February 14, 2014

Digital media could work as tool to improve health

NEW YORK Sat Feb 15, 2014 2:58am IST

(Reuters Health) - After a desperate mother in South Wales, UK, posted a video of her baby having a seizure on Facebook, one of her friends provided the diagnosis that had eluded the boy's doctor.

The discovery that Evan Owens suffers from reflex anoxic seizures, a rare but treatable disease, provided a happy ending and is just one example of the public health benefits of digital media, says a new perspective in the Journal of Public Health.

Evan's story, published in the UK's Daily Mail, illustrates how people are turning to the Internet for healthcare advice and how important it is for healthcare professionals to participate in the discussion, the perspective's lead author, Amelia Burke-Garcia, told Reuters Health. (The Daily Mail story is online here:dailym.ai/1eWaEl6.)

"There's always the risk of misinformation or false information floating around on these channels," Burke-Garcia said. "The fact that people are using them demonstrates the need for healthcare professionals to be active and share information in these environments."

Public health professionals are beginning to use digital media as a research tool and to deliver messages about everything from obesity to AIDS, the study says. "But there are many other opportunities that can be explored especially because existing platforms will evolve and new ones will emerge," Burke-Garcia said.

She runs the Center for Digital Strategy and Research at Westat, a research corporation in Rockville, Maryland. She and Dr. Gabriel Scally, from the University of the West of England in Bristol, analyzed academic and online literature to identify future directions for digital media in public health research and communications.

"Digital media is set to revolutionize the way in which health information is communicated and gathered," the researchers write in their perspective. But, they say, despite numerous studies, there has been little "effective and meaningful evaluation."

Digital media is being used to track disease spread and mobilize responses. Healthcare organizations have used it to frame debates and communicate with wide segments of the population.

One future trend the authors identify is what they call "buzz monitoring," listening in on public online conversations about health issues, like smoking or obesity, in an effort to tailor future public health announcements.

Another use of digital media connects healthcare providers and consumers in online meeting places that bring people together for a variety of purposes. As an example, Burke-Garcia said, public health workers might talk to "Mommy and Me" groups about vaccinations.

Recent research found specially created Facebook groups worked to encourage gay men to reach out for information about home HIV/AIDS testing (see Reuters Health story of September 2, 2013 here: reut.rs/1b2pANv.)

Oyinlola Oyebode, a public health researcher at University College London, told Reuters Health in an email that she has seen firsthand the power of digital media in health research. Reports of vomiting on Facebook helped her team identify an additional 80 cases in one disease outbreak, she said.

In addition, she recently ran a study examining text-message reminders and breast cancer screening. Women reminded by text were more likely to attend screening appointments, she said.

Oyebode wrote a commentary published with Burke-Garcia and Scally's perspective.

Social scientist Peter John Aspinall also was not involved in the current study but wrote his own commentary. He told Reuters Health in an email that "the more routine adoption of these technologies may represent something of a slow march given the substantial pressures on already stretched public health resources."

Aspinall, from the UK's University of Kent, warned that web-based disease surveillance "can get the trends wrong because of the lack of contextual information." For example, he said, Google Flu Trends overestimated the number of Americans stricken with flu last year.

"This has led international experts in disease surveillance to conclude that flu-tracking techniques based on the mining of web data should be seen to complement rather than substitute for traditional epidemiological surveillance networks," he said.

Asked about digital media's propensity for fear mongering, Burke-Garcia said new media is no different than old when it comes to whipping up panic.

"I don't think digital media creates fear where other channels don't," she said.

"There are downsides to the speed and the ubiquity of messages in digital. You can say that the channel creates fear. The channel also creates opportunities to combat that fear."

Though Oyebode has embraced digital media, she sees potential drawbacks, particularly if public health announcements keep people in their chairs or on their couches in front of screens.

"It might be an effective way to encourage people to make healthy lifestyle changes or to help them connect and find social support during a difficult time," she said. "And there are some particular instances, for example relating to sexual health, where it might be easier for people to seek information . . . online than face to face," Oyebode added.

"However, those developing online interventions should think about how much sedentary time their intervention will encourage."

