non-South Asian Research Articles

Contribution of circulating Mfge8 to human T2DM and cardiovascular disease

MFGE8 is a major exosome (EV) protein known to mediate inflammation and atherosclerosis in type 2 diabetes mellitus (T2DM) in animal studies. The pathophysiological role of this protein in obesity, T2DM, and cardiovascular disease is less investigated in humans. Earlier we reported a rare Asian Indian population-specific missense variant (rs371227978; Arg148His) in the MFGE8 gene associated with increased circulating Mfge8 and T2DM. We have further investigated the role of Mfge8 with T2DM risk in additional Asian Indians (n = 4897) and Europeans and other multiethnic cohorts from UK Biobank (UKBB) (n = 455,808) and the US (n = 1150). We also evaluated the exposure of Mfge8-enriched human EVs in zebrafish (ZF) for their impact on cardiometabolic organ system.Most individual carriers of Arg148His variant not only had high circulating Mfge8 but also revealed a positive significant correlation with glucose (r = 0.42; p = 4.9 × 10−04), while the non-carriers showed a negative correlation of Mfge8 with glucose (r = −0.38; p = 0.001) in Asian Indians. The same variant was monomorphic in non-South Asian ethnicities. Even without the variant, serum Mfge8 correlated significantly with blood glucose in other non-South Asian ethnicities (r = 0.47; p = 2.2 × 10−13). Since Mfge8 is an EV marker, we tested the exposure of Mfge8-enriched human EVs to ZF larvae as an exploratory study. The ZF larvae showed rapid effects on insulin-sensitive organs, developing fatty liver disease, heart hypertrophy and exhibiting redundant growth with poor muscular architecture with and without the high-fat diet (HFD). In contrast, the control group fishes developed fatty liver disease and heart hypertrophy only after the HFD feeding. Backed with strong support from animal studies on the role of Mfge8 in obesity, insulin resistance, and atherosclerosis, the current research suggests that circulating Mfge8 may become a potential marker for predicting the risk of T2DM and cardiovascular disease in humans.

Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community

AimsSquamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK. Materials and methodsAll patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported. ResultsOf the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01). ConclusionOur analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.

COVID-19 vaccine effectiveness among South Asians in Canada.

We evaluated the effectiveness of COVID-19 vaccines among South Asians living in Ontario, Canada compared to non-South Asians and compared the odds of symptomatic COVID-19 infection and related hospitalizations and deaths among non-vaccinated South Asians and non-South Asians. This was a test negative design study conducted in Ontario, Canada between December 14, 2020 and November 15, 2021. All eligible individuals >18 years with symptoms of COVID-19 were subdivided by ethnicity (South Asian vs other) and vaccination status (vaccinated versus not). The primary outcome was vaccine effectiveness as defined by COVID-19 infections, hospitalizations, and deaths, and secondary outcome was the odds of COVID-19 infections, hospitalizations, and death comparing non-vaccinated South Asians to non-vaccinated non-South Asians. 883,155 individuals were included. Among South Asians, two doses of COVID-19 vaccine prevented 93.8% (95% CI 93.2, 94.4) of COVID-19 infections and 97.5% (95% CI 95.2, 98.6) of hospitalizations and deaths. Among non-South Asians, vaccines prevented 86.6% (CI 86.3, 86.9) of COVID-19 infections and 93.1% (CI 92.2, 93.8) of hospitalizations and deaths. Non-vaccinated South Asians had higher odds of symptomatic SARS-CoV-2 infection compared to non-vaccinated non-South Asians (OR 2.35, 95% CI 2.3, 2.4), regardless of their immigration status. COVID-19 vaccines are effective in preventing infections, hospitalizations and deaths among South Asians living in Canada. The observation that non-vaccinated South Asians have higher odds of symptomatic COVID-19 infection warrants further investigation.

