South Asian Ethnic Background Research Articles

Is obesity more likely among children sharing a household with an older child with obesity?

ObjectivesWe used a dynamic method of identifying household members from Electronic Health Records (EHRs) linked to National Child Measurement Programme (NCMP) data to estimate the likelihood of children with obesity sharing a household with an older child with obesity, accounting for individual and household characteristics.
 MethodsWe included 126,829 NCMP participants in four London boroughs and assigned households from encrypted Unique Property reference Numbers (UPRNs) at NCMP date for 115,466 (91%). We categorised the ethnic-adjusted body mass index of the youngest and oldest household child (underweight/healthy weight<91st, ≥91st to <98th overweight, obesity≥98th centile) and explored associations of the youngest child’s weight status with: oldest child’s weight status, number of household children (two, three or ≥4), youngest child’s sex, ethnicity and school year of NCMP participation (reception or year 6). We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of obesity in the youngest child.
 Results19,702 UPRNs were shared by two or more NCMP participants (youngest children: 51.2% male, 69.5% reception). 10.4% of youngest (95% CI: 10.0,10.9) and 13.0% of oldest (12.5,14.3) children were living with obesity. One third of youngest children with obesity shared a household with another child with obesity (33.2%; 31.2,35.2), compared with 9.2% (8.8,9.7) of those with a healthy weight. Youngest children living with an older child with overweight (aOR: 2.33; 95% CI: 2.06,2.64) or obesity (4.59, 4.10,5.14), those from South Asian ethnic backgrounds (1.89; 1.64,2.19) or taking part in NCMP in year 6 (2.21; 2.00,2.43) were more likely, and girls (0.73; 0.67,0.81), children living with just one other child (0.87; 0.77,0.98) and from Black ethnic backgrounds (0.78; 0.66,0.93) less likely, to be living with obesity.
 ConclusionLinked EHRs can provide novel insights into the shared weight status of children sharing the same household. Further qualitative research is needed to understand how household food practices may vary by other household characteristics to improve our understanding of how the home environment influences childhood obesity.

Analysis of the significance of a male sexual wellbeing (mswb) clinic in an area of high diversity in east london, uk.

To analyse the socio-demography of the clinic attendees, associated comorbidities, investigations and final diagnosis. A sample of 100 attendees were selected using simple random sampling out of a total of 270 patients between 2015-2017. The socio-demographic details, associated comorbidities, relevant examination, investigations including hormonal assessments and treatment methods were extracted from the electronic records. 270 patients visited the MSWB with a total of 539 visits during this period. The mean age was 40.37. More than half of the patients were of South Asian ethnic background. 75% of the clients experienced Erectile Dysfunction (ED). Rapid ejaculation (RE) was reported in 22% of the sample. 86% of the sample had a full sexual health screening within a year. 13% were PLWH who were on ARVs. 66% of the ED patients had any form of other underlying medical condition. Baseline hormonal assessments were carried out in 57% of the sample and 96% of them suffered from ED. 57% of patients were diagnosed with ED and 23 of them suffered from psychogenic related ED. Lifelong and acquired RE was diagnosed in 5 & 13 patients respectively. 7 patients were diagnosed with a mixture of ED & RE. Orgasmic and anorgasmic ejaculation was diagnosed in each one patient. 2 Peronei's and 1 Hypogonadism were diagnosed and referred to the specialist service. Different modes of treatment were given including PDE5 inhibitors, vasodilators in the form of urethral stick and cream for the ED patients. 59% of the attendees were referred to our psychosexual service. It reveals the importance of having MSWB service for a diverse population. The clinical assessments and further investigations lead to newer diagnoses and further management. No conflicts of Interest

Are children living with obesity more likely to consult their general practitioner for knee pain? Longitudinal analysis of linked primary care and National Child Measurement Programme (NCMP) records.

