Post Rate Research Articles

Changes in Patient Measures as Predictors of Therapists’ Ratings of Treatment Collaboration and Change in Eating Disorder Subgroups

This study examined how implicit and explicit changes following integrative inpatient treatment of adolescents with eating disorder (ED) may predict the posttreatment ratings of psychodynamic therapists of their patients' openness to therapeutic processes and their change (Therapist Evaluation Inventory). The relative contribution of inpatients' ego functions was compared with that of their mental distress and ED symptoms in two subgroups: restricting type anorexia (AN-R) and binging/purging type EDs (B/P). Data indicated that the implicit personality variable of elevated ability to modulate affects was the best predictor of therapist-rated global outcome among patients with B/P symptoms, whereas in patients with AN-R, evolving openness to implicit negative affects and a reduction in reported distress were best predictors. In patients with AN-R, attenuated affect control was also significantly correlated with therapist posttreatment ratings. These data point that in addition to addressing behavioral/symptomatic aspects, personality variables should be addressed in the psychological treatment of EDs.

Treatment gain for sexual offenders against children predicts reduced recidivism: A comparative validity study.

To determine whether pro-social treatment change in sexual offenders would predict reductions in recidivism beyond static and dynamic risk factors measured at pretreatment and whether different methods for assessing change based on self-reports and structured clinical rating systems would show convergent validity. We compared 3 methods for assessing treatment change with a sample of adult male sexual offenders against children (n = 218) who completed a prison-based cognitive-behavioral treatment program between 1993 and 2000. The methods were measures of change derived from offender self-reports on a psychometric battery administered both pre- and posttreatment, change across treatment on the Violence Risk Scale: Sexual Offender Version (VRS:SO; Olver, Wong, Nicholaichuk, & Gordon, 2007), and posttreatment ratings on the Standard Goal Attainment Scaling for Sex Offenders (SGAS; Hogue, 1994). Offenders were followed up for an average of 12.24 years after release. All measures of treatment gain were positively correlated, and all significantly predicted reductions in sexual recidivism, with values for the area under the receiver-operating characteristic curve ranging from .66 (SGAS) to .70 (VRS:SO). Survival analyses showed that measures of change based on the psychometric battery significantly predicted recidivism after controlling for both static and dynamic factors measured at pretreatment, while results for the VRS:SO were similar but failed to reach significance. Measures of treatment change based on offender self-reports and structured clinical rating systems show convergent and predictive validity, which suggests that effective treatment that targets dynamic risk factors leads to a reduction in sexual recidivism.

Improving Chlamydia trachomatis retesting rates by mailed self-collection kit

To assess a mailed self-collection kit for chlamydia testing as an intervention to increase post-treatment retesting rates. This prospective intervention study took place at a sexual health clinic in Townsville, North Queensland (Australia) between 2006 and 2008. The intervention consisted of offering to mail a self-collection kit for retesting 3 months after treatment. The achieved retesting rates were compared to those from the previous year and to concurrent controls who did not participate in the intervention. Both control groups received standard advice on retesting. Of the 46 participants in the intervention group, 34.8% returned the sample for retesting 3 to 4 months after initial treatment, in comparison to 6.8% of the historic control groups (n=206) and 1.4% of the concurrent control group (n=142) (P<0.001, respectively). Retesting rates for Chlamydia trachomatis were substantially and significantly improved using the mailed self-collection kit evidencing that the kit could deliver a much needed intervention to improve notoriously low retesting rates.

