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2.
Acta Psychol (Amst) ; 249: 104436, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39142256

RESUMEN

OBJECTIVES: One of the largest health concerns, postpartum depression (PPD), has detrimental effects on new mothers, their child, and their family. Investigating under-researched risk factors for postpartum depression in Asian women is the goal of this review of the literature. METHODS: The literature was searched using a number of electronic research databases. This review included studies that meet the following requirements: (a) they evaluated risk variables; (b) they were conducted in Asian countries using quantitative or qualitative methods; and (c) they were published in English in peer-reviewed journals between 2007 and 2023. A total of 90 studies from 14 different countries were reviewed, compiled, and synthesized. RESULTS: In Asian countries, where rates ranged from 0.82 % to 93 %, South Korea and Japan had the lowest and highest rates of postpartum depression, respectively. The risk factors for postpartum depression were divided into five main categories: biological/physical (e.g., ABO blood group, oxytocin level), psychological (e.g., antenatal depression, body dissatisfaction, child care stress), obstetric/pediatric (e.g., loss of baby, abortions, pain), socio-demographic (e.g., low social support, poverty, loss of autonomy), and cultural (e.g., gender preference). CONCLUSION: This phenomenon is prevalent in Asian cultures as it is in European Countries. The repercussions of untreated postpartum depression can lead to long-term psychological and developmental issues in children and strain the familial bonds essential for a nurturing environment. Moreover, understanding the specific risk factors faced by Asian women can pave the way for culturally sensitive interventions and support systems designed to address and mitigate these challenges effectively.


Asunto(s)
Depresión Posparto , Humanos , Depresión Posparto/etnología , Femenino , Factores de Riesgo , Asia/etnología , Pueblo Asiatico/estadística & datos numéricos
3.
Stud Health Technol Inform ; 315: 681-682, 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39049379

RESUMEN

South Asian individuals experience a higher burden of chronic diseases and limited access to health care services compared with their Caucasian peers. Digital health interventions can enhance the delivery of health care, minimize health inequities, and consequently improve health status among minority ethnic groups. However, it is unclear how South Asian people view and perceive the use of digital health technologies to support their health needs. Thus, the aim of this review is to identify South Asian individuals' experiences and attitudes of digital health and explore the barriers and facilitators affecting their use of digital health services.


Asunto(s)
Telemedicina , Humanos , Accesibilidad a los Servicios de Salud , Asia/etnología , Salud Digital
4.
BMC Public Health ; 24(1): 1342, 2024 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-38762730

RESUMEN

BACKGROUND: Exercise and physical activity are key components of management in patients with rheumatic musculoskeletal diseases (RMD), but people of the South Asian communities have a lower level of engagement with these activities compared to their Caucasian counterparts. The aim of this qualitative systematic review was to determine the barriers and facilitators of exercise and physical activity in South Asian communities who have migrated and live in western countries, particularly in those who have RMD. METHODS: Qualitative studies, published in English between 1999 and 2021 and including evaluation of barriers and/or facilitators to exercise or physical activity behaviour in people of South Asian adult communities who have migrated and/or lived in western countries were identified from Embase, MEDLINE, CINAHL, PsycINFO, Google Scholar and manual searches. The studies were appraised using the CASP checklist. Inductive thematic synthesis was used to identify common and global themes. RESULTS: A total of 32 studies that discussed barriers and facilitators of physical activity in South Asian communities who have migrated and lived in western countries were used for this review but there were no studies identified that focussed specifically on those with RMD. Following appraisal of the reporting of the studies, 30 studies were included in the pooling of the results. The facilitators and barriers to physical activities were broadly categorized into 'extrinsic' and 'intrinsic' factors. Extrinsic factors such as 'opportunity' included environmental factors such as weather and safety; socioeconomic factors such as education, language and literacy, and support in the form of social, psychological and resources. Intrinsic factors included cultural factors, such as life stages and family influence, beliefs and knowledge, which impacted attitudes and skills. CONCLUSIONS: This review has synthesised evidence of barriers or facilitators and identified potentially modifiable factors influencing physical activity and exercise engagement, which could form the basis of evidence-based interventions to promote participation in healthy behaviour change. Provision of a safe, comfortable and culturally acceptable environment together with culturally-aligned cognitive strategies to facilitate acquisition of exercise-efficacy skills could help engagement. REGISTRATION: The systematic review was registered on PROSPERO, registration no. 289,235.


