/databases.html. 24
Physician Guidelines and Databases 119
·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
·
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
·
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
·
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
·
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
·
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
·
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat hepatitis A, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and hepatitis A using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “hepatitis A” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with hepatitis A. The following is a sample result:
120 Hepatitis A
·
Prevention of Hepatitis A Through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Source: MMWR. Morbidity and Mortality Weekly Report. 48(RR-12): 137. October 1, 1999. Contact: Available from Superintendent of Documents, U.S. Government Printing Office. Washington, DC 20402. (202) 512-1800. Available for free in electronic format on the World Wide Web at www.cdc.gov or from CDC's file transfer protocol server at ftp.cdc.gov. Summary: Routine vaccination of children is the most effective way to reduce hepatitis A incidence nationwide over time. Since licensure of hepatitis A vaccine in 1995, this strategy has been implemented incrementally, starting with the recommendation of the Advisory Committee on Immunization Practices (ACIP) in 1996 to vaccinate children living in communities with the highest rates of infection and disease. This report updates the ACIP's 1996 recommendations on the prevention of hepatitis A through immunization; representing the next phase of this immunization strategy. Vaccination of children living in States and communities with consistently elevated rates of hepatitis A will provide protection from disease and is expected to reduce the overall incidence of hepatitis A. The report includes new data about the epidemiology of hepatitis A; recent findings about the effectiveness of community based hepatitis A vaccination programs; and recommendations for the routine vaccination of children in States, counties, and communities with rates that are twice the 1987 to 1997 national average or greater (that is, greater than 20 cases per 100,000 population) and consideration of routine vaccination of children in States, counties, and communities with rates exceeding the 1987 to 1997 national averaged. Unchanged in this report are previous recommendations regarding the vaccination of persons in groups at increased risk for hepatitis A or its adverse consequences and recommendations regarding the use of immune globulin for protection against hepatitis A. 5 figures. 6 tables. 161 references.
·
Todas las Semanas, Miles de Individuos Sexualmente Activos se Contagian con la Hepatitis B: Protejase! Vacunese!. [Every Week Thousands of Sexually Active People Are Infected With Hepatitis B] Contact: Immunization Action Coalition, 1573 Selby Ave Ste 234, St Paul, MN, 55104, (651) 647-9009, http://www.immunize.org. Summary: This brochure, written for the general public, discusses the hepatitis B virus (HBV). Hepatitis B is a sexually transmitted liver
Physician Guidelines and Databases 121
disease, caused by HBV, which is much easier to contract than the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and can cause severe liver disease, scarring, and liver cancer. A quiz is supplied in the brochure for individuals to use to assess their risks for HBV. HBV can be spread through unprotected vaginal or anal sex, needle-sharing for injection drugs use, contact with open sores, and prolonged exposure to an individual with HBV. It can also be contracted through body piercing or tattooing with unsterile equipment, the sharing of personal products that may contain blood such as toothbrushes or razors, and human bites. Individuals can protect themselves from HBV through vaccination and by practicing safer sex. The symptoms of hepatitis B include loss of appetite, nausea, fever, dark-colored urine, jaundice, fatigue, joint pain, and a bloated and tender belly. Most people who get HBV will fully recover; however, a small percentage will carry the infection in their bodies for life. The only way for individuals to know if they have been infected with HBV is to get tested. The HBV vaccine will not protect individuals from the hepatitis A vaccine (HAV) or the hepatitis C virus (HCV). The HBV vaccine may be available at no charge through clinics or health departments. ·
Hepatitis A and Your Kids: Facts Every Parent Should Know Source: Philadelphia, PA: SmithKline Beecham Pharmaceuticals. 1996. 11 p. Contact: Available from SmithKline Beecham. Consumer Brands, P.O. Box 1467, Pittsburgh, PA 15230. (800) 245-1040. Price: Single copy free. For bulk orders, physicians may call (800) 233-2426. Summary: This brochure, written in a question and answer format, provides parents with information about hepatitis A and the vaccine available to prevent it. Hepatitis A is a highly contagious viral disease. It attacks the liver and can lead to varying degrees of illness. The brochure discusses situations that may put a child a particular risk of getting hepatitis A, including international travel. The author stresses that the symptoms of hepatitis A infection in children may be mild or nonexistent. However, children can still transmit the virus to those with whom they come into contact. The remainder of the brochure describes the Havrix vaccine, a vaccine that protects against hepatitis A. The brochure concludes with the complete prescribing information for health care providers. 7 references.
