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A comparison of HLA-DR and -DQ allele and haplotype frequencies in Trinidadian populations of African, South Asian, and mixed ancestry.

Using polymerase chain reaction-sequence-specific primer (PCR-SSP) typing, this study determined the frequency of human leukocyte antigen (HLA) DR- and -DQ alleles and haplotypes in individuals of African (n = 75), South Asian (n = 98), and mixed (n = 102) ancestry from the Caribbean island of Trinidad. We detected 19 different haplotypes containing DRB3, 8 containing DRB4, 6 containing DRB5, and 6 different haplotypes without DRB3/4/5 genes. Twenty-nine haplotypes were identified in Africans, 24 in the South Asians, and 32 in the mixed group. We detected significant differences between the populations, principally at the DQA1 and DQB1 loci, although the allele frequency for DRB1*0901 was highest in the Africans (p(c) < 0.05). Trinidad African and mixed groups were generally more diverse than the South Asians and displayed a wider range of DRB1-DQB1 associations; DQB1*02 and DQB1*0301 each associated with five to six different DRB1 alleles in the Africans and mixed group but only two in South Asians. In the Africans and the mixed group, DQB1*04 was found with DRB1*0302 and DRB1*04, but only with DRB1*08 in the South Asians. Trinidad Africans revealed consistencies with populations in Western, Central, and Northern Africa, but differed considerably from individual populations on the African continent. Trinidad South Asians displayed similar allele frequencies and associations to other populations from Northern India.

Alleles↗

A variant of the endotheliotropic herpesvirus in Asian elephants (Elephas maximus) in European zoos.

Newly discovered, lethal elephant endotheliotropic herpesviruses (EEHV) have been identified in both Asian (Elephas maximus) and African (Loxodonta africana) elephants. Carried by otherwise healthy African elephants they can be fatal mainly for young Asian elephants. Since zoos often harbour both elephant species, we conducted a survey on the presence of EEHV in Asian elephants from 12 European zoos, 3 circuses and 1 Israeli zoo. Here, we demonstrate that all EEHV that have affected Asian elephants so far belong to the EEHV1 group. We also describe the detection and the partial sequencing of an endotheliotropic herpesvirus variant (named EEHV1b) in Asian elephants, being either an EEHV endogenous to Asian elephants or indicating different sources (African elephants) of infection.

2-Aminopurine↗

Ethnicity and type 2 diabetes: focus on Asian Indians.

Though the overall prevalence of type 2 diabetes is increasing in US and in all other westernized countries, significant differences are noted among different ethnic groups. The reasons for ethnic differences in the risk of type 2 diabetes are not entirely understood. For example, Asian Indians (people from India, Pakistan, and Bangladesh) have remarkably high prevalence of type 2 diabetes compared to Caucasians. However, the incidence of obesity, an important risk factor in the development of type 2 diabetes, is significantly lower in Asian Indians compared to Caucasians. Though westernization of lifestyle with dietary changes and lack of exercise may play a role in increased prevalence of type 2 diabetes in migrant Asian Indians, various epidemiological studies have shown that these factors alone are not sufficient to explain this trend. One important factor contributing to increased type 2 diabetes in Asian Indians is excessive insulin resistance compared to Caucasians. This difference in the degree of insulin resistance may be explained by either an environmental or a genetic factor or by combination of both. The understanding of the etiology and mechanisms causing increased insulin resistance in Asian Indians will provide clues to more effective prevention and treatment of diabetes in this ethnic group. Furthermore, the information may help in understanding the pathophysiology of type 2 diabetes in other ethnic groups and improve methods of treatment and prevention in all ethnic groups. Since the ethnic mix of the US population is changing rapidly and it is estimated that by the year 2020, over 50% of US population will include non-Caucasian ethnicity, the identification of the mechanism involved in the excessive development of type 2 diabetes in non-Caucasians becomes important. In this review, possible etiology of excessive insulin resistance and role of free fatty acids (FFA) in insulin resistance in Asian Indians is discussed. Finally, the role of targeting insulin resistance in prevention and treatment of diabetes is discussed.

