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Pregnancy and antenatal care: the attitudes and experiences of Asian women.

Asian women living in the East End of London were interviewed in English or in their own language to assess their attitudes to and experiences of pregnancy and antenatal care and to consider some factors which may influence their experiences, especially their fluency in English. In some respects Asian women's experiences were similar to those of non-Asian women reported in other studies, e.g. similar levels of nausea and lack of tie-up between nausea and negative reactions to pregnancy. However there were also some differences, e.g. Asian women expressed greater concern about the sex of the child and about eating 'cool' foods to counterbalance the hot state of pregnancy. Asian women were good patients: they attended antenatal clinics, read the leaflets provided and about half attended antenatal classes, although some were keener than others to seek information about pregnancy and childbirth and only a quarter bought books or watched videos. Less than half of the women were living in extended families and receiving support from in-laws in the traditional way. Those living in nuclear families received support from friends, neighbours and especially husbands. There were considerable individual differences in women's reactions and experiences. Women who spoke little or no English were less knowledgeable and had lived for a shorter time in the UK than women who were fluent in English. Leaflets in languages women can read and link workers at clinics helped some women.

Acculturation↗

Expectations of support among White British and Asian-Indian older people in Britain: the interdependence of formal and informal spheres.

Abstract The discourse surrounding community care characterises informal support being superior to and preferred over formal sources of support, with this distinction buttressed by policy changes. There is a lack of understanding of the interdependence of both spheres of support. This article argues that an individual's experience and expectation of one type of support is often made in relation to his or her understanding, expectation and experience of other sources of support. There is also an urgent need to understand how these associations operate in a cross-cultural context as it is naïve to assume that normative expectations will remain constant when the relationship between family, state and other sources of support are unstable. This article reports on findings emerging from part of a Growing Older study funded by the Economic and Social Research Council of Great Britain to explore the relationship between quality of life and the social networks and support of older people from different ethnic groups. Research involved the use of a questionnaire comprising closed- and open-ended questions. In addition, in-depth qualitative interviews covering the existence and nature of social networks and support, as well as perceptions and expectations of these, were also conducted. This article reports on data relating to a sample comprising seven White British men, 10 White British women, 12 Asian-Indian men, and nine Asian-Indian women aged 55 and over derived from the Family Resources Survey. Findings reveal that the high level of expectation for family support amongst Asian-Indian respondents coexists with a high level of expectation for state support and an acknowledgement that the ideal of family support may not always materialise. Amongst White British respondents, the high level of expectation for state support exists regardless of whether the respondent has satisfactory informal social networks. This expectation is commonly expressed in terms of rights and entitlement by White British respondents but not by Asian-Indians. Associated with this, Asian-Indian respondents display a consistently lower level of awareness and usage of a range of health and social care services. Regardless of the extent of current and past usage of services, however, respondents from both groups overwhelmingly indicate an expectation for the continued provision of such services as they would like to be able to use one or more of these at some stage.

Aged↗

Difference in root canal length between Asians and Caucasians.

AIM: To investigate whether there is a racial difference in canal length between the Asians and Caucasians. METHODOLOGY: Five hundred and fifteen Asian patients who had received root canal treatment at the Yonsei University Hospital, Korea between 1995 and May 2001 and 324 Caucasoid patients who had received root canal treatment at the Graduate Endodontic Clinic at the University of Pennsylvania, US were selected. The clinical endodontic procedures at both clinics were similar. An electronic apex locator (Root-ZX; J. Morita Co., Kyoto, Japan) was used to measure the initial working lengths and this was verified by conventional radiography. The measurements from both Asian and Caucasian teeth were compared using a Student's t-test and a Mann-Whitney test. RESULTS: The mean difference in canal length of pooled teeth between the Asian and Caucasian teeth was 1.2 mm, with a range from 0 to 2.5 mm. The greatest difference was in the distobuccal canal (2.5 mm) of maxillary first molar teeth followed by the mesiolingual canal (2.3 mm) of mandibular second molar, the buccal canal (2.1 mm) of the maxillary second premolar, the maxillary first molar and the mandibular second molar. CONCLUSION: Tooth lengths in Asians were shorter than Caucasians.