·
Prevention, Diagnosis, and Management of Viral Hepatitis: A Guide for Primary Care Physicians Source: Chicago, IL: American Medical Association. 1995. 21 p.
122 Hepatitis A
Contact: Available from American Medical Association. Division of Health Science, 515 North State Street, Chicago, IL 60610. (312) 464-5563. Fax (613) 464-5842. Price: $1.50. Item Number AA36.94-802.225M.1/95. Summary: This report reflects the views of experts and the medical literature as of January 1995 on the prevention, diagnosis, and management of viral hepatitis. Topics include the viral characteristics and epidemiology of hepatitis A, B, C, D, and E; the clinical manifestations of acute and chronic hepatitis; diagnostic considerations; management issues for acute and chronic hepatitis; and prevention of hepatitis A, B, and C. The author stresses that, because patients with hepatitis may be asymptomatic, primary care physicians must be aware of the epidemiology and clinical manifestations of acute and chronic hepatitis. The report concludes with a list of abbreviations used and a list of selected readings. 4 figures. 10 tables. 28 references. (AA-M). ·
Hepatitis Information You Need to Know: The Impact of Viral Hepatitis in Our Community Source: New York, NY: American Liver Foundation. 199x. [4 p.]. Contact: Available from American Liver Foundation. 1425 Pompton Avenue, Suite 3, Cedar Grove, NJ 07009. (800) 465-4837. E-mail:
[email protected]. Website: www.liverfoundation.org. Price: $0.75 for a single copy; bulk copies available; plus shipping and handling. Summary: Viral hepatitis is an infection of the liver that affects people from all walks of life regardless of age, race, gender, or sexual orientation. This brochure describes the different types of viral hepatitis and provides information about avoiding the risk factors that enable transmission of hepatitis. Hepatitis A infection can cause an acute, flu like illness with yellowing of the skin (jaundice), nausea and vomiting, fatigue, loss of appetite, abdominal pain, or diarrhea. Hepatitis B infection can causes symptoms similar to hepatitis A; in approximately 5 percent of cases, it becomes chronic and can result in cirrhosis (liver scarring). Hepatitis C infection can result in up to 85 percent of cases becoming chronic, and often causes no symptoms until liver damage has occurred many years after infection. Risk factors for each type of hepatitis are outlines, with a special section discussing the emerging epidemic of hepatitis C infection. The brochure then encourages readers to consider getting tested for hepatitis; this section briefly describes the treatment options for the main types of hepatitis. Adoption of a healthy lifestyle with a good diet, plenty of rest, and stress reduction can improve one's health and well being. Studies show that the use of alcohol substantially increases the risk of serious liver damage in persons with chronic viral hepatitis, and thus should be avoided. The brochure then discusses a viral hepatitis
Physician Guidelines and Databases 123
education campaign, the Digestive Health Initiative (DHI), which is educating consumers, patients, physicians, policy makers, and other healthcare professionals about hepatitis. The brochure concludes with a list of sources of information and support for people affected by hepatitis. 1 table.
The NLM Gateway26 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.27 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.28 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hepatitis A” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 28 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 26 27
124 Hepatitis A
Results Summary Category Items Found Journal Articles 343187 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349233
HSTAT29 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.30 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.31 Simply search by “hepatitis A” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists32 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 31 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 32 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 29 30
Physician Guidelines and Databases 125
recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.33 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.34 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 34 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 33
126 Hepatitis A
The Genome Project and Hepatitis A With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to hepatitis A. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).35 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “hepatitis A” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for hepatitis A: ·
Hepatitis a Virus Cellular Receptor 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?606518
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
35
Physician Guidelines and Databases 127
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez
Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences,
128 Hepatitis A
macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “hepatitis A” (or synonyms) and click “Go.”
