BackgroundHepatitis B is an important disease of ethnic disparity which affects Asian Americans and other minority populations disproportionately. Despite the high prevalence of hepatitis B in Asian Americans, many of them remain unscreened and untreated. A majority of the individuals chronically infected with hepatitis B virus (HBV) are not linked to care, for instance, due to a lack of culturally competent programs. There are many serious barriers preventing linkage to care (LTC), including personal, socio-cultural, and economic issues. The purpose of this study was to evaluate various barriers affecting LTC and to investigate the role and efficacy of a community-based Patient Navigator (PN) program in expediting LTC and in improving health outcomes for hepatitis B patients in a high risk population.MethodsA total of 45 individuals chronically infected with HBV were identified through community screening events and were subsequently linked to patient navigators (PN), who then arranged for the patients to have a medical evaluation with a provider of their choice in their communities. The navigators kept detailed records of the patients’ progress towards goal, and planned follow up visits for each patient. A self-report questionnaire was employed to assess patients’ demographics, history of HBV infection, and barriers in accessing health care. Specifically, the levels of importance of the barriers due to language, culture, financial reasons were assessed.ResultsThe study revealed that 38 of the 45 HBV infected individuals knew about their infection status from previous screening. Forty two out of 45 HBV infected individuals were linked to care within a 12 month period, demonstrating a high linkage rate. Most significant barriers identified were language and finance, followed by cultural barrier and others.ConclusionThere are specific barriers to accessing adequate care for the patients affected by chronic hepatitis B (CHB) in Korean American community. The implementation of a PN program in conjunction with the community network of health care providers may help to overcome the barriers and facilitate LTC in hepatitis B.
The hypothesis tested was that feeding rats sucrose rather than invert sugar (50:50 mixture of glucose and fructose) or cornstarch would result in a more rapid excretion of glucuronides and tritium from intravenously injected [1,2-3H]aldosterone. Thirty 56-d-old male rats of the Sprague-Dawley strain were fed for 8 wk one of three diets containing 45% of dietary energy from sucrose, invert sugar or cornstarch; 15% of energy was from protein and 40% from fat. Body weights and systolic blood pressures were measured weekly. After 60 d of feeding the diets ad libitum, all rats were injected intravenously with [1,2-3H]aldosterone and the percent recovery of tritium in both urine and feces was determined over the next 4 d. Urinary and fecal excretion of both free and conjugated glucuronic acid was determined over those 4 d. Urinary excretion of sodium and potassium (mg/d) was also determined. There were no differences between groups in food or water intakes, body weights, systolic blood pressures, daily fecal weights and daily urine volumes. The cornstarch-fed group excreted less sodium and potassium than did the other groups (P less than 0.05). The sucrose-fed group had a greater 4-d excretion of tritium (urinary + fecal) than did the invert sugar- or cornstarch-fed groups (P less than 0.01). The sucrose-fed group had a greater percentage of excreted glucuronic acid that was conjugated (urinary + fecal) than did the invert sugar- or cornstarch-fed groups (P less than 0.05). These results tended to confirm the hypothesis.
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