Asunto(s)
Emigrantes e Inmigrantes , Ejercicio Físico , Investigación Cualitativa , Humanos , Ejercicio Físico/psicología , Emigrantes e Inmigrantes/psicología , Adulto , Asia/etnología
5.
BMJ Glob Health ; 9(5)2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38697655

RESUMEN

INTRODUCTION: The present paper assessed the relationship between maternal life satisfaction (MLS) and the intergenerational transmission of female genital cutting (FGC, female circumcision). It was hypothesised that the association would be more strongly positive in countries in which FGC is more prevalent (ie, culturally normative), suggesting a practice that is socially reinforcing within sociocultural contexts in which it is common. METHODS: Across two studies with more than 85 000 participants in 15 African and Asian countries, mothers completed surveys reporting on their own FGC experiences and those of their daughters' and on their educational history and socioeconomic status. RESULTS: The association between MLS and daughter circumcision was weak but positive for the full sample. Contrary to predictions, in countries in which FGC is uncommon, it was more positively associated with MLS, and in countries in which it is common, it was weakly or negatively associated with MLS. CONCLUSION: Results are contrary to the notion that the intergenerational transmission of FGC is a function of happiness deriving from its cultural normativity. They suggest, instead, a diversity of social motives depending on cultural context. Customised messaging to reduce the intergenerational transmission of FGC is discussed.


Asunto(s)
Circuncisión Femenina , Satisfacción Personal , Humanos , Femenino , Adulto , Circuncisión Femenina/etnología , Circuncisión Femenina/psicología , África/etnología , Madres/psicología , Asia/etnología , Núcleo Familiar , Adulto Joven , Adolescente , Persona de Mediana Edad , Encuestas y Cuestionarios
6.
Nature ; 629(8011): 376-383, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38658749

RESUMEN

From AD 567-568, at the onset of the Avar period, populations from the Eurasian Steppe settled in the Carpathian Basin for approximately 250 years1. Extensive sampling for archaeogenomics (424 individuals) and isotopes, combined with archaeological, anthropological and historical contextualization of four Avar-period cemeteries, allowed for a detailed description of the genomic structure of these communities and their kinship and social practices. We present a set of large pedigrees, reconstructed using ancient DNA, spanning nine generations and comprising around 300 individuals. We uncover a strict patrilineal kinship system, in which patrilocality and female exogamy were the norm and multiple reproductive partnering and levirate unions were common. The absence of consanguinity indicates that this society maintained a detailed memory of ancestry over generations. These kinship practices correspond with previous evidence from historical sources and anthropological research on Eurasian Steppe societies2. Network analyses of identity-by-descent DNA connections suggest that social cohesion between communities was maintained via female exogamy. Finally, despite the absence of major ancestry shifts, the level of resolution of our analyses allowed us to detect genetic discontinuity caused by the replacement of a community at one of the sites. This was paralleled with changes in the archaeological record and was probably a result of local political realignment.


Asunto(s)
Arqueología , ADN Antiguo , Composición Familiar , Pradera , Linaje , Adulto , Femenino , Humanos , Masculino , Arqueología/métodos , Asia/etnología , Cementerios/historia , Consanguinidad , ADN Antiguo/análisis , Europa (Continente)/etnología , Composición Familiar/etnología , Composición Familiar/historia , Genómica , Historia Medieval , Política , Adolescente , Adulto Joven
7.
Trauma Violence Abuse ; 25(4): 2927-2941, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38389397

