RESUMEN
There is limited information regarding follow-up and hepatitis B serological status of Asian Americans diagnosed with chronic hepatitis B (CHB) through community screening. The aims of this study were to evaluate the prevalence and characterize CHB among Asians living in Los Angeles, assess follow-up of individuals with CHB diagnosed at screening and compare with patients with CHB followed by community gastroenterologists. Between October 2007 and May 2010, 7387 Asians were tested for HBV. HBsAg positive individuals (CHB) underwent additional testing for ALT, HBeAg/anti-HBe and HBV DNA. Patients with CHB were contacted 6 months later to determine whether they received follow-up care. We compared serological patterns of these individuals with CHB to patients with CHB who were seen for the first time (treatment naïve) by community gastroenterologists during the study period. Prevalence of CHB was 5.2%. About 99% patients with CHB were foreign-born, and only 27% could read/write English. 297 (77%) patients with CHB could be reached 6 months after diagnosis; 43% did not receive follow-up care, mostly because of lack of medical insurance. Patients with CHB followed by gastroenterologists were more likely to have insurance (69% vs 26%, P < 0.0001). 90% patients with CHB at screening were HBeAg negative/anti-HBe positive with 62% having inactive disease compared to only 30% of patients seen by gastroenterologists (P < 0.0001). Among CHB participants, 13% met criteria for treatment compared to 51% of patients with CHB (P < 0.0001). Only a small number of CHB screening participants require antiviral therapy. Lack of medical insurance is the main reason for most patients with CHB not seeking follow-up care after screening.
Asunto(s)
Asiático , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/epidemiología , Tamizaje Masivo , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , ADN Viral/sangre , Demografía , Femenino , Estudios de Seguimiento , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Humanos , Los Angeles/epidemiología , Los Angeles/etnología , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
At a time when the role of the laboratory in clinical medicine and in medical research was evolving rapidly, a young Chinese graduate of the Hong Kong College of Medicine and the University of Edinburgh undertook a period of intensive training at the laboratory of the Royal College of Physicians of Edinburgh that was to play a pivotal role in determining his future career as the first Professor of Pathology at the University of Hong Kong and its first professor of Chinese descent. Chung Yik Wang's subsequent achievements over a span of ten years were a testament to the solid foundation that had been laid during that early period, and was an excellent example of how the skills of medical science could be transferred across continents to best effect. Tragically, Wang's career was cut short when he succumbed to tuberculosis, the disease he had spent many years studying.