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Chronic illness and disability becoming world’s leading health challenges – UW-led study finds

Globe 125X125By Michael McCarthy

We’re living longer, but many of us are living with chronic illnesses that significantly lower the quality of our lives, according to a new study led by researchers at the University of Washington.

The survey, called the Global Burden of Disease Study, finds that there has been a major change in the causes and impact of poor health over the past decades, with a shift away from early death to chronic illnesses and disability.

The survey found that since 1970 life expectancy has increased by 11.1 years for men and 12.1 years for women and that deaths among children under age 5 have plummeted, except in subSaharan Africa where childhood mortality remains high.

In general, improvement in life expectancy has been steady, but it slowed in the 1990s largely due to deaths from HIV infection in sub-Saharan Africa and alcohol-related deaths in in easter Europe and central Asia.

With our longer life expectancy, the major burden caused by disease is no longer early death but instead chronic illnesses that cause pain and disability, such as arthritis, diabetes and dementia, and psychological disorders, the study concludes.

Change in the leading cause of deaths from 1990 to 2010

Change in the leading cause of deaths from 1990 to 2010 – Click on image for interactive display.

The study was led by University of Washington’s Institute for Health Metrics and Evaluation and funded by the Bill & Melinda Gates Foundation.

“We’re finding that very few people are walking around with perfect health and that, as people age, they accumulate health conditions,” said Dr. Christopher Murray, director of IHME and one of the founders of the Global Burden of Disease.

“At an individual level, this means we should recalibrate what life will be like for us in our 70s and 80s. It also has profound implications for health systems as they set priorities,” Murray said.

Dr. Paul Ramsey, chief executive officer of UW Medicine and dean of the University of Washington School of Medicine, said the study will serve as “a management tool for ministers of health and leaders of health systems to prepare for the specific health challenges coming their way.”

“At a time when world economies are struggling, it is crucial for health systems and global health funders to know where best to allocate resources,” Dr. Ramsey said.

The study found that while heart disease and stroke remained the two greatest causes of death between 1990 and 2010, all the other rankings in the top 10 causes changed.

Diseases such as diabetes, lung cancer, and chronic obstructive pulmonary disease moved up the list, and diarrhea, lower respiratory infections, and tuberculosis moved down, the researchers report.

Explore the changes with this interactive chart.

And while malnutrition used to be a major cause of illness and death, today poor diet and physical inactivity are to blame for soaring rates of obesity, diabetes, heart disease and stroke the study found.

“We have gone from a world 20 years ago where people weren’t getting enough to eat to a world now where too much food and unhealthy food – even in developing countries – is making us sick,” said Dr. Majid Ezzati, Chair in Global Environmental Health at Imperial College London and one of the study’s lead authors.

The study appears in this week’s issue of the medical journal The Lancet.

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Hepatitis Awareness

What you should know about hepatitis

More than 4 million Americans have viral hepatitis and an estimated 85,000 become infected each year, according the U.S. Centers for Disease Control and Prevention (CDC).

In some cases, people come down with a serous illness that can last for months but often people experience only a mild illness and some have no symptoms at all.

Some forms of viral hepatitis go away on their own, but others, like Hepatitis B and Hepatitis C, can go one to become chronic, lifelong infections, which can lead to serious health problems including liver damage, cirrhosis, liver cancer, and even death, the CDC warns.

Most people with chronic hepatitis do not know they are infected and can go 20 or 30 years without showing symptoms.

A simple blood test can determine whether you have hepatitis.

The month of May has been designated Hepatitis Awareness Month in the United States, and tomorrow, May 19th, is being recognized as the first ever Hepatitis Testing Day in the United States.

The National Digestive Diseases Information Clearinghouse has prepared the following material to explain about the different kinds of hepatitis, how to avoid infection and what you can do if you are infected.

Viral Hepatitis: A through E and Beyond

What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.

All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.

Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus.

Key Points

  • Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.
  • Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.
  • Vaccines offer protection from hepatitis A and hepatitis B.
  • No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.
  • Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis.

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What are the symptoms of viral hepatitis?

Symptoms include

  • jaundice, which causes a yellowing of the skin and eyes
  • fatigue
  • abdominal pain
  • loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • low grade fever
  • headache

However, some people do not have symptoms.

Hepatitis A

How is hepatitis A spread?

Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood.

Who is at risk for hepatitis A?