Effect of empagliflozin on cardiac remodelling in South Asian and non-South Asian individuals: insights from the EMPA-HEART CardioLink-6 randomised clinical trial

BackgroundThis exploratory sub-analysis of the EMPA-HEART CardioLink-6 trial examined whether the previously reported benefit of the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on left ventricular (LV) mass (LVM) regression differs between individuals of South Asian and non-South Asian ethnicity.MethodsEMPA-HEART CardioLink-6 was a double-blind, placebo-controlled clinical trial that randomised 97 individuals with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) to either empagliflozin 10 mg daily or placebo for 6 months. LV parameters and function were assessed using cardiac magnetic resonance imaging. The 6-month changes in LVM and LV volumes, all indexed to baseline body surface area, for South Asian participants were compared to those for non-South Asian individuals.ResultsCompared to the non-South Asian group, the South Asian sub-cohort comprised more males, was younger and had a lower median body mass index. The adjusted difference for LVMi change over 6 months was -4.3 g/m2 (95% confidence interval [CI], -7.5, -1.0; P = 0.042) for the South Asian group and -2.3 g/m2 (95% CI, -6.4, 1.9; P = 0.28) for the non-South Asian group (Pinteraction = 0.45). There was no between-group difference for the adjusted differences in baseline body surface area-indexed LV volumes and LV ejection fraction.ConclusionsThere was no meaningful difference in empagliflozin-associated LVM regression between South Asian and non-South Asian individuals living with T2DM and CAD in the EMPA-HEART CardioLink-6 trial.Trial registrationClinicalTrials.gov Identifier: NCT02998970 (First posted on 21/12/ 2016).

Demographic and Clinical Profile of South Asian vs. non-South Asian Patients with Parkinson’s disease (P6-11.003)

<h3>Objective:</h3> To determine differences in demographic and clinical profile of South Asian vs. non-South Asian patients with Parkinson’s disease (PD) undergoing deep brain stimulation (DBS). <h3>Background:</h3> The majority of knowledge of PD has been gleaned from the discoveries made in familial and/or sporadic forms of PD in the Caucasian population. The transferability and the clinical utility of such biochemical and genetic discoveries to other ethnically diverse populations are unknown, with the South Asian population being underrepresented in PD research. <h3>Design/Methods:</h3> We performed a retrospective review of South Asian vs. non-South Asian PD patients undergoing STN-DBS between 2017–2022. Demographic data and clinical data were obtained. Pre-operative OFF/ON evaluation (dopamine challenge), neuropsychological testing scores (Dementia Rating Scale-2), motor and non-motor complaints were compared between the two groups using a Student’s T-test or chi-squared test as appropriate. <h3>Results:</h3> We compared data from 9 South Asian and 21 non-South Asian PD patients. Demographic characteristics were not different between the two groups. Alcohol use was less common in the South Asian population with a trend towards significance (88% never used vs. 57%, respectively, p = 0.09). At the pre-DBS evaluation, there was no difference in percent change in Unified Parkinson’s Disease Rating Scale (UPDRS) scores comparing OFF and ON evaluations, nor differences in DRS-2 scores. About 86% of non-South Asian patients complained of tremor pre-DBS, compared with only 44% in the South Asian group (p = 0.02). REM Behavior Disorder (RBD) was also less commonly reported in the South Asian vs. non-South Asian group (0% vs. 43%, respectively, p = 0.02). <h3>Conclusions:</h3> In this pilot study, we found differences in the clinical profile of South Asian vs. non-South Asian PD patients. Larger studies are needed to further examine these differences in the South Asian population which may lead to improved care and treatment in this group of patients. <b>Disclosure:</b> Mr. Srinivasan has nothing to disclose. Dr. Hargreaves has nothing to disclose. Ms. Caputo has nothing to disclose. Jasdeep Hundal has received research support from Rutgers University CAHBIR/BHI. Jasdeep Hundal has received research support from Horizon BCBS. Jasdeep Hundal has received research support from National Cancer Institute (NCI). Jasdeep Hundal has received research support from National Institute of Health/NIA. Dr. Danish has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for medtronic. Dr. Chen has nothing to disclose. Dr. Pal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint. Dr. Pal has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Kyowa Kirin. Dr. Pal has stock in Baudax Bio. The institution of Dr. Pal has received research support from National Institutes of Health. The institution of Dr. Pal has received research support from Parkinson’s Foundation.