ObjectivesMore than one in four 11-year-old children in England are living with obesity. The implications for future musculoskeletal health remain unclear. We assessed whether general practitioner consultations for knee pain were more likely among children with obesity, and how this varied by sex, ethnic background, and area-level deprivation.
 ApproachOf 61,478 11-year-old NCMP participants (2013-19), we linked 60,723 (98.8%) to their primary care records. 58,761 children (50.9% male) had no recorded knee pain consultation (including arthralgia and Osgood-Schlatter’s disease) prior to the NCMP measurement date. We calculated the proportion with a consultation for knee pain by ethnic-adjusted weight status (underweight<2nd; overweight≥91st; obese≥98th centile), sex, ethnic background and Index of Multiple Deprivation quintile. We studied time to first general practitioner consultation for knee pain after the NCMP date by fitting Cox proportional hazards models, estimating mutually-adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for boys and girls separately.
 ResultsWe identified 2503 (4.3%) children with at least one consultation for knee pain after the NCMP date. Boys were more likely to consult than girls (mean difference 1.5%; 95% CI: 1.2,1.9). Median time to first knee pain consultation was 1.88 years (IQR: 0.94,2.93). In adjusted analyses, boys with underweight (aHR 0.16; 95% CI: 0.05,0.51), from South Asian ethnic backgrounds (0.80; 0.69,0.92) and living in less deprived areas (Wald test statistic: 11.41; p-value=0.0223) were less likely, and those from Black ethnic backgrounds (1.31; 1.13,1.51) more likely, to consult with knee pain. Girls from South Asian ethnic backgrounds (0.70; 0.59,0.84) and those living in less deprived areas (15.44; p-value=0.0039) were less likely, and those with a BMI considered obese (1.30; 1.10,1.54) more likely to do so.
 ConclusionAdolescent girls, but not boys, living with obesity are more likely to consult their general practitioner with knee pain. Ethnic differences in knee pain consultations merit further study. Linkage of primary care and NCMP records enables greater understanding of health service utilisation by children by weight status and demographic characteristics.

Are children who do not receive their first Measles Mumps and Rubella (MMR1) vaccination by 24 months more likely to share a household with older non-vaccinated children? Linked household-level analysis of primary care electronic health records (EHRs).

ObjectivesOnly 89.4%  of UK children receive MMR1 by age 24 months. We investigated whether children not receiving MMR1 by this age were more likely to share a household with children also not vaccinated by this age, and its variation by sex, ethnic background and area-level deprivation.
 ApproachWe identified 208,907 children born between 2013-2019 and eligible for MMR1 from the primary care EHRs of 1,192,630 children registered to a general practitioner in North East London between 2001-2021.  We estimated the proportion of children and 95% Confidence Interval (CI) receiving MMR1 between 12 and 24 months of age. We calculated prevalence ratios (PR) by sex, ethnicity, and deprivation (Index of Multiple Deprivation (IMD) quintiles).  We identified all children with the same pseudonymised Unique Property Reference Numbers (pUPRNs) at the MMR1 date. We are completing analyses to calculate mutually adjusted PRs and examine household-level associations in timeliness of MMR1.
 ResultsOverall, 172,319 (82.5%) of 208,907 eligible children received an MMR1 between age 12-24 months.  Non-receipt of MMR1 by 24 months was less likely in children from South Asian ethnic backgrounds (PR 0.74; 95% CI: 0.68,0.79), and more likely in those from Black ethnic backgrounds (1.43;1.31,1.56) and in those living in the most deprived IMD quintile (1.83;1.49,2.23). We identified 137,919 children with the same pUPRNs at the MMR1 date, comprising 69,892 boys (50.7%) and 41,846 (30.3%), 32,631 (23.7%), 10,793 (7.8%), 12,246 (8.9%) and 40,403 (29.3) from White, South Asian, Black, Mixed/Other and Missing ethnic backgrounds respectively. We are calculating adjusted PRs and will estimate associations between non-receipt of MMR1 in the youngest and oldest children within a household.
 ConclusionOur findings suggest that non-receipt of MMR1 by 24 months is ethnically patterned and more likely in areas of higher deprivation.  Household-level analyses provide actionable insights into the characteristics of measles-susceptible households and opportunities for data-enabled primary care interventions to reduce vaccination inequalities and prevent measles outbreaks.

Fusion Sign-Vehicles: A Semiotics Analysis of Social and Musical Behavior in South Asian Fusion A Cappella

In 1996, the first collegiate South Asian A Cappella choir, Penn Masala, was founded at the University of Pennsylvania. Over the last twenty-two years, nearly fifty such groups have been founded at colleges and universities across the United States. These ensembles blend western popular music with South Asian music, namely Bollywood film songs. Membership in these groups typically involves participants with South Asian ethnic backgrounds as well as participants from various other ethnic backgrounds. This paper discusses the way in which sign-vehicles of South Asian a cappella performance aid in the construction of the ethnicities of its performers, showing how identities are blended, reinvented, and performed in both musical and social settings. Specifically, I will analyze the way that Dhamakapella, a South Asian A Cappella choir at Case Western Reserve University, behaves in a fashion that conveys a fusion of South Asian and western identities.

Does parental concern about their child’s future risk of overweight vary by their ethnic background? Cross-sectional analysis of a national cohort study

ObjectivesChildren from South Asian ethnic backgrounds are at increased risk of obesity and its associated future health risks; however, evidence is lacking as to whether parental concern about their child’s...

Adolescent Aggression as Predicted from Parent-Child Relationships and Executive Functions.

