Culturally sensitive strategies designed to target the silent epidemic of hepatitis B in a Filipino community.
ABSTRACT Hepatitis B is frequent in the Philippines. A high rate of immigration to the United States has brought many Filipinos with infections who are asymptomatic yet will go on to develop liver cancer and cirrhosis unless diagnose and evaluated. Interventions are necessary to educate this ethnic community, identify those infected, and offer therapy. In an effort to reach this high risk population in Hawai'i an intervention program was designed to address the silent epidemic of hepatitis. Ethnic barriers were crossed through involvement of trusted, key stakeholders and individuals within the Filipino health care and church communities, along with groups that had joint missions to address viral hepatitis. After extensive planning and meetings with faith-based organizations and health care providers in the Filipino community, it was decided to hold a community health fair in the Filipino community to provide culturally appropriate health information and services. More than 500 individuals attended the health fair; 167 participated in a survey and were tested for hepatitis B. Significant knowledge gaps were found in relation to risk factors, prevention strategies, and transmission. Five individuals tested positive; all were immigrants and did not know of their disease. The objective to educate people and test them for hepatitis was successful through utilizing ethnic community leaders, religious organizations, health care professionals, and a collaborative health fair.
- SourceAvailable from: Kamran B Lankarani[show abstract] [hide abstract]
ABSTRACT: Hepatitis B virus (HBV) infection is endemic in the Middle East region and is associated with significant morbidity and mortality. Strict strategies are needed for prevention, diagnosis and management of HBV infection. Reviewing literature about seroepidemilogy and modes of infection transmission in Iran and Pakistan performed. Iran is in low endemicity and Pakistan in intermediate endemicity of HBV infection, now. Therapeutic injections, vertical transmission, transfusion, cultural and special traditions like ear, nose piercing, and high risk groups are important risk factors in Pakistan. Prevalence of HBV infection is still significant in children. High risk behaviors, including injection drug use (IDU) and sexual contact are main routes of HBV transmission in Iran. Intensifying vaccination of high risk groups and control on interfamily transmission in both countries is necessary. Effective coverage of HBV vaccination, has more control on therapeutic injections, screening pregnant women for HBV infection, and follow-up of babies of the HBsAg positive mothers in Pakistan is recommended. Regional collaboration of the two countries may overcome the spread of infection by promoting universal vaccination in all provinces of Pakistan, screening of hepatitis B, education, and surveillance in high risk groups of Iran. To implicate effective vaccination by regional and international health units, and addiction control in neighboring countries is necessary.Hepatitis Monthly. 01/2007;
June 2007, Volume 66, No. 6, ISSN: 0017-8594
HUMAN SERUM ALBUMIN LEVELS AND CARDIOVASCULAR RISK
FACTORS IN ELDERLY JAPANESE-AMERICAN MEN:
THE HONOLULU HEART PROGRAM
Chung-Eun Ha PhD, et al
CULTURALLY SENSITIVE STRATEGIES DESIGNED TO TARGET
THE SILENT EPIDEMIC OF HEPATITIS B IN A FILIPINO COMMUNITY
Michelle Marineau PhD, APRN, et al
A RARE CASE OF A PANCREATIC TUMOR IN ASSOCIATION
WITH THE SYNDROME OF INAPPROPRIATE ANTIDIURETIC
Sean Hirota MSIII, et al
MEDICAL SCHOOL HOTLINE
Is Clinical Empathy Teachable? A Medical Humanities Initiative
Carolyn Riederer Annerud MD, FACEP
CANCER RESEARCH CENTER HOTLINE
Emerging Bone Health Issues in Women with Breast Cancer in Hawai‘i
Jennifer Fu Carney MD and James Davis
MEDICAL LEGAL HOTLINE
Issues in Medical Malpractice XII
S.Y . T an MD, JD
Russell T . Stodd MD
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HAWAI‘I MEDICAL JOURNAL, VOL 66, JUNE 2007
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HAWAI‘I MEDICAL JOURNAL, VOL 66, JUNE 2007
Human Serum Albumin Levels and