Socio-economic and ethnic disparities in childhood cancer survival, Yorkshire, UK

BackgroundEstablishing the existence of health inequalities remains a high research and policy agenda item in the United Kingdom. We describe ethnic and socio-economic differences in paediatric cancer survival, focusing specifically on the extent to which disparities have changed over a 20-year period.MethodsCancer registration data for 2674 children (0–14 years) in Yorkshire were analysed. Five-year survival estimates by ethnic group (south Asian/non-south Asian) and Townsend deprivation fifths (I–V) were compared over time (1997–2016) for leukaemia, lymphoma, central nervous system (CNS) and other solid tumours. Hazard ratios (HR: 95% CI) from adjusted Cox models quantified the joint effect of ethnicity and deprivation on mortality risk over time, framed through causal interpretation of the deprivation coefficient.ResultsIncreasing deprivation was associated with significantly higher risk of death for children with leukaemia (1.11 (1.03–1.20)) and all cancers between 1997 and 2001. While we observed a trend towards reducing differences in survival over time in this group, a contrasting trend was observed for CNS tumours whereby sizeable variation in outcome remained for cases diagnosed until 2012. South Asian children with lymphoma had a 15% reduced chance of surviving at least 5 years compared to non-south Asian, across the study period.DiscussionEven in the United Kingdom, with a universally accessible healthcare system, socio-economic and ethnic disparities in childhood cancer survival exist. Findings should inform where resources should be directed to provide all children with an equitable survival outcome following a cancer diagnosis.

Rising Incidence of Inflammatory Bowel Disease in South Asian Children in New Zealand-A Retrospective Population-Based Study.

High rates of inflammatory bowel disease (IBD) are reported in children of South Asian (SA) descent in some western countries. This population-based study describes the incidence and clinical course of IBD in SA children compared to non-South Asian (NSA) children in New Zealand (NZ). Children (≤15 years) with new-onset IBD presenting to a centralized tertiary referral center in Auckland, NZ from 2010 to 2020 were identified. Disease phenotype, clinical characteristics, response to exclusive enteral nutrition, clinical remission rates at 3 and 12 months, biologic use, corticosteroid exposure, and disease complications were compared by ethnicity; IBD incidence was calculated. There were 127 (26 SA; 101 NSA) children with Crohn disease, 41 (10 SA; 31 NSA) with ulcerative colitis, and 10 (3 SA; 7 NSA) with IBD-unclassified. IBD incidence in SA and NSA children was 14.1 per 100,000 and 4.3 per 100,000 respectively ( P < 0.001). IBD incidence increased by 5.6% per year ( P = 0.022), due to a greater rise in incidence in SA (SA 16.8% per year, P = 0.015; NSA 4.5% per year, P = 0.317). At presentation, SA children had worse biochemical parameters, severe colitis, and vitamin D deficiency. SA children had lower rates of remission following exclusive enteral nutrition (28.5% vs 65.0%, P < 0.001) or biologic induction (35.7% vs 70.8%, P = 0.020), at 3-month (35.3% vs 69.8%, P < 0.001) and 12-month follow-up (29.4% vs 55.0%, P = 0.005). No significant differences were found in disease location or corticosteroid burden. Increasing incidence of IBD was disproportionately represented by SA children with more severe disease and lower remission rates following exclusive enteral nutrition or biologic therapy.

Exploring the Drivers of Second-Generation South Asian American Eating Behaviors Using a Novel Qualitative Methodology: Virtual Free-Listing Informed Mind-Mapping

