Chronic Hepatitis B in Indian Americans: Lack of Screening and Poor Linkage to Care

Background: Chronic hepatitis B (CHB) is a major cause of liver-related morbidity and mortality in the United States (US) and globally. CHB disproportionately affects Asian Americans and many other immigrant minority populations, primarily owing to the high prevalence of CHB in their countries of origin. India is a country with a medium-to-high prevalence of hepatitis B (HB) (>2%) and has over 40 million people infected with hepatitis B virus (HBV), with more than 115,000 deaths annually from HBV-related complications. Indian Americans are one of the largest immigrant populations in the US but remain underdiagnosed and poorly linked to clinical care. We, therefore, assessed the HBV prevalence and evaluated the linkage-to-care (LTC) among Indian Americans to develop strategic plans to reduce the impact of HBV in the US. Methods: Between April 2022 and January 2024, serologic screening and surveys were provided to 328 Indian American adults (age 20 - 80) in New York City. All participants were tested for a triple panel consisting of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core IgG antibody (anti-HBc). A survey was conducted on the subjects chronically infected with HBV regarding their histories of infection. Self-administered questionnaires were employed to evaluate demographic and epidemiologic characteristics. Results: Of 328 screened and evaluated (246 males and 82 females), 10 (3.0%) were HBV-infected, 222 (67.7%) were susceptible to HBV, and 96 (29.3%) were immune. The prevalence of chronic HBV varied between the age groups: 4.6% (age 20 - 40), 3.4% (age 41 - 60), and 1.7% (age 61 - 80). Of 10 chronically infected, only two subjects had been previously diagnosed but were not engaged in care. Conclusion: HBV disproportionately affects Asian Americans, primarily owing to immigration from parts of the world where the disease is endemic. Indian Americans belong to an intermediate-risk group, with an HBV prevalence of >2%, but remain underdiagnosed and poorly linked to care. Our pilot study on Indian American populations, the first of its kind, demonstrates a 3% prevalence of CHB, none of whom are linked to care. In addition, this population has a high percentage of unimmune subjects, creating a large reservoir for future infection. With the growing population of Indian Americans, our findings can be used to develop community-based strategies for HBV screenings and LTC that target high-risk groups.

Community-Based Hepatitis B Campaign in Asian Americans

Chronic hepatitis B (CHB) disproportionately affects minority groups in the US, particularly Asian Americans, with numerous factors contributing to this disparity. Of the 2.4 million people living with chronic HBV in the US, 60% are Asian American. Many are unaware of their status and lack access to proper clinical care, with less than ten percent receiving necessary antiviral treatment. Barriers to screening and care include lack of disease awareness, language and cultural barriers, and financial constraints. Additionally, healthcare providers and systems in the US often overlook the importance of CHB, leading to inadequate care. In response, the Center for Viral Hepatitis (CVH) has implemented a community-based outreach program over the past sixteen years, employing a multifaceted approach involving all sectors of society and various organizations to combat health disparities in CHB. This grassroots campaign has proven highly effective, leveraging CVH’s leadership in spearheading numerous collaborative activities with community members, healthcare professionals, and policymakers. We have summarized the key points of CVH's efforts and their significance in combating CHB-related health disparities. The CHB Screening and Awareness Campaign, tailored to the Asian American community, serves as a successful model for increasing CHB screening, linkage-to-care, and addressing socio-cultural barriers and health literacy. Insights from these outreach programs have guided the development of culturally relevant resources and education initiatives. These findings suggest that such community-driven approaches are essential for addressing health disparities. The strategies and outcomes of CVH’s efforts can inform future health initiatives for other minority communities in the US and globally.

Analysis on Bicultural Identities of Chinese Americans Based on Acculturation Theory

In the context of globalization,the communication between countries is gradually enhanced and the immigration is increasing.Chinese Americans,as a unique ethnic group,are easy to fall into the difficult problem of self-identity construction when facing the bicultural identity conflict between Chinese and American.This paper selects the film The Farewell created by a Chinese American director as the research object,analyzes the cultural identity crisis of Chinese Americans,introduces the cultural adaption strategy adopted by Chinese Americans from the perspective of Acculturation Theory,and provides reference for Chinese Americans about how to realize the bicultural identities in the cultural diaspora.