People most likely to get hepatitis A are

  • international travelers, particularly those traveling to developing countries
  • people who live with or have sex with an infected person
  • people living in areas where children are not routinely vaccinated against hepatitis A, where outbreaks are more likely
  • day care children and employees, during outbreaks
  • men who have sex with men
  • users of illicit drugs

How can hepatitis A be prevented?

The hepatitis A vaccine offers immunity to adults and children older than age 1. The Centers for Disease Control and Prevention recommends routine hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation also help prevent hepatitis A.

What is the treatment for hepatitis A?

Hepatitis A usually resolves on its own over several weeks.

Hepatitis B

How is hepatitis B spread?

Hepatitis B is spread through contact with infected blood, through sex with an infected person, and from mother to child during childbirth, whether the delivery is vaginal or via cesarean section.

Who is at risk for hepatitis B?

People most likely to get hepatitis B are

  • people who live with or have sexual contact with an infected person
  • men who have sex with men
  • people who have multiple sex partners
  • injection drug users
  • immigrants and children of immigrants from areas with high rates of hepatitis B
  • infants born to infected mothers
  • health care workers
  • hemodialysis patients
  • people who received a transfusion of blood or blood products before 1987, when better tests to screen blood donors were developed
  • international travelers

How can hepatitis B be prevented?

The hepatitis B vaccine offers the best protection. All infants and unvaccinated children, adolescents, and at-risk adults should be vaccinated. For people who have not been vaccinated, reducing exposure to the virus can help prevent hepatitis B. Reducing exposure means using latex condoms, which may lower the risk of transmission; not sharing drug needles; and not sharing personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis B?

Drugs approved for the treatment of chronic hepatitis B include alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system, and the antiviral drugs lamivudine, adefovir dipivoxil, entecavir, and telbivudine. Other drugs are also being evaluated. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

People who develop acute hepatitis B are generally not treated with antiviral drugs because, depending on their age at infection, the disease often resolves on its own. Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an antiviral drug such as lamivudine.

Cirrhotic liver showing scarring (Photo by Nephron under a Creative Common license).

Hepatitis C

How is hepatitis C spread?

Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth.

Who is at risk for hepatitis C?

  • People most likely to be exposed to the hepatitis C virus are
  • injection drug users
  • people who have sex with an infected person
  • people who have multiple sex partners
  • health care workers
  • infants born to infected women
  • hemodialysis patients
  • people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced
  • people who received clotting factors made before 1987, when methods to manufacture these products were improved

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis C?

Chronic hepatitis C is treated with peginterferon together with the antiviral drug ribavirin.

If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended.

Hepatitis D

How is hepatitis D spread?

Hepatitis D is spread through contact with infected blood. This disease only occurs at the same time as infection with hepatitis B or in people who are already infected with hepatitis B.

Who is at risk for hepatitis D?

Anyone infected with hepatitis B is at risk for hepatitis D. Injection drug users have the highest risk.

Others at risk include

  • people who live with or have sex with a person infected with hepatitis D
  • people who received a transfusion of blood or blood products before 1987

How can hepatitis D be prevented?

People not already infected with hepatitis B should receive the hepatitis B vaccine. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.

What is the treatment for hepatitis D?

Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.

Hepatitis E

How is hepatitis E spread?

Hepatitis E is spread through food or water contaminated by feces from an infected person. This disease is uncommon in the United States.

Who is at risk for hepatitis E?

People most likely to be exposed to the hepatitis E virus are

  • international travelers, particularly those traveling to developing countries
  • people living in areas where hepatitis E outbreaks are common
  • people who live with or have sex with an infected person

How can hepatitis E be prevented?

There is no U.S. Food and Drug Administration (FDA)-approved vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing risk of exposure means avoiding tap water when traveling internationally and practicing good hygiene and sanitation.

What is the treatment for hepatitis E?

Hepatitis E usually resolves on its own over several weeks to months.

What else causes viral hepatitis?

Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus.

These cases are called non-A–E hepatitis. Scientists continue to study the causes of non-A–E hepatitis.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into the nature and transmission of the hepatitis viruses, and the activation and mechanisms of the immune system. Results from these basic and clinical studies are used in developing new treatments and methods of prevention.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

For More Information

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837), 1–888–4HEP–USA (443–7872), or 212–668–1000

Fax: 212–483–8179

Email: info@liverfoundation.org

Internet: www.liverfoundation.org

 

Centers for Disease Control and Prevention

Division of Viral Hepatitis

1600 Clifton Road

Mail Stop C–14

Atlanta, GA 30333

Phone: 1–800–CDC–INFO (232–4636)

Fax: 404–371–5488

Email: cdcinfo@cdc.gov

Internet: www.cdc.gov/hepatitis

 

Hepatitis Foundation International

504 Blick Drive

Silver Spring, MD 20904–2901

Phone: 1–800–891–0707 or 301–622–4200

Fax: 301–622–4702

Email: hfi@comcast.net

Internet: www.hepatitisfoundation.org

 

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your doctor for more information.

