Approaches to managing diabetes in Asian people.
The prevalence of diabetes is four times higher in people of Asian origin than in Caucasians. Mary Burden discusses how the management of diabetes differs in Asians.
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The prevalence of diabetes is four times higher in people of Asian origin than in Caucasians. Mary Burden discusses how the management of diabetes differs in Asians.
BACKGROUND: The aim of this research was to determine the hepatitis B surface antigen (HBsAg) carrier prevalence among cases of hepatocellular carcinoma (HCC), and the population attributable risk of HBsAg carriage for HCC, by ethnicity in New Zealand. METHODS: The hospital notes of HCC cases registered with the New Zealand Cancer Registry, for the years 1987-1994 inclusive, were viewed to determine the HBsAg status. Results The HBsAg status was determined for 193 cases of HCC. The HBsAg carrier prevalence for non-Europeans with HCC was markedly higher than that for Europeans, being 76.7% for Maori, 80.0% for Pacific Island people, and 88.5% for Asians, compared to 6.0% for Europeans. In addition to the effect of ethnicity, HCC cases aged <60 years were more likely to be HBsAg carriers than those aged > or = 60 years. The estimated population attributable risk of HBsAg for HCC, within each ethnic group, was only marginally less than the HBsAg prevalence due to the high relative risk of HBsAg carriage for HCC. The standardized incidence rate ratios of HCC for Maori, Pacific Island people and Asians compared to Europeans were 9.6, 20.4, and 22.3, respectively. Hepatocellular carcinoma attributable to HBsAg carriage explained 79%, 83%, and 92% of the excess standardized rate of HCC, compared to Europeans, for Maori, Pacific Island people, and Asians, respectively. Conclusions The HBsAg carrier prevalence in non-European cases of HCC in New Zealand is between 75% and 90%. HBsAg carriage explains the majority of the excess rate of HCC in non-Europeans compared to Europeans in New Zealand.
OBJECTIVES: Higher rates of mortality from ischemic heart disease among South Asian people are well established and appear to be unrelated to socioeconomic position. However, traditional indicators of socioeconomic position may be inadequate when making comparisons across ethnic groups. This study investigates these issues in a British morbidity survey. METHODS: The Fourth National Survey was a British cross-sectional study conducted from 1993 to 1994. The study used a national representative community sample, consisting of 2867 white respondents, 2001 Indian respondents, and 1776 Pakistani and Bangladeshi respondents. Data on occupational class and standard of living were used to examine the contribution of socioeconomic factors to differences in rates of reported severe chest pain and diagnosed heart disease. RESULTS: White and Indian respondents had similar rates of reported indicators of heart disease, while Pakistani and Bangladeshi respondents had rates that were considerably higher. There was a clear socioeconomic gradient in reported heart disease for each ethnic group, with those who were poorer having higher rates. Controlling for occupational class made little difference to the greater risk of heart disease found in the Pakistani and Bangladeshi group; however, controlling for a more sensitive indicator of socioeconomic position-standard of living-greatly reduced their disproportionate risk. DISCUSSION: The findings suggest that South Asian people do not share a uniformly greater risk of heart disease. The more economically advantaged South Asian group, Indians, had rates that are similar to those found among white people, while the poorest groups, Pakistanis and Bangladeshis, had rates that are considerably higher. Socioeconomic position predicted risk in each ethnic group and made a key contribution to the higher risk found for Pakistani and Bangladeshi individuals. Other studies may have failed to identify the important contribution of socioeconomic position because the indicators used were too crude.