Asian People↗

Factors that influence Asian communities' access to mental health care.

This paper presents the findings of a qualitative study to identify factors that influence Asian communities' access to mental health care and how mental health care is delivered to them. Semistructured interviews were completed with Asian community members/leaders and health-care professionals. Content analysis identified major themes. Participants also completed a demographic data sheet. The research aimed to provide health professionals with an increased understanding of the values and beliefs held by people from Asian communities regarding the cause and treatment of mental illness. Data analysis identified six main themes that influenced Asian communities' access to mental health care and how mental health care is delivered to them. They were: shame and stigma; causes of mental illness; family reputation; hiding up; seeking help; and lack of collaboration. The findings highlighted that people from Asian communities are unwilling to access help from mainstream services because of their beliefs, and that stigma and shame are key factors that influence this reluctance. The findings also highlight that the mental health needs of refugee women are significant, and that they comprise a vulnerable group within Australian society.

Adaptation, Psychological↗

Why do Asian-born women have a higher incidence of gestational diabetes? An analysis of racial differences in body habitus, lipid metabolism and the serum insulin response to an oral glucose load.

We have observed a higher incidence of gestational diabetes (GDM) in Asian-born than in Caucasian women. Body habitus, serum lipid levels and the serum insulin response to a glucose load in pregnancy were compared in 15 women with normal glucose tolerance, 16 Caucasian women with GDM and 19 Asian-born women with GDM. Caucasian women with GDM, unlike Asian-born women with GDM, were obese compared with control women as measured by body mass index (p = 0.022). Both groups of GDM women had similar patterns of insulin response to oral glucose with a delayed insulin peak and an elevated 2-hour insulin level (p = 0.0021). In addition, the insulin response per unit of glycaemic stimulus (incremental insulin area/incremental glucose area at 1 hour) was reduced in both GDM groups (p = 0.035). Fasting serum triglyceride levels were higher in women with GDM although this was only significant in the Caucasian group (p = 0.014). Asian-born women with GDM had significantly lower (p = 0.041) serum cholesterol levels than Caucasian women with GDM. There was a significant correlation (p = 0.025) between glucose tolerance (area under the curve) and fasting serum triglyceride values. The relationship between lipid and carbohydrate metabolism in Asian-born and Caucasian women in pregnancy requires further investigation.

Adult↗

Asian Americans' reports of their health care experiences. Results of a national survey.

OBJECTIVE: To examine how Asian race/ethnicity affects patients' health care experiences and satisfaction with care. DESIGN: Telephone interview using random-digit dialing, stratified to over-sample adults living in areas with disproportionately large numbers of minorities. PARTICIPANTS AND SETTING: White (N = 3,205) and Asian-American (N = 521) respondents, weighted to represent all such adults living in the continental U.S. in telephone households. MEASUREMENTS: Reports of health care experiences and trust in the doctor at the last visit, and overall satisfaction with care and desire to change doctors in the last 2 years. MAIN RESULTS: Asian Americans were less likely than whites to report that their doctors ever talked to them about lifestyle or mental health issues (P < or =.01). They were more likely to report that their regular doctors did not understand their background and values (P < or =.01). When asked about the last visit, they were more likely to report that their doctors did not listen, spend as much time, or involve them in decisions about care as much as they wanted (all P < or =.0001). In multivariable analyses, Asian Americans were less likely than whites to report that they were very satisfied with care (odds ratio [OR], 0.64, 95% confidence interval [CI], 0.42 to 0.99). However, they were not significantly less likely than whites to trust their doctors (OR, 0.79, 95% CI, 0.52 to 1.20), or to change doctors (OR, 0.93, 95% CI, 0.56 to 1.56). CONCLUSIONS: In a national survey, Asian Americans were less likely to receive counseling and less likely to report positive interactions with their doctors than white respondents. More research is needed to determine the reasons for these differences.