Gender differences of lower urinary tract symptoms in older Chinese Americans

Objective To describe whether or not there are gender differences in lower urinary tract symptoms(LUTS)prevalence and risk factors in community-dwelling older Chinese Americans.Methods We performed a secondary analysis of a prospective cross-sectional population-based survey of Chinese Americans aged 60 years and older between January 2011 and December 2013 in English,Mandarin,Cantonese,Taishanese,or Teochew.A clinical review of systems was used to assess LUTS,which included urinary frequency,urgency,burning and/or pain,blood in urine,and urinary incontinence.Results Of the total 3157 people queried,42%were men and 58%were women.More men reported LUTS compared to women(32.9%vs.28.6%,p=0.01).In a multivariable analysis,female gender(adjusted odds ratio[aOR]0.60,95%confidence interval[CI]0.49-0.73),being married(aOR 0.79,95%CI 0.65-0.97),and smoking(aOR 0.66,95%CI 0.49-0.88)were found to be protective,while traditional Chinese medicine use(aOR 1.51,95%CI 1.28-1.78),heart disease(aOR 1.54,95%CI 1.24-1.91),and anxiety(aOR 1.69,95%CI 1.25-2.28)were most strongly associated with increased odds of LUTS.When examining genders separately,being married was found to be protective only in women.Meanwhile,unique factors found in men were hypertension,heart disease,and practice of Tai Chi.Conclusion In this large population-based study,LUTS were more prevalent in older Chinese American men than women.We also found gender-specific factors that influenced the odds of reporting LUTS;however,traditional Chinese medicine use was the only factor that was shared by both genders.Future longitudinal investigations are needed to elucidate these underlying mechanisms to provide evidence-based and culture-specific guidelines for this rapidly growing population.

The COVID-19 Pandemic: A Double Threat to Chinese Americans’ Mental Health

Objective:To explore the double psychosocial threats of the COVID-19 pandemic,targeted behavior toward Chinese Americans,and the correlates to their mental health.Methods:A quantitative,cross-sectional,and descriptive design was utilized by using a purposive convenience sample of 301 Chinese Americans over the age of 18 residing in the United States.Online data collection was conducted through the social media platform WeChat from April 8–21,2021.Descriptive statistical analysis was used for the participants’demographic charac-teristics,Multidimensional Scale of Perceived Social Support(MSPSS),Double Threat Situations,COVID-19 Racial Discrimination,and General Anxiety Disorder-7(GAD-7).Stepwise logistic regression was conducted to verify predictors for anxiety levels by GAD-7.Results:In this sample(N=301),127(42.19%)were male and 174(57.81%)were female.The average age was 41.67(SD=5.89).Among MSPSS subscales,social support from family(MSPSS-Fam,79.73%,n=240)and social support from significant others(MSPSS-SO,73.75%,n=222)were high.231(76.74%)reported threats due to their Chinese ethnic background during the COVID-19 outbreak.Predictors for the high anxiety level by GAD-7 were COVID-19 racial discrimination from the local community(OR=0.47,95%CI=0.39–0.71,p<0.001),media/online(OR=0.36,95%CI=0.26–0.53,p<0.001),the perceived threat from the COVID-19 virus(OR=0.33,95%CI=0.23–0.51,p<0.001)and Perceived racism threat from Chinese back-ground related to COVID-19(OR=0.31,95%CI=0.21–0.49,p<0.001).Conclusions:COVID-19 double-threats(The virus and racial discrimination)situations are significantly related to the high level of anxiety among Chinese Americans.The sense of belonging and social perceptions of Chinese immigrants is closely related to public health problems in Western societies and needs to be addressed at all levels.Ourfindings call for the attention of health-care workers to specific racism double-threatened situations and high mental health risks,as well as direct and indirect ethnic discrimination that Chinese Americans are experiencing during this pandemic,the long-term influ-ences and effective coping ways related to this issue should be explored in further research.

American tegumentary leishmaniasis mimicking myiasis and granulomatous vasculitis:A case report

Rationale:American tegumentary leishmaniasis comprises cutaneous and mucocutaneous manifestations caused by parasitic infections by various Leishmania species.This report details the clinical interventions for a patient with American tegumentary leishmaniasis in Mendoza,Argentina,a non-endemic region.Patient concerns:A 43-year-old male was admitted to a tertiary care hospital in Mendoza,Argentina Republic with a history of progressive nasal discharge,septal perforation,facial pain,and pruritus.Despite treatment for presumed nasal myiasis and vasculitis with granulomatosis,symptoms persisted.Diagnosis:American tegumentary leishmaniasis.Interventions:Intravenous liposomal amphotericin B.Outcomes:Follow-up at 30 days showed no recurrence of symptoms with a remarkable clinical improvement of the nasal lesion.Lessons:This case sheds light on the necessity of accurate identification for timely intervention and the need to recognize the diverse manifestations of American tegumentary leishmaniasis to avoid misdiagnosis.