OBJECTIVES: Epistaxis is a common ENT complaint. Although casual observation suggested that it is more common in Caucasian, compared with Asian people, a literature search failed to find any studies investigating ethnicity and epistaxis. The aim of this study was to identify any differences in emergency admission rates for epistaxis between Asian and Caucasian people. DESIGN: Retrospective observational study using hospital computerised data (HISS). SETTING: Large University Hospital accepting ENT emergencies. PARTICIPANTS: All Asian and Caucasian patients admitted under ENT care as an emergency (1 January 2000 to 30 November 2005), split into two groups: one composed of epistaxis patients, the other of all other ENT emergency admissions. MAIN OUTCOMES MEASURES: The proportions of Asian and Caucasian patients among the two patient groups, either epistaxis admissions or other ENT emergency admissions. RESULTS: The proportions of Asian and Caucasian patients in the group admitted with emergency epistaxis were 7.1% (100/1410) and 92.9% (1310/1410) respectively. However, the proportions of Asian and Caucasian patients in the group composed of any other ENT emergency were 13.2% (729/5515) and 86.8% (4786/5515), respectively (chi-squared P < 0.01). CONCLUSIONS: Caucasian people form an unexpectedly large, and Asians a smaller proportion of emergency epistaxis admissions. The possibility of an ethnic risk factor for epistaxis warrants further investigation.
The mortality and morbidity from coronary heart disease (CHD) is higher in people of South Asian origin than in whites, but is significantly lower in the black (Afro-Caribbean origin) community in the United Kingdom. To investigate whether this may be related to differences in fatty food intake, we performed a questionnaire survey of the weekly food purchasing habits and preparation methods in white, black (Caribbean) and Asian households in Birmingham. We interviewed 224 housewives from three ethnic groups (84 white, 76 black/Afro-Caribbean and 72 Asian). The highest quantity of fat in foods purchased per week was found in the Asian population (median 1409 g/week per person, interquartile range (IQR) 850-1952), which was significantly greater than black subjects, who had the lowest quantity of fat in foods purchased (1012 g/week per person, IQR 835-1388) (Mann-Whitney test:median differences 300.5, 95% C.I. 23.3-600.4, P = 0.029). The median quantity of fat in foods purchased by the white households was intermediate, at 1186 g/week per person (IQR 861-1711). There was a higher quantity of fat in foods purchased in the lower social classes (IV and V) in both the white and Asian populations. Butter, egg and milk consumption was significantly greater in Asians; with ghee consumption almost exclusive amongst this group (98%). Amongst whites and blacks, the commonest food preparation methods were grilling, boiling or poaching; whilst amongst Asians, frying was more common (chi 2 = 81.25, d.f. = 4, P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: The number of minority ethnic people living with dementia (PLWD) in the UK is predicted to rise to 50 000 by 2026 and 172 000 by 2051. As the global population ages, there is a greater need to develop culturally appropriate post-diagnostic support for PLWD from minority ethnic backgrounds. METHODS: A rapid review was conducted of culturally adapted post-diagnostic dementia support for South Asian people with dementia and carers. Eight electronic databases were searched from inception until 16 September 2025. Databases included Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, MEDical Literature Analysis and Retrieval System Online, Psychological Information, Turning Research Into Practice, Allied and Complementary Medicine Database, Social Policy and Practice and the Cochrane Database of Systematic Reviews. Two reviewers independently screened the studies. Consistent with rapid review methods, no formal quality assessment of included studies was undertaken. The rapid review adhered to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. RESULTS: Twelve studies were included. These included seven carer support programmes focusing on raising awareness and education on dementia and care. These interventions increased carers' knowledge of dementia and confidence in caregiving. Four studies reported on psychosocial interventions: Cognitive Stimulation Therapy, Cognitive Behaviour Therapy and Meditation Therapy, demonstrating benefits for caregiver burden and mental health. One study reported on service-level innovations through a South Asian link nurse, which improved access to services and facilitated the development of culturally appropriate information materials. CONCLUSION: The findings of this rapid review demonstrate the feasibility and perceived value of culturally sensitive psychoeducation, carer training and psychosocial interventions. However, research remains small-scale, methodologically limited, with little focus given to interventions directly supporting PLWD.