Measuring perceived difficulty in post-acute brain injury rehabilitation: The Sister Kenny Symptom Management Scale

Primary objective: Patients’ perceptions of difficulty managing symptoms contribute to disability after brain injury. This study introduces the Sister Kenny Symptom Management Scale (KSMS) and reports on its factor structure, reliability, validity and clinical value.Method: Archived data from (overlapping) samples of patients with brain injuries of mixed aetiologies, seen at an outpatient clinic over 16 years were used in development and validation studies of the KSMS. Comparison measures included the Profile of Mood States (POMS), neuropsychological test scores and employment.Results: Factor analysis of 34 items (n = 328) identified five sub-scales with satisfactory internal consistency and test–re-test stability representing difficulty with executive functions, language, recent memory, aggressive behaviour and physical symptoms. A pattern of correlations (n = 336) with Profile of Mood States (POMS) sub-scales of similar and different content supported the concurrent validity of KSMS sub-scales. Only the Memory sub-scale correlated with its test index. The Language score and test index approached significance. The Executive sub-scale did not. Hierarchical regression analysis (n = 102) that included ratings of mood and symptom management showed that employment after discharge was only predicted by post-treatment ratings of difficulty with cognitive functions.Conclusion: Self-assessments of difficulty managing symptoms can be reliably assessed and may contribute to understanding patients’ disability, treatment response and future prospects.

Cognitive‐behaviour therapy for medication‐resistant positive symptoms in early psychosis: a case series

Cognitive-behaviour therapy (CBT) for psychosis reduces the severity of medication-resistant positive symptoms in chronic schizophrenia, but its efficacy for early psychosis outpatients with a similar profile has not been established. This paper describes an uncontrolled evaluation of CBT, added to medication and comprehensive care in an early psychosis program, in a group of stable outpatients. The sample was drawn from 24 consecutive referrals. Fourteen were eligible, i.e. had positive symptom(s) and had been on the same medication regime for 3 months. Patients received an average of 16 individual sessions with a senior psychologist. Symptom severity was assessed both by an independent rater, and by patient self-report. Eleven of 14 patients completed treatment. Both clinician and self-report post-treatment ratings of positive symptoms were significantly reduced following CBT. For positive symptom totals, effect sizes ranged from d = 1.0 to 1.3. Clinically significant changes were apparent in at least eight of 11 patients. While case-series studies have significant limitations, the large effect sizes described here suggest that CBT shows promise for effectiveness with early psychosis patients. A randomized trial is needed to establish both the effect size over and above a control condition, and the durability of gains of CBT for medication-resistant symptoms in early psychosis.

Improved Quality of Life, Clinical, and Psychosocial Outcomes Among Heroin-dependent Patients on Ambulatory Buprenorphine Maintenance

Aim: A prospective longitudinal design was employed to examine the effects of buprenorphine maintenance on quality of life (QOL), clinical, and psychosocial characteristics of heroin-dependent patients. Method: Between 2003 and 2005 data were collected on 259 patients attending the outpatient centers for treatment of drug addictions across Israel, of which 157 were reevaluated 16 weeks later and 105 reevaluated 32 weeks later using the Clinical Global Impression, Distress Scale for Adverse Symptoms, Quality of Life Enjoyment and Satisfaction Questionnaire, General Health Questionnaire, General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support. Univariate and multivariate analyses were conducted to examine the association between the parameters and the cross-sectional and longitudinal predictions of the QOL outcomes. Results: The groups did not differ in baseline values and their post-treatment ratings revealed significant improvement on virtually all the scales. Perceived self-efficacy and social support from friends and significant others at baseline as well as their changes over time were the best predictors of the QOL in the short and long terms. The study's limitations are noted. Conclusions: The beneficial effects on the QOL were associated with improvement in the psychosocial parameters and a reduction in buprenorphine-related side effects and psychological distress. This study could stimulate research to compare the QOL related to buprenorphine and methadone treatment and serve as a basis on which a controlled study should be performed.

Insecticidal Activity of Cleisthopholis patens (Benth) Engl and Diels (Annonaceae) Against the Stored Product Moth, Ephestia cautella (Walker) [Lepidoptera:Pyralidae], in Stored Cocoa [Theobroma cacao (L.)]Beans.

