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PubMed2004

Health care seeking for HIV/AIDS among South Asians in the United States.

Health-related behavior is a function of the sociocultural and environmental contexts in which it occurs. With South Asian immigrants, a comprehensive approach that focuses on community and individual factors may be more effective than an individualistic one. This article explores the factors that may influence HIV/AIDS-related health care seeking by South Asian immigrants to the United States. It focuses on South Asians from Bangladesh, India, and Pakistan. The need to involve the community in any intervention process is discussed. An understanding of the determinants of HIV-related health care seeking and behavioral change factors can help social work practitioners develop effective interventions for and with South Asian immigrants.

Asian↗
PubMed1994

Breast cancer and serum organochlorines: a prospective study among white, black, and Asian women.

BACKGROUND: Five small case-control studies have examined the relationship between exposure to organochlorines and the risk of breast cancer and have found inconsistent results. In these studies, organochlorine levels in breast cancer patients were measured after (or at most 6 months before) diagnosis. PURPOSE: We tested the hypothesis that organochlorines are a risk factor for breast cancer, using prospectively gathered data on serum levels of DDE [1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene] (the main metabolite of the pesticide DDT [2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane]) and polychlorinated biphenyls (PCBs). METHODS: Study subjects belonged to a cohort of 57,040 women (46,629 white, 8123 black, and 2288 Asian) from the San Francisco Bay Area who took a multiphasic health examination, independent of concern about risk of breast cancer, in the late 1960s. At that time, a sample of blood was obtained, then frozen and stored. Follow-up was through December 31, 1990. We conducted a nested case-control study of 150 case patients and 150 matched control subjects. A random sample of 50 women per racial/ethnic group who had been diagnosed with breast cancer more than 6 months after the multiphasic examination (mean follow-up = 14.2 years) was selected, and each case patient was matched to a cancer-free control subject. RESULTS: Matched analyses found no differences in the case patients' and control subjects' serum levels of DDE (mean difference = 0.2 parts per billion [ppb]; 95% confidence interval [CI] = -6.7, 7.2) or PCBs (mean difference = -0.4 ppb; 95% CI = -0.8, 0.1). DDE levels, however, tended to be higher among black case patients compared with black controls (mean difference = 5.7 ppb; 95% CI = -3.3, 14.8), and PCBs were lower among white case patients compared with white controls (mean difference = -0.6 ppb; 95% CI = -1.2, -0.1). Organochlorine levels were significantly higher among black and Asian women compared with white women. The mean difference for DDE was 11.0 ppb for black women (95% CI = 4.3, 17.6) and 12.6 ppb for Asian women (95% CI = 6.0, 19.2); for PCBs, the respective differences were 0.8 ppb for black women (95% CI = 0.2, 1.4) and 1.4 ppb for Asian women (95% CI = 0.8, 1.9). The results were not altered by adjusting for relevant confounders, and the lack of association between exposure to organochlorines and breast cancer was present regardless of length of follow-up, year of diagnosis, or the case patient's menopausal and estrogen-receptor status. CONCLUSION: The data do not support the hypothesis that exposure to DDE and PCBs increases risk of breast cancer. IMPLICATIONS: Future investigations must consider the biologic mechanisms involved and variations in exposure to chemical pollutants and of breast cancer incidence rates among diverse groups of women.

Adult↗
PubMed1995

Prostate cancer in relation to diet, physical activity, and body size in blacks, whites, and Asians in the United States and Canada.

BACKGROUND: International and interethnic differences in prostate cancer incidence suggest an environmental, potentially modifiable etiology for the disease. PURPOSE: We conducted a population-based case-control study of prostate cancer among blacks (very high risk), whites (high risk), and Asian-Americans (low risk) in Los Angeles, San Francisco, Hawaii, Vancouver, and Toronto. Our aim was to evaluate the roles of diet, physical activity patterns, body size, and migration characteristics on risk in these ethnic groups and to assess how much of the interethnic differences in risk might be attributed to interethnic differences in such lifestyle characteristics. METHODS: We used a common protocol and questionnaire to administer personal interviews to 1655 black, white, Chinese-American, and Japanese-American case patients diagnosed during 1987-1991 with histologically confirmed prostate carcinoma and to 1645 population-based control subjects matched to case patients by age, ethnicity, and region of residence. Sera collected from 1127 control subjects were analyzed for levels of prostate-specific antigen (PSA) to permit comparison of case patients with control subjects lacking serological evidence of prostate disease. Odds ratios were estimated using conditional logistic regression. We estimated the proportion of prostate cancer attributable to certain risk factors and the proportion of interethnic risk differences attributable to interethnic differences in risk-factor prevalence. RESULTS: A positive statistically significant association of prostate cancer risk and total fat intake was found for all ethnic groups combined. This association was attributable to energy from saturated fats; after adjusting for saturated fat, risk was associated only weakly with monounsaturated fat and was unrelated to protein, carbohydrate, polyunsaturated fat, and total food energy. Saturated fat intake was associated with higher risks for Asian-Americans than for blacks and whites. In all ethnic groups combined, the risk tended to be higher when only case patients with advanced disease were compared with control subjects with normal PSA levels. Among foreign-born Asian-Americans, risk increased independently with years of residence in North America and with saturated fat intake. Crude estimates suggest that differences in saturated fat intake account for about 10% of black-white differences and about 15% of white-Asian-American differences in prostate cancer incidence. Risk was not consistently associated with intake of any micronutrients, body mass, or physical activity patterns. CONCLUSIONS: These data support a causal role in prostate cancer for saturated fat intake but suggest that other factors are largely responsible for interethnic differences in risk.