This paper explores how Asian deaf young people negotiate identity claims against the backdrop of deaf politics, ethnicity, religion, gender and age. The paper is based on a qualitative study of Asian (mainly Pakistani Muslim) deaf young people and their parents in the UK. The findings provide little support for notions of singular or primary identities (as, for example, 'Deaf' people or 'Muslims') which may make other identity claims irrelevant. Instead, young people's identifications were multiple, complex and contingent. However, resources and structures remained important for identifications to be cultivated and gaining legitimisation.
Glaucoma is the leading cause of irreversible blindness worldwide. East Asians account for approximately half of all glaucoma sufferers. It is likely that trabeculectomy will be needed for many of these people as the intraocular pressure is to be maintained at a satisfactorily low level. The eyes of East Asian people differ in some aspects from those of other races. This review describes the natural history of the eye after trabeculectomy in East Asians.
This article investigates the challenges faced by those trying to develop 'culturally competent' palliative care for South Asian cancer patients in Luton, UK. It discusses the findings of a phenomenological study of service providers' attitudes to and experiences of caring for South Asian patients. Ten semi-structured in-depth interviews were carried out with a range of staff who work in home and community-based palliative care settings, including nurses, community liaison personnel and representatives of non-statutory organisations. The authors begin by considering how these service providers construct ideas of cultural difference and how these relate to philosophies of palliative care. They then examine attempts to deal with cultural diversity in everyday practice, focusing in particular on the social context of care in the home. The paper considers the ways in which staff attempt to incorporate the cultural needs of patients, family, kin and community. Rather than criticising current working practices, the authors highlight the complexity of delivering culturally competent services from the perspective of those working directly with patients. In doing so, they contribute to ongoing debates about the development of anti-discriminatory practice in health and social care.
BACKGROUND: /aim: A current consensus in epidemiological studies of primary angle closure (PAC) is to diagnose the condition only if the posterior (usually pigmented) trabecular meshwork is seen for less than 90 degrees of the angle circumference, termed an "occludable angle." The authors sought to assess the validity of this epidemiological classification by exploring the relation between drainage angle width, peripheral anterior synechiae (PAS) and glaucomatous optic neuropathy (GON). METHODS: 918 Mongolians and 995 Chinese Singaporeans, both groups aged 40 years and older were examined in two population based surveys. Gonioscopic angle width was graded in five categories (0 = closed to 4 = wide open) according the scheme described by Shaffer. Cases with secondary PAS were excluded. RESULTS: The rate of PAS was between 0.3% and 1.7% in people with wide angles (grades 3 and 4). In those with grade 2 angles, PAS were seen in between 8% of eyes. In eyes with grade 1 angles, the rate rose to 17% in Chinese Singaporeans, and 31% in Mongolians. The odds of PAS were higher in people with narrower angles. However, there was a greater absolute number of people with PAS whose drainage angles were classified as "not occludable" than those classified "occludable." CONCLUSIONS: The traditional view that primary angle closure becomes a significant possibility in drainage angles of < or = grade 2 (approximately 20 degrees ) is valid in east Asians. The definition of an "occludable" angle examined here excludes many people with PAS. This probably serves to underemphasise the role of PAC in population surveys of glaucoma prevalence in Asian people.
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Distances from the apex to the buccal bone plate were measured on the computed tomography (CT) images of 1806 teeth from 66 patients, using an image analyzer program (Image-Pro Plus, Ver. 4.0, Media Cybernetics). In the mandible, the mean distance from the distal apex of the mandibular second molar to the buccal bone plate was the largest distance measured, at 8.51 mm, followed by distance from the mesial root to the buccal bone (7.34 mm). In the mandibular first molar, the mean distal and mesial bone thicknesses were 5.18 mm and 4.09 mm, respectively. However, when there were two distal roots, the distance of the disto-lingual root to the buccal plate was found to be 9.52 mm, which constitutes the greatest measured thickness. In the maxillary buccal roots, the distances from the mesio-buccal and disto-buccal root of the second molar to the buccal bone plate were the largest, at 4.63 mm and 3.61 mm, respectively. The average distances from the palatal apex of the maxillary first and second molars to the buccal bone plate were 10.69 mm and 10.17 mm, respectively, while, from the palatal bone plate, average distances of 3.15 mm and 3.08 mm were measured. Special considerations, such as bony lid approach, lingual approach, or intentional replantation may be required, especially when a patient has a surgical need in the second molars and the disto-lingual root of the mandibular first molar, or in the palatal root of the maxillary molars.