RESUMEN

Intimate partner violence (IPV) is a pressing public health issue affecting women worldwide. Thirty percent of women experience some form of violence throughout their lifetime globally, and South Asian countries have a higher prevalence of IPV (33%-51%). Notably, IPV has detrimental psychological impacts not only on women but also on their children. Despite this, limited empirical attention has explored protective factors for IPV trauma recovery. This review examines protective factors aiding South Asian immigrant IPV survivors' trauma recovery using Joanna Briggs Institute JBI methodology. The study draws on PubMed, Scopus, and PsychINFO data, resulting in 20 articles retrieved using Rayyan software. Protective factor's themes and subthemes revealed in the literature operated at multiple levels, including personal, interpersonal, community, and professional factors. Personal factors were selfhood, collective self, and adaptation, as well as those that enabled the utilization of interpersonal, community, and professional factors; interpersonal factors were family and friends, children as motivators, and religion; and community and professional factors were resources and technology usage. Immigrant status and culture significantly impacted the protective factors, acting as barriers among some IPV survivors. Therefore, future research should focus on exploring the experiences and cultural values of South Asian immigrant women with other influencing factors that may hinder the development and impact of protective factors on IPV trauma recovery. These findings can help design culturally sensitive support services that incorporate the unique needs of female South Asian immigrant IPV survivors.


Asunto(s)
Emigrantes e Inmigrantes , Violencia de Pareja , Factores Protectores , Sobrevivientes , Humanos , Femenino , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Violencia de Pareja/psicología , Violencia de Pareja/etnología , Sobrevivientes/psicología , Adulto , Asia/etnología
8.
Midwifery ; 131: 103956, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38401252

RESUMEN

BACKGROUND: Despite numerous initiatives attempting to enhance BF across Asia, recent studies show that exclusive BF rates remain alarmingly low. With globalization, society has shifted from traditional family roles towards more egalitarian marriages, where Asian fathers are now more involved in parenting. As fathers' involvement in breastfeeding is highly complex and context-sensitive, evaluation of a wide range of concepts and evidence within the Asian context is necessary. OBJECTIVE: This review aims to consolidate and appraise empirical studies exploring fathers' breastfeeding knowledge, attitude, and involvement within the Asian context. DESIGN: A systematic mixed-studies review was conducted. Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and ProQuest Dissertations and Theses Global) were searched from each database's inception date until June 2022. Studies were appraised using the Mixed Method Appraisal Tool and data was synthesised using the results-based convergent integration method. FINDINGS: Twenty-two studies were included in this review. The synthesis of findings identified two main themes and six sub-themes. KEY CONCLUSIONS: Asian fathers have a varied understanding of breastfeeding and their involvement in breastfeeding is influenced by personal, cultural, religious, social, and environmental factors. IMPLICATIONS FOR PRACTICE: Perinatal care professionals play a crucial role in engaging and enhancing fathers' involvement in breastfeeding education programmes. The findings also urge policymakers to introduce more 'father-friendly' breastfeeding guidelines and educate perinatal care professionals to be more aware and sensitive to the needs of fathers. There is also a need to introduce more flexible and economically sensitive paternal leave policies to improve fathers' breastfeeding involvement.


Asunto(s)
Lactancia Materna , Padre , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactancia Materna/psicología , Padre/psicología , Masculino , Asia/etnología , Femenino , Adulto
9.
Hawaii J Health Soc Welf ; 83(2): 48-53, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38344695

RESUMEN

The objective of this study was to estimate the prevalence of chronic hepatitis B infection in foreign-born Asians and Pacific Islanders at Kalihi-Palama Health Center in Honolulu, Hawai'i, and to assess the association between both chronic and resolved hepatitis B infection and risk factors such as household exposure to hepatitis B virus and geographic location of birthplace. The study involved cross-sectional data from 997 participants who accessed medical services at Kalihi-Palama Health Center between September 2015 and July 2020. The prevalence of chronic hepatitis B was 10.7%. On multivariable logistic regression analysis, the adjusted prevalence odds ratio of chronic hepatitis B infection was 3.3 times greater (95% confidence interval: 1.1, 9.2) for those who reported household contact with a person with hepatitis B infection than those who reported no such contact. No association was found with place of birth in this study population. Age was a significant predictor of chronic hepatitis B, with participants between 35-44 years of age having the highest prevalence. Age was also a significant predictor of resolved hepatitis B infection, with participants 65 years of age or older having the highest prevalence. These findings emphasize the need for targeted screening and appropriate follow-up-including vaccination or treatment-in this at-risk population.