Abstract Objectives South Asian Americans (SAAs) face a growing non-communicable disease burden, however the behavioral contributors to health disparities experienced by second-generation South Asians remain under-explored. The aim of this study was to identify major drivers of the foods typically eaten by second-generation SAAs. Methods Between October-November 2020, second-generation SAAs aged 18–29 years old were recruited to conduct virtual video-conferencing-based interviews using a novel qualitative methodology which integrated free-listing and ranking, mind-mapping, and discussion-based exercises. Ranked free-lists were quantitatively analyzed to identify salient drivers of eating behaviors, while the USDA socio-ecological model was used to inform a semi-inductive thematic analysis of interview transcripts. A network analysis was conducted by quantifying connections made across participant mind-maps. Results Overall, 32 participants (53% female, 22.4 mean age) were interviewed in the study. Thirty-five distinct eating behavior drivers were identified in the free-listing data; those with the highest saliency scores (unadjusted for ranking) were 1) family, 2) friends, 3) taste, and 4) health; when adjusted for participant rankings, the most impactful drivers were 1) taste, 2) family, 3) health, and 4) friends. In applying the USDA socio-ecological model, individual-level drivers included personal capacity to cook, convenience in accessing certain foods, cost, emotional state, and preferences regarding taste or novelty of non-South Asian foods. Setting-level drivers included specific daily activities (e.g., socializing, working), people (e.g., family, roommates), and places (e.g., workplaces, religious institutions). Notably less sector-level drivers were identified but included interacting with the healthcare sector or social media. Norm-level drivers included South Asian cultural background, religious background, and priorities regarding health and vegetarianism informed by values outside of religion. Conclusions Complex, interconnected, and multi-level drivers were identified motivating second-generation SAAs eating behaviors. Findings highlight the need to distinguish these drivers from first generation SAAs to better design interventions to improve health of second-generation SAAs. Funding Sources N/A.

225-LB: Demographic and Clinical Comparisons of South Asians with Type 2 Diabetes vs. Caucasians and African Americans in an Urban Clinical Setting

Background: The incidence of type 2 diabetes (T2D) is rising worldwide. South Asians are at higher risk, nearly 2-4 times greater than white Europeans, and tend to develop T2D at an earlier age and lower BMI. Prior studies have shown a potential advantage of incretin-based therapies in South Asians. The purpose of this study is to compare baseline characteristics of South Asians with T2D with those of other ethnic groups and to determine whether South Asians have a better glycemic response to incretin-based therapies in an urban United States diabetes center. Methods: Retrospective chart review of patients with T2D at the University of Maryland Center for Diabetes and Endocrinology from 2010-16 was performed. Adult patients (ages 18-85) with T2DM were included. A total of 43 South Asians (India, Bangladesh, Pakistan, Sri Lanka) and 182 non-South Asians (further subclassified into black or Non-Hispanic white) were enrolled. Data on age of T2DM diagnosis, family history, BMI, diabetic medications, exercise, blood pressure, and presence of micro- or macrovascular complications were collected. Baseline characteristics were compared and tested for statistical significance by Chi-square test and student t-tests. Results: South Asians were diagnosed with T2D at a lower BMI (29 vs. 34; p&amp;lt;0.0001) compared to their non-south Asian counterparts. In the South Asian group, there was a trend towards lower age at diagnosis, higher incidence of CAD and nephropathy compared to non- South Asians. No differences in hemoglobin A1c between South Asians vs. non-South Asians were noted at 3-month follow-up after initiation of incretin-based therapy. Conclusion: South Asians are more likely to have T2D at a lower BMI than black or Non-Hispanic white patients in an urban United States setting. No significant difference in T2DM complications was noted among ethnic groups, and incretin-based therapies did not have a significant effect on in South Asians vs. non-South Asians. Disclosure A. Ahmed: None. W. Rahman: None. K.M. Munir: None.

Social Network Characteristics Are Correlated with Dietary Patterns Among Middle Aged and Older South Asians (SA) Living in the United States (US) (P04-124-19)

ObjectivesSocial and cultural norms, operating through social networks, may influence an individual’s dietary choices. We examined the correlations among social network characteristics and dietary patterns among SA in the US. MethodsData from the Mediators of Atherosclerosis in South Asians Living in America Social Network study were analyzed among 756 participants (mean age 59 y standard deviation [SD] = 9 y; 44% women). A culturally adapted, validated food frequency questionnaire was used for dietary assessment. Principal component analysis yielded, three dietary patterns named: “Animal protein”, “Fried snacks, sweets and high-fat dairy”, and “Fruits, vegetables, nuts and legumes”, based on contribution of food groups. Social network characteristics were assessed using a standard egocentric approach, where participants (egos) self-reported data on perceived dietary habits of their network members. Partial correlations between social network characteristics and egos’ dietary patterns were examined. ResultsThe mean social network size of egos was 4.2 (SD = 1.1), with high proportion of network members being family (72%), SA ethnicity (89%), and half having daily contact. Higher scores for the “Animal protein” pattern among egos, were negatively correlated with daily fruits and cooked vegetables consumption of their network. This pattern was also positively correlated with the proportion of network who weekly consumed non-South Asian foods, diet drinks, non-vegetarian foods, processed meat and fried foods, and dined out. Scores for the “Fried snacks, sweets and high-fat dairy” pattern were positively correlated with proportion of network who weekly consumed sugar-sweetened beverages, South Asian sweets, fried foods, fast foods and ghee (clarified butter). Higher scores for the “Fruits, vegetables, nuts and legumes” pattern were positively associated with proportion of network who daily consumed both raw and cooked vegetables and fruits, and brown rice/quinoa weekly. ConclusionsNetwork member characteristics and perceived dietary behaviors of network members were correlated with dietary patterns of SA in the US. Dietary intervention studies among SA should consider social network characteristics as candidate components for dietary intervention. Funding SourcesNational Institutes of Health. Supporting Tables, Images and/or Graphs▪

