The prevalence of hepatitis B virus (HBV) infection in the Asian American population is disproportionately high compared with the US population as a whole. Effective management is difficult because of cultural barriers, which can be better understood with recognition of the diversity of the Asian continent in terms of language and spiritual beliefs. Barriers to care among the Asian American population include educational deficits, low socioeconomic status, lack of health insurance, noncitizenship, inability to communicate in English, negative perceptions of Western medicine, and underrepresentation among health care professionals. Given the diversity of the population, some subpopulations may be more directly affected by certain barriers than others. The resulting delays in seeking care can lead to poor outcomes and risk of HBV transmission to household members. Health care providers are obligated to educate themselves regarding cultural sensitivity and to advocate for improved access to care.
"days, which was substantially shorter than previous reports.,  In mainland China, health insurance does not cover liver transplantation.,  Thus the cost of this surgical procedure must be paid out-of-pocket by the patient himself. "
[Show abstract][Hide abstract] ABSTRACT: The number of people undergoing living donor liver transplantation (LDLT) has increased rapidly in many transplant centres. Patients considering LDLT need to know whether LDLT is riskier than deceased donor liver transplantation (DDLT). The aim of this study was to compare the outcomes of patients undergoing LDLT versus DDLT.
A total of 349 patients with benign liver diseases were recruited from 2005 to 2011 for this study. LDLT was performed in 128 patients, and DDLT was performed in 221 patients. Pre- and intra-operative variables for the two groups were compared. Statistically analysed post-operative outcomes include the postoperative incidence of complication, biliary and vascular complication, hepatitis B virus (HBV) recurrence, long-term survival rate and outcomes of emergency transplantation.
The waiting times were 22.10±15.31 days for the patients undergoing LDLT versus 35.81±29.18 days for the patients undergoing DDLT. The cold ischemia time (CIT) was 119.34±19.75 minutes for the LDLT group and 346±154.18 for DDLT group. LDLT group had higher intraoperative blood loss, but red blood cell (RBC) transfusion was not different. Similar ≥ Clavien III complications, vascular complications, hepatitis B virus (HBV) recurrence and long-term survival rates were noted. LDLT patients suffered a higher incidence of biliary complications in the early postoperative days. However, during the long-term follow-up period, biliary complication rates were similar between the two groups. The long-term survival rate of patients undergoing emergency transplantation was lower than of patients undergoing elective transplantation. However, no significant difference was observed between emergency LDLT and emergency DDLT.
Patients undergoing LDLT achieved similar outcomes to patients undergoing DDLT. Although LDLT patients may suffer a higher incidence of early biliary complications, the total biliary complication rate was similar during the long-term follow-up period.
PLoS ONE 11/2011; 6(11):e27366. DOI:10.1371/journal.pone.0027366 · 3.23 Impact Factor
"English language proficiency was identified as the main barrier in communicating between health care providers about CHB in a study of Asian-Americans . This barrier was not directly addressed in our study where most interviews were held in English and participants had at least minimal English proficiency. "
[Show abstract][Hide abstract] ABSTRACT: The implementation of a comprehensive public health response to hepatitis B in Australia is urgently required to reduce the increasing burden of hepatitis B infection on the health system and the community. A significant gap in the public health response to hepatitis B is an understanding of how people with chronic hepatitis B (CHB) respond to CHB.
A qualitative study involving semi-structured interviews and focus group discussions was conducted. Interviews were held with 20 people with CHB from three states of Australia. In addition, four focus group discussions were held with a total of 40 community and health workers from culturally and linguistically diverse communities in four Australian states.People with CHB reported no formal or informal pre or post test discussion with little information about hepatitis B provided at the point of diagnosis. Knowledge deficits about hepatitis B were found among most participants. Few resources are available for people with CHB or their families to assist them in understanding the infection and promoting their health and well-being. A lack of confidence in the professional knowledge of service providers was noted throughout interviews.
People with CHB need culturally and linguistically appropriate education and information, particularly at the point of diagnosis. Primary health care professionals need the knowledge, skills and motivation to provide appropriate information to people with CHB, to ensure they have the capacity to better manage their infection.
BMC Research Notes 03/2011; 4(1):45. DOI:10.1186/1756-0500-4-45
[Show abstract][Hide abstract] ABSTRACT: Hepatitis B remains a global health issue, despite an effective vaccine. Mother to child transmission (MTCT) of hepatitis B has become increasingly recognized, especially in those patients with high maternal viremia. In a woman of childbearing age, carefully assessing disease status and urgency of treatment is key, along with discussion of family planning, timing and choice of therapy. In a pregnant patient with chronic hepatitis B, treatment in the third trimester may be considered in those with HBV DNA levels >107 copies (2 × 106 IU/ml) and may reduce the perinatal transmission rate, but a thorough discussion of the risks and benefits is essential. Duration of antiviral therapy depends upon the indication for treatment as those individuals treated for active disease from the hepatitis B would need long term therapy, while those treated in the third trimester only to prevent MTCT may have therapy discontinued.
Current Hepatitis Reports 03/2013; 12(1). DOI:10.1007/s11901-012-0154-2
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