Cardiovascular Risk Factors in Elderly
Japanese-American Men: The Honolulu
Chung-Eun Ha PhD, Kamal H. Masaki MD, Helen Petrovitch MD, Randi Chen MS,
Lenore Launer PhD, Nadhipuram V. Bhagavan PhD, Alan T. Remaley MD, PhD,
and J. David Curb MD
The objective of this study is to investigate the relation-
ship between low levels of human serum albumin (HSA)
and the incidence of coronary heart disease (CHD) in a
cohort of elderly Japanese-American men. Using data
from the Honolulu Heart Program’s fourth examination
(1991-1993), HSA levels of 998 Japanese American
men aged 71-93 years was compared with plasma
levels of fibrinogen, total cholesterol, HDL cholesterol,
LDL cholesterol, triglycerides, diastolic BP, BMI, and
fasting blood glucose. HSA was significantly negatively
associated with age and fibrinogen, and significantly
positively associated with total cholesterol, HDL cho-
lesterol, LDL cholesterol, triglycerides, diastolic BP,
BMI and fasting blood glucose. After adjusting for age,
tertiles of HSA were significantly positively associated
with total cholesterol, HDL cholesterol and triglycerides,
and significantly negatively associated with fibrinogen.
Using multivariate stepwise regression, significant
correlations were seen between HSA and fibrinogen,
cholesterol, age, HDL cholesterol and triglycerides, and
a borderline correlation was seen with systolic blood
pressure. However, the model R-square for all variables
was only 0.10. In conclusion, HSA levels are significantly
associated with several traditional cardiovascular risk
factors, particularly serum lipid levels.
Coronary heart disease (CHD) is the leading cause of
morbidity and mortality worldwide. The understanding
of traditional risk factors, cigarette smoking, hyperten-
sion, obesity, diabetes mellitus, physical inactivity, and
plasma levels of total cholesterol, low-density lipopro-
tein cholesterol (LDL-C), high-density lipoprotein cho-
lesterol (HDL-C) and triglycerides has made significant
contribution in reducing the morbidity and mortality of
CHD.1 The major risk factors, nevertheless, are impli-
cated in only as many as 75% of CHD cases.2 Several
epidemiological studies have supported the observation
that a high concentration of HDL-C is cardio-protective.
However, this inverse relationship between HDL-C and
CHD is not applicable to a significant number of CHD
patients. For example, 27% of the men participating in
the Framingham Heart Study cohort showed premature
CHD but did not have HDL-C levels in the bottom 10th
percentile.3 Thus, non-traditional risk factors may play
a significant role in CHD risk. One of these is human
serum albumin (HSA). Many observational epide-
miological studies have demonstrated an association
between low levels of HSA and increased incidence
of CHD.4-12 In particular, a population based study
regarding the relationship between the levels of HSA
and total cholesterol and mortality among the Japanese
general population showed that a combination of low
levels of HSA and above-average total cholesterol were
associated with higher mortality.13 Furthermore, this
study showed that the low serum albumin level group
(≤43 g/L) was associated with higher cardiovascular
mortality for men.
There is evidence that HSA levels may be dependent
on, or influence other cardiovascular risk factors such
as serum lipid levels. Before exploring the possible
direct relationship of HSA levels to CHD incidence,
it is important to determine the interactions that exist
between HSA levels and proven CHD risk factors that
might act as mediators. In this report, we examined the
relationship between HSA and several other traditional
cardiovascular risk factors in a cohort of elderly Japa-
The Honolulu Heart Program (HHP) is a prospective
epidemiologic observational study of cardiovascular
disease that began in 1965. The identification of the
study cohort was undertaken by using World War II
Selective Service registration cards which were on file in
Honolulu. This process led to the finding of registration
Chung-Eun Ha PhD
Kamal H. Masaki MD
Helen Petrovitch MD
Randi Chen MS
Lenore Launer PhD
HAWAI‘I MEDICAL JOURNAL, VOL 66, JUNE 2007
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