SOURCES: bit.ly/1hggf7q, bit.ly/1gzHvcn and bit.ly/1kF3VOz Journal of Public Health, January 2014.


Are Doctors Screening Their Patients for Hepatitis B?

Provided by Physicians News Digest

Submitted by bin_admin on February 14, 2014 – 4:50 pm

By Curtis T. Miyamoto, MD


I recently met with Chari Cohen, MPH DrPh(c), Director of Public Health, and Kuan-Lung Daniel Chen, MPH, CPH, Program Manager, of the Hepatitis B Foundation about the challenges they are facing working in the area of detection and treatment of the hepatitis B virus. Like many nonprofit organizations, they are having some huge challenges. This particular foundation, however, is unique and special for our area.  You may already know that the hepatitis B virus was discovered in Philadelphia — at the Fox Chase Cancer Center — by Dr. Baruch Blumberg, who created the first vaccine.

The Hepatitis B Foundation, founded in Bucks County, is the only national, nonprofit organization focused on hepatitis B.  It concentrates on hepatitis B research, disease awareness, immunizations and treatment initiatives.

They have a large Philadelphia public health awareness and education campaign, free screening initiative and assist patients with finding care providers. There is also a Hep B United Philadelphia Coalition with over 75 coalition partners and a partnership with the CDC.

Hepatitis B is the most common serious liver infection in the world; 50 to 100 times more infectious than HIV; and affects 1.4 to 2 million Americans. Chronic infections have a one in four chance to develop hepatocellular carcinoma or liver failure and is preventable and treatable.

Asians, especially those new to the United States, are among the highest risk groups for developing hepatitis B. They are the second fastest growing population in Philadelphia behind Hispanics. Nearly one in 10 foreign-born Asian and Pacific Islander Americans have a chronic hepatitis B virus infection. But they are not the only group at risk.

The CDC has specific guidelines for testing. All persons born in regions of high and intermediate HBV endemicity, IV drug users, men with male sexual partners, immunosuppressed patients, people with elevated liver function tests, blood product donors, hemodialysis patients, pregnant women, infants born to HBsAg positive mothers, people living with infected patients, people who engage in needle sharing, individuals with sexual contact with hepatitis B surface antigen positivity and HIV-positive individuals should be tested and treated appropriately. And all US-born citizens not vaccinated as an infant should be tested.

This is an extensive list of individuals who are risk and, therefore, many more individuals should be tested than are currently being tested.  In spite of this, many patients at risk in the Philadelphia region are not being screened for hepatitis B. This means that patients who are chronically infected are not being diagnosed and patients who have been exposed are not being vaccinated, putting them at greater risk. Under the Patient Protection and Affordable Care Act, hepatitis B vaccination is covered. The obvious question is — why aren’t all patients at risk being screened?

The hepatitis B foundation has tirelessly tried to get the word out to both the physician community as well as the patients at risk to increase the amount of screening and improve access to vaccination and treatment. Although there has been some improvement, many patients are still being missed. Of course, funding is also an issue for these efforts. This is a problem for almost every nonprofit organization. In spite of the problems with the economy, there should always be funds for such life-saving and truly altruistic and life saving foundations such as the Hepatitis B foundation, American Cancer Society, etc.

In this particular case, the Hepatitis B Foundation is a local oragnization that is deserving of special attention by our healthcare professionals. The least we can do is to improve our efforts to screen all patients at risk and therefore save lives and encourage the many volunteers in this organization. The Philadelphia County Medical Society strongly supports improved hepatitis B screening, vaccination and treatment, and supports the Hepatitis B foundation.


Curtis T. Miyamoto, MD is president of the Philadelphia County Medical Society.