Diabetes Mellitus, Type 2↗

Neonatal feeding practices of Anglo American mothers and Asian Indian mothers living in the United States and India.

OBJECTIVE: To compare the colostrum and prelacteal feeding practices of Anglo American mothers and Asian Indian mothers living in the United States and India. DESIGN: Data were collected by interviews in the mother's home. SETTING: Southeastern United States and India. PARTICIPANTS: Participants included 75 mother-infant pairs (n=25 per ethnic group). VARIABLES MEASURED: Demographic characteristics, length of US residence, mother's colostrum and prelacteal feeding practices, and associated reasons. ANALYSIS: Descriptive statistics. RESULTS: All Anglo American mothers initiated breast-feeding immediately after the infant's birth, and none gave prelacteal feeds. Asian Indian mothers living in the United States and India initiated breast-feeding postpartum at means of 12 and 30 hours, respectively. Six of the Asian Indian women living in the United States and 17 Asian Indian mothers living in India delayed introducing colostrum and fed prelacteal feeds. CONCLUSIONS AND IMPLICATIONS: Asian Indian women who come to live in the United States demonstrate different feeding practices than their Indian counterparts. In India, women may receive guidance regarding breast-feeding primarily from relatives and friends, whereas in the United States, breast-feeding counseling may be provided by health professionals. Nutritionists are encouraged to understand the maternal reasons for withholding colostrum and prelacteal feeding and to give compatible messages targeted at women of Asian Indian origin about breast-feeding.

Adult↗

Generational changes in height and body mass differences between British Asians and the general population in Glasgow.

A weighted total of 630 pupils aged 14-15 in Glasgow schools, about evenly divided between pupils of South Asian and non-Asian (overwhelmingly British) background, were measured for height and weight and compared with previous results for a similar Glasgow sample aged 30-40. Among 14-15-year-olds, British Asians were not so short compared with non-Asians as among 30-40-year-olds, especially females. Among 30-40-year-old Glasgow Asians only 7% were born in the UK, while among 14-15-year-old Glasgow Asians 86% were so born, indicating that they are the children of migrants. Generational differences in these comparisons cannot be due to positive selection of the migrant generation for height, and are attributed to improved environment, including nutrition and public health measures. This suggests the possibility of corresponding improvements in coronary and diabetic risk.

Adolescent↗

Diabetes mellitus and retinal vein occlusion in patients of Asian, west Indian and white European origin.

The incidence of retinal vein occlusion (RVO) is known to be related to several cardiovascular risk factors including diabetes mellitus, hypertension and hyperlipidaemia. We have assessed the prevalence of these risk factors in Caucasian (N = 536, mean age = 65.21 years), West Indians (N = 24, mean age = 57.3 years) and Asian (N = 28, mean age = 51.4 years) patients presenting with RVO. We found no significant differences between the three groups in the distribution of hyperlipidaemia, but diabetes mellitus was more common amongst both the Asians and W. Indians (10% v 29% and 38%, p < 0.01 and p < 0.001). Hypertension was also more common in both the Asians and the West Indians (59% v 64% and 83% m p < 0.001 and p < 0.0001). The Asians and West Indians presenting with RVO were significantly younger and had significantly higher body mass index than their Caucasian counterparts (Ethnic origin, BMI, mean age: Asian, 28.1 +/- 4.3, 51.5 +/- 12.3 years; West indian: 30.2 +/- 7.7, 57.3 + 10 years; White: 24.8 +/- 4.2, 65.2 +/- 11.4 years). In this study RVO occurred at a younger age in Asians and West Indians, and was associated with a greater prevalence of diabetes mellitus and hypertension. The prevalence of hyperlipidaemia was no different in the three groups.

Age Factors↗

The clinical characteristics of Asian and Caucasian patients on Bradford's Low Vision Register.