A Study on the Infiltration Methods of British and American Literature in High School English Reading Teaching

Reading is the key content of high school English teaching,which can improve students’mastery of words,grammar,and other knowledge,and can expand their horizons.British and American literature is the essence of British and American culture,and its application in high school English reading teaching can help improve students’English proficiency.This paper outlines the problems of high school English teaching,analyzes the role of British and American literature in high school English reading teaching,and explores the infiltration methods of British and American literature in high school English reading teaching,in order to provide references for teachers.

A Corpus Study of Acupuncture from the Perspective of Mass Media Based on the Corpus of Contemporary American English

Based on the Corpus of Contemporary American English(COCA),this study examines acupuncture from the perspective of mass media.Acupuncture has been circulating throughout the Chinese Cultural Circle since the Qin and Han Dynasties,and has since spread directly or indirectly to the rest of the world.The United States boasts the world’s second-largest acupuncture market,with its laws,regulations,industry growth,research,and education all positively influencing the development of acupuncture in other nations.This study uses COCA to analyze the form and content of acupuncture’s dissemination in eight different types of media.The findings show that acupuncture appears in COCA a total of 1,788 times,with the highest frequency in magazines,followed by blogs,and the lowest frequency in fiction.These findings reveal the popularity of acupuncture in mass media in the United States and provide empirical data and insights for the future dissemination and development of acupuncture in the United States.

Theme Analysis of Everyday Use by Alice Walker——about Afro-Americans' Cultural Identification

By discussing the cultural and historical context of the story and through detailed reviewing of the content,the article tries to deeply analyze the theme of Alice Walker's Everyday Use,and it shows that the writer wants to tell readers two mistakes in Afro-Americans' cultural identification: escaping from the painful history and blind seeking for African culture.

Gut microbiome profiling and colorectal cancer in African Americans and Caucasian Americans

AIM To determine whether and to what extent the gut microbiome is involved in regulating racial disparity in colorectal cancer(CRC). METHODS All patients were recruited and experiments were performed in accordance with the relevant guidelines and regulations by the Institutional Review Boards (IRB), committees of the John D. Dingell VAMC and Wayne State University guidelines. African American (AA) and Caucasian American (CA) patients were scheduled for an outpatient screening for colonoscopy, and no active malignancy volunteer patients were doubly consented, initially by the gastroenterologist and later by the study coordinator, for participation in the study. The gut microbial communities in colonic effluents from AAs and CAs were examined using 16 sRNA profiling, and bacterial identifications were validated by performing SYBR-based Real Time PCR. For metagenomic analysis to characterize the microbial communities, multiple software/tools were used, including Metastats and R statistical software.RESULTS It is generally accepted that the incidence and mortality of CRC is higher in AAs than in CAs. However, the reason for this disparity is not well understood. We hypothesize that the gut microbiome plays a role in regulating this disparity. Indeed, we found significant differences in species richness and diversity between AAs and CAs. Bacteroidetes was more abundant in AAs than in CAs. In particular, the pro-inflammatory bacteria Fusobacterium nucleatum and Enterobacter species were significantly higher in AAs, whereas probiotic Akkermansia muciniphila and Bifidobacterium were higher in CAs. The polyphyletic Clostridia class showed a divergent pattern, with Clostridium XI elevated in AAs, and Clostridium IV, known for its beneficial function, higher in CAs. Lastly, the AA group had decreased microbial diversity overall in comparison to the CA group. In summary, there were significant differences in pro-inflammatory bacteria and microbial diversity between AA and CA, which may help explain the CRC disparity between groups.CONCLUSION Our current investigation, for the first time, demonstrates microbial dysbiosis between AAs and CAs, which could contribute to the racial disparity of CRC.