Asunto(s)
Asiático , Emigrantes e Inmigrantes , Hepatitis B Crónica , Pueblos Isleños del Pacífico , Adulto , Humanos , Asia/etnología , Asiático/estadística & datos numéricos , Estudios Transversales , Hawaii/epidemiología , Hepatitis B/epidemiología , Hepatitis B Crónica/epidemiología , Hepatitis B Crónica/prevención & control , Pueblos Isleños del Pacífico/estadística & datos numéricos , Islas del Pacífico/etnología , Prevalencia , Factores de Riesgo , Anciano , Emigrantes e Inmigrantes/estadística & datos numéricos
10.
J Hum Nutr Diet ; 37(2): 550-563, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38234263

RESUMEN

BACKGROUND: People from South Asian heritage are at high risk of type 2 diabetes, but there are limited specific strategies to prevent and manage this condition. The aim was to assess the effectiveness of culturally bespoke lifestyle programmes in South Asians that target weight loss for the prevention or remission of type 2 diabetes mellitus (T2DM). METHODS: We performed a systematic review and meta-analysis of intervention trials. PubMed, Scopus, MEDLINE (EBSCOhost), CINAHL, PsycINFO and CENTRAL were searched. Human intervention trials (randomised controlled trials and quasi-experimental) investigating the effect of lifestyle interventions on the prevention and remission of T2DM in South Asians were included. Studies including participants at risk of T2DM (prevention trials) and having the disease (remission trials) with duration ≥12 weeks were eligible. For prevention trials, the primary outcome was change in weight (kg) from baseline; for remission trials, it was decrease in HbA1c to non-diabetic levels (HbA1c ≤ 6.5%) without diabetes medications. Prevention trials were separated into (i) lifestyle modification advice and (ii) lifestyle modification advice including a supervised physical activity programme. RESULTS: Twenty-four trials were eligible (21 prevention trials and 3 remission trials). In T2DM prevention trials involving only lifestyle modification advice, the mean postintervention difference in weight between intervention and control groups was -0.65 kg (95% confidence interval [CI]: -1.04, -0.26; p = 0.01). Lifestyle modification advice including a physical activity programme was associated with greater decreases in weight: -1.13 kg (95% CI: -2.04, -0.21; p = 0.02). Fasting blood glucose levels were slightly lower in intervention groups for both intervention subtypes, although there was no significant change in HbA1c levels or 2-h plasma glucose levels. Diabetes remission trials showed potential acceptability but were limited in number and involved a small sample size, and some did not include a control group. CONCLUSIONS: In South Asians, lifestyle interventions for prevention of T2DM offer only modest impacts on weight and glucose control and will unlikely reduce diabetes incidence. Alternative lifestyle interventions co-designed with members of the communities and aimed at both prevention and remission of T2DM must be urgently considered. Systematic review registration number: PROSPERO CRD42022385174 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=385174.