Black or African American↗
PubMed1989

Health of British Asians; a research review.

About 2.5 per cent of United Kingdom residents are of Asian (or Indian subcontinent) origin though the term 'Asian' hides their internal diversities of languages, religions and national origins. The research on the health of these populations is heavily concentrated in areas of rickets and osteomalacia, tuberculosis, maternal and child health, and mental health, and is mainly dependent on analysis of routinely available morbidity and mortality data. Little has been published on the use of primary care services, racism in health service delivery, quality of care and doctor-patient communication. Also, few of the studies have attempted to interpret their findings against the disadvantaged background of Asian communities. It is implied that differences in health status are due to linguistic and cultural factors alone. The research literature on the health of Asian populations is critically reviewed.

Adolescent↗
PubMedDate not supplied

Asthma prevalence among inner-city Asian American schoolchildren.

OBJECTIVE: Though asthma has been studied in many inner-city populations in the United States, there have been no studies specifically on Asian American immigrants. The authors conducted a cross-sectional survey of the prevalence of asthma among schoolchildren at the Josiah Quincy Elementary School, located in Boston Chinatown. Roughly 62% of the students in the school are Asian American. METHODS: The authors utilized the Brief Asthma Pediatric Screen (BAPS), a five-question instrument that was validated through the Chicago public schools. The survey was administered to kindergarten through fifth grade students. RESULTS: Of the 606 respondents (69.9% of the students), 16% had previously diagnosed asthma and 3% had possible undiagnosed asthma. Asthma was more prevalent in boys than in girls (relative risk [RR] 1.75; 95% confidence interval [CI] 1.20, 2.56). In addition, the respondents who lived in Chinatown were less likely to have been diagnosed with asthma (RR 0.59; 95% CI 0.39, 0.90), as were those with Asian surnames (RR 0.65; 95% CI 0.44, 0.97). CONCLUSION: Although this study was preliminary, our results suggest that asthma rates are substantial among inner-city Asian immigrant children, but possibly lower than for other inner-city children.

Asian↗
PubMed2004

Registering ischaemic heart disease: are we meeting the targets for South Asians?

BACKGROUND: Registration on a primary care disease register is a necessary first step for the provision of systematic care for ischaemic heart disease (IHD). We examined whether there is any potential bias in IHD registration based upon the ethnic origin of the patient. METHODS: 'Observed' rates of ischaemic heart disease registration from 12 general practices in Bristol were contrasted with national 'expected' rates derived from the Health Survey for England, 1999, with the aim of comparing rates of registration between patients whose countries of origin were South Asian and non-South Asian. Ethnicity was classified by the patients' surname. Data were stratified by age, sex and ethnicity. RESULTS: Overall, no major differences in 'observed' and 'expected' rates of registration between South Asian and non-South Asians were observed. In general, however, 'observed' rates were lower than the 'expected' rates for both groups. CONCLUSION: We found no overall bias in IHD registration based upon the patient's ethnic origin but we did observe generally low rates of IHD registration overall.

Adult↗
PubMed2006

Acculturation stress and depression among Asian immigrant elders.

This study examines the association between acculturation stress and depressive symptoms in a regional probability sample (n = 407) of six groups of Asian immigrant elders (Chinese, Korean, Indian, Filipino,Vietnamese, and Japanese). Findings suggest that about 40 percent of the sample were depressed, indicating higher depression rates than found in other studies of older American or Asian elderly samples in the United States and Asia. Multiple regression analyses indicated that acculturation stress caused by elders' perception of a cultural gap between themselves and their adult children was associated with high depression levels. Other predictors of depression were poor perceived health, stressful life events, religiosity, proximity of children, assistance received from adult children, and longer residence in the United States. Data suggest that depression is prevalent among urban Asian immigrant elders and that there is great heterogeneity among Asian ethnic subgroups. Implications for social work practice are discussed.