Hepatitis B among Asian Americans:Prevalence, progress, and prospects for control

After tobacco use, chronic hepatitis B(CHB) viral infections are the most important cause of cancer globally in that 1 out of 3 individuals have been infected with the hepatitis B virus(HBV). Though infection rates are low(< 1%) in the United States, Asian Americans who comprise about 6% of the population experience about 60% of the CHB burden. This paper reviews the magnitude of hepatitis B(HBV) burden among Asian Americans and the progress being made to mitigate this burden, primarily through localized, communitybased efforts to increase screening and vaccination among Asian American children, adolescents, and adults. This review brings to light that despite the numerous community-based screening efforts, a vast majority of Asian Americans have not been screened and that vaccination efforts, particularly for adults, are sub-optimal. Greater efforts to integrate screenings by providers within existing healthcare systems are urged. Evidence-based strategies are offered to implement CDC's three major recommendations to control and prevent hepatitis B through targeted screening and enhanced vaccination efforts.

Poor CD4 count is a predictor of untreated depression in human immunodeficiency virus-positive African-Americans

AIM: To determine if efforts to improve antiretroviral therapy(ART) adherence minimizes the negative impact of depression on human immunodeficiency virus(HIV) outcomes. METHODS: A cross-sectional study of a clinic-based cohort of 158 HIV seropositive(HIV+) African Americans screened for major depressive disorder(MDD) in 2012. CD4 T lymphocyte(CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count(< 350 cells/mm3). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders. RESULTS: Out of 147 individuals with available CD4+ T lymphocyte data, 31% had CD4+ count < 350 cells/mm^3 and 28% reported poor ART adherence. As expected the group with > 350 cells/mm^3 CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm3 CD4+ T lymphocyte count(P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group.CONCLUSION: Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients.

Association between recognizing dementia as a mental illness and dementia knowledge among elderly Chinese Americans

AIM: To investigate whether older Chinese Americans perceive dementia as a mental illness and the relationship between such perception and their general understanding of dementia remains unclear. Our study aims to understand this relationship and its future implication on improving dementia literacy among ethnic minorities.METHODS: Elderly Chinese American participants from the Greater Los Angeles were asked to complete an 11-item dementia questionnaire, following a community health seminar. Cross-sectional survey data was analyzed using standard statistical methods.RESULTS: The questionnaire received an 88.3% response rate. Among 316 responders, only 28.8%(n = 91) of elderly Chinese Americans identified dementia as a mental illness, and 71.2%(n = 225) did not recognize its mental disease origin. Furthermore, in comparison between these two groups, the first group demonstrated significantly higher level of baseline knowledge of the disease.CONCLUSION: This study reveals that only approximately 1 out of 4 older Chinese Americans recognized dementia as a mental illness, consistent with previous studies on Asian Americans. Our study however showed that when dementia was being perceived as a mental illness, such perception was associated with a higher level of baseline dementia understanding. The current study suggested the potential of improving older Chinese Americans dementia literacy by increasing awareness of its mental illness origin.

Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites

AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classif ication, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P < 0.01). Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans (28.1% vs 7.9%; P < 0.001). CONCLUSION: Distribution of RE grade and frequency of reflux-related esophageal ulcer, stricture andhiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.

Chronic liver disease in Aboriginal North Americans

A structured literature review was performed to detail the frequency and etiology of chronic liver disease (CLD) in Aboriginal North Americans. CLD affects Aboriginal North Americans disproportionately and is now one of the most common causes of death. Alcoholic liver disease is the leading etiology of CLD, but viral hepatitis, particularly hepatitis C, is an important and growing cause of CLD. High rates of autoimmune hepatitis and primary biliary cirrhosis (PBC) are reported in regions of coastal British Columbia and southeastern Alaska. Non-alcoholic liver disease is a common, but understudied, cause of CLD. Future research should monitor the incidence and etiology of CLD and should be geographically inclusive. In addition, more research is needed on the treatment of hepatitis C virus (HCV) infection and non-alcoholic fatty liver disease (NAFLD) in this population.