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Hepatitis Awareness Month Logo

UW students team up with community groups to tackle hepatitis

By Celina Kareiva

The hepatitis B virus, or HBV, is a leading cause of liver cancer, so when Connie Chan’s grandfather was diagnosed with liver cancer, all the members of her family wondered if they too might be infected with the cancer-causing virus.

“It was scary,” said Chan, a student of public health at the University of Washington “He could have transmitted it to everyone in the family and no one might have known.”

In the end, it turned out her grandfather did not carry HBV. Nevertheless, the scare led Chan to want to learn more about the virus, so in January she joined UW’s Team HBV, a chapter of a national organization dedicated to raising awareness of the risks of hepatitis B infection and to promoting testing and vaccination, particularly among Asian and Pacific Islanders (APIs) and other immigrant communities.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that between 800,000 and 1.4 million Americans have chronic HBV infections—and that two-thirds don’t know they carry the virus.

HBV virions -- CDC

APIs are at particular risk: although they make up about 4.5 percent of the U.S. population, they account for 50 percent of the cases of chronic hepatitis B infection.

Asian Americans and Pacific Islanders not only have the highest rates of chronic infection, the CDC says, they also have a higher risk of developing liver cancer as a result of the infection than do other racial and ethnic groups.

In fact, liver cancer is the third leading cause of cancer death among Asian American, Native Hawaiian and other Pacific Islander groups, whereas liver cancer is 16th leading cause of cancer among non-Hispanic whites.

Vaccination can prevent infection and treatment is available for infection.

Earlier this month, Chan joined with fellow students, health professionals and community members at the 2011 Hepatitis B Forum, one of a series of community events this May to mark Viral Hepatitis Month.

Among the event’s participants were Virginia Mason Medical Center, International Community Health Services, and Harborview Medical Center .

The partnership with the international community, said Kim Nguyen, program manager for the Hepatitis B Coalition of Washington, which organized the forum, is important because it offers innovative approaches to tackling a virus that disproportionately affects many foreign-born populations.

“Many [of those infected] don’t know they have it because it’s a silent virus, it doesn’t show symptoms readily or quickly,” Nguyen said.

HBV is most commonly transmitted through contact with blood and infected bodily fluids. Intravenous drug use and sexual activity are common causes of its spread, but many infants are infected during childbirth if their mothers carry the virus.

In underdeveloped countries, many mothers lack basic prenatal care and so give birth without screening for such viruses as hepatitis B, Nguyen explained, and if HBV is contracted in infancy, individuals are significantly more likely to develop a chronic infection.

People who are at highest risk are those who are born overseas in regions where rates of HBV infection are high. This includes Southeast Asia and China but also sub-Saharan Africa, home to many of the region’s new immigrants, said Nguyen.

Prevalence of HBV surface antigen a sign chronic infection -- CDC

In many of these regions, HBV infection carries a social stigma making frank discussion about the disease difficult, says Chan. “It’s related to sex and drugs and that’s not really talked about as openly as in America,” she said.

To encourage discussion, Chan and others are developing “ethnically sensitive” awareness campaigns.

In one campaign, Chan and her teammates at the University of Washington made life-sized posters of individuals holding signs about HBV and displayed them throughout campus to encourage students to get informed.

The Fred Hutchinson Cancer Research Center with the help of several community partners has created informational pamphlets in Chinese, Farsi, Korean, Punjabi, Khmer and Vietnamese.

Progress is being made, said Nguyen, several community health fairs are now offering hepatitis B testing in addition to the usual high blood pressure and diabetes screening.

But more and broader outreach is necessary, says Nguyen, as immigration patterns have changed and more and more people arrive in the region from East and sub-Saharan Africa, so has the face of hepatitis B.

Celina Kareiva is a contributing writer for Seattle LocalHealthGuide, Seattle Weekly and Real Change. She is a graduate student in the Journalism program at the University of Washington and has written and edited for the student paper, The Daily.

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