Vitamin D Levels Vary during Antiviral Treatment but Are Unable to Predict Treatment Outcome in HCV Genotype 1 Infected Patients



Georgios Grammatikos, Christian Lange, Simone Susser, Susanne Schwendy, Nektarios Dikopoulos, Peter Buggisch, Jens Encke, Gerlinde Teuber, Tobias Goeser, Robert Thimme, Hartwig Klinker, Wulf O. Boecher, Ewert Schulte-Frohlinde,  Marissa Penna-Martinez, Klaus Badenhoop, Stefan Zeuzem, Thomas Berg, Christoph Sarrazin

Published: February 07, 2014 DOI: 10.1371/journal.pone.0087974



Different parameters have been determined for prediction of treatment outcome in hepatitis c virus genotype 1 infected patients undergoing pegylated interferon, ribavirin combination therapy. Results on the importance of vitamin D levels are conflicting. In the present study, a comprehensive analysis of vitamin D levels before and during therapy together with single nucleotide polymorphisms involved in vitamin D metabolism in the context of other known treatment predictors has been performed.


In a well characterized prospective cohort of 398 genotype 1 infected patients treated with pegylated interferon-α and ribavirin for 24–72 weeks (INDIV-2 study) 25-OH-vitamin D levels and different single nucleotide polymorphisms were analyzed together with known biochemical parameters for a correlation with virologic treatment outcome.


Fluctuations of more than 5 (10) ng/ml in 25-OH-vitamin D-levels have been observed in 66 (39) % of patients during the course of antiviral therapy and neither pretreatment nor under treatment 25-OH-vitamin D-levels were associated with treatment outcome. The DHCR7-TT-polymorphism within the 7-dehydrocholesterol-reductase showed a significant association (P = 0.031) to sustained viral response in univariate analysis. Among numerous further parameters analyzed we found that age (OR = 1.028, CI = 1.002–1.056, P = 0.035), cholesterol (OR = 0.983, CI = 0.975–0.991, P<0.001), ferritin (OR = 1.002, CI = 1.000–1.004, P = 0.033), gGT (OR = 1.467, CI = 1.073–2.006, P = 0.016) and IL28B-genotype (OR = 2.442, CI = 1.271–4.695, P = 0.007) constituted the strongest predictors of treatment response.


While 25-OH-vitamin D-levels levels show considerable variations during the long-lasting course of antiviral therapy they do not show any significant association to treatment outcome in genotype 1 infected patients.

Citation: Grammatikos G, Lange C, Susser S, Schwendy S, Dikopoulos N, et al. (2014) Vitamin D Levels Vary during Antiviral Treatment but Are Unable to Predict Treatment Outcome in HCV Genotype 1 Infected Patients. PLoS ONE 9(2): e87974. doi:10.1371/journal.pone.0087974

Editor: Kostas Pantopoulos, Lady Davis Institute for Medical Research/McGill University, Canada

Received: October 14, 2013; Accepted: December 31, 2013; Published: February 7, 2014

Copyright: © 2014 Grammatikos et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: KB is supported by the European Union FP7 program NAIMIT, grant agreement 241447. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.


Almost 3% of the world population is chronically infected with hepatitis c virus (HCV) and thus potentially confronted with life-threatening complications such as liver cirrhosis and liver cancer[1]. During permanent attempts to improve therapeutic strategies, beside the recent approval of two novel direct acting antiviral compounds [2], several predictors of treatment response have been identified [3] with recent studies including gamma-glutamyl-transferase (gGT) [4], cholesterol [5], early viral kinetics [6], interferon-γ-inducible-protein-10 (IP10) [7], ferritin [8] and the interleukin-28B (IL28B) polymorphism [9] as further important predictors of sustained viral response (SVR) as well. However, the pursuit of further surrogate factors able to optimize therapeutic regimes remains challenging.