The toxicity of powdered leaf, stem bark and root bark of “apako”, Cleisthopholis patens (Benth) Engl and Diels (Annonacea), to Ephestia cautella (Walker) was evaluated in the laboratory at 28±2°C and 75±5% RH. Four rates of each powder. 0.5, 1.0,2.0, and 3.0 g/20 g of cocoa [Theobroma cacao (L.)] beans. were tested in completely randomized design. The treatments and an untreated control were replicated three times. In another test, treated and untreated cocoa beans were infested with 30 one-day old E. cautella eggs and the numbers of hatched eggs (at day 3 post-infestation) and emerged adults (at day 40 postinfestation) were converted to percentages. Toxicity to adults generally increased with the rate of product application and duration post-treatment. At 24 h post-treatment, only the root bark caused mortality (22.8-45.3%). Mortality increased considerably thereafter reaching the peak (100%) at 72 h for 3.0 g root bark/20 g cocoa bean, and at 96 h for 2.0 g and 3.0 g stem bark. With the leaf powder. the highest mortality was 78.9% for 3.0 g/20 g cocoa bean. All parts of C. patens at 0.5-3.0 g/20 g cocoa beans completely inhibited egg hatch whereas on the untreated control the percentage of hatched eggs ranged between 73.4 and 96.7% and percentage adult emergence ranged between 60.0 and 90.0% .

HCV Response in Patients With End Stage Renal Disease Treated With Combination Pegylated Interferon α-2a and Ribavirin

To determine the efficacy and safety of combination therapy in patients with hepatitis C virus (HCV) and end-stage renal disease (ESRD). There is little data on the treatment of ESRD patients with pegylated interferon and ribavirin. We designed a pilot study to determine the initial and 12-week posttreatment viral response. A nonrandomized, prospective observational study of adjusted-dose combination therapy. Twenty patients were enrolled and began pegylated interferon at 135 microg/wk SC, and 4 weeks later ribavirin was started at 200 mg PO weekly, increasing gradually to 3 times a week for a total of 48 weeks. Twenty patients: M:F 18:2; mean age 52.4 years; genotype 1: 18, non-genotype 1: 2. Of the 20 patients, 5 withdrew before starting treatment. Of the 11 patients who reached 3 months, 6 had early virologic response, defined as at least a 2-log drop in their HCV count (54.5%). Of the 5 patients who were treated for 1-year, only 1 patient had a response 12 weeks after treatment. Side effects included 4 cases of anemia and 1 patient with headache. The initial response rate in individuals taking 3 months of treatment in our study is comparable with studies in non-ESRD patients with no serious adverse side effects. However, the sustained posttreatment rate was low. This demonstrates that combination therapy is a safe therapeutic option in the ESRD population with HCV infection which needs further testing to determine if increasing the length of treatment and/or the dose of ribavirin will affect posttreatment rates.

Incidence and treatment of acute biliopancreatic diseases in the elderly patients: our experience in 130 cases

Background Acute biliopancreatic diseases occur commonly in the elderly patients, representing a surgical problem. By the age of 70 years, gallstone diseases (cholelithiasis, choledocholithiasis), inflammatory diseases and malignant biliary and pancreatic neoplasms, are the most common disorders of the biliary tree. Co-morbidity increases post-treatment mortality rate. In this epidemiological study, we evaluated incidence of these diseases and their treatment options, in the over seventy years old patients.

Sustained Response of Hepatitis B e Antigen-Negative Patients 3 Years After Treatment with Peginterferon Alfa-2a

Patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B treated with peginterferon alpha-2a with or without lamivudine achieve significantly higher 6-month posttreatment rates of response compared with those treated with lamivudine alone. The durability of <or=3-year posttreatment response was investigated in this study. Patients received peginterferon alpha-2a only (180 microg once weekly; n = 177), in combination with lamivudine (100 mg daily; n = 179) or lamivudine alone (n = 181) for 48 weeks. A total of 315 patients (116, 114, and 85, respectively) participated in this posttreatment observational study. Three years after treatment, the percentage of patients with normal alanine aminotransferase (ATL) was higher for patients treated with peginterferon alpha-2a (31%) than with lamivudine (18%; P = 0.032). Similarly, 28% of patients treated with peginterferon had hepatitis B virus (HBV) DNA levels <or= 10,000 copies/mL versus 15% of patients treated with lamivudine (P = .039). Peginterferon alpha-2a treatment and high baseline ALT level were independent baseline predictors of long-term virologic response (P = .040 and P = .01, respectively). Of the patients who had been treated with a peginterferon alpha-2a-containing regimen, 8.7% cleared hepatitis B surface antigen (HBsAg; 44% of those with undetectable HBV at 3-year posttreatment follow-up) compared with none treated with lamivudine alone. Biochemical and virologic responses were sustained for <or=3 years in approximately 25% of patients given a 48-week course of peginterferon alpha-2a, with or without lamivudine. The increased rate of HBsAg clearance in patients with HBeAg-negative chronic hepatitis B supports the use of peginterferon alpha-2a as a first-line treatment.

Is Oddi sphincterotomy an indication for hepatolithiasis?

The purpose of treatment for hepatolithiasis is reducing recurrent cholangitis. This study was designed to determine the long-term outcome of Oddi sphincterotomy for hepatolithiasis. Thirty-two consecutive hepatolithiasis patients, including 15 cases that had undergone conventional open surgical transduodenal sphincteroplasty (COSTS) and 17 cases with endoscopic sphincterotomy (EST), were followed up for a long term. We compared the post-treatment rates of recurrent cholangitis and acute cholangitis severe type (ACST) with the ones of pretreatment in each group, respectively. Paired chi(2) test was used. In the COSTS group, neither the post-operative rate of recurrent cholangitis (86.7%, 13/15 vs. 100%, 15/15) nor ACST (26.7%, 4/15 vs. 46.7%, 7/15) decreased (p > 0.05) compared with before the operation. In the EST group, the situation was the same: neither the rate of post-EST recurrent cholangitis (76.5%, 13/17 vs. 82.4%, 14/17) nor ACST (29.4%, 5/17 vs. 23.5%, 4/17) were reduced significantly (p > 0.05). Both eradication of hepatobiliary lesions and keeping Oddi sphincter intact should be emphasized in the management of hepatolithiasis. Neither COSTS nor EST is an effective method or can achieve the goal of reducing cholangitis for hepatolithiasis.

Abstract LB-244: A phase 0 trial of riluzole in patients with resectable stage III or IV melanoma.

Abstract Recently, our group described a murine model of melanoma that is based on ectopic expression of metabotropic glutamate receptor 1 (Grm1). Grm1 is a normally occurring receptor in the central nervous system of mammals that controls excitatory neural impulses. Ectopic expression of this receptor in melanocytes results in transformation of these cells into a murine form of melanoma indistinguishable from human melanoma. We also found that &amp;gt;60% of human melanoma samples tested ectopically to date express Grm1 while normal skin and melanocytes from the same patients fail to express this protein. Furthermore, stimulation of this receptor in vitro results in downstream upregulation of phosphorylated (activated) ERK, demonstrating that this receptor is involved in the regulation of the MAPK pathway, a pathway in the cell important in melanoma formation and growth. Finally, a murine xenograft model of melanoma treated with riluzole, an oral Grm1 blocking agent, showed decreased tumor growth in the treated mice compared to the untreated controls. The goal of this study was to validate Grm1 as a therapeutic target in humans with melanoma. To accomplish this we enrolled patients with resectable stage III and stage IV melanoma on a Phase 0 NCI Quick Trial of oral riluzole. We performed a pre-treatment biopsy, treated the patients with 200 mg of oral riluzole per day for 14 days, and then resected the patients’ remaining tumors. We compared the level of pERK in the pre- and post-treatment tumor samples to determine if treatment with an oral Grm1 blocking agent results in modulation of the Grm1 signaling pathway in human melanoma. We also assessed overall metabolic activity and proliferation of the tumors pre- and post-treatment, using PET scanning, assessement of pre- and post-treatment mitotic rate of the tumors, and pre- and post-treatment Ki-67 staining intensity. We have accrued 10 of the 15 patients we need for this trial and all 10 appear to express Grm1. Preliminary results demonstrate a significant decrease in pERK in post-treatment tumor samples as compared to pre-treatment samples in 50% of the cases so far (P&amp;lt;0.01). We also found a significant decrease in post-treatment Ki-67 staining in one patient. Three patients had a significant decrease in PET intensity post-treatment while all other patients had similar pre- and post-treatment PET scan findings except for one patient whose post-treatment PET scan revealed progressive disease. Our preliminary data demonstrates that glutamate-blockade with riluzole can inhibit signaling through the MAPK pathway and suppress metabolic activity of melanoma in a significant number of patients. The ectopic expression of metabotropic glutamate receptors may be important in the pathogenesis of human melanoma and targeting this pathway may be an effective therapy for patients with melanoma.