South Asians living in the UK and adherence to coronary heart disease medication: a mixed- method study

Background The prevalence of coronary heart disease amongst South Asian population in the UK is higher compared to the general population. Objective This study sought to investigate beliefs and experiences of South Asian patients regarding coronary heart disease and medication taking behaviour. Setting A London Heart Attack Centre. Methods This mixed method study is part of an original pilot randomised study on 71 patients involving a pharmacy-led intervention to improve medication adherence in coronary heart disease patients. South Asian patients from the randomised study took part in qualitative semi-structured telephone interviews. Both South Asian and non-South Asian patients completed the questionnaire about adherence and beliefs regarding medicines using Morisky Scale and the Belief About Medicines Questionnaire-Specific at 2 weeks, 3 and 6 months. Outcome Patients’ beliefs about coronary heart disease and medication adherence. Results Seventeen South Asian patients and 54 non-South Asian patients took part. Qualitative data from 14 South Asian patients showed that while some attributed coronary heart disease to genetic, family history for their illness, others attributed it to their dietary patterns and ‘god’s will’ and that little could be done to prevent further episodes of coronary heart disease. On the Belief About Medicines Questionnaire-Specific in South Asian patients, beliefs about necessity of medicines outweighed concerns. South Asian patients (n = 17) showed a similar pattern of adherence compared to non-Asian patients (n = 54). Adherence decreased with time in both populations, adherence measured by Morisky Scale. Conclusion South Asian patients in this study often attributed coronary heart disease to additional causes besides the known risk factors. Future studies on their understanding of the importance of cultural context in their attitudes to prevention and lived experience of the disease is warranted.

Stroke Risk and Vascular Dementia in South Asians.

South Asians (SA) are at a higher risk for stroke and vascular dementia due to the disproportionate burden of diabetes, hypertension, and dyslipidemia. This review summarizes the rationale for screening, early detection, and aggressive control of metabolic factors, and critically examines the published literature on primary and secondary stroke prevention. South Asians have a higher prevalence of diabetes than non-SA. SA with diabetes are at a higher risk of recurrent ischemic stroke and have a higher incidence of stroke-related dementia compared to non-South Asians. South Asians are one of the fastest-growing ethnic groups worldwide with an unusually increased risk of heart disease and stroke. An accurate assessment of those at risk of stroke and cognitive impairment is urgently needed to plan preventive strategies.

Protection Rackets and Party Machines

Control over means of violence and protection emerge as crucial in much research on corruption in non-South Asian contexts. In the Indian context, however, we still know little about the systems of organised violence that sustain the entanglement of crime, capital and democratic politics. This timely comparative ethnographic piece explores two different manifestations of what our informants identify as “Mafia Raj” (“rule by mafia”) across North India (Uttar Pradesh and Punjab). Drawing on analytical concepts developed in the literature on bossism and “mafias”, we explore protection and racketeering as central statecraft repertoires of muscular styles of governance in the region. We show how a predatory economy together with structures of inter- and intra-party political competition generate the demand for and the imposition of unofficial and illegal protection and shape different manifestations of Mafia Raj. In doing so, the paper aims to contribute to debates on the relationship between states and illegalities in and beyond South Asia.

Stroke recurrence among South Asians with diabetes in Ontario, Canada.