AIM: To analyse the clinical characteristics of patients on the Bradford Low Vision Register with regards to the type (partially sighted or blind), sex, race, causes and age at registration. METHODS: All the data were obtained from the Morley Street Resource Centre, which keeps records of all registrations in the Bradford Metropolitan District. Information including postcode, date of birth, age, gender, ethnic group, degree, date of registration, cause of registration and age at registration were entered into a database. RESULTS: Of all registrations, 64% were blind and 36% were partially sighted. Asians were younger at registration and there were a significantly lower number of females compared to Caucasians. When data were analysed for the different age groups, in the older group of over 65 years, Asians showed significantly more diabetic retinopathy (26.1%) compared to Asians (7.8%), while Caucasians demonstrated significantly more glaucoma (C: 29.3%; A: 17.4%). In the younger age group (<30 years), the leading causes for Asians were retinitis pigmentosa and nystagmus while for Caucasians it was congenital cataracts and optic atrophy. The proportion of Asians registered was significantly lower than expected from the projected population estimates in Bradford. CONCLUSIONS: The study indicates significant differences in the clinical profiles of the two racial groups. The data do not follow the predictions from published population estimates, with Asians, especially females, being under-represented in the register.

Adult↗

Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians.

OBJECTIVE: To investigate the association between circulating C-reactive protein (CRP) concentrations and indices of body fat distribution and the insulin resistance syndrome in South Asians and Europeans. DESIGN: : Cross-sectional study. SUBJECTS: A total of 113 healthy South Asian and European men and women in West London (age 40-55 y, body mass index (BMI) 17-34 kg/m(2)). MEASUREMENTS: Fatness and fat distribution parameters (by anthropometry, dual-energy X-ray absorptiometry and abdominal CT scan); oral glucose tolerance test with insulin response; modified fat tolerance test; and CRP concentration by sensitive ELISA. RESULTS: Median CRP level in South Asian women was nearly double that in European women (1.35 vs 0.70 mg/1, P=0.05). Measures of obesity and CRP concentration were significantly associated in both ethnic groups. The correlation to CRP was especially strong among South Asians (P<0.01) for measures of central obesity (waist girth and visceral fat area), whereas BMI and percentage fat were more significantly associated with CRP in Europeans (P<0.05). In South Asians the associations of CRP with visceral fat area and waist girth persisted after adjustment for either BMI or percent fat (all, P<0.05). In age-, sex- and smoking-adjusted regression analyses CRP concentrations were significantly associated with fasting and 2 h insulin and lipid levels in both ethnic groups (P<0.05). When further statistical adjustment was made for visceral fat area these associations were abolished (P>0.15). CONCLUSION: We suggest that adiposity and in particular visceral adipose tissue is a key promoter of low-grade chronic inflammation. This observation may in part account for the association of CRP with markers of the metabolic syndrome. Future studies should confirm whether CRP concentrations are elevated in South Asians and whether losing weight by exercise or diet, or reduction in visceral fat mass, is associated with reduction in plasma CRP concentrations.

Adipose Tissue↗

Polycystic ovaries and associated metabolic abnormalities in Indian subcontinent Asian women.