Treatment of Occult Reflux Lowers the Incidence Rate of Pediatric Febrile Urinary Tract Infection

To examine whether vesicourethral reflux diagnosed by positioned instillation of contrast (PIC-VUR) shows clinical importance by comparing the incidence rates of febrile urinary tract infection (FUTI) before and after treatment of PIC-VUR. Beginning in 2001 we used a multi-institutional registry to prospectively enroll consecutive pediatric patients with a history of FUTI without VUR according to voiding cystourethrogram (VCUG) and yet who show PIC-VUR. Treatment of PIC-VUR was with prophylactic antimicrobials or antireflux surgery. The post-treatment occurrence of FUTI was tracked. A total of 14 centers enrolled 118 patients (mean age, 7.2 years; range, 0.5 to 20 years). Parents self-selected the treatment of PIC-VUR as endoscopic injection (104), ureteral reimplantation (3), or antimicrobial prophylaxis (11). Study intervals surveying for FUTI before PIC (mean, 12 months; range, 1 to 17 years) and after PIC treatment (mean, 11 months; range, 0 to 3 years) were not significantly different. Overall the incidence rate for FUTI decreased significantly from 0.16 per patient per month before PIC-VUR treatment to 0.008 per patient per month after treatment (rate ratio 20; 95% confidence interval 11 to 36). The post-treatment rate of FUTI in patients treated with antibiotics versus surgery was not significantly different (rate ratio 2.5; 95% confidence interval 0.33 to 27). The diagnosis of PIC-VUR is clinically important because children treated for PIC-VUR with either antimicrobial prophylaxis or surgery show a significant reduction in the incidence rate of FUTI. This is the basis for a current prospective study randomizing patients with PIC-VUR to treatment or observation.

Pilot Evaluation of Parent–Child Interaction Therapy Delivered in an Australian Community Early Childhood Clinic Setting

Parent-child interaction therapy (PCIT) is a short-term, evidence-based parent training intervention used widely in the treatment of behaviourally disordered preschool-aged children. Outcome studies have shown PCIT to be associated with lasting improvements in child and sibling behaviours and in the interactional styles, stress levels, confidence, and psychological functioning of parents. To date, however, all outcome studies have been conducted in university research clinic settings, and therefore understanding about the effectiveness of PCIT applied in a real-world setting has been limited. The present study evaluated the effectiveness of PCIT delivered to families in an Australian community-based early childhood clinic. Participants included 43 families with children aged 19-52 months who were referred for treatment of disruptive child behaviours and who completed PCIT treatment at the Karitane Toddler Clinic, in Sydney, Australia. Parents provided pre- and post-treatment ratings of child behaviours, parental stress, parental psychopathology and parental attitudes to therapy. At the end of the programme, clinically and statistically significant improvements were seen in child behaviours and parental well-being, and parents reported high levels of satisfaction with treatment. Implications for the implementation of PCIT programmes in community-based settings are discussed and areas of further research are identified.