Physician Guidelines and Databases 129
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database36 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database37 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “hepatitis A” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 37 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 36
130 Hepatitis A
often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in hepatitis A (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna · Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, 2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna
Dissertations 131
CHAPTER 9. DISSERTATIONS ON HEPATITIS A Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to hepatitis A. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Hepatitis A ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to hepatitis A. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with hepatitis A: ·
Assessment of Reasons for Refusing Hepatitis A (HAV) and Hepatitis B (HBV) Vaccinations and of Willingness-to-pay for HAV and HBV Vaccinations in a Sexually Transmitted Disease (STD) Clinic Setting by
132 Hepatitis A
Thometz, Ellen Marie; Phd from University of California, Los Angeles, 2001, 210 pages http://wwwlib.umi.com/dissertations/fullcit/3024048 ·
Cultural Factors Related to the Epidemiology of Viral Hepatitis in a Southwestern United States County (infectious Disease, Socioeconomic, Public Health, Behavior, Communicable) by Mccombie, Susan Carole, Phd from The University of Arizona, 1986, 184 pages http://wwwlib.umi.com/dissertations/fullcit/8613437
·
Hepatitis A Infection and Men Who Have Sex with Men in New York City by Chu, Alvin F.; Edd from Columbia University Teachers College, 2001, 166 pages http://wwwlib.umi.com/dissertations/fullcit/3014753
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to hepatitis A is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
133
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with hepatitis A and related conditions.
Researching Your Medications 135
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with hepatitis A. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for hepatitis A. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of hepatitis A. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
136 Hepatitis A
Your Medications: The Basics38 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of hepatitis A. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with hepatitis A take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for hepatitis A. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
38
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 137
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for hepatitis A). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for hepatitis A. One such source
138 Hepatitis A
is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.39 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of hepatitis A. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to hepatitis A: Alglucerase ·
Systemic - U.S. Brands: Ceredase http://www.nlm.nih.gov/medlineplus/druginfo/alglucerasesyste mic202625.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
39
Researching Your Medications 139
Cholestyramine ·
Oral - U.S. Brands: Questran http://www.nlm.nih.gov/medlineplus/druginfo/cholestyramine oral202137.html
Hepatitis A Vaccine Inactivated ·
Systemic - U.S. Brands: Havrix; Vaqta http://www.nlm.nih.gov/medlineplus/druginfo/hepatitisavaccin einactivatedsy202902.html
Hepatitis B Vaccine Recombinant ·
Systemic - U.S. Brands: Engerix-B http://www.nlm.nih.gov/medlineplus/druginfo/hepatitisbvaccin erecombinantsy202281.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with hepatitis A (including those with contraindications):40 ·
Immune Globulin Intramuscular (IGIM; IG; Gamma Globulin; ISG) http://www.reutershealth.com/atoz/html/Immune_Globulin_Intramus cular_(IGIM;_IG;_Gamma_Globulin;_ISG).htm
·
Immune Globulin Intramuscular (IGIM; IG; Gamma Globulin;ISG) http://www.reutershealth.com/atoz/html/Immune_Globulin_Intramus cular_(IGIM;_IG;_Gamma_Globulin;ISG).htm
40
Adapted from A to Z Drug Facts by Facts and Comparisons.
140 Hepatitis A
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with hepatitis A--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat hepatitis A or potentially create deleterious side effects in patients with hepatitis A. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause
Researching Your Medications 141
unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with hepatitis A. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with hepatitis A. The FDA warns patients to watch out for41: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
41
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
142 Hepatitis A
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna · Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna
Researching Alternative Medicine 143
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to hepatitis A. Finally, at the conclusion of this chapter, we will provide a list of readings on hepatitis A from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?42 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 42
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
144 Hepatitis A
treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?43 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
43
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
Researching Alternative Medicine 145
practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
146 Hepatitis A
Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
Researching Alternative Medicine 147
Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.44
44
Adapted from http://www.4woman.gov/faq/alternative.htm.
148 Hepatitis A
Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Hepatitis A Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for hepatitis A. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “hepatitis A” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Four Major Ayurvedic Herbs: A Western Perspective Source: Alternative and Complementary Therapies. 4(4): 321-326. October 1998.
Researching Alternative Medicine 149
Summary: This journal reviews four major Ayurvedic medicinal herbs, their traditional uses, and modern research into their efficacy and safety. 'Gymnema sylvestre' is used to treat diabetes mellitus and suppress sweet taste. Gymnemic acids, saponins, and the polypeptide gurmarin are thought to contribute to its actions. Two major clinical trials have reported beneficial effects in both insulin dependent and non-insulin dependent diabetes. 'Andrographis paniculata' is used by Ayurvedic physicians to treat a range of infectious diseases and digestive complaints. Clinical trials have shown that it can shorten the duration and ease the symptoms of the common cold. Other evidence suggests that it may be useful in the treatment of hepatitis and atherosclerosis. Traditional uses for 'Terminalia arjuna' include heart conditions, fever, dysentery, wounds, and convulsions. Modern research suggests it may be useful in the treatment of congestive heart failure and ischemic heart disease, but its active constituents and mechanism of action have yet to be determined. 'Picrorrhiza kurroa' (kutki) has been used to treat a variety of illnesses from asthma to arthritis. It has shown hepatoprotective and hepatoregenerative effects in numerous animal and 'in vitro' studies, but only one clinical trial has been conducted to date. Other studies report positive results using kutki to treat asthma. The article has 2 tables and 53 references.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to hepatitis A and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “hepatitis A” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to hepatitis A: ·
An outbreak of hepatitis A among homosexual men in Amsterdam, 1991-1993. Author(s): Leentvaar-Kuijpers A, Kool JL, Veugelers PJ, Coutinho RA, van Griensven GJ.
