Reasons for noncompliance with five-yearly screening flexible sigmoidoscopy

Charlie Henri Viiala, John Kevin OlynykSchool of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Perth, Western Australia, AustraliaObjective: To determine factors influencing the low return rate observed in a program of flexible sigmoidoscopy for average risk screening for colorectal carcinoma.Methods: Flexible sigmoidoscopy-based screening of average risk 55–64 yr olds has been ongoing since 1995. Greater than 3400 primary and 1000 follow up screening examinations have been performed. Participants with a primary screen in 1997–1999 and eligible for rescreening in 2002–2004 were studied. A questionnaire assessing possible reasons for noncompliance was sent to subjects who did not attend the five year repeat screening.Results: 1672 primary screening flexible sigmoidoscopies were performed in 1997–1999 with 1362 being normal or having hyperplastic polyps only. The return rate was 45%: 48% of eligible males and 39% of eligible females had returned (p = 0.001 for difference). 709 questionnaires were mailed with a 50% response rate and 162 requests for repeat flexible sigmoidoscopy were generated. 27% of all respondents had undergone further bowel evaluation since the original normal sigmoidoscopy. Of eligible subjects who refused further screening, 65% did so because of concerns over procedural pain.Conclusions: Reasons for nonattendance relate to uptake of other bowel investigations and pain felt at initial screening. Return rate can be raised with ongoing prompting to attend screening.Keywords: sigmoidoscopy, colonoscopy, colonic neoplasm, population surveillance, patient compliance&nbsp

Impact of modern antiviral therapy of chronic hepatitis B and C on clinical outcomes of liver disease

Chronic infections with the hepatitis B and C viruses have significant worldwide health and economic impacts. Previous treatments for hepatitis C such as interferon and ribavirin therapy were ineffective and poorly tolerated by patients. The introduction of directly acting curative antiviral therapy for hepatitis C and the wider use of nucleos(t)ide analogues for suppression of chronic Hepatitis B infection have resulted in many positive developments. Decreasing the prevalence of hepatitis B and C have concurrently reduced transmission rates and hence, the number of new infections. Antiviral treatments have decreased the rates of liver decompensation and as a result, lowered hospitalisation and mortality rates for both chronic hepatitis B and C infection. The quality of life of chronically infected patients has also been improved significantly by modern treatment. Antiviral therapy has stopped the progression of liver disease to cirrhosis in certain patient cohorts and prevented ongoing hepatocellular damage in patients with existing cirrhosis. Longer term benefits of antiviral therapy include a reduced risk of developing hepatocellular carcinoma and decreased number of patients requiring liver transplantation. This review article assesses the literature and summarises the impact of modern antiviral therapy of chronic hepatitis B and C on clinical outcomes from liver disease

Pathological Video Gaming and Self Concept in Canadian Adolescents

This paper presents a comprehensive literature review on the topic of Pathological Video Gaming (PVG) and its effects on adolescent self-concept. The historic development and subsequent cultural acceptance of video game technologies has presented young Canadians with appealing opportunities to escape, grow, and develop within multifaceted virtual worlds. These offerings have fundamentally shifted the way that adolescents interact, play, and think about themselves and others. This paper examines the complex relationship between PVG and self concept with a specific emphasis on the numerous personal meanings that underly this practice. Within this review, an investigation of PVG's global cultural characteristics, motivational theories, and current trends and characteristics will be explored. Further to that, this paper will incorporate a second component on the same topic concerning: implications for counsellors and clinicians, a reflexive self statement, areas for research, and recommendations for future practice

Barriers to exercise in patients with metabolic dysfunction-associated steatotic liver disease: A patient survey

Background: Although adequate physical activity is an essential component of treatment for metabolic dysfunction-associated stea-totic liver disease (MASLD), the majority of people with MASLD do not engage in regular exercise and lead sedentary lifestyles. We aimed to identify perceived barriers to exercise and to examine awareness about the role of exercise in the treatment of MASLD. Methods: Individuals aged 18 years and above were recruited from a hepatology outpatient clinic. MASLD severity was assessed using controlled attenuation parameter (CAP) and transient elastography (TE) determined liver stiffness measurement (LSM) for the severity of hepatic steatosis and fibrosis, respectively. An online questionnaire was administered to record self-reported exercise patterns, barriers to exercise, and knowledge regarding effectiveness of different types of exercise for MASLD. Results: Eighty-one participants (57% female) with a mean age of 55.3 ± 13.4 years and a mean body mass index (BMI) of 33.8 ± 6.4 answered the questionnaire. The mean CAP score was 335.7 ± 47.8 dB/m, and the median LSM was 12.45 kPa. While most patients (83%) considered MASLD to be a serious health concern, 73% did not achieve the recommended exercise levels of \u3e 150 min of moderate-intensity physical activity per week, and 54% were unsure about the role of exercise in the treatment of MASLD. Commonly reported barriers to exercise included physical and mental health issues (57%), lack of time (43%), lack of enjoyment in exercising (31%), fatigue caused by exercise (24%), and others (25%). Conclusions: Most participants with MASLD were unaware of the role of exercise as a potential treatment option and were not achieving recommended exercise levels. Inadequate time, physical and mental health problems, lack of enjoyment in exercise, and fatigue were major barriers

Liver Disease in Aboriginal and Torres Strait Islander People

Aboriginal and Torres Strait Islander people have a substantially higher prevalence of liver disease than non-Indigenous Australians. Cirrhosis and its complications were the sixth leading cause of mortality for Aboriginal and Torres Strait Islander people in 2020. Liver disease has been estimated to be the third leading cause of the mortality gap between Aboriginal and Torres Strait Islander and non-Indigenous people due to chronic disease, accounting for 11% of this gap. While current trends show reducing mortality rates for Aboriginal and Torres Strait Islander people for conditions including circulatory disease, diabetes and kidney disease, there are no data to suggest a similar decline for liver disease. This review highlights the common causes of liver disease affecting Aboriginal and Torres Strait Islander people, which include hepatitis B, hepatitis C, alcohol related liver disease, metabolic dysfunction-associated fatty liver disease, and cirrhosis and its complications including hepatocellular carcinoma. Current treatments including liver transplantation as well as suggestions for improving detection, treatment and access to liver care will also be discussed. Recent revolutions in the detection and treatment of liver disease make efforts to improve access to treatment and outcomes an urgent priority for Aboriginal and Torres Strait Islander people