Previous research has emphasized the role of parent-child relationships (PCRs) in child and adolescent development. The present study extends the previous findings by examining the direct and mediated relationship between PCRs, executive functioning (EF), and adolescent aggression. Five hundred twelve adolescents of South Asian ethnic background, enrolled at the secondary and higher secondary levels (aged 13-19 years; 50% boys), participated in the study. The Parent-Child Relationship Scale (Rao, 2000), Aggression Scale (Mathur & Bhatnagar, 2004), and four tests from the Delis-Kaplan Executive Function System (Delis, Kaplan, & Kramer, 2001) were administered to measure the perceived quality of PCR, level of aggression, and EF, respectively, in participants. Pearson correlation coefficients revealed that perceived PCRs were related to EF and adolescent aggression among South Asian youth. Furthermore, multiple regression analyses using Baron and Kenny's (1986) guidelines showed that the influence of PCRs on aggression was partially mediated by EF The findings suggest that PCRs and EF can be important factors to focus on in interventions aimed at preventing adolescent aggression in society.

Apparent discrimination in the provision of biologic therapy to patients with Crohn's disease according to ethnicity

ObjectivesThe objective of the study was to investigate whether patients from a South Asian ethnic background who had Crohn's disease received equivalent access to therapy with biologics compared to patients with an English background. Study designThe study was retrospective and covered the period 2008 to 2012. It was based on a register of all patients with Crohn's disease in Leicestershire who are treated with biologics. The prevalence of Crohn's disease in Leicestershire amongst South Asian and English patients was known from earlier studies and from these data it was possible to make corrections to allow for the difference in frequency of the condition between the two communities. MethodsAll adult patients who received biologics for treatment of Crohn's disease in Leicestershire between 2008 and 2012 were reviewed and their gender and ethnicity noted as well as whether they had received infliximab or adalumimab. The expected numbers of patients who should have received these therapies were calculated in two ways:i.The proportion of the total population of cases based on prevalence data (the preferred method);ii.The proportion who should have received the treatment based on the population distribution within Leicester and Leicestershire. ResultsOne hundred and twenty six patients with Crohn's disease who received treatment with biologics were European and 13 South Asian. The patients' gender was also noted and 67 European patients (53%) were female as were six Asians (46%). Based on prevalence data, the expected distribution of the treatment would have been for 97 of the patients to have been European and 42 to have been South Asian. If 126 European patients warranted treatment, on this basis the expected number of South Asian patients in need of biologic therapy would have been 55. Based on the smaller predicted number of South Asian patients (42) the difference is significant at P < 0.0001 [Proportion difference=0.69 (95% confidence interval=0.539278–0.809576]. For the difference to be extinguished the number of English patients who should have received biologic therapy would have been as low as between 30 and 39 cases (based on the calculated proportion of 97 and the actual figure of 126 European patients respectively). Based on a population composition, rather than prevalence data, in which 24% of the Leicester community should have been of South Asian origin, 33 patients would have received biologics compared with 92 patients of English origin (66%). This is significantly different to the 13 patients who did receive treatment (z=−3.2, P < 0.001). ConclusionsSuggested reasons for these differences have included concerns about the animal origins of infliximab as well as difficulties associated with accessing the service, such as the provision of information in an appropriate language through appropriate media. For those who come from groups with significant social deprivation there is often a readiness to accept more limited clinical services. However, such differences themselves, are examples of discrimination in clinical practice.

Rationale, design and baseline data from the Pre-diabetes Risk Education and Physical Activity Recommendation and Encouragement (PREPARE) programme study: A randomized controlled trial

The PREPARE programme study is a randomized controlled trial which aims to determine whether structured education can be used to increase physical activity and improve glucose tolerance in individuals with impaired glucose tolerance (IGT). This paper outlines the rationale, design and baseline data from the PREPARE programme study. Individuals with IGT were recruited from ongoing diabetes screening programmes. Outcomes included an oral glucose tolerance test, physical activity (piezoelectric pedometer) and psychological determinants. 103 individuals (male n = 65; female n = 38) were recruited, 28% of whom were from a South Asian ethnic background. At baseline the participants' mean age and BMI were 64 +/- 9 years and 29.4 +/- 4.5 kg/m2 respectively. Steps per day were associated with 2-h glucose (p = -0.22, p = 0.03), fasting glucose (p = 0.22, p = 0.04), HDL-cholesterol (p = 0.23, p = 0.02), triglycerides (p = -0.22, p = 0.03) and body fat percentage (p = -0.26, p = 0.01). Mean self-efficacy scores were significantly (p < 0.01) higher for walking than for any other form of exercise. Participants reported high levels of concern about their IGT status but were confident that exercise would help treat/control IGT. This study demonstrates the importance of developing effective physical activity and self-management programmes for individuals with IGT. This study provides a detailed framework for the promotion of physical activity in a population identified with an increased risk of developing type 2 diabetes which, if successful, could feasibly be implemented in a primary health care or community setting.