150 Hepatitis A
Source: International Journal of Epidemiology. 1995 February; 24(1): 21822. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7797346&dopt=Abstract ·
Efficacy of an indigenous compound preparation (Liv-52) in acute viral hepatitis-a double blind study. Author(s): Sama SK, Krishnamurthy L, Ramachandran K, Lal K. Source: The Indian Journal of Medical Research. 1976 May; 64(5): 738-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=786874&dopt=Abstract
·
Hepatitis A, B, C and D in a community in Italy of immigrants from NE Africa. Author(s): Faustini A, Franco E, Saitto C, Cauletti M, Zaratti L, Papini P, Ali' Ahmed S, Zampieri F, Ierussi A, Pana A, et al. Source: Journal of Public Health Medicine. 1994 March; 16(1): 71-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8037956&dopt=Abstract
·
Incidence of hepatitis among students at a university in Taiwan. Author(s): Beasley RP, Hwang LY, Lin CC, Ko YC, Twu SJ. Source: American Journal of Epidemiology. 1983 February; 117(2): 213-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6402925&dopt=Abstract
·
Patients' expressions of complaints as a predictor of the course of acute hepatitis A. Author(s): Rose M, Scholler G, Jorres A, Danzer G, Klapp BF. Source: Journal of Psychosomatic Research. 2000 February; 48(2): 107-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10719126&dopt=Abstract
·
Possible infectious causes in 651 patients with acute viral hepatitis during a 10-year period (1976-1985). Author(s): Kiyosawa K, Gibo Y, Sodeyama T, Furuta K, Imai H, Yoda H, Koike Y, Yoshizawa K, Furuta S. Source: Liver. 1987 June; 7(3): 163-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3112489&dopt=Abstract
Researching Alternative Medicine 151
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
·
AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
·
Chinese Medicine: http://www.newcenturynutrition.com/
·
drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
·
Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
·
Google: http://directory.google.com/Top/Health/Alternative/
·
Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Alternative/
·
TPN.com: http://www.tnp.com/
·
Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
·
WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
·
WellNet: http://www.wellnet.ca/herbsa-c.htm
·
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to hepatitis A; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Viral Hepatitis Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
·
Chinese Medicine Hugan Pian Alternative names: Hugan Tablets
152 Hepatitis A
Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Hugan%20Pian&m h=10&sb=---&view_records=View+Records ·
Herbs and Supplements Alpha-Lipoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Alpha-lipoic acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 02,00.html Amino acids Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Astragalus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000101.html Ava Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/KavaKavac h.html Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Blue Flag Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm
Researching Alternative Medicine 153
Corydalis Alternative names: Corydalis turtschaninovii, Corydalis yanhusuo Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Corydalis.htm Cysteine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Cyst einecs.html Estrogen Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Glutathione Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Green Tea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Inosine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Interferon Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Interferon Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
154 Hepatitis A
Kava Kava Alternative names: Piper methysticum, Ava Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/KavaKavac h.html Lecithin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Licorice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Licorice Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Liquorice Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsj-l.htm Liver Extracts Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Mad-dog Skullcap Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Skullcapch. html Milk Thistle Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Milk Thistle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
Researching Alternative Medicine 155
Milk Thistle Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsm-o.htm Oral Contraceptives Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Phyllanthus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Phyllanthus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Picrorhiza Alternative names: Picrorhiza kurroa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Picrorhiza.htm Picrorhiza Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Piper methysticum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/KavaKavac h.html S-Adenosylmethionine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm SAMe (S-adenosylmethionine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
156 Hepatitis A
Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,818, 00.html Schisandra Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Scutellaria lateriflora Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Skullcapch. html Skullcap Alternative names: Scutellaria lateriflora, Mad-dog Skullcap Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Skullcapch. html Taurine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000196.html Terminalia Alternative names: Myrobalans; Terminalia arjuna Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Thymus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Thymus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Thymus Extracts Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
Researching Alternative Medicine 157
Uva Ursi Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000103.html ·
Related Conditions Bladder Infection Alternative names: Urinary Tract Infection [UTI] Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000269.html Hepatitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Hepatitis, Viral Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hepati tisViralcc.html Insomnia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Sleeplessness Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of
158 Hepatitis A
general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH]
Researching Alternative Medicine 159
Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH]
Researching Nutrition 161
APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with hepatitis A. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with hepatitis A may be given different recommendations. Some recommendations may be directly related to hepatitis A, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of hepatitis A. We will then show you how to find studies dedicated specifically to nutrition and hepatitis A.