Asunto(s)
Diabetes Mellitus Tipo 2 , Pérdida de Peso , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Asia/etnología , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/etnología , Ejercicio Físico , Estilo de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Personas del Sur de Asia
11.
Nature ; 625(7994): 312-320, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38200293

RESUMEN

The Holocene (beginning around 12,000 years ago) encompassed some of the most significant changes in human evolution, with far-reaching consequences for the dietary, physical and mental health of present-day populations. Using a dataset of more than 1,600 imputed ancient genomes1, we modelled the selection landscape during the transition from hunting and gathering, to farming and pastoralism across West Eurasia. We identify key selection signals related to metabolism, including that selection at the FADS cluster began earlier than previously reported and that selection near the LCT locus predates the emergence of the lactase persistence allele by thousands of years. We also find strong selection in the HLA region, possibly due to increased exposure to pathogens during the Bronze Age. Using ancient individuals to infer local ancestry tracts in over 400,000 samples from the UK Biobank, we identify widespread differences in the distribution of Mesolithic, Neolithic and Bronze Age ancestries across Eurasia. By calculating ancestry-specific polygenic risk scores, we show that height differences between Northern and Southern Europe are associated with differential Steppe ancestry, rather than selection, and that risk alleles for mood-related phenotypes are enriched for Neolithic farmer ancestry, whereas risk alleles for diabetes and Alzheimer's disease are enriched for Western hunter-gatherer ancestry. Our results indicate that ancient selection and migration were large contributors to the distribution of phenotypic diversity in present-day Europeans.


Asunto(s)
Asiático , Pueblo Europeo , Genoma Humano , Selección Genética , Humanos , Afecto , Agricultura/historia , Alelos , Enfermedad de Alzheimer/genética , Asia/etnología , Asiático/genética , Diabetes Mellitus/genética , Europa (Continente)/etnología , Pueblo Europeo/genética , Agricultores/historia , Sitios Genéticos/genética , Predisposición Genética a la Enfermedad , Genoma Humano/genética , Historia Antigua , Migración Humana , Caza/historia , Familia de Multigenes/genética , Fenotipo , Biobanco del Reino Unido , Herencia Multifactorial/genética
12.
Int J Stroke ; 18(6): 663-671, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-36872640

RESUMEN

BACKGROUND: Ethnic differences in post-stroke outcomes have been largely attributed to biological and socioeconomic characteristics resulting in differential risk factor profiles and stroke subtypes, but evidence is mixed. AIMS: This study assessed ethnic differences in stroke outcome and service access in New Zealand (NZ) and explored underlying causes in addition to traditional risk factors. METHODS: This national cohort study used routinely collected health and social data to compare post-stroke outcomes between NZ Europeans, Maori, Pacific Peoples, and Asians, adjusting for differences in baseline characteristics, socioeconomic deprivation, and stroke characteristics. First and principal stroke public hospital admissions during November 2017 to October 2018 were included (N = 6879). Post-stroke unfavorable outcome was defined as being dead, changing residence, or becoming unemployed. RESULTS: In total, 5394 NZ Europeans, 762 Maori, 369 Pacific Peoples, and 354 Asians experienced a stroke during the study period. Median age was 65 years for Maori and Pacific Peoples, and 71 and 79 years for Asians and NZ Europeans, respectively. Compared with NZ Europeans, Maori were more likely to have an unfavorable outcome at all three time-points (odds ratio (OR) = 1.6 (95% confidence interval (CI) = 1.3-1.9); 1.4 (1.2-1.7); 1.4 (1.2-1.7), respectively). Maori had increased odds of death at all time-points (1.7 (1.3-2.1); 1.5 (1.2-1.9); 1.7 (1.3-2.1)), change in residence at 3 and 6 months (1.6 (1.3-2.1); 1.3 (1.1-1.7)), and unemployment at 6 and 12 months (1.5 (1.1-2.1); 1.5 (1.1-2.1)). There was evidence of differences in post-stroke secondary prevention medication by ethnicity. CONCLUSION: We found ethnic disparities in care and outcomes following stroke which were independent of traditional risk factors, suggesting they may be attributable to stroke service delivery rather than patient factors.