Acculturation↗
PubMed1989

Ptosis surgery in the Asian eyelid.

There are many characteristic features of the Asian eyelid that differ significantly from those of the Occidental. The most noticeable of these are fullness of the upper eyelid and a low or absent upper lid crease. The patient may desire the preservation of these distinctive features during ptosis surgery. The surgical techniques of ptosis repair and the preservation of the typical Asian eyelid features during ptosis repair have not previously been described in the literature. This study describes the histologic differences between the Asian and Occidental upper eyelid, and the application of this anatomic knowledge to surgical techniques of ptosis repair with special emphasis on the preservation of the Asian eyelid features.

Adipose Tissue↗
PubMed1992

Child sexual abuse of Asians compared with other populations.

This retrospective chart review study of a child sexual abuse clinic compared a consecutive sample of substantiated sexual abuse cases of Asian victims with random samples of black, white, and Hispanic victims. The findings suggest that there are clinically relevant differences between Asians and the other three populations. Asian victims showed a distinct demographic profile, suffered less physically invasive forms of abuse, were more likely to express suicidality, less likely to display anger and sexual acting out, and had less supportive primary caretakers than non-Asians. Awareness of such ethnic differences will help clinicians better evaluate and treat minority victims.

Adolescent↗
PubMed1984

Prevalence of depression among Asian-Americans.

The dearth of population-based studies and epidemiological investigations on the mental health problems of Asian-Americans, especially since the change in the immigration laws in 1965, has led to contradictory speculations about the prevalence rates of mental illness and the general mental health status among Asian-Americans, as opposed to other segments of the population. We administered the Center for Epidemiologic Studies Depression (CES-D) scale to 499 samples drawn from a Northwestern coastal city in order to make an initial assessment of the amount of depression experienced by Asian-Americans. The investigation compared the Asian-Americans' CES-D scores with those of whites and other minority groups, examined the scale's patterns of factor loading by ethnicity, and discovered that, even with statistical controls, there exists a distinction among the individual groups of Chinese, Filipinos, Japanese, and Koreans with respect to their score averages of depressive symptoms.

Adolescent↗
PubMed1998

Systematic approach and selective tissue removal in blepharoplasty for young Asians.

Although the double eyelid operation was initially designed to create supratarsal folds in Asians, it has evolved into a cosmetic procedure to make Asian eyelids more aesthetically pleasing. Therefore, it is appropriate to call it "blepharoplasty for young Asians." All the candidates for this operation desired natural-looking attractive eyelids with double folds, which is far from puffiness and severe epicanthus. Two hundred forty-one patients underwent "blepharoplasty for young Asians" from 1991 to 1996 at Asan Medical Center, and they were performed by one surgeon (Yoon). A systemic approach has been adopted for the procedure: first, the size of the folds is determined; second, debulking of the upper eyelids and handling of the epicanthus is taken into consideration in relationship with future folds. In addition to creating folds, half Z-plasty is used to alleviate the epicanthus, and a selective tissue removal technique is applied to titrate the amount of puffiness in the upper lids.

Adipose Tissue↗
PubMed1998

Symptomatic age-related macular degeneration in Asian patients.

PURPOSE: To characterize retinal and fluorescein angiographic findings of Asian patients with symptoms secondary to age-related macular degeneration (ARMD). METHODS: We retrospectively reviewed 453 consecutive medical records corresponding to fluorescein angiograms performed between November 1992 and November 1995 to identify Asian patients with symptomatic ARMD. Presenting visual symptoms, best-corrected Snellen visual acuities, and retinal examination findings were determined from the medical records. Fundus photos and fluorescein angiograms were reviewed. RESULTS: There were 26 symptomatic eyes in 19 Asian patients with a median age of 73 years. Presenting visual symptoms included decreased visual acuity (19 eyes), metamorphopsia (5 eyes), or scotoma (2 eyes). Retinal findings included occult choroidal neovascularization (CNV) in 5 (19%) eyes, serous pigment epithelial detachment (PED) in 8 (31%) eyes, PED with CNV in 5 (19%) eyes, drusen in 5 (19%) eyes, retinal pigment epithelial atrophy in 1 (4%) eye, vitreous hemorrhage in 1 (4%) eye, and a disciform scar in 1 (4%) eye. CONCLUSION: In this cohort of Asian patients with ARMD, the majority of symptomatic eyes had either CNV (46%) or serous PED (31%).