162 Hepatitis A
Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
·
Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
·
Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
·
Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
Researching Nutrition 163
nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
·
Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
·
Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
·
Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
·
Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
·
Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
·
Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
·
Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
164 Hepatitis A
·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
·
Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
·
Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
·
Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
·
Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
·
Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:45 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
45
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
Researching Nutrition 165
·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?46
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”47 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.48 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 47 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 48 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 46
166 Hepatitis A
the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Hepatitis A The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.49 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
49
Researching Nutrition 167
periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “hepatitis A” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on hepatitis A: ·
Determinants of the quality of life of patients with diabetes under intensified insulin therapy. Author(s): Department of Psychosomatic Medicine and Psychotherapy, Medical Clinic and Policlinic, Charite Campus-Virchow, Humboldt University, Berlin, Germany.
[email protected] Source: Rose, M Burkert, U Scholler, G Schirop, T Danzer, G Klapp, B F Diabetes-Care. 1998 November; 21(11): 1876-85 0149-5992
·
Is protein-calorie malnutrition a problem in alcoholic hepatitis. Source: Nutr-Rev. Washington, D.C. : Nutrition Foundation. April 1985. volume 43 (4) page 108-109. charts. 0029-6643
·
Nutrition support for individuals with liver failure. Author(s): Division of Gastroenterology, Hepatology, and Nutrition, Loyola University Medical Center, Maywood, IL 60153, USA. Source: Li, S D Lue, W Mobarhan, S Nadir, A Van Thiel, D H Hagerty, A Nutr-Revolume 2000 August; 58(8): 242-7 0029-6643
The following information is typical of that found when using the “Full IBIDS Database” when searching using “hepatitis A” (or a synonym): ·
Examination of potential inhibitors of hepatitis A virus uncoating. Author(s): Hepatitis Research Unit, Macfarlane Burnet Centre for Medical Research, Fairfield, Vic., Australia.
[email protected] Source: Bishop, N E Intervirology. 1998; 41(6): 261-71 0300-5526
·
Hepatitis A virus replication: an intermediate in the uncoating process. Author(s): Hepatitis Research Unit, Macfarlane Burnet Centre for Medical Research, Fairfield, Vict., Australia. Source: Bishop, N E Intervirology. 2000; 43(1): 36-47 0300-5526
168 Hepatitis A
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
·
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
·
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
·
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
·
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
·
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
·
Google: http://directory.google.com/Top/Health/Nutrition/
·
Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Nutrition/
Researching Nutrition 169
·
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
·
WebMDÒHealth: http://my.webmd.com/nutrition
·
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Nadir: The lowest point; point of greatest adversity or despair. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH]
170 Hepatitis A
Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 171
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.50
50
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
172 Hepatitis A
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):51 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
·
California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
51
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 173
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
·
California: San José PlaneTree Health Library, http://planetreesanjose.org/
·
California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
·
California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
·
Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
·
Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
·
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
174 Hepatitis A
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
·
Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
·
Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
·
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
·
Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
·
Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
·
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
·
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
·
Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 175
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
·
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
·
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
·
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
·
Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
·
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
·
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
·
Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
·
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
176 Hepatitis A
·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
·
New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
·
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
·
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
·
Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 177
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
·
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
·
Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
·
Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
·
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
·
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
·
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 179
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with hepatitis A faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.52 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
52Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
180 Hepatitis A
·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 181
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
182 Hepatitis A
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 183
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.53
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”54 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 54 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 53
184 Hepatitis A
·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.55 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.56 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 56 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 55
Your Rights and Insurance 185
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
186 Hepatitis A
7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 187
contact information on how to find more in-depth information about Medicaid.57
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
57
188 Hepatitis A
Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 189
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.58 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
58
190 Hepatitis A
programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:59 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
59
Your Rights and Insurance 191
Vocabulary Builder Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Hepatomegaly: Enlargement of the liver. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Prothrombin Time: Measurement of clotting time of plasma recalcified in the presence of excess tissue thromboplastin. Factors measured are fibrinogen, prothrombin, and factors V, VII, and X. It is used for monitoring anticoagulant therapy with coumarins. [NIH] Splenomegaly: Enlargement of the spleen. [EU]
Online Glossaries 193
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to hepatitis A and keep them on file. The NIH, in particular, suggests that patients with hepatitis A visit the following Web sites in the ADAM Medical Encyclopedia:
194 Hepatitis A
·
Basic Guidelines for Hepatitis a Hepatitis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001154.htm Hepatitis A Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000278.htm Hepatitis A - vaccine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/005107.htm Hepatitis B Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000279.htm Hepatitis C Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000284.htm HSV Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001368.htm
·
Signs & Symptoms for Hepatitis a Clay colored stools Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003129.htm Dark urine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003138.htm Difficulty breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm
Online Glossaries 195
Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm Hepatomegaly Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003275.htm Itching Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Jaundice Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003243.htm Loss of appetite Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003121.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Muscle aches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm
196 Hepatitis A
Nausea and vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Rash Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Splenomegaly Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003276.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm ·
Diagnostics and Tests for Hepatitis a Albumin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003480.htm Alkaline phosphatase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003470.htm ALT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm AST Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm Bilirubin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003479.htm
Online Glossaries 197
Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm ESR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm Hepatitis A virus (HAV) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003558.htm Hepatitis serology Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003558.htm IgG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003544.htm IgM Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003544.htm Liver biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003895.htm Liver function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003436.htm Prothrombin time Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003652.htm
198 Hepatitis A
Serology Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003511.htm Sonogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm ·
Surgery and Procedures for Hepatitis a Liver transplant Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003006.htm
·
Background Topics for Hepatitis a Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Antibodies Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002223.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Hepatic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002378.htm Immunity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000821.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm
Online Glossaries 199
Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 201
HEPATITIS A GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigens: Substances that cause an immune response in the body. The body "sees" the antigens as harmful or foreign. To fight them, the body produces antibodies, which attack and try to eliminate the antigens. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Artery: A large blood vessel that carries blood from the heart to other parts
202 Hepatitis A
of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astrovirus: A genus of small, circular RNA viruses in the family astroviridae. They cause gastroenteritis and are found in the stools of several vertebrates including humans. Transmission is by the fecal-oral route. There are at least seven human serotypes and the type species is human astrovirus 1. [NIH] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU]
Capsid: The outer protein protective shell of a virus, which protects the viral nucleic acid. [NIH]
Glossary 203
Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Caspases: A family of intracellular cysteine endopeptidases. They play a key role in inflammation and mammalian apoptosis. They are specific for aspartic acid at the P1 position. They are divided into two classes based on the lengths of their N-terminal prodomains. Caspases-1,-2,-4,-5,-8, and -10 have long prodomains and -3,-6,-7,-9 have short prodomains. EC 3.4.22.-. [NIH]
Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU]
204 Hepatitis A
Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cyclospora: A genus of coccidian parasites in the family eimeriidae. Cyclospora cayetanensis is pathogenic in humans, probably transmitted via the fecal-oral route, and causes nausea and diarrhea. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH]
Glossary 205
Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats:
206 Hepatitis A
saturated and unsaturated. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Handwashing: The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatomegaly: Enlargement of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hormones: Chemical substances having a specific regulatory effect on the
Glossary 207
activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunization: The induction of immunity. [EU] Immunogenic: Producing immunity; evoking an immune response. [EU] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Interferons:
Proteins secreted by vertebrate cells in response to a wide
208 Hepatitis A
variety of inducers. They confer resistance against many different viruses, inhibit proliferation of normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other immunomodulatory functions. [NIH] Intramuscular: Within the substance of a muscle. [EU] Intravenous: Within a vein or veins. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Leukapheresis: The preparation of leukocyte concentrates with the return of red cells and leukocyte-poor plasma to the donor. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Listeria: A genus of bacteria which may be found in the feces of animals and man, on vegetation, and in silage. Its species are parasitic on cold-blooded and warm-blooded animals, including man. [NIH] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Malaise: A vague feeling of bodily discomfort. [EU] Mebendazole: A nematocide in humans and animals. It acts by interfering with the carbohydrate metabolism and associated energy production of the parasite. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that
Glossary 209
induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Methamphetamine: A central nervous system stimulant and sympathomimetic with actions and uses similar to dextroamphetamine. The smokable form is a drug of abuse and is referred to as crank, crystal, crystal meth, ice, and speed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Papain: A proteolytic enzyme obtained from Carica papaya. It is also the name used for a purified mixture of papain and chymopapain that is used as
210 Hepatitis A
a topical enzymatic debriding agent. EC 3.4.22.2. [NIH] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physicochemical: Pertaining to physics and chemistry. [EU] Plasminogen: The inactive precursor of plasmin (=enzyme that catalyses the hydrolysis of peptide bonds at the carbonyl end of lysine or arginine residues). [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH]
Glossary 211
Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Prothrombin Time: Measurement of clotting time of plasma recalcified in the presence of excess tissue thromboplastin. Factors measured are fibrinogen, prothrombin, and factors V, VII, and X. It is used for monitoring anticoagulant therapy with coumarins. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychoneuroimmunology: The field concerned with the interrelationship between the brain, behavior and the immune system. Neuropsychologic, neuroanatomic and psychosocial studies have demonstrated their role in accentuating or diminishing immune/allergic responses. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU]
212 Hepatitis A
Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reconstitution: 1. a type of regeneration in which a new organ forms by the rearrangement of tissues rather than from new formation at an injured surface. 2. the restoration to original form of a substance previously altered for preservation and storage, as the restoration to a liquid state of blood serum or plasma that has been dried and stored. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Respiratory: Pertaining to respiration. [EU] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Rhinovirus: A genus of picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rotavirus: A genus of reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. [NIH] Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the
Glossary 213
lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are
214 Hepatitis A
designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Splenomegaly: Enlargement of the spleen. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substrate: A substance upon which an enzyme acts. [EU] Superinfection: A new infection complicating the course of antimicrobial therapy of an existing infectious process, and resulting from invasion by bacteria or fungi resistant to the drug(s) in use. It may occur at the site of the original infection or at a remote site. [EU] Surgical: Of, pertaining to, or correctable by surgery. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Telecommunications: electronic means. [NIH]
Transmission of information over distances via
Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH]
Glossary 215
Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Transgenes: Genes that are introduced into an organism using gene transfer techniques. [NIH] Translations: Products resulting from the conversion of one language to another. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vibrio: A genus of vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Viremia: The presence of viruses in the blood. [NIH] Virion: The infective system of a virus, composed of the viral genome, a protein core, and a protein coat called a capsid, which may be naked or enclosed in a lipoprotein envelope called the peplos. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
216 Hepatitis A
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
·
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
·
A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
·
Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
·
Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
·
Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
·
Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
·
Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
Glossary 217
·
Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
218 Hepatitis A