Asunto(s)
Accidente Cerebrovascular , Anciano , Humanos , Asia/etnología , Estudios de Cohortes , Etnicidad , Europa (Continente)/etnología , Pueblo Maorí , Nueva Zelanda/epidemiología , Pueblos Isleños del Pacífico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/terapia , Evaluación del Resultado de la Atención al Paciente
13.
Nature ; 607(7920): 732-740, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35859178

RESUMEN

Detailed knowledge of how diversity in the sequence of the human genome affects phenotypic diversity depends on a comprehensive and reliable characterization of both sequences and phenotypic variation. Over the past decade, insights into this relationship have been obtained from whole-exome sequencing or whole-genome sequencing of large cohorts with rich phenotypic data1,2. Here we describe the analysis of whole-genome sequencing of 150,119 individuals from the UK Biobank3. This constitutes a set of high-quality variants, including 585,040,410 single-nucleotide polymorphisms, representing 7.0% of all possible human single-nucleotide polymorphisms, and 58,707,036 indels. This large set of variants allows us to characterize selection based on sequence variation within a population through a depletion rank score of windows along the genome. Depletion rank analysis shows that coding exons represent a small fraction of regions in the genome subject to strong sequence conservation. We define three cohorts within the UK Biobank: a large British Irish cohort, a smaller African cohort and a South Asian cohort. A haplotype reference panel is provided that allows reliable imputation of most variants carried by three or more sequenced individuals. We identified 895,055 structural variants and 2,536,688 microsatellites, groups of variants typically excluded from large-scale whole-genome sequencing studies. Using this formidable new resource, we provide several examples of trait associations for rare variants with large effects not found previously through studies based on whole-exome sequencing and/or imputation.


Asunto(s)
Bancos de Muestras Biológicas , Bases de Datos Genéticas , Variación Genética , Genoma Humano , Genómica , Secuenciación Completa del Genoma , África/etnología , Asia/etnología , Estudios de Cohortes , Secuencia Conservada , Exones/genética , Genoma Humano/genética , Haplotipos/genética , Humanos , Mutación INDEL , Irlanda/etnología , Repeticiones de Microsatélite , Polimorfismo de Nucleótido Simple/genética , Reino Unido
14.
J Hepatol ; 76(3): 726-734, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34619251

RESUMEN

Recent data suggest that non-alcoholic fatty liver disease (NAFLD) has become a major public health problem in Asia, with an updated population prevalence of 34%. In parallel, NAFLD-associated hepatocellular carcinoma (HCC) is also on the rise. In this review, we describe the changing epidemiology of HCC in Asia over the past 30 years. While traditional risk factors for HCC (older age, male sex and metabolic factors) are also important in Asia, the PNPLA3 gene polymorphism is particularly prevalent in East Asia and may increase the risk of HCC. NAFLD among non-obese individuals is also commonly described in Asia. Because NAFLD is often undiagnosed, few patients receive HCC surveillance, and the target surveillance population beyond patients with cirrhosis remains poorly defined. As a result, NAFLD-associated HCC is often diagnosed at an advanced stage, rendering curative treatment impossible. Finally, despite around 20-30 years of universal vaccination, chronic HBV infection remains prevalent in Asia, and emerging evidence highlights the importance of metabolic factors and concomitant hepatic steatosis on HCC development in infected patients. Future studies should explore the role of metabolic treatments in HCC prevention among patients with hepatic steatosis and concomitant liver diseases.


Asunto(s)
Pueblo Asiatico/estadística & datos numéricos , Carcinoma Hepatocelular/epidemiología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Asia/epidemiología , Asia/etnología , Pueblo Asiatico/etnología , Carcinoma Hepatocelular/etnología , Progresión de la Enfermedad , Humanos , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/etnología , Enfermedad del Hígado Graso no Alcohólico/etnología , Prevalencia , Factores de Riesgo
15.
Clin Transl Sci ; 15(2): 297-308, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34704362