Smoking cessation treatment in a real-life setting: the Greek experience

The aim of this study was to estimate the clinical efficacy of counseling combined with currently used pharmacotherapy for smoking cessation (bupropion SR and nicotine replacement therapy, NRT) in actual clinical practice, and to identify predictors of successful abstinence at the end of therapy, as well as predictors of sustained abstinence in one year. 895 smokers, self-motivated to quit, received bupropion SR for 7 or 19 weeks and/or nicotine replacement therapy (NRT) (nicotine patch) for 9 weeks in combination with individual behavioural therapy. An intensive program including repetitive visits and telephone contacts during treatment and one year's follow-up period was available for supporting and motivating smokers to prevent relapse. Post-treatment abstinence rates were 71.6% and 53.2% in bupropion SR groups for 7 and 19 weeks of treatment, respectively, (p < 0.001), 63.4% in bupropion SR plus nicotine patch group and 45% (p < 0.001) in nicotine patch group. One year's follow-up abstinence rates were 43.1%, 29.6%, 30.4% and 18.4% (p < 0.05), respectively. Predictors of successful abstinence at the end of therapy included (a) bupropion SR, (b) lower DSM IV symptom score, and (c) lower nicotine addiction, while predictors for sustained abstinence in one year included: (a) bupropion SR, (b) lower nicotine addiction, and (c) smoker's motivation. Smoking cessation interventions implementing intensive multi-component programs and constant smokers' motivation in health care settings of actual practice seem promising for increasing short and long-term abstinence rates.

Within-Session Mood Changes From TMS in Depressed Patients

Within-Session Mood Changes From TMS in Depressed Patients

Documenting changes in communication behaviours using a Structured Observation System

The Structured Observation System (SOS) is a data collection method developed to document changes in the communication behaviours of children identified with speech and language delays. The system employs a rating scale which reflects the occurrence of communication behaviours as well as the amount of assistance needed for behaviours to occur. Pre- and post-treatment rating scores may be compared to measure changes in communication behaviours. The Structured Observation System is an effective, efficient and practical method to record clinical data. It was designed to be used frequently during a treatment programme and it may be adapted by others for the same purpose.

Pilot evaluation of hypnosis for the treatment of hot flashes in breast cancer survivors

This single arm, pilot study investigated the use of hypnosis to reduce hot flashes in 16 breast cancer survivors. Each patient provided baseline data and received 4 weekly sessions of hypnosis that followed a standardized transcript. Patients were also instructed in self-hypnosis. Throughout the clinical care, patients completed daily diaries of the frequency and severity of their hot flashes. Patients also completed baseline and post-treatment ratings of the degree to which hot flashes interfered with daily activities and quality of life. Results indicated a 59% decrease in total daily hot flashes and a 70% decrease in weekly hot flash scores from their baselines. There was also a significant decrease in the degree to which hot flashes interfered with daily activities for all measures including work, social activities, leisure activities, sleep, mood, concentration, relations with others, sexuality, enjoyment of life, and overall quality of life. This pilot study suggests that clinical hypnosis may be an effective non-hormonal and non-pharmacological treatment for hot flashes. A randomized, controlled clinical trial is planned to more definitively elucidate the efficacy and applicability of hypnosis for reducing hot flashes.

Hemorrhage Rate in Patients With Spetzler-Martin Grades IV and V Arteriovenous Malformations