OBJECTIVES: To determine the prevalence of polycystic ovaries (PCO) in Asian women living in England who are of Indian subcontinent origin or ancestry and to investigate the relationship between the presence of PCO and/or non-insulin dependent diabetes mellitus (NIDDM) and insulin sensitivity and other metabolic parameters. DESIGN: A random sample of Indian subcontinent Asian women was obtained from the lists of local General Practitioners and a translating service. These women were invited to attend for a medical history questionnaire, examination, venous blood sample for hormonal assessment and transvaginal ovarian ultrasonography. Groups of women without PCO or NIDDM, with NIDDM but not PCO, with PCO but not NIDDM and with both NIDDM and PCO were drawn at random from this population and from Indian subcontinent Asian women attending the Diabetes Unit. They underwent further studies, including measurement of insulin sensitivity using a short intravenous insulin tolerance test. SUBJECTS: 212 Indian subcontinent Asian women aged 18-40 took part in the initial study. Insulin sensitivity was measured in 13 women without PCO or NIDDM, 13 women with NIDDM but not PCO, 15 women with PCO but not NIDDM and 12 women with both NIDDM and PCO. MEASUREMENTS: The main outcome measures were prevalence of polycystic ovaries, clinical features of hyperandrogenism, fertility, blood pressure, serum gonadotrophins, testosterone and sex hormone binding globulin, fasting blood lipids, glucose and insulin, and insulin sensitivity. RESULTS: The prevalence of PCO in Indian subcontinent Asian women was 52% (110/212). There were significant associations between PCO and menstrual irregularity; infertility; the Ferriman and Gallwey score for body hair distribution; the presence of acanthosis nigricans and the fasting blood glucose concentration. There were no differences between women with PCO and those with normal ovarian morphology with respect to systolic and diastolic blood pressure, fasting total, HDL and LDL cholesterol and triglyceride concentrations. The subgroup of women without PCO or NIDDM had the highest insulin sensitivity (189.1 +/- 46.4 mumol glucose/l/min, mean +/- SD) and the women with both PCO and NIDDM had the lowest insulin sensitivity (80.5 +/- 30.9 mumol glucose/l/min). There was no significant difference in insulin sensitivity between those with PCO but not NIDDM (125.0 +/- 59.5 mumol glucose/l/min) and those with NIDDM but not PCO (120.8 + 38.0 mumol glucose/l/min). The effects of NIDDM and PCO on insulin sensitivity were independent; the effect of PCO on insulin sensitivity was -60 mumol glucose/l/min (95% confidence interval -100 to -21, P = 0.004) and the effect of NIDDM was -68 mumol glucose/l/min (95% confidence interval -105 to -31, P < 0.001). There were no significant relationships between insulin sensitivity and fasting plasma insulin, systolic or diastolic blood pressure, fasting serum cholesterol or triglyceride. CONCLUSIONS: The prevalence of polycystic ovaries in Indian subcontinent Asian women is very high and it has significant clinical associations. Polycystic ovaries and non-insulin dependent diabetes mellitus are associated with similar degrees of reduced insulin sensitivity in this population. Their effects are independent suggesting that these changes in insulin sensitivity involve different mechanisms. Polycystic ovaries unlike non-insulin dependent diabetes mellitus, are not associated with a defect in the secretion of insulin.

Adolescent↗

Asian migration to Australia: food and health consequences.

Australia's food and health patterns are inextricably and increasingly linked with Asia. Indigenous Australians arrived in the continent via Asia and have linguistic connections with people who settled in south India; there was interaction and food trade between both South-East Asia and China and northern indigenous Australians over thousands of years. After European settlement in 1788, there have been several and increasing (apart from the period of the infamous White Australian Policy following the Colonial period and Independence, with Federation, in 1901) waves of Asian migration, notably during the gold rush (Chinese), the building of the overland Telegraph (Afghans), the Colombo Plan and Asian student education in Australia from the 1950s onwards (South-Eeast Asians), and with refugees (Vietnamese and mainland Chinese), and business (late twentieth century) and progressive family reunion. Each wave has injected additional food cultural elements and caused a measure of health change for migrants and host citizens. Of principal advantage to Australia has been the progressive diversification of the food supply and associated health protection. This has increased food security and sustainability. The process of Australian eating patterns becoming Asianized is evident through market garden development (and the introduction of new foods), fresh food markets and groceries, restaurants and the development of household cooking skills (often taught by student boarders). Most of the diversification has been with grain (rice), legumes (soy), greens, root vegetables, and various 'exotic fruits'. Food acculturation with migration is generally bi-directional. Thus, for Asians in Australia, there has been a decrease in energy expenditure (and a lower plane of energy throughput), an increase in food energy density (through increased fat and sugary drink intakes), and a decrease in certain health protective foods (lentils, soy, greens) and beverages (tea). This sets the stage for 'eco-diseases'. In a population probably genetically programmed (but modifiably) in utero to abdominal obesity, diabetes (type II and gestational) and cardiovascular disease, these conditions may be rapidly acquired on migration, along with certain cancers (breast, colo-rectal and prostate). Thus, whilst Asian migration to Australia has provided health opportunities for host citizens, there have been threats to migrant citizens in regard to nutrition-related health.