RESUMEN

Cladribine tablets have been approved in many countries for the treatment of patients with various forms of relapsing multiple sclerosis (MS). Cladribine has a unique pharmacokinetic/pharmacodynamic (PK/PD) profile with a short elimination half-life (~ 1 day) relative to a prolonged PD effect on specific immune cells (most notably a reversible reduction in B and T lymphocyte counts). This results in a short dosing schedule (up to 20 days over 2 years of treatment) to sustain efficacy for at least another 2 years. Global clinical studies were conducted primarily in White patients, in part due to the distinctly higher prevalence of MS in White patients. Given the very low prevalence in Asian countries, MS is considered as a rare disease there. In spite of the limited participation of Asian patients, to demonstrate favorable benefit/risk profile in the treatment of MS demanded application of a Totality of Evidence approach to assess ethnic sensitivity for informing regulatory filings in Asian countries and supporting clinical use of cladribine in Asian patients. Population PD modeling and simulation of treatment-related reduction in absolute lymphocyte count, as a mechanism-related biomarker of drug effect, confirmed consistent PDs in Asian and non-Asian patients with MS, supporting absence of ethnic sensitivity and a common dosage across populations. Through this example, we demonstrate the value of holistic integration of all available data using a model-informed drug development (MIDD) framework and a Totality of Evidence mindset to evaluate ethnic sensitivity in support of Asia-inclusive development and use of the drug across populations.


Asunto(s)
Cladribina/administración & dosificación , Relación Dosis-Respuesta a Droga , Asia/etnología , Disponibilidad Biológica , Cladribina/farmacocinética , Interacciones Farmacológicas/etnología , Humanos , Resultado del Tratamiento
17.
Nature ; 599(7886): 628-634, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34662886

RESUMEN

A major goal in human genetics is to use natural variation to understand the phenotypic consequences of altering each protein-coding gene in the genome. Here we used exome sequencing1 to explore protein-altering variants and their consequences in 454,787 participants in the UK Biobank study2. We identified 12 million coding variants, including around 1 million loss-of-function and around 1.8 million deleterious missense variants. When these were tested for association with 3,994 health-related traits, we found 564 genes with trait associations at P ≤ 2.18 × 10-11. Rare variant associations were enriched in loci from genome-wide association studies (GWAS), but most (91%) were independent of common variant signals. We discovered several risk-increasing associations with traits related to liver disease, eye disease and cancer, among others, as well as risk-lowering associations for hypertension (SLC9A3R2), diabetes (MAP3K15, FAM234A) and asthma (SLC27A3). Six genes were associated with brain imaging phenotypes, including two involved in neural development (GBE1, PLD1). Of the signals available and powered for replication in an independent cohort, 81% were confirmed; furthermore, association signals were generally consistent across individuals of European, Asian and African ancestry. We illustrate the ability of exome sequencing to identify gene-trait associations, elucidate gene function and pinpoint effector genes that underlie GWAS signals at scale.


Asunto(s)
Bancos de Muestras Biológicas , Bases de Datos Genéticas , Secuenciación del Exoma , Exoma/genética , África/etnología , Asia/etnología , Asma/genética , Diabetes Mellitus/genética , Europa (Continente)/etnología , Oftalmopatías/genética , Femenino , Predisposición Genética a la Enfermedad/genética , Variación Genética , Estudio de Asociación del Genoma Completo , Humanos , Hipertensión/genética , Hepatopatías/genética , Masculino , Mutación , Neoplasias/genética , Carácter Cuantitativo Heredable , Reino Unido
18.
Public Health Rep ; 136(6): 774-781, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34546812

RESUMEN

OBJECTIVE: Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy. METHODS: From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance. RESULTS: Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons. CONCLUSION: Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.


Asunto(s)
Vacunas contra la COVID-19/administración & dosificación , COVID-19/epidemiología , COVID-19/prevención & control , Aceptación de la Atención de Salud/etnología , Refugiados/psicología , Adolescente , Adulto , África/etnología , Asia/etnología , COVID-19/etnología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Factores Sexuales , Factores Socioeconómicos , Estados Unidos/epidemiología , Adulto Joven
19.
BMC Cardiovasc Disord ; 21(1): 320, 2021 06 30.
Artículo en Inglés | MEDLINE | ID: mdl-34193052