Aged↗
PubMedDate not supplied

Coronary artery disease in South Asians: an emerging risk group.

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide and was responsible for 7.2 million deaths in 2003. Various studies have pointed out that South Asians have a higher prevalence of CAD as compared with other ethnicities. South Asians may have a genetic predisposition to CAD; however, environmental, nutritional, and lifestyle factors may also be responsible. South Asians have a much higher prevalence of metabolic syndrome, diabetes, insulin resistance (and resultant hyperinsulinemia), central obesity, dyslipidemias (lower high-density lipoprotein, increased lipoprotein[a], higher triglyceride levels), increased thrombotic tendency (increased plasminogen activator inhibitor-1 and decreased tissue plasminogen activator levels), decreased levels of physical activity, and low birth weights ("fetal origins hypothesis"). In addition, the dietary indiscretions and sedentary lifestyle practiced by most South Asians puts them at a higher risk. A multidisciplinary approach involving the population at risk, healthcare personnel, and the government is required to diminish the incidence. Educational programs regarding the genetic predisposition as well as risk factors for CAD, physical activity, and dietary modifications need to be encouraged. There is a need for implementation of newer guidelines as well as a lower threshold for initiating therapeutic interventions in this population. Mass media should be involved to bring about behavioral changes, and these changes should be reinforced at the physician's level.

Age of Onset↗
PubMedDate not supplied

Microscopic anatomy of Asian lower eyelids.

PURPOSE: To elucidate the microscopic anatomy of the Asian lower eyelid. METHODS: Specimens (full-thickness sections of lower eyelids from 19 postmortem lower eyelids) from 11 Asians aged 73 to 96 years at death were fixed in 10% buffered formalin and microscopically examined. After pretreatment, sagittal sliced sections of the central part were stained with Masson trichrome. RESULTS: The distinct junction of the orbital septum to the capsulopalpebral fascia (CPF) was confirmed in 7 eyelids in which orbital septum was clearly stained, with an average distance from the tarsus to the junction of 2.38 mm. The other 12 eyelids did not show a distinct junction, and the orbital septum was poorly defined anteriorly and indistinct posteriorly. There was a distinct layer between the orbicularis oculi muscle and the orbital septum. The inferior and the posterior attachments of the CPF to the tarsus were seen in all eyelids. Seventeen of the 19 eyelids had attachment of the CPF on the anterior aspect of the tarsus, from which an extension of the CPF through the pretarsal orbicularis oculi muscle was observed. All eyelids had anterior extension of the CPF through the preseptal orbicularis oculi muscle, which was overridden on the pretarsal orbicularis oculi muscle. CONCLUSIONS: The microscopic findings of Asian lower eyelids, especially fascial components, were mostly similar to those of non-Asian eyelids, but differences existed in higher or indistinct septum fusion, anterior and superior orbital fat projection, and the overriding of the preseptal orbicularis oculi muscle.

Aged↗
PubMed2005

Does the white-coat effect in people of African and South Asian descent differ from that in White people of European origin? A systematic review and meta-analysis.

OBJECTIVE: To assess whether the white-coat effect in people of African (Blacks) and South Asian descent differs from that of people of European origin (Whites), and if so, whether this explains demonstrated ethnic variations in blood pressure. METHODS: A systematic literature review was carried out using Medline 1966-2003, Embase 1980-2003, and citations from references. The meta-analysis was performed using the Cochrane review manager software (RevMan version 4.2; Oxford, UK). RESULTS: Eight studies were examined, four studies from the UK and four from the USA. The mean systolic and diastolic white-coat effect was similar in Blacks and Whites. The weighted mean difference in systolic white-coat effect was 0.31 [confidence interval 95% (CI)=-1.96, 2.57; P=0.79] and in diastolic white-coat effect was 0.18 (95% CI=-1.70, 1.35; P=0.82). Two studies reported on South Asians. Both systolic and diastolic white-coat effect was significantly lower in South Asians than in Whites; the weighted mean difference in systolic white-coat effect was -8.90 (95% CI=-13.04, -4.76; P<0.0001) and in diastolic white-coat effect was -4.66 (95% CI=-7.29, -2.03; P<0.0001). CONCLUSION: The blood pressure differences between Blacks and Whites are unlikely to be a result of variations in white-coat effect. In contrast, the slightly lower clinic blood pressure in some South Asian populations such as Bangladeshis might be partly caused by a low white-coat effect but more studies are needed in this subject.

Asian People↗
PubMed2004

Advantages of adding a footplate incision in Asian rhinoplasty.