Adolescent↗

Advance directive preferences among subpopulations of Asian nursing home residents in the Pacific Northwest.

OBJECTIVE: To study advance directives (code status) among subgroups of Asian nursing home residents. DESIGN: Cross-sectional design. PARTICIPANTS AND SETTING: A total of 423 residents of Asian descent (aged >55) from two ethnic nursing homes in Seattle, Washington. METHODS: Chart review was conducted on 423 residents (199 discharged between 1995 and 1998 and 244 current residents) to ascertain code status, age, gender, ethnicity, comorbidity (using the Charlson Index), and religion. RESULTS: Seventy percent of the residents were women, median age was 83 +/- 9, 43% were Chinese, 40% Japanese, and 17% other Asian (Korean, Filipino, Southeast Asian). The majority of the patients in any subgroup (72% overall) were 'no code'. In bivariate analysis, ethnicity, increased age, and comorbidity were correlated with no code status. In multivariable logistic regression, Japanese residents were more likely to be no code (OR 4.1 (95% CI, 3.1- 5.4)) controlling for age, comorbidity, gender, and religion. Chinese were more likely to be full code (OR 3.3 (95% CI, 2.6-4.2)). CONCLUSIONS: Code status differs significantly among Asian subgroups in these ethnic nursing homes. Whereas the majority of residents are no code, Japanese residents are more likely than Chinese or others to be no code. Higher age and comorbidity are also correlated with no code status.

Advance Directives↗

An Asian perspective on relationship and marriage education.

The goal of this article is to provide couple therapists and relationship educators with information to enhance the cultural relevance of their work with Asian populations. Because of the rapid social, economic, cultural, and gender role changes, the various Asian interpretations of the institution of marriage are undergoing major transformation. This article describes the general trends in marriage in several Asian nations, with a focus on the swiftly rising divorce rates and changing cultural attitudes to marriage, and discusses current relationship education initiatives in these nations. Finally, based on my experiences working with Asian populations, I present a few humble insights regarding adaptation of marriage education to render it more culturally appropriate for Asians.

Asian People↗

Declining case fatality rates for acute myocardial infarction in South Asian and white patients in the past 15 years.

OBJECTIVES: To determine whether case fatality rates in South Asian (Bangladeshi, Indian and Pakistani) patients with acute myocardial infarction have shown similar declines to those reported for white patients during the past 15 years. DESIGN: Cross-sectional, observational study. SETTING: Coronary care unit in east London. PATIENTS: 2640 patients-29% South Asian-admitted with acute myocardial infarction between January 1988 and December 2002. MAIN OUTCOME MEASURES: Differences over time in rates of in-hospital death, ventricular fibrillation and left ventricular failure. RESULTS: The proportion of South Asians increased from 22% in 1988-92 to 37% in 1998-2002. Indices of infarct severity were similar in South Asian and white patients, with declining frequencies of ST elevation infarction (88.2% to 77.5%, p < 0.0001), Q wave development (78.1% to 56.9%, p < 0.0001) and mean (interquartile range) peak serum creatine kinase concentrations (1250 (567-2078) to 1007 (538-1758) IU/l, p < 0.0001) between 1988-92 and 1998-2002. Rates of in-hospital death (13.0% to 9.4%, p < 0.01), ventricular fibrillation (9.2% to 6.0%, p < 0.001) and left ventricular failure (33.2% to 26.5%, p < 0.0001) all declined; these changes did not interact significantly with ethnicity. Odds ratios for the effect of time on risk of death increased from 0.81 (95% CI 0.70 to 0.93) to 1.02 (95% CI 0.87 to 1.21) after adjustment for ethnicity and indices of infarct severity (ST elevation, peak creatine kinase, Q wave development and treatment with a thrombolytic). CONCLUSIONS: In the past 15 years, death from acute myocardial infarction among South Asians has declined at a rate similar to that seen in white patients. This is largely caused by reductions in indices of infarct severity.