RESUMEN

BACKGROUND: There appears to be an inequality in the risk of cardio-metabolic disease between those from a South Asian (SA) background when compared to those of White Europeans (WE) descendance, however, this association has not been explored in a large European cohort. This population-based open retrospective cohort explores the incidence of cardio-metabolic disease in those without pre-existing cardiometabolic disease taken from a large UK primary care database from 1st January 2007 to 31st December 2017. METHODS: A retrospective open cohort matched population-based study using The Health Improvement Network (THIN) database. The outcomes of this study were the incidences of cardio-metabolic events (type 2 diabetes mellitus, hypertension, ischemic heart disease, stroke, heart failure, and atrial fibrillation). RESULTS: A total of 94,870 SA patients were matched with 189,740 WE patients. SA were at an increased risk of developing: T2DM (adjusted hazard ratio (aHR) 3.1; 95% CI 2.97-3.23); HTN (1.34; 95% CI: 1.29-1.39); ischaemic heart disease (IHD) (1.81; 95% CI: 1.68-1.93) and heart failure (HF) (1.11; 95% CI: 1.003-1.24). However, they were at a lower risk of atrial fibrillation (AF) (0.53; 95% CI: 0.48-0.59) when compared to WE. Of those of SA origin, the Bangladeshi community were at the greatest risk of T2DM, HTN, IHD and HF, but were at the lowest risk of AF in when compared to Indians and Pakistanis. CONCLUSION: Considering the high risk of cardio-metabolic diseases in the SA cohort, differential public health measures should be considered in these patients to reduce their risk of disease, which may be furthered tailored depending on their country of origin.


Asunto(s)
Pueblo Asiatico , Enfermedades Cardiovasculares/etnología , Diabetes Mellitus Tipo 2/etnología , Disparidades en el Estado de Salud , Hipertensión/etnología , Síndrome Metabólico/etnología , Población Blanca , Adulto , Asia/etnología , Factores de Riesgo Cardiometabólico , Enfermedades Cardiovasculares/diagnóstico , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Humanos , Hipertensión/diagnóstico , Incidencia , Masculino , Síndrome Metabólico/diagnóstico , Persona de Mediana Edad , Prevalencia , Atención Primaria de Salud , Pronóstico , Factores Raciales , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Reino Unido/epidemiología
20.
Horm Metab Res ; 53(10): 672-675, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34233374

RESUMEN

Ethnic differences in intact parathyroid hormone (iPTH) at similar total 25 hydroxyvitamin D [25(OH)D] concentrations have been reported between US resident Whites, Blacks, and Hispanics, but this has not been studied between South Asians and Whites. We, therefore, compared the iPTH relationship to 25(OH)D in UK resident South Asians and Whites. A comparative, cross-sectional observational study in which demographic and laboratory data on South Asian and White residents of Wolverhampton, UK were analyzed. Log-log models measured the association between 25(OH)D and the interaction term of ethnicity and iPTH. Seven hundred and seventy-two patients consisting of 315 white subjects (208 women) and 457 South Asian subjects (331 women) were studied. Compared to South Asians, White subjects were older, had higher serum concentrations of 25(OH)D, creatinine (lower eGFR), adjusted calcium and magnesium, but similar concentrations of iPTH and phosphate. In an adjusted model, variables significantly associated with 25(OH)D included age, creatinine, adjusted calcium and ethnicity; but not iPTH and the interaction term of ethnicity and iPTH (beta coefficient -0.071, 95% CI -0.209, 0.067, p=0.32). In our study cohort, iPTH was not, per se, influenced by 25 (OH)D. We found no ethnic differences in the association between iPTH and 25(OH)D between South Asians and White UK residents.


Asunto(s)
Etnicidad/estadística & datos numéricos , Hormona Paratiroidea/sangre , Vitamina D/análogos & derivados , Adulto , Anciano , Asia/etnología , Pueblo Asiatico/estadística & datos numéricos , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reino Unido/epidemiología , Vitamina D/sangre , Población Blanca/estadística & datos numéricos
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