Background South Asians have more vascular risk factors, earlier cardiovascular disease onset, and higher stroke mortality than non-South Asians. However, ethnic differences in long-term outcomes post-stroke in diabetics are unclear. Aims We compared cardiovascular outcome risk after first ischemic stroke between South Asian and non-South Asian diabetics. Methods Using population-based health care databases in Ontario, Canada, we selected all patients with diabetes hospitalized with first ischemic stroke between 1 April 2002 and 31 March 2012, and assigned South Asian versus non-South Asian ethnicity using a validated surname algorithm. Kaplan-Meier survival analysis estimated survival functions, and competing risk models estimated hazards of death, stroke, and myocardial infarction. The primary predictor was ethnicity, and models were adjusted for demographics and vascular risk factors. Sensitivity analysis including adjustment for medication use was performed in those aged ≥65 years. Results There were 25,495 diabetics with first ischemic stroke; 840 were South Asian. South Asians were younger, more often male, had lower income, and had shorter Ontario residency compared to non-South Asians. South Asians had higher incidence and cumulative risk of recurrent stroke. In fully adjusted competing risk models, recurrent stroke rate was increased among South Asians compared to non-South Asians (HR 1.17 [95% CI 1.00-1.38]) in the whole cohort and in those aged ≥65 years, both with adjustment for medication use (HR 1.23 [1.01-1.50]) and without (1.27 [1.04-1.54]). Conclusions In this large population-based study, South Asian diabetic stroke patients had higher recurrent stroke rates compared to non-South Asians, despite a younger age profile. Further research is needed to reduce stroke burden in South Asians.

Abstract TP176: Stroke Recurrence Among South Asians With diabetes in Ontario, Canada

Introduction: South Asians have earlier cardiovascular disease onset and higher stroke mortality than non-South Asians, but disparities in long-term outcomes after stroke in patients with diabetes are not well described. We compared risk of cardiovascular outcomes after first ischemic stroke between South Asian and non-South Asian patients with diabetes. Hypothesis: We hypothesized that South Asian stroke patients with diabetes were younger and had higher stroke recurrence, even accounting for competing risk of death. Methods: Using population-based health care databases in Ontario, Canada, we selected all patients with diabetes hospitalized with first ischemic stroke between April 1, 2002 and March 31, 2012, and assigned South Asian vs. non-South Asian ethnicity using a validated surname algorithm. Kaplan-Meier survival analysis and competing risk models estimated risk of death, stroke, and myocardial infarction. The primary predictor was ethnicity; models were adjusted for demographics and vascular risk factors. Sensitivity analysis including adjustment for medication use was performed in those aged &gt;=65 years. Results: There were 25495 diabetics with first ischemic stroke; 840 were South Asian and were younger, more often male, had lower income, and had shorter Ontario residency compared to non-South Asians. South Asians had higher incidence and cumulative risk of recurrent stroke (Figure). In adjusted competing risk models, recurrent stroke risk was increased among South Asians compared to non-South Asians (HR 1.17 [95% CI 1.00-1.38]) in the whole cohort and in those aged &gt;=65 years, both with adjustment for medication use (HR 1.23 [1.01-1.50]) and without (1.27 [1.04-1.54]). Conclusions: In this large population-based study, South Asian stroke patients with diabetes had higher recurrent stroke risk compared to non-South Asians, despite younger age. Further research and targeted interventions are needed to reduce stroke burden in South Asians.

Spectrum of cancers among South Asians working in Brunei Darussalam.

Background:Worldwide the incidence of cancers is increasing and this seen more in developing nations. This study looks at the spectrum of cancers among South Asian nationals working in Brunei Darussalam, a developing Southeast Asia nation.Materials and Methods:The cancer registry from 1994 to 2012 maintained by the State Laboratory was retrospectively reviewed.Results:Over the period, there was a total of 123 cancer cases diagnosed among South Asians, giving an incidence of 1.5% (n = 123/8253). The mean age at diagnosis was 42.9 ± 17.1 with a gender ratio of (male 60; female 63). Among the South Asians, Indians accounted for the most (53.7%) cases, followed by Nepalese (39.8%), Pakistani (3.3%) and Sri Lankan (2.4%). The most common cancers were cancers of the female reproductive/gynecologic organs, gastrointestinal tract, and breast. Among the two major ethnic groups; cancers of the breast was the most common among Indians followed by gastrointestinal tract where among the Nepalese, these were gastrointestinal tract followed by gynecologic (esp. cervical cancers). Among the South Asian, the Nepalese were younger at diagnosis compared to the other groups.Conclusion:The spectrum of cancers among South Asian residing in Brunei is comparable to what have been reported from South Asia with the exception of lung cancers. The most common cancers were cancers of female reproductive/gynecologic organs, gastrointestinal tract and breast. South Asians were younger at diagnosis of cancers compared to non-South Asians.

