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1.
JCO Glob Oncol ; 8: e2200260, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36315923

RESUMO

PURPOSE: South Asian Association for Regional Cooperation (SAARC) nations are a group of eight countries with low to medium Human Development Index values. They lack trained human resources in primary health care to achieve the WHO-stated goal of Universal Health Coverage. An unregulated service sector of informal health care providers (IPs) has been serving these underserved communities. The aim is to summarize the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socioeconomic milieu that sustains their existence. METHODS: A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms Informal Health Care Provider/Informal Provider and Primary Health Care across databases such as Medline (PubMed), Google Scholar, and Cochrane database of systematic reviews, as well as World Bank, Center for Global Development, American Economic Review, Journal Storage, and Web of Science. In addition, citation lists from the primary articles, gray literature in English, and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC. RESULTS: IPs across the rural landscape often comprise more than 75% of primary caregivers. They provide accessible and affordable, but often substandard quality of care. However, their network would be suitable for prompt cancer referrals. Care delivery and accountability correlate with prevalent standards of formal health care. CONCLUSION: Acknowledgment and upskilling of IPs could be a cost-effective bridge toward universal health coverage and early cancer diagnosis in SAARC nations, whereas state capacity for training formal health care providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals who form the core of the rural public primary health care system.


Assuntos
Atenção à Saúde , Pessoal de Saúde , Neoplasias , Atenção Primária à Saúde , Humanos , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Neoplasias/diagnóstico , Neoplasias/terapia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Revisões Sistemáticas como Assunto , Cuidadores/normas , Assistência ao Paciente , Ásia Ocidental/epidemiologia
3.
BMC Endocr Disord ; 21(1): 233, 2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34814899

RESUMO

BACKGROUND: A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging health information technology (HIT) have been developed to mitigate disease among this population. This paper describes the protocol for a multi-level, community-clinical linkage intervention to improve glycemic control among South Asians with uncontrolled diabetes. METHODS: The study includes three components: 1) building the capacity of primary care practices (PCPs) to utilize electronic health record (EHR) registries to identify patients with uncontrolled diabetes; 2) delivery of a culturally- and linguistically-adapted CHW intervention to improve diabetes self-management; and 3) HIT-enabled linkage to culturally-relevant community resources. The CHW intervention component includes a randomized controlled trial consisting of group education sessions on diabetes management, physical activity, and diet/nutrition. South Asian individuals with type 2 diabetes are recruited from 20 PCPs throughout NYC and randomized at the individual level within each PCP site. A total of 886 individuals will be randomized into treatment or control groups; EHR data collection occurs at screening, 6-, 12-, and 18-month. We hypothesize that individuals receiving the multi-level diabetes management intervention will be 15% more likely than the control group to achieve ≥0.5% point reduction in hemoglobin A1c (HbA1c) at 6-months. Secondary outcomes include change in weight, body mass index, and LDL cholesterol; the increased use of community and social services; and increased health self-efficacy. Additionally, a cost-effectiveness analysis will focus on implementation and healthcare utilization costs to determine the incremental cost per person achieving an HbA1c change of ≥0.5%. DISCUSSION: Final outcomes will provide evidence regarding the effectiveness of a multi-level, integrated EHR-CHW intervention, implemented in small PCP settings to promote diabetes control among an underserved South Asian population. The study leverages multisectoral partnerships, including the local health department, a healthcare payer, and EHR vendors. Study findings will have important implications for the translation of integrated evidence-based strategies to other minority communities and in under-resourced primary care settings. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov: NCT03333044 on November 6, 2017.


Assuntos
Serviços de Saúde Comunitária/métodos , Diabetes Mellitus/terapia , Controle Glicêmico/métodos , Implementação de Plano de Saúde , Atenção Primária à Saúde/métodos , Ásia Sudeste , Ásia Ocidental/etnologia , Americanos Asiáticos , Índice de Massa Corporal , LDL-Colesterol/sangue , Serviços de Saúde Comunitária/economia , Agentes Comunitários de Saúde , Análise Custo-Benefício , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Registros Eletrônicos de Saúde , Hemoglobina A Glicada/análise , Educação em Saúde , Humanos , Cidade de Nova Iorque/epidemiologia , Inquéritos Nutricionais , Atenção Primária à Saúde/economia , Resultado do Tratamento
4.
PLoS One ; 16(10): e0258494, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34648578

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is an emerging public health issue globally. The prevalence estimates on CKD in South Asia are however limited. This study aimed to examine the prevalence of CKD among the general and high-risk population in South Asia. METHODS: We conducted a systematic review and meta-analysis of population-level prevalence studies in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). Three databases namely PubMed, Scopus and Web of Science were systematically searched for published reports of kidney disease in South Asia up to 28 October 2020. A random-effect model for computing the pooled prevalence was used. RESULTS: Of the 8749 identified studies, a total of 24 studies were included in the review. The pooled prevalence of CKD among the general population was 14% (95% CI 11-18%), and 15% (95% CI 11-20%) among adult males and 13% (95% CI 10-17%) in adult females. The prevalence of CKD was 27% (95% CI 20-35%) in adults with hypertension, 31% (95% CI 22-41%) in adults with diabetes and 14% (95% CI 10-19%) in adults who were overweight/obese. We found substantial heterogeneity across the included studies in the pooled estimates for CKD prevalence in both general and high-risk populations. The prevalence of CKD of unknown origin in the endemic population was 8% (95% CI 3-16%). CONCLUSION: Our study reaffirms the previous reports that CKD represents a serious public health challenge in South Asia, with the disease prevalent among 1 in 7 adults in South Asian countries.