Asian People↗

Differences in heart rate variability between Asian and Caucasian children living in the same Canadian community.

Heart rate variability (HRV) is an umbrella term for a variety of measures that assess autonomic influence on the heart. Reduced beat-to-beat variability is found in individuals with a variety of cardiac abnormalities. A reduced HRV positively correlates with obesity, poor aerobic fitness, and increasing age. Racial (black-white) differences are apparent in adults and adolescents. We aimed to evaluate (i) Asian-Caucasian differences in HRV and (ii) differences in HRV between girls and boys. Sixty-two children (30 male (15 Caucasian, 15 Asian) and 32 female (15 Caucasian, 17 Asians)) with a mean age of 10.3 +/- 0.6 y underwent 5 min resting HRV recording, fitness testing (Leger's 20 m shuttle), and self-assessed maturity. Outcome HRV measures were a ratio of low to high frequency power (LF:HF), standard deviation of R-R intervals (SDRR) and root mean square of successive R-R intervals (RMSSD). Data were compared between groups using analysis of covariance (ANCOVA). There were no race or sex differences for time domain variables, mean R-R, body mass index, or blood pressure. Compared with Caucasian children, Asian children displayed a higher adjusted (fitness, R-R interval) LF:HF ratio (72.9 +/- 59.4 vs. 120.6 +/- 85.3, p < 0.05). Girls demonstrated a higher adjusted LF:HF power than boys (117.2 +/- 85.1 vs. 76.6 +/- 62.4, p = < 0.05). In conclusion, Asian and Caucasian children display different frequency domain components of heart rate variability.

Asian People↗

Ethnic differences in pulmonary function in healthy nonsmoking Asian-Americans and European-Americans.

We investigated ethnic differences in spirometry and gas transfer (DL(CO)) in a young, healthy population of nonsmoking physicians and medical students aged 22-33 yr, of European or Asian descent. Each answered questions detailing ethnic background, medical history, level of physical activity, and length of residence in the United States. Spirometry and single-breath DL(CO) maneuvers were performed in accordance with ATS standards. Venous blood was measured for hemoglobin (Hb). The same equipment was used to test all subjects. Data were analyzed by multiple linear regression. Eighty subjects were studied, with 20 in each of the following groups: European male, European female, Asian male, and Asian female. Asian values for forced vital capacity, forced expiratory volume in 1 s (FEV(1)), and alveolar volume (VA') were significantly lower than for Europeans, but DL(CO), DL(CO)/VA', and DL(CO)/VA'/Hb did not differ significantly. These differences could not be attributed to age, length of residence in the United States, activity level, or variance in baseline characteristics and anthropometric measurements, and therefore represent a true physiologic difference. Ethnic differences between individuals of Asian and European backgrounds should be considered when interpreting pulmonary function tests, especially when predicted values are based on populations of European descent.

Adult↗

A psychiatric residency curriculum about Asian-American issues.

Asian Americans constitute the third-largest and the fastest-growing minority group in the United States, with a population of 10.2 to 11.9 million in Census 2000. It is a heterogeneous group that includes at least 43 ethnic subgroups with different languages and dialects, immigration patterns, and religious beliefs; varying socioeconomic status; and different traditional patterns of seeking health care. These social and cultural variables affect Asian Americans' help-seeking behaviors, development of psychiatric disorders, manifestation of psychiatric symptoms, treatment strategies, compliance, and outcomes. This article reviews experiences of Asian Americans relevant to their mental health, including migration patterns to the United States, socioeconomic status, and cultural variables. It proposes educational objectives in the assessment and treatment of Asian-American patients that are essential for the training of psychiatric residents. In particular, it addresses special considerations in implementation of a psychiatric curriculum directed to the care of Asian-American psychiatric patients.

Journal Article↗

Mental health issues for Asian Americans.