Acculturation↗

Women with a history of gestational diabetes of European and South Asian origin are shorter than women with normal glucose tolerance in pregnancy.

AIMS: It has been reported that short individuals are more likely to have abnormalities of glucose homeostasis. The aim of this study was to examine the relationship between adult height and gestational diabetes mellitus (GDM), taking into account possible artefactual or confounding explanations. METHODS: Three hundred and forty-six women with previous GDM (169 European, 102 South Asian, 75 Afro-Caribbean) and 470 control women with no previous history of GDM (282 European, 94 South Asian and 94 Afro-Caribbean) were studied. Post-partum glucose status and height were measured. RESULTS: European and South Asian women with previous GDM were shorter than control women from the same ethnic groups (European: (mean +/- SD) 162.9 +/- 6.1 vs. 165.3 +/- 6.8 cm, P < 0.0001; South Asian: 155.2 +/- 5.4 vs. 158.2 +/- 6.3 cm, P = 0.003, adjusted for age). A similar, but non-significant trend was observed among Afro-Caribbean women (162.2 +/- 6.2 vs. 163.7 +/- 6.1 cm, P = 0.1). Similar, significant height differences were observed in Europeans and South Asians when analysis was restricted to those GDM women who had received insulin during pregnancy. There was no association between height and glucose tolerance postpartum within the GDM group. CONCLUSIONS: European and South Asian women with previous GDM are shorter than control women from the same ethnic groups. The data demonstrate that this is unlikely to be an artefact resulting from the use of an fixed 75 g load in women of differing sizes, and suggest that there are likely to be common pathophysiological mechanisms underlying GDM and the determination of final adult height.

Adult↗

Risk of diabetes-related amputation in South Asians vs. Europeans in the UK.

AIMS: To compare the risk of and risk factors for diabetes-related amputation in South Asians and Europeans. METHODS: This was a population-based case control study based in the health districts of Bolton, Oldham and Central Manchester in the UK. Cases with diabetes-related amputation performed between 1992 and 1997 (n = 172) and controls with diabetes and no amputation (n = 376) were selected from the primary care-based North-west Diabetes Foot Study database. Risk factor data were also collected. RESULTS: Age at diagnosis adjusted odds ratio (OR) of amputation in South Asians compared with Europeans was 0.26, 95% confidence interval (CI) 0.11-0.65, P = 0.004. In the control population, South Asians were less likely than Europeans to have peripheral vascular disease (PVD) (9% vs. 24%, P = 0.02), neuropathy (30% vs. 54%, P = 0.003), and less likely to have ever been smokers (31% vs. 57%, P = 0.03). When these factors were added to the model, the OR was attenuated to 0.84, 95% CI 0.23-3.08, P = 0.8. CONCLUSIONS: South Asians with diabetes have about a quarter of the risk of amputation of Europeans. This is mostly explained by low rates of PVD and neuropathy in South Asians, in part associated with low rates of smoking. The reasons for the South Asian protection from both PVD and neuropathy deserve further exploration.

Age of Onset↗

Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men.