Assuntos
Insuficiência Renal Crônica/epidemiologia , Ásia Sudeste/epidemiologia , Ásia Ocidental/epidemiologia , Complicações do Diabetes , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão/patologia , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/patologia , Fatores de Risco
5.
Mol Genet Genomics ; 296(6): 1177-1202, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34557965

RESUMO

Medicinal plants of the North-Western Himalayan region are known for their unprecedented biodiversity and valuable secondary metabolites that are unique to this dynamic geo-climatic region. From ancient times these medicinal herbs have been used traditionally for their therapeutic potentials. But from the last 2 decades increasing pharmaceutical demand, illegal and unorganized trade of these medicinal plants have accelerated the rate of over-exploitation in a non-scientific manner. In addition, climate change and anthropogenic activities also affected their natural habitat and driving most of these endemic plant species to critically endangered that foresee peril of mass extinction from this eco-region. Hence there is an urgent need for developing alternative sustainable approaches and policies to utilize this natural bioresource ensuring simultaneous conservation. Hither, arise the advent of sequencing-based transcriptomic studies significantly contributes to better understand the background of important metabolic pathways and related genes/enzymes of high-value medicinal herbs, in the absence of genomic information. The use of comparative transcriptomics in conjunction with biochemical techniques in North-Western Himalayan medicinal plants has resulted in significant advances in the identification of the molecular players involved in the production of secondary metabolic pathways over the last decade. This information could be used to further engineer metabolic pathways and breeding programs, ultimately leading to the development of in vitro systems dedicated to the production of pharmaceutically important secondary metabolites at the industrial level. Collectively, successful adoption of these approaches can certainly ensure the sustainable utilization of Himalayan bioresource by reducing the pressure on the wild population of these critically endangered medicinal herbs. This review provides novel insight as a transcriptome-based bioresource repository for the understanding of important secondary metabolic pathways genes/enzymes and metabolism of endangered high-value North-Western Himalayan medicinal herbs, so that researchers across the globe can effectively utilize this information for devising effective strategies for the production of pharmaceutically important compounds and their scale-up for sustainable usage and take a step forward in omics-based conservation genetics.


Assuntos
Plantas Medicinais/genética , Plantas Medicinais/metabolismo , Metabolismo Secundário/fisiologia , Transcriptoma/genética , Alcaloides/metabolismo , Ásia Ocidental , Metabolismo Energético/genética , Extinção Biológica , Engenharia Genética , Melhoramento Vegetal , Propanóis/metabolismo , Terpenos/metabolismo
7.
Asia Pac J Public Health ; 33(5): 489-501, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34165364

RESUMO

Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.


Assuntos
Nascimento Prematuro , Natimorto , Ásia Ocidental/epidemiologia , Feminino , Idade Gestacional , Indicadores Básicos de Saúde , Humanos , Recém-Nascido , Ilhas do Pacífico/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Organização Mundial da Saúde
8.
BMJ Glob Health ; 6(6)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34130991

RESUMO

BACKGROUND: The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. METHODS: We obtained nationally representative data on the CS rate from countries worldwide from 1990 to 2018. We used routine health information systems reports and population-based household surveys. Using the latest available data, we calculated current regional and subregional weighted averages. We estimated trends by a piecewise analysis of CS rates at the national, regional and global levels from 1990 to 2018. We projected the CS rate and the number of CS expected in 2030 using autoregressive integrated moving-average models. RESULTS: Latest available data (2010-2018) from 154 countries covering 94.5% of world live births shows that 21.1% of women gave birth by caesarean worldwide, averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean. CS has risen in all regions since 1990. Subregions with the greatest increases were Eastern Asia, Western Asia and Northern Africa (44.9, 34.7 and 31.5 percentage point increase, respectively) while sub-Saharan Africa and Northern America (3.6 and 9.5 percentage point increase, respectively) had the lowest rise. Projections showed that by 2030, 28.5% of women worldwide will give birth by CS (38 million caesareans of which 33.5 million in LMIC annually) ranging from 7.1% in sub-Saharan Africa to 63.4% in Eastern Asia . CONCLUSION: The use of CS has steadily increased worldwide and will continue increasing over the current decade where both unmet need and overuse are expected to coexist. In the absence of global effective interventions to revert the trend, Southern Asia and sub-Saharan Africa will face a complex scenario with morbidity and mortality associated with the unmet need, the unsafe provision of CS and with the concomitant overuse of the surgical procedure which drains resources and adds avoidable morbidity and mortality. If the Sustainable Development Goals are to be achieved, comprehensively addressing the CS issue is a global priority.