Views on cultural barriers to caring for South Asian women

The study examined whether UK midwives perceived any difficulties in providing effective prenatal care to women from South Asian ethnic backgrounds; explored whether perceptions were associated with their length of midwifery experience and degree of contact with patients from South Asian cultural backgrounds; and collated suggestions for improving the cultural appropriateness of prenatal care. Questionnaires were returned by 30 qualified and student midwives. Respondents reported a number of communication difficulties during the prenatal care of women from South Asian backgrounds, and perceived certain cultural barriers as having at least a moderately important limiting influence on prenatal care. Midwives with higher proportions of South Asian mothers in their caseload were significantly more positive about their communications during prenatal care, and saw cultural barriers as less detrimental. Many respondents recommended closer liaison with the South Asian community to find out about pregnant women's needs, and thought it helpful to have more midwives from South Asian backgrounds in their profession.

Outcome of renal transplantation in South Asian recipients is similar to that in non-Asians.

The United Kingdom has a large South Asian population, in which there is a high rate of renal disease and which forms a significant percentage of the renal transplant waiting list. Information about short- and long-term transplant outcomes in this ethnic group is limited, although it has been suggested that graft survival is poorer in this population compared with non-Asians. The authors examined the outcome and determinants of medium-term (5-year) survival in 245 renal transplants, 53 of which were performed in South Asian patients between 1995 and 2002. Three-year survival with a functioning graft was 89% for the non-Asians and 85% for the South Asians. At 5 years, this deviated to 83% and 70%, respectively, for the two groups, but this did not reach statistical significance. Acute rejection rates were similar in the two groups. South Asian ethnicity was not a significant predictor of medium-term graft loss in the authors' study. In this cohort of patients, South Asian ethnic background did not confer a survival disadvantage after renal transplantation.

Comparative incidence of Type I diabetes in children aged under 15 years from South Asian and White or Other ethnic backgrounds in Leicestershire, UK, 1989 to 1998

Estimates of incidence of Type I (insulin-dependent) diabetes mellitus in childhood populations vary around the world. This study aimed to estimate and compare the incidence of Type I diabetes in Leicestershire of children of South Asian and White or Other ethnic backgrounds. All new cases of childhood-onset Type I diabetes diagnosed before 15 years of age in Leicestershire during the period 1989-98 were studied. Population data for Leicestershire from the 1991 census was used. Ethnicity was assigned to all children in the study according to their surnames. Incidence rates (95%-Confidence limits) for the South Asian and white or other ethnic group were estimated and compared. Over the 10-year period, 46 South Asian children and 263 children who were white or from another ethnic group fulfilled the criteria for inclusion in the study. Crude incidence rates per 100,000 person-years were 19.2 (12.0, 29.1) girls and 20.3 (13.0, 30.3) boys for South Asians and 17.7 (14.8, 21.1) girls and 17.7 (14.8, 20.9) boys for whites/others. Age and sex-specific rates were higher for South Asians over 5 years of age but differences were not statistically significant. Type I diabetes incidence rates for South Asian children in Leicestershire were very similar to those for children who were in the white/other ethnic group, in contrast to very low rates reported from Asia. The convergence of rates for South Asians with other ethnic groups in Leicestershire suggests that environmental factors are more important than genetic predisposition in causing Type I diabetes in people of South Asian ethnic background.

Partial remission phase of diabetes in children younger than age 10 years.

There is renewed interest in the phase of partial remission in recently diagnosed diabetes because of the potential for pharmacological and immune intervention to preserve beta cell function. 95 children younger than 10 years were investigated to assess the influence of age, sex, diabetic ketoacidosis (DKA), admission at diagnosis, and ethnicity on the frequency of remission and insulin requirements during the first two years after diagnosis. Partial remission was defined as a requirement of insulin < 0.5 U/kg body weight/day. There was partial remission in 41 patients, with no differences for children aged 2-4 years and those aged 5-9 years. None of the five children aged < 2 years remitted. Forty five of 95 children were admitted to hospital at diagnosis, of whom 26 of 45 had DKA (blood pH < 7.25). In this number of children we were unable to show a statistical difference in the rate of remission with respect to DKA, admission to hospital at diagnosis, sex, or South Asian ethnic background. There were no differences in insulin requirements between the different groups by the end of two years and at that time seven of the children required insulin < 0.5 U/kg/day. The results suggest that even in preschool children there is potential for attempting to preserve beta cell function.