INDEX A Abdominal.....37, 38, 69, 95, 96, 122, 202, 210 Anal ...........................17, 18, 21, 113, 121 Anemia ................................................127 Anorexia ................................................69 Antibodies..................65, 74, 75, 113, 201 Antibody .......56, 57, 65, 70, 96, 106, 204, 209, 213 Antigens...........................75, 79, 201, 212 Antimicrobial ..................................81, 214 Antiviral ................................68, 71, 84, 93 Artery ...................................................106 Assay.....................................................94 Astrovirus.......................................75, 202 Asymptomatic ..........................66, 92, 122 B Bile.....................31, 45, 92, 191, 202, 208 Biliary...............................................35, 36 Biochemical .............................72, 79, 210 Biopsy............................................23, 197 Buccal ..............................56, 78, 202, 208 C Campylobacter ......................................92 Capillary.................................................71 Capsid .....................................69, 81, 215 Capsules..............................................165 Carbohydrate.........................78, 164, 208 Carcinoma ...............66, 67, 69, 84, 93, 94 Cholera ........................................115, 215 Cholesterol ..................................162, 164 Cirrhosis .....20, 23, 35, 38, 66, 67, 93, 98, 122 Coagulation ...................................77, 206 Condoms ...............................................18 Constipation...................................96, 210 Coronary..............................................106 Cutaneous .....................................78, 208 Cysteine.................................................72 Cytomegalovirus....................................71 D Degenerative .........................96, 163, 205 Diarrhea...........13, 92, 115, 122, 162, 204 Digestion..................................32, 79, 214 Diphtheria ..............................................28 Dysentery ............................................149 E Electrophoresis......................................71 Encephalitis ...........................................71 Enzyme....... 56, 72, 78, 79, 81, 191, 201, 205, 209, 210, 211, 214
Epidemic ....................................... 90, 122 Epidemiological......................... 66, 67, 69 F Fatigue .......... 17, 20, 22, 37, 38, 121, 122 Fats . 78, 95, 162, 169, 202, 203, 205, 208 Fluorescence ................................ 77, 206 G Gastrointestinal . 77, 91, 93, 115, 206, 215 Genotype ................................ 64, 79, 210 H Handwashing .................................. 19, 21 Hematology........................................... 10 Hepatic.................................. 4, 65, 84, 85 Hepatocellular ... 39, 66, 67, 69, 84, 93, 94 Herpes .................................... 56, 68, 206 Hormones ....................... 56, 79, 204, 212 Hydrophobic.................................. 77, 207 Hygienic ................................................ 19 I Immunity ........... 32, 65, 77, 105, 207, 215 Immunization ... 20, 26, 27, 39, 63, 67, 69, 70, 77, 80, 98, 105, 106, 120, 207, 213 Immunogenic ........................ 70, 108, 109 Incubation ..................................... 69, 113 Induction ............................................. 207 Inflammation .... 22, 23, 30, 39, 56, 64, 69, 76, 78, 98, 158, 203, 205, 207 Ingestion ..................... 113, 115, 165, 210 Insulin..... 75, 96, 149, 159, 167, 201, 207, 209 Intravenous ..................................... 24, 66 J Jaundice..... 17, 20, 21, 23, 37, 38, 39, 67, 69, 93, 98, 121, 122 L Lipid ............................................ 159, 207 M Methamphetamine ................................ 64 Molecular ... 10, 64, 65, 79, 84, 94, 96, 99, 118, 125, 126, 212, 215 Monotherapy ......................................... 64 N Nausea..... 19, 20, 21, 37, 38, 39, 69, 115, 121, 122, 204 Neonatal................................................ 36 Neural ................................... 78, 163, 210 Niacin .................................................. 163 O Oral .... 21, 31, 75, 96, 113, 115, 169, 202, 203, 204, 209 Overdose ............................................ 163
Index 219
P Pancreas .................78, 96, 159, 207, 209 Papain .....................................72, 78, 209 Paralysis ........................................78, 210 Pathogen .......................................77, 207 Perinatal ..........................................67, 69 Pharmacist...................................136, 141 Pharmacodynamics ...............................70 Pharmacologic...............................32, 214 Phenotype .....................................79, 210 Physicochemical....................................94 Poisoning.......................................80, 213 Polypeptide..........................................149 Porphyria ...............................................35 Precursor .................................71, 79, 210 Prevalence.............50, 66, 67, 68, 99, 108 Prisons...................................................17 Progressive....................................76, 204 Prophylaxis ....................67, 68, 89, 91, 94 Proteins .22, 56, 65, 69, 71, 162, 164, 204 R Receptor ..............................................106 Recurrence ............................................68 Reinfection.............................................65 Remission......................................80, 212 Respiratory ................31, 78, 80, 207, 212 Riboflavin.............................................162 Rotavirus ...............................................92 Rubella ..................................................28 S Salmonella.............................................92 Sanitation.........................................18, 19 Saponins..............................................149 Selenium..............................................164 Serology ........................................91, 197
Serum ............... 71, 80, 96, 210, 212, 213 Species ...... 75, 76, 80, 92, 96, 115, 202, 203, 205, 208, 213, 215 Spectrum......................................... 10, 92 Stomach..... 12, 17, 19, 20, 21, 23, 77, 96, 206, 209 Subclinical..................... 64, 65, 66, 68, 92 Surgical ......................................... 32, 215 Symptomatic ........................... 57, 62, 214 Systemic ....................................... 30, 205 T Telecommunications............................. 25 Tetanus ......................................... 57, 214 Thermoregulation................................ 162 Thyroxine ............................................ 164 Toxicology..................................... 10, 119 Toxin ............................................. 57, 214 Transfusion ........................................... 17 Translations .......................................... 36 Transplantation ............. 35, 68, 69, 84, 98 U Urology.................................................. 10 V Vaccination ...... 17, 19, 26, 39, 62, 63, 73, 105, 106, 107, 108, 109, 110, 113, 120, 121 Vaccine .... 14, 17, 18, 19, 21, 32, 39, 84, 92, 94, 99, 104, 105, 107, 108, 109, 110, 113, 114, 120, 121, 194, 215 Vaginal ................................................ 121 Viremia.......................................... 92, 106 Virion..................................................... 71 Viruses .... 11, 14, 22, 23, 24, 32, 34, 37, 38, 56, 65, 69, 71, 75, 78, 84, 90, 92, 93, 100, 113, 201, 202, 208, 209, 215
220 Hepatitis A