Electrocardiographic abnormalities among Mexican Americans: Correlations with diabetes, obesity, and the metabolic syndrome

INTRODUCTION: Resting ischemic electrocardiographic abnormalities have been associated with cardio-vascular mortality. Simple markers of abnormal autonomic tone have also been associated with diabetes, obesity, and the metabolic syndrome in some populations. Data on these electrocardiographic abnormalities and correlations with coronary risk factors are lacking among Mexican Americans wherein these conditions are prevalent. This study aimed to evaluate the prevalent resting electrocardiographic abnormalities among community-dwelling Mexican Americans, and to correlate these findings with coronary risk factors, particularly diabetes, obesity, and the metabolic syndrome. METHODS: Study subjects (n = 1280) were drawn from the Cameron County Hispanic Cohort comprised of community-dwelling Mexican Americans living in Brownsville, Texas at the United States-Mexico border. Ischemic electro-cardiographic abnormalities were defined as presence of ST/T wave abnormalities suggestive of ischemia, abnormal Q waves, and left bundle branch block. Parameters that reflect autonomic tone, such as heart rate-corrected QT interval and resting heart rate, were also measured. RESULTS: Ischemic electrocar-diographic abnormalities were more prevalent among older persons and those with hypertension, diabetes, obesity, and the metabolic syndrome. Subjects in the highest quartiles of QTc interval and resting heart rate were also more likely to have diabetes, hypertension, obesity, or the metabolic syndrome. CONCLU- SIONS: Among Mexican Americans, persons with diabetes, obesity, and the metabolic syndrome were more likely to have ischemic electrocardiographic abnormalities, longer QTc intervals, and higher resting heart rates. A resting electrocardiogram can play a complementary role in the comprehensive evaluation of cardiovascular risk in this minority population.

African Americans,hypertension and the renin angiotensin system

African Americans have exceptionally high rates of hypertension and hypertension related complications. It is commonly reported that the blood pressure lowering efficacy of renin angiotensin system(RAS) inhibitors is attenuated in African Americans due to a greater likelihood of having a low renin profile. Therefore these agents are often not recommended as initial therapy in African Americans with hypertension. However, the high prevalence of comorbid conditions, such as diabetes, cardiovascular and chronic kidney disease makes treatment with RAS inhibitors more compelling. Despite lower circulating renin levels and a less significant fall in blood pressure in response to RAS inhibitors in African Americans, numerous clinical trials support the efficacy of RAS inhibitors to improve clinical outcomes in this population, especially in those with hypertension and risk factors for cardiovascular and related diseases. Here, we discuss the rationale of RAS blockade as part of a comprehensive approach to attenuate the high rates of premature morbidity and mortality associated with hypertension among African Americans.

Mortality and morbidity due to the failure to treat mild anemia unrelated to cancer in elderly Americans—Review of the literature and case presentation

Even mild iron deficiency anemia, as defined by the World Health Organization, is associated with increased mortality and significant morbidity in elderly individuals who are cancer free. Yet, anemia in the elderly is often dismissed as a benign sign of aging. This problem is exacerbated by the fact that elderly individuals often suffer from gastrointestinal complaints that preclude treatment with iron supplements by mouth. The FDA has approved two brands of injectable iron for treating such patients. Nonetheless, a major American health maintenance organization refuses to treat elderly patients with injectable iron, even when it is indicated, unless their anemia is associated with cancer. This may well reflect a public health crisis afflicting many elderly residents of the United States.

The Influence of Jewish Americans on U. S. Middle East Policy

Ever since the establishment of Israeli statehood in 1948, the United States has been its staunch supporter. This is because of their common beliefs in values, political system and ideology, and America’s interests in the Middle East. However one important factor cannot be ignored., the influence of Jewish Americans’ political forces on U. S. Middle East policy. Since few articles deal with such a topic systematically in China, this essay tries to make a preliminary study on it.

Fast-food Culture and Americans' Outlooks on Life

Fast-food is always the one of the main culture in America just like it has been known.It is not only very important in Americans’lives,but can reflect some of their outlooks on life.This thesis gives an analysis of reflection of Americans’outlooks on life in fast-food culture.Five types of Americans’outlooks on life have been surveyed:working hard and playing hard,optimism and open-mindedness,treating the time as the life,self-independence and believing the equality.Beginning with the introduction of the emergence and development of fast-food culture in America,the thesis brings why the fast-food can be popularized among Americans to light.Consequently,we can find that some of the Americans’outlooks on life can be consistent with their fast-food culture.This thesis will be divided into four parts.The first part is the introduction and the last conclusion.The focus of this thesis is laid on the two middle parts which first display the five types of Americans’outlooks on life,then give the analysis of the reflection in fast-food culture.This thesis attempts to explore the Americans’outlooks on life.Although by the thesis we can not learn about a nation completely,we still know some aspects of their outlooks on life from fast-food culture.Key words:outlook;Americans;fast-food;