One of fastest-growing population groups in recent decades, Asian Americans represent a vastly diversified and rich mixture of cultures, languages, beliefs, and practices, many of which differ widely from those of European Americans. As immigrants, Asian Americans have experienced and continue to experience various emotional and behavioral problems. However, they tend to underuse existing services except those that are culturally appropriate and linguistically compatible. Misdiagnosis frequently occurs, and the existence of culture-bound syndromes points to a lack of precise correspondence between indigenous labels and established diagnostic categories. Due to Asian traditions of viewing the body and mind as unitary rather than dualistic, patients tend to focus more on physical discomforts than emotional symptoms, leading to an overrepresentation of somatic complaints. Traditional practices and healing methods are frequently used to alleviate distress both before and after patients and their family members approach the conventional mental health care system. Help seeking typically is a family venture. Asian patients respond well to highly structured therapeutic interventions such as those used in behavioral, cognitive, and interpersonal models. When applying pharmacotherapy, clinicians should pay attention to Asians' unique responses to psychotropics, especially in regard to dosage requirements and side effects. Research in this area as well as on other important issues is in the early stage of development.

Asian↗

Profiles of Asian American students with LD at initial referral, assessment, and placement in special education.

Alhough Asian American students are underrepresented in special education, recent studies have highlighted concerns about the cultural and linguistic appropriateness of the identification and placement process. This study examined the characteristics of Asian American elementary students with learning disabilities (LD) in a school district in the Southwest that was selected because it served the largest number of Asian American students with LD in the state. Due to the small numbers of students served, the sample included all Asian American students with LD in Grades K to 5 (N = 26). Variables of interest included students' demographic characteristics, factors associated with referral, assessment practices and student profiles, and instructional recommendations for special education services. The results suggest that the experiences of Asian American students with LD are similar to those of Mexican American students with LD reported in earlier studies. These findings also reflect the challenges faced by educators in providing appropriate educational services for language minority students.

Asian↗

Differences in the urinary excretion of 6-beta-hydroxycortisol/cortisol between Asian and Caucasian women.

The urinary ratio of 6-beta-hydroxycortisol/cortisol has been used as a noninvasive probe for human cytochrome P450 3A4 isoforms (CYP3A4). Ethnic-related differences in the ratio have not been evaluated. The aim of this study was to determine if there are differences in the ratio between Asian and Caucasian women over a menstrual cycle. First-morning urine samples were collected every other day starting from the second day of menstruation for a complete menstrual cycle from 15 Asians and 16 Caucasian women who were 18 to 40 years old, healthy, nonsmoking, and alcohol and drug free, including oral contraceptives. Urine concentrations of 6-beta-hydroxycortisol and cortisol were measured by high-pressure liquid chromatography (HPLC). For statistical analysis, three phases of the menstrual cycle were evaluated: menstruation (days 1-4), follicular or postmenstruation (days 6-10), and the luteal phase (days 21-24) based on the average menstrual cycle (28 days). Statistical analysis was performed by an independent sample t-test using the Bonferroni correction for repeated measures. Large intersubject and intrasubject variations of the 6-beta-hydroxycortisol/cortisol ratios were observed during the menstrual cycles in both ethnic groups. Asian women had a statistically significant lower ratio than Caucasian women did for all three phases of the menstrual cycle: 2.2 +/- 1.1 versus 5.1 +/- 3.5, 2.1 +/- 1.1 versus 6.0 +/- 4.9, and 2.8 +/- 1.6 versus 5.6 +/- 3.0 for the menstruation, follicular, and luteal phases, respectively. The two- to threefold lower 6-beta-hydroxycortisol/cortisol ratios in Asian women suggest that Asian women may have a lower CYP3A activity compared with Caucasian women. Differences in ethnicity may mask potential gender-related effects if ethnic background is not evaluated as a contributing factor.

Adolescent↗

Development of a questionnaire to assess attitudes and beliefs toward organ donation among Asians.