Type 2 diabetes mellitus (T2DM) is strongly associated with obesity in most, but not all, ethnic groups, suggesting important ethnic differences in disease susceptibility. Although it is clear that insulin resistance plays a major role in the pathogenesis of T2DM and that insulin resistance is strongly associated with increases in hepatic (HTG) and/or intramyocellular lipid content, little is known about the prevalence of insulin resistance and potential differences in intracellular lipid distribution among healthy, young, lean individuals of different ethnic groups. To examine this question, 482 young, lean, healthy, sedentary, nonsmoking Eastern Asians (n = 49), Asian-Indians (n = 59), Blacks (n = 48), Caucasians (n = 292), and Hispanics (n = 34) underwent an oral glucose tolerance test to assess whole-body insulin sensitivity by an insulin sensitivity index. In addition, intramyocellular lipid and HTG contents were measured by using proton magnetic resonance spectroscopy. The prevalence of insulin resistance, defined as the lower quartile of insulin sensitivity index, was approximately 2- to 3-fold higher in the Asian-Indians compared with all other ethnic groups, and this could entirely be attributed to a 3- to 4-fold increased prevalence of insulin resistance in Asian-Indian men. This increased prevalence of insulin resistance in the Asian-Indian men was associated with an approximately 2-fold increase in HTG content and plasma IL-6 concentrations compared with Caucasian men. These data demonstrate important ethnic and gender differences in the pathogenesis of insulin resistance in Asian-Indian men and have important therapeutic implications for treatment of T2DM and for the development of steatosis-related liver disease in this ethnic group.

Adipose Tissue↗

Vitamin D deficiency: a concern in pregnant Asian women.

Vitamin D status of Asian mothers in Cardiff was investigated during early pregnancy and at the time of the birth of their babies, using serum parathyroid hormone (PTH). Median values in Asian (n 32) and Caucasian (n 63) mothers in early pregnancy were 1.56 and 0.81 pmol/l respectively. PTH levels from a separate sample of nineteen Asian and twenty-five Caucasian mothers at the time of birth were 3.0 and 2.20 pmol/l respectively. Altogether twelve Asian and two Caucasian women had elevated PTH. All Asian women who had high PTH values also had a very low serum 25-hydroxycholecalciferol level (25OHD). All samples were taken from women with no significant medical history and normal obstetric history. These findings suggest that subclinical vitamin D deficiency is still a cause for concern in Asian women. More active measures need to be taken to implement current recommendations to improve their vitamin D intake in pregnancy.

Asia↗

Null and opposing effects of Asian ginseng (Panax ginseng C.A. Meyer) on acute glycemia: results of two acute dose escalation studies.

OBJECTIVE: We have repeatedly reported that a batch of American ginseng with a specific ginsenoside (glycosidal saponin) profile decreases acute postprandial glycemia. We investigated whether Asian ginseng is able to replicate this glycemia-lowering efficacy in two separate acute dose escalation studies. METHODS: Each study was conducted in a separate sample of 11 healthy subjects (gender: 8M:3F and 6M:5F, age: 29 +/- 2y and 27 +/- 3y, BMI: 28.5 +/- 2.1 kg/m(2) and 26.9 +/- 1.4 kg/m(2)) using a randomized, single-blind, placebo-controlled, multiple-crossover design. Treatments consisted of 0 (placebo), 1, 2, and 3 g of Asian ginseng for the first study and 0 (placebo), 3, 6, and 9 g Asian ginseng for the second study administered 40 minutes before a 75g-OGTT protocol with blood drawn at -40, 0, 15, 30, 45, 60, 90, and 120 minutes. Ginsenosides were analyzed by HPLC-UV. RESULTS: Neither the main effect of pooled-treatment, nor dose, nor either factors interaction with time was significant for incremental plasma glucose and insulin. But the diagnostically and therapeutically relevant two-hour plasma glucose (2h-PG) value was significantly higher for pooled Asian ginseng treatment than placebo (5.46 +/- 0.31 versus 4.99 +/- 0.30 mmol/L, p = 0.050). Ginsenoside analyses showed that the Asian ginseng contained up to 96% lower and sevenfold higher quantities of various ginsenosides and their ratios than our previous efficacious batch of American ginseng. CONCLUSIONS: Asian ginseng showed both null and opposing effects on indices of acute postprandial plasma glucose and insulin. This is in contrast to our findings with American ginseng. One explanation may be the marked ginsenoside differences. Practitioners and consumers should be aware of ginseng's variable effects.

Acute Disease↗

Cervical cancer screening among South Asian women in Canada: the role of education and acculturation.