We sought to examine the prospective annual risk of hemorrhage in patients harboring Spetzler-Martin grades IV and V arteriovenous malformations (AVMs) before and after initiation of treatment. Medical records of 61 consecutive patients presenting with Spetzler-Martin grades IV and V AVMs were retrospectively reviewed for demographics, angiographic features, presenting symptom(s), and time of all hemorrhage events, before or after treatment initiation. Pretreatment hemorrhage rates (excluding hemorrhages at presentation) and posttreatment rates were subsequently calculated. Modified Rankin Scale (mRS) scores before and after treatment were recorded. The annual pretreatment hemorrhage rate for all patients was 10.4% per year (95% CI, 2.2 to 15.4%), 13.9% (95% CI, 3.5 to 22.1%) in patients with hemorrhagic presentation and 7.3% (2.6 to 14.3%) in patients with nonhemorrhagic presentation. Posttreatment hemorrhage rates were 6.1% per year (95% CI, 2.5 to 13.2%) for all patients, 5.6% (95% CI, 2.1 to 11.8%) for patients presenting with hemorrhage and 6.4% (95% CI, 1.6 to 10.1%) in patients with nonhemorrhagic presentation. A noninferiority test showed that the posttreatment hemorrhage rate was less than or equal to the pretreatment hemorrhage rate (P<0.0001), with some indication that the reduction was greatest in patients with hemorrhagic presentation. Of the 62 patients, 51 (82%) had an mRS score of 0 to 2 before treatment, and 47 (76%) had an mRS score of 0 to 2 at the last follow-up after treatment. The annual rate of hemorrhage in grades IV and V AVMs is higher in this series than reported for all AVMs, which may reflect some referral bias in this single-center study. Nevertheless, initiation of treatment does not appear to increase the rate of subsequent hemorrhage. Treatment for these lesions may be warranted, given their poor natural history.

Work-Up and Treatment of Chronic Hepatitis B in Clinical Practice

Purpose: To review work-up and treatment of chronic hepatitis B in community practice. Methods: Retrospective records review of subjects with chronic hepatitis B (18 years or older, N = 334) identified by ICD-9 codes and a positive serum HBsAg at HealthPartners [HP] (HMO, Digestive Care Center) and Minnesota Gastroenterology [MNG] (Specialty Clinic) during 1999–2003. Data collected: age, gender, ethnicity, serum transaminases, serum eAg/eAb and HBV-DNA, liver biopsy, comorbidities (HCV/HIV coinfection, treatment drug (s), dates and length of treatment. Rates of eAg seroconversion and/or degree of suppression of HBV-DNA after treatment were obtained. Results: 334 subjects (168-HP, 166-MNG) were 51%Male, 56% Asian, 25% African. 89% had documented serum eAg (60% neg,40% pos) and HBV-DNA (<10∧4 copies/ml [c/ml] in 41%, 10∧4 to 10∧5 c/ml in 9%, >10∧5 c/ml in 47%). 84% of HBeAg pos subjects had >10∧5 c/ml; 29% of HBeAg negative subjects had >10∧4 c/ml. 32% of subjects had liver biopsy (106/334, 70% eAg pos, 30% eAg neg; indicatioN = elevated transaminases and/or elevated DNA levels as >10∧4 copies/ml in 84/106). 63% (67/106) of biopsied subjects were treated. 84 of 334 subjects (25%) were treated including 67 biopsied (22 stage 3 or 4) and 17 non-biopsied subjects (2 with clinical cirrhosis, 2 on chemotherapy, 9 with elevated transaminases, 3 with DNA >10∧4, and 1 not documented). 69% (58/84) of treated patients were HBeAg pos and 26% (22/84) were HBeAg neg. Serum HBV-DNA was = or >10∧5 c/ml in 76% (61/84). Treatment drugs: Interferon (14%), Lamivudine (36%), Adefovir (39%), Entecavir (2%). Rate of HBeAg seroconversion post-treatment was 37% (20/54). Serum HBV-DNA was suppressed to undetectable and/or <10∧4 c/ml after treatment in 51% (53/84) of treated subjects. Conclusions: In our gastroenterology practices one third of subjects with chronic hepatitis B had indication to liver biopsy. 25% of all subjects with cronic hepatitis B underwent treatment, after significant fibrosis was found in one fourth of them. Treatment was effective in a significant proportion of subjects. Protocolized post-treatment follow-up of HBV serologies will be necessary to assess long-term response and recurrence rates.