Assuntos
Cesárea , Pobreza , África ao Sul do Saara/epidemiologia , Ásia/epidemiologia , Ásia Ocidental , Feminino , Humanos , Gravidez
9.
Sci Rep ; 11(1): 9406, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931717

RESUMO

Increased brachial systolic blood-pressure (BP) predicts diabetes (T2DM) but is not fully effective. Value of absolute ankle systolic BP for T2DM compared to brachial systolic BP is not known. Our objectives were to assess independent relationships of ankle-systolic BP with T2DM and cardiovascular disease in Europeans and south Asians. Cross-sectional studies of anonymised data from registered adults (n = 1087) at inner city deprived primary care practices. Study includes 63.85% ethnic minority. Systolic BP of the left and right-brachial, posterior-tibial and dorsalis-pedis-arteries measured using a Doppler probe. Regression models' factors were age, sex, ethnicity, body mass index (BMI) and waist height ratio (WHtR). Both brachial and ankle systolic-BP increase with diabetes in Europeans and south Asians. We demonstrated that there was a significant positive independent association of ankle BP with diabetes, regardless of age and sex compared to Brachial. There was stronger negative association of ankle blood pressure with cardiovascular disease, after adjustment for BMI, WHtR and ethnicity. Additionally, we found that ankle BP were significantly associated with cardiovascular disease in south Asians more than the Europeans; right posterior tibial. Ankle systolic BPs are superior to brachial BPs to identify risks of Type 2DM and cardiovascular diseases for enhanced patient care.


Assuntos
Índice Tornozelo-Braço , Pressão Sanguínea , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Adulto , Idoso , Ásia Ocidental/etnologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
10.
Biomed Res Int ; 2021: 5568262, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33997009

RESUMO

Bioinformatics education has been a hot topic in South Asia, and the interest in this education peaks with the start of the 21st century. The governments of South Asian countries had a systematic effort for bioinformatics. They developed the infrastructures to provide maximum facility to the scientific community to gain maximum output in this field. This article renders bioinformatics, measures, and its importance of implementation in South Asia with proper ways of improving bioinformatics education flaws. It also addresses the problems faced in South Asia and proposes some recommendations regarding bioinformatics education. The information regarding bioinformatics education and institutes was collected from different existing research papers, databases, and surveys. The information was then confirmed by visiting each institution's website, while problems and solutions displayed in the article are mostly in line with South Asian bioinformatics conferences and institutions' objectives. Among South Asian countries, India and Pakistan have developed infrastructure and education regarding bioinformatics rapidly as compared to other countries, whereas Bangladesh, Sri Lanka, and Nepal are still in a progressing phase in this field. To advance in a different sector, the bioinformatics industry has to be revolutionized, and it will contribute to strengthening the pharmaceutical, agricultural, and molecular sectors in South Asia. To advance in bioinformatics, universities' infrastructure needs to be on a par with the current international standards, which will produce well-trained professionals with skills in multiple fields like biotechnology, mathematics, statistics, and computer science. The bioinformatics industry has revolutionized and strengthened the pharmaceutical, agricultural, and molecular sectors in South Asia, and it will serve as the standard of education increases in the South Asian countries. A framework for developing a centralized database is suggested after the literature review to collect and store the information on the current status of South Asian bioinformatics education. This will be named as the South Asian Bioinformatics Education Database (SABE). This will provide comprehensive information regarding the bioinformatics in South Asian countries by the country name, the experts of this field, and the university name to explore the top-ranked outputs relevant to queries.


Assuntos
Biologia Computacional/educação , Biologia Computacional/organização & administração , Ásia Ocidental , Países em Desenvolvimento , Humanos , Universidades
11.
Artigo em Inglês | MEDLINE | ID: mdl-33921377

RESUMO

This study investigated effects of home confinement on physical activity (PA) in Team Handball during the COVID-19 outbreak. A total of 1359 handball players participated (age: 23 ± 6 years). Participants from Europe, Western Asia, and North Africa answered an online version of the International Physical Activity Questionnaire (IPAQ) considering "before" and "during" confinement. COVID-19 home confinement has had a negative effect on PA (vigorous, moderate, walking, and overall). The largest decrease was in the sum parameter "all PA" (MET (metabolic equivalent of task)-min/week, ηp2 = 0.903; min/week, ηp2 = 0.861). Daily sitting time increased from 2.7 to 5.0 h per weekday (p < 0.001, ηp2 = 0.669). For gender, continent, country, level of handball league, and playing position, no significant differences (group and interaction effects) were observed. The largest change in PA behavior was in walking (minutes per day: ηp2 = 0.755), with males displaying the greatest decrease (from 62 ± 11 to 30 ± 14 min per weekday; d = 2.67). In terms of magnitude, difference between genders was greatest for sitting time (difference in d = 1.20). In conclusion, while COVID-19 measures were essential to preserve public health, PA was compromised and sedentary behavior increased because of these public health measures regardless of gender, playing position, and competition level.