Cervical cancer screening by Papanicolaou (Pap) smear lowers the incidence and provides early detection of cervical cancer and is a preventative health care measure that should be available on a regular basis to all women at risk. As the population of ethnic women increases, it is important to assess whether these women are aware of and are utilizing this health service. A self-administered questionnaire was completed by 124 South Asian women, aged 18 to 60 years. Sixty-two South Asian students were selected from a university setting and 62 Tamil women were selected from a community center for South Asian women. This study examined the knowledge and use of Pap smears in South Asian women in Canada, and whether their level of acculturation or formal education influenced whether they know about and receive Pap smears. Low level of knowledge about the Pap test and a low prevalence of Pap testing behaviour was significantly correlated (p < 0.001) with a low level of formal education, education taking place outside of Canada, and a low index of acculturation. South Asian students were significantly more acculturated than Tamil women (p < 0.001). In conclusion, there was a low level of knowledge and prevalence of cervical cancer screening among South Asian women. This study highlights the need for educational interventions in Canada directed to ethnic women especially from South Asia.

Acculturation↗

The need for change in UK mental health services: South Asian service users' views.

OBJECTIVES: UK literature on mental health services for ethnic minority service users relies heavily on perceptions of professionals, carers and community representatives. This research investigates the views of South Asian service users themselves about experiences of mental health services and how they might be improved. DESIGN: Thematic analysis of material from focus groups and individual interviews with Asian mental health service users within one local area. RESULTS: South Asian service users clearly identify the impact of socio-economic exclusion upon their mental health. Cultural and institutional exclusion compound this, leading to continuing insensitivity towards their particular needs within hospital and community-based services. Asian service users feel unsafe to share their particular concerns within many service settings. They see advocacy that recognises their experience of exclusion as a significant resource for mental health improvement. They want sounder financing of culturally appropriate services for recovery; further development of the cultural competence of staff within mainstream services; and educational programmes about mental health directed at minority communities. CONCLUSION: UK mental health services remain unresponsive to the consistently expressed views of South Asian service users. A major cultural change is required if the UK Government initiative Delivering Race Equality is to impact successfully at the local level. It will have a greater chance of success if the rhetoric of user involvement is matched by systematic consultation with South Asian service users.

Adult↗

Knowledge, uptake and availability of health and social services among Asian Gujarati and white elderly persons.

OBJECTIVES: To investigate factors affecting the uptake of health and social services by elderly Asian Gujarati. METHODS: Four hundred and five Hindu Gujaratis and 381 whites aged 65 years and over residing in Leicester were randomly sampled from the Leicestershire District FHSA list by a computerized method based on linguistic analysis of the patient's name. One hundred and fifty Hindu Gujaratis and 152 whites were interviewed with response rates of 72% for the Asian Gujaratis and 80% for the white groups. The outcome measures were the activities of daily living (ADLs), incontinence, auditory/ visual deficits, cardiovascular disease, cognitive impairment (measured by the Mini-mental State Examination), depression, use of GP and hospital services, knowledge of community health and social services, willingness to use, suitability and cultural accessibility. RESULTS: The poorer uptake of services by elderly Asian Gujarati could not be explained by better health. They were significantly more likely to be dependent in six of the 14 ADLs and had higher rates of diabetes and impaired vision. Significantly more Asian Gujaratis than whites lived with others (84 versus 52%, p < 0.0001) with a greater availability of alternative sources of help and support. The knowledge and understanding of services were significantly poorer in the Gujarati group; fewer Asian Gujaratis knew how to apply for services and of those applying, fewer had been successful. Where services had been obtained, the levels of dissatisfaction were higher in the Gujarati group. The literacy rates were low in the Gujarati sample with 79% being unable to read or write in English and 27% unable to read or write in their mother tongue. CONCLUSIONS: The lower uptake of services by elderly Asian Gujarati is not the result of better health but may be explained by greater family support together with a lack of knowledge of and dissatisfaction with what is available. Health services will need to reappraise and revise some of their practices if they are to cater adequately for this growing population with many needs as yet unmet.

Aged↗