Excessive adiposity at low BMI levels among women in rural Bangladesh.

Asian populations have a higher percentage body fat (%BF) and are at higher risk for CVD and related complications at a given BMI compared with those of European descent. We explored whether %BF was disproportionately elevated in rural Bangladeshi women with low BMI. Height, weight, mid-upper arm circumference, triceps and subscapular skinfolds and bioelectrical impedance analysis (BIA) were measured in 1555 women at 3 months postpartum. %BF was assessed by skinfolds and by BIA. BMI was calculated in adults and BMI Z-scores were calculated for females <20 years old. Receiver operating characteristic (ROC) curves found the BMI and BMI Z-score cut-offs that optimally classified women as having moderately excessive adipose tissue (defined as >30 % body fat). Linear regressions estimated the association between BMI and BMI Z-score (among adolescents) and %BF. Mean BMI was 19·2 (sd 2·2) kg/m(2), and mean %BF was calculated as 23·7 (sd 4·8) % by skinfolds and 23·3 (sd 4·9) % by BIA. ROC analyses indicated that a BMI value of approximately 21 kg/m(2) optimised sensitivity (83·6 %) and specificity (84·2 %) for classifying subjects with >30 % body fat according to BIA among adults. This BMI level is substantially lower than the WHO recommended standard cut-off point of BMI ≥ 25 kg/m(2). The equivalent cut-off among adolescents was a BMI Z-score of -0·36, with a sensitivity of 81·3 % and specificity of 80·9 %. These findings suggest that Bangladeshi women exhibit excess adipose tissue at substantially lower BMI compared with non-South Asian populations. This is important for the identification and prevention of obesity-related metabolic diseases.

Statements to Assess Diabetes Knowledge (SADK) Questionnaire Used for Non-South-Asian Patients with Type 2 Diabetes - ‘Can one Shoe fit all’?

Background: NICE recommends well designed and structured diabetes educational programmes to all patients at the time of diagnosis and with annual updates. This article aims to discuss the importance of assessing knowledge pre and post education, as this allowed the team to ascertain existing knowledge and identified areas for development. Aims and objectives: The Statements to Assess Diabetes Knowledge (SADK) questionnaire was used in non-South Asian patients with type 2 diabetes to assess patients’ learning. It was used to identify gaps in diabetes knowledge. Learning was ‘quantified’ by measuring recalled information immediately post-education session and at six months during a reunion session. The tool also allowed the team, which consisted of a diabetes specialist nurse and dietician, to assess gaps in the structured education programme being delivered. The SADK was originally adapted from a Mexican tool [1], redesigned, and piloted as part of an MSc Thesis in 2005 [2], to assess basic diabetes knowledge in South Asian patients with type 2 diabetes. The results of the pilot study were published in an article in 2008 [3]. Methods: A questionnaire Statement to Assess Diabetes Knowledge (SADK) was given to all attendees at prior to and after attending the course and again after 6 months. All completed forms were collated and assessed. HbA1c results pre and post were also collected but unable to report in this article. All patients were referred into services run by Staffordshire and Stoke on Trent Partnership Trust. Results: 203 non-South Asian patients were referred and attended for type 2 education over a 12mths period from January 2012 to 2013 which was run at local sites. 183 (90%) of patients stated that English was their spoken or preferred language. None of the patients stated that they required an interpreter however 9% gave no response with one patient who stated Spanish. In 173 (85%) of the patients the SADK scores had improved. In 14 (7%) patients-had no change in their scores. In 16 (8%) patients scores had declined. The biggest improvement at this stage was question 6, ‘If I am a diabetic, my children have a bigger chance of becoming diabetic’. 28% of attendees completed the questionnaire at 6 months. Of these, 81% had improved their scores at 6 months. 23 out of the 24 questions had shown further improvements at 6 months compared to pre course results. Conclusion: Findings demonstrated that the SADK questionnaire is useful in showing that learning had occurred with increased diabetes understanding. The SADK model has been shown to be an effective tool in identifying knowledge-gaps in non-South Asian patients with type 2 diabetes by assessing existing diabetes knowledge. Hence this article shows that structured education to newly diagnosed patients with diabetes has been beneficial, assessed using the SADK tool, with knowledge being absorbed and retained at 6 months. Therefore it is concluded that the SADK tool is suitable for all type 2 diabetes patients to assess current knowledge and identify their educational needs; hence ‘one shoe can fit all’.