There is a high prevalence of non-insulin dependent diabetes (NIDD) in some Asian populations in the UK. The study by Mckeigue showed that the prevalence was high amongst the Bangladeshi population. Most doctors were aware of this and concerned that they did not know sufficient about the everyday lives and eating patterns of their patients to advise them about how to adjust their lifestyle to control their diabetes. As non-insulin dependent diabetes is managed by controlling eating, and by tablets which stimulate the production or use of the naturally produced insulin, it is important that the medically prescribed treatment is integrated into the lifestyle because the day to day treatment is in the hands of the patients themselves. The patient has to control his or her eating; decide what to eat, how much to eat, and what not to eat. All diabetic people have to make these decisions in the context of their everyday lives surrounded by other people who are enjoying eating without such restraints. The evidence from this study suggests that the problem is particularly difficult for diabetic. Bangladeshi people. The reason for this appears to be that food plays a very important part in Bangladeshi culture which has many rules restricting what can be eaten and also placing importance on eating certain foods. The problem for them, is to integrate this traditional and religious rule governed system of eating with the system of modern medicine. The aim of this study was to understand and describe the ways in which diabetic Bangladeshi people are attempting this integration.
In order to understand the role of raw meat and viscera eating habits in the transmission of taeniasis in Asian countries, 1502 infected aborigines in ten mountainous districts/towns of six counties in Taiwan, 58 infected persons in two villages on Cheju Island, Korea, and 97 cases in Ambarita District on Samosir Island, North Sumatra, Indonesia were studied during the field surveys. All infected Taiwan aborigines had the habit of eating raw meat and viscera of wild and/or domestic animals. Among these aborigines, 73% ate wild boar, 66% flying squirrel, 65% wild goat, 56% muntjac, 49% wild rats, 46% monkey, 38% hare, 20% civet-cats, 18% weasel, 17% pheasant, 14% squirrel, 4% grouse, 1% deer, 1% snake, less than 1% bamboo partridge, less than 1% frog, less than 1% bear, less than 1% dog, and less than 1% fox. Of the 58 infected persons with Taenia on Cheju Island, Korea, 72% ate raw meat and/or viscera of pig and cattle, 19% raw pork only, and 9% raw beef only. Among 12 infected persons infected with T. saginata-like tapeworms, 7 had eaten raw pork, 2 raw beef and pork and 3 raw pork. Almost all of the 97 cases of taeniasis on Samosir Island of North Sumatra, Indonesia, had eaten only undercooked pork. Eleven of 15 cases were found to be infected with T. saginata-like tapeworms. Eating habits observed suggest an unusual way of transmission of Taenia in East Asia.
Because of cultural differences between East and West, any attempt at outright adaptation of Western ideas in Asia will undoubtedly encounter problems, if not rejection. Transferring an idea from one place to another is just like transplanting an organ from a donor to a recipient--rejection is to be expected. Human cultures respond to new ideas from different value systems in very much the same way. Recently, biomedical ethics has received much attention in Asia. Fundamental advances in medicine have motivated medical scientists to look at the ethical issues arising from this progress. Will the principles upheld by the bioethicists in the West meet the challenge in Asia? This article argues that Asian bioethicists must develop a bioethics responding to their own cultural contexts. If Western principles are adopted, then they must be re-interpreted and even modified, if necessary, in light of Asian beliefs.
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