In the United Kingdom, people from the Indian subcontinent have a higher incidence of kidney failure, are less likely to receive a kidney transplant, and have a higher mortality rate from renal disease. In addition, Asians are reluctant donors; white people make up 95% of the donor pool. We developed a questionnaire to determine the knowledge and attitudes toward organ donation in the Asian communities. The setting was a public forum; the aims were (1) to study the attitudes of Asians toward organ donation, (2) to validate our questionnaire, and (3) to initiate a campaign of increasing awareness of organ donation and transplantation in the Asian community in the greater Glasgow area. Our survey suggested that Asians have an awareness of organ donation and transplantation, and they would donate an organ to a family member; however, they did not carry a donor card. Respondents unanimously agreed that lobbying by religious leaders was the best means to promote awareness.

Adult↗

De novo genome assemblies of threatened Asian hornbills (Bucerotidae) reveal declining population trajectories during the late Pleistocene.

BACKGROUND: Asian hornbills are flagship species of the wet tropics that face significant threats from hunting, habitat loss, and fragmentation. Despite being conservation flagships, whole genome information is available for only two of the 32 Asian hornbill species. In this study, we provide the first de novo genome assemblies for four hornbill species (Bucerotidae) in Asia. METHODS: We used a combination of long-read and short-read sequencing data to assemble and annotate de novo hybrid genomes of four species of hornbills. We also assembled and compared mitochondrial genomes of these species. Using a comparative genomics approach, we performed orthology assignment and gene evolution analyses to identify unique gene families in Asian hornbills, gene families that showed significant expansion, their functions and structural variation. Furthermore, using the Pairwise Sequentially Markov Coalescent (PSMC) method, we reconstructed demographic histories of hornbill species to examine changes in their population trajectories in the past. RESULTS: We present hybrid genome assemblies for Great Hornbill (B. bicornis - GH), Rufous-necked Hornbill (A. nipalensis- RNH), Malabar Pied Hornbill (A. coronatus- MPH) and Wreathed Hornbill (R. undulatus- WH). The genome sizes of these hornbills range from 1.1 Gb to 1.3 Gb, with over 95.9% completeness and gene prediction BUSCO. We reported 10,525 orthogroups shared among four Asian hornbill species and identified significant expansion in gene families associated with structural keratin development in Asian hornbills compared to their ancestors. We also provide annotated mitogenomes for each of these species. Furthermore, we found that the WH, a more abundant, widely distributed, and migratory species, showed a higher Ne than the other three hornbill species. However, an overall decline in Ne for all species was recorded during the Pleistocene climatic fluctuations. CONCLUSIONS: We present the first-ever, high-quality reference genomes for the threatened hornbill species from Asia. Hornbills have shown significant expansion in genes involved in structural keratin development. Our results indicate that Pleistocene climatic fluctuations have led to dramatic population declines in all four species. We believe that this study provides robust genomic resources to support future comparative and conservation genomics efforts for hornbills.

Animals↗

Genetics of type 1 diabetes: similarities and differences between Asian and Caucasian populations.

Transracial studies are a powerful tool for genetic association studies of multifactorial diseases, such as type 1 diabetes. We therefore studied the association of candidate genes, HLA, INS, CTLA4, PTPN22, and SUMO4, with type 1 diabetes in Asian populations in comparison with Caucasian populations. Class II HLA was strongly associated with type 1 diabetes in both Asian and Caucasian populations, but alleles associated with type 1 diabetes are different among different ethnic groups due to difference in allele distribution in general populations. INS was associated with type 1 diabetes in both Japanese and Caucasian populations, but frequency of disease-associated haplotype was markedly higher in Japanese than in Caucasian populations. CTLA4 association was reported for both type 1 diabetes and autoimmune thyroid diseases (AITD) in Caucasian populations, but the association with type 1 diabetes was concentrated in a subset of patients with AITD in Japanese. A variant (R620W) of PTPN22 was consistently associated with type 1 diabetes in Caucasian populations, but the variant was absent in Asian populations including Japanese. M55V variant of SUMO4 was significantly associated with type 1 diabetes in Asians, but genetic heterogeneity between Asian and Caucasian populations was suggested. These data indicate the importance of transracial studies with a large number of samples in each ethnic group in genetic dissection of type 1 diabetes.

Alleles↗