The dimension, shape, and projection of the nasal tip are significantly determined by the position of the footplates of the medial crura. The length of the footplate segment in Asians is much longer than that in Caucasians. A surgeon may be able to use a longer footplate segment when operating on an Asian to recreate the lower vault of the nose more effectively. The purpose of this study is to introduce the advantages of addition of a footplate incision to obtain greater satisfaction in esthetic rhinoplasty for Asians. This incision is extended along the caudal border of the footplate of the medial crura onto the floor of the nasal vestibule bilaterally, in endonasal or open approach rhinoplasty. By approximating the lateral curves of the medial crural footplates, the width and the length of the columella could be narrowed and lengthened. The columella can also be advanced caudally and thus elongate the shape of the nostrils. In addition, a cartilage graft or an implant insertion for alar base augmentation could be performed through this footplate incision, eliminating the need for an additional incision. Another advantage is that, during the correction of caudal septal deviation, displaced septal cartilage can be repositioned by suturing to the periosteum or soft tissue around the anterior nasal spine without drilling into it through an intraoral incision. One hundred ten consecutive patients who underwent esthetic rhinoplasty using our footplate incision technique between August of 1999 and May of 2002 were included in this study. A total of 66 patients had an adequate follow-up time of over 6 months. Patient satisfaction and postoperative complications were recorded. The majority of the patients (57/66 cases) were satisfied with the results of the procedure. The authors believe that the addition of the footplate incision in esthetic rhinoplasty is safe and reliable for effecting better results for Asians.

Adolescent↗
PubMed2003

Methods for using Medicare data to compare procedure rates among Asians, blacks, Hispanics, Native Americans, and whites.

OBJECTIVE: Small sample sizes in Asian, Hispanic, and Native American groups and misreporting of race/ethnicity across all groups (including blacks and whites) limit the usefulness of racial/ethnic comparisons based on Medicare data. The objective of this paper is to compare procedure rates for these groups using Medicare data, to assess how small sample size and misreporting affect the validity of comparisons, and to compare rates after correcting for misreporting. DATA: We use 1997 physician claims data for a 5 percent sample of Medicare beneficiaries aged 65 and older to study cardiac procedures and tests. STUDY DESIGN: We calculate age and sex-adjusted rates and confidence intervals by race/ethnicity. Confidence intervals are compared among the groups. Out-of-sample data on misreporting of race/ethnicity are used to assess potential bias due to misreporting, and to correct for the bias. PRINCIPAL FINDINGS: Sample sizes are sufficient to find significant ethnic and racial differences for most procedures studied. Blacks' rates tend to be lower than whites. Asian and Hispanic rates also tend to be lower than whites', and about the same as blacks'. Sample sizes for Native Americans are very small (about .1 percent of the data); nonetheless, some significant differences from whites can still be identified. Biases in rates due to misreporting are small (less than 10 percent) for blacks, Hispanics, and whites. Biases in rates for Asians and Native Americans are greater, and exceed 20 percent for some procedures. CONCLUSIONS: Sample sizes for Asians, blacks, and Hispanics are generally adequate to permit meaningful comparisons with whites. Implementing a correction for misreporting makes Medicare data useful for all ethnic groups. Misreporting race/ethnicity and small sample sizes do not materially limit the usefulness of Medicare data for comparing rates among racial and ethnic groups.

Aged↗
PubMed2007

Asthma in young south Asian women living in the United Kingdom: the importance of early life.

BACKGROUND: Studies of immigrants suggest that the environment during fetal life and duration of residence in the host country might influence the development of asthma. Little is known about the importance of the timing of the exposure in the host country and whether migrants might be especially vulnerable in certain age windows. OBJECTIVE: We compared the reported prevalence of asthma between young white and south Asian women in the United Kingdom, and investigated associations with country of birth and age at immigration. METHODS: A questionnaire on atopic disorders was posted to 2380 south Asian and 5796 white young mothers randomly sampled in Leicestershire. Data on ethnicity were also available from maternity records. Data were analysed using multivariable logistic regression and a propensity score approach. Results The reported prevalence of asthma was 10.9% in south Asian and 21.8% in white women. South Asian women who migrated to the United Kingdom aged 5 years or older reported less asthma (6.5%) than those born in the United Kingdom or who migrated before age 5 (16.0%), with an adjusted odds ratio of 0.38 [95% Confidence Interval 0.23-0.64, P<0.001]. For those who migrated aged over 5 years, the prevalence did not alter with the duration of residence in the United Kingdom. Current exposure to common environmental risk factors had relatively little effect on prevalence estimates. CONCLUSION: These data from a large population-based study support the hypothesis that early life environmental factors influence the risk of adult asthma.

Adult↗