Effects of regional trading agreements on South Asian trade: a Gravity model analysis

Regionalism in South Asia, through formation of regional and bilateral trading agreements, dates back to mid 1990s. The objective of this study is to assess the effects of various forms of trade agreements on bi-lateral trade of South Asia. Gravity model of international trade was used as the analytical tool and the effects of the World Trade Organization (WTO), Regional Trade Agreements (RTA) such as SAFTA, EU, ASEAN, BIMSTEC and NAFTA, and Bilateral Trade Agreements (BTA) were estimated. Three types of BTAs were included; between two South Asian countries, between a South Asian country and a country not in the region, and between two non-South Asian countries. Distance between the trading partners, sharing of common language, and colonial ties were the remaining explanatory variables included in the models. Cross sectional data covering 2555 bilateral trade for the year 2012 were used for the estimation and the data were extracted from the gravity databases of the Asia Pacific Research and Training Network, the World Bank and the WTO. The models were estimated using Ordinary Least Squares including importer and exporter fixed effects. The results of the estimation suggest that sharing of a common language, sharing a common colony, and membership of WTO positively and significantly affect export values and the effect of geographical distance, as expected, on the same has a negative effect. The memberships in BTA and RTA have mixed effects. Among RTAs used in the study, only the co-efficient for EU is statistically significant. SAFTA, ASEAN, BIMSTEC and NAFTA do not show significant effects on bilateral trade. The effects of all BTAs are positive and significant and they indicate that BTAs within South Asia enhance its regional trade greater than the BTAs with non-members. These results suggest that proliferation of BTAs within South Asia helped in expanding regional trade. Tropical Agricultural Research Vol. 26 (3): 468 – 485 (2015)

Ethnic variation in colorectal cancer risk following a positive faecal occult blood test in an English bowel cancer screening programme centre.

The literature on colorectal cancer (CRC) screening and ethnic diversity is dominated by studies from the USA. There are no such published data from the UK bowel cancer screening programme (BCSP) population. The Wolverhampton Bowel Cancer Screening Centre serves a population of 900,000 in the Black Country and South Staffordshire. South Asians (SA) comprise 9% of the population. We aimed to determine the effects of ethnicity and sex on the risk for cancer or adenoma detected by colonoscopy following a positive faecal occult blood test over a 5-year period (2007-2011). Data were collected from the prospectively maintained BCSP cohort. South Asian patients were identified and compared with those of non-South Asian ethnicity, and colonoscopy outcomes were determined. A total of 3552 participants underwent BCSP colonoscopy (non-South Asian=3363; SA=189). There were 271 cancers (7.6%) detected within the non-South Asian group and seven cancers (0.2%) in the South Asian population (P<0.05). The probability of colon cancer is higher [odds ratio (OR)=3.84, P<0.05] in non-South Asians compared with South Asians. Patients in the 65-70-year age group have the highest risk (OR=1.60; P<0.05) for CRC. During the study 1313 adenomas were detected. A total of 771 high-risk and intermediate-risk adenomas were detected in the non-South Asian group, and 14 were detected in the South Asian group. The risk of adenoma in non-South Asians is six times higher than in South Asians (OR=5.99, P<0.001) following positive faecal occult blood testing. There are fewer colorectal cancers in South Asians compared with the non-South Asian population in this regional study. This is the first such study in the BCSP population.