Beside the above mentioned parameters many studies suggested vitamin D (VitD) as an additional predictor of SVR, whereas low pretreatment levels of 25-OH-Vitamin D3 (25(OH)D3) (<20 ng/ml) associated significantly with low responsiveness to antiviral therapy[10][14]. However, recent findings also indicate that the pretreatment concentration of VitD is not always capable of predicting treatment outcome in chronic HCV infection [15] as well as in HCV/HIV-coinfected patients [16], [17]. Moreover, serum concentrations of 25(OH)D3 are getting affected by various factors such as nutrition, comorbidities and seasonal sunlight exposure [18] and since an additional hydroxylation step is needed, 25(OH)D3-levels just offer an indirect association to the active form of VitD, 1,25(OH)2D3. The latter has a half-life of only 4 hours and is detectable in much lower serum concentrations than 25(OH)D3. 1,25(OH)2D3 is additionally strongly affected by the serum levels of calcium, phosphate and parathyroid hormone with clinical guidelines still recommending the routine assessment of 25(OH)D3 as the appropriate parameter in order to monitor the VitD status of patients [19]. In this context genetic polymorphisms within key enzymes regulating the pathophysiology of VitD have been shown to affect substantially VitD signaling in clinical diseases [20], [21]. In chronic HCV infection genetic polymorphisms within VitD binding proteins [12], the CYP27B1-hydroxylase [22] and the VitD-receptor [23] have been shown to correlate significantly with the outcome of antiviral therapy.

Purpose of the present study is therefore to evaluate the predictive potential of serum VitD levels both prior to as well as during antiviral therapy in a large (n = 398), well characterized cohort of genotype 1 HCV infected patients treated prospectively with pegylated interferon-α (PEG-IFNα) and ribavirin (RBV) for 24–72 weeks (INDIV-2 study) [24]. Since liver histology and genetic data were available in the majority of patients, we additionally evaluated genetic polymorphisms within major enzymes regulating 25(OH)D3- and 1,25(OH)2D3-concentrations,CYP2R1, CYP27B1, DHCR7, CYP24A1 and within VitD binding proteins (DBP). Findings concerning the prediction of treatment outcome were further analyzed in association with several prognostic parameters being available prior to initiation, during and after completion of antiviral therapy in our patient cohort.

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Be an Advocate: Participate in Liver Capitol Hill Day, March 26

By Erika Miller, Cavarocchi – Ruscio – Dennis Associates, Consultants to AASLD

Reports from Washington may be making you question what is in store for your research, your patients, and your practice. The NIH budget may have received a temporary reprieve, but promoting the Institute’s growth is a priority during the continuing debates on the fiscal health of this country. Your patients are providing conflicting reports on what the Affordable Care Act means to them, and at the same time, you may be struggling with meeting the Medicare quality reporting requirements that will impact your reimbursement.

March 26, 2014 marks the Seventh Annual Liver Capitol Hill Day sponsored by the American Association for the Study of Liver Diseases. With the state of affairs in Washington, DC, if there was ever a year in which you need to participate in Liver Capitol Hill Day, 2014 is that year. You will have the opportunity to address these issues and their impact on your patients and your practice directly with the members of Congress and staff.

Any decisions Congress makes will impact the National Institutes of Health, the Centers for Disease Control and Prevention, your patients’ access to health care services, and other programs of importance to you and AASLD. Your expertise is a vital part of these discussions. If you do not educate Congress on how these programs impact the study and treatment of liver disease, no one else will.

AASLD will provide all the tools you need to succeed on Liver Capitol Hill Day. The Public Policy Committee will develop an agenda and meetings with Members of the House and Senate and their staffs will be scheduled for you. You will be supplied with information in advance on process, topics, and who you will be meeting with, so you will be fully briefed on both the issues and the process. AASLD will be creating a Liver Capitol Hill Day website that will include information about the issues you will cover and what to expect during your meetings.

The morning of Liver Capitol Hill Day you will attend a breakfast briefing at which all of the issues you will be bringing to the Hill will be discussed and information to leave behind during your Congressional visits that will summarize the issues will be provided. This information will also be available in advance on the website.

What makes your participation critical is that you know firsthand how liver disease impacts constituents in the member’s state or district. We hope that this visit is the start of an ongoing relationship with the offices, which will require follow up on your part. We will also be providing tips on how to best follow up and remain in contact with those whom you meet.

AASLD members are encouraged to invite a patient to come along if they’d like; the combination of physician and patient is a very powerful one on Capitol Hill. In addition, we have invited patient advocacy groups, including the National Viral Hepatitis Roundtable, the Hepatitis B Foundation, and the American Liver Foundation, to participate in the event.

To make this day work we need to know your plans by February 21. To participate, contact Greg Bologna at AASLD at 703-299-9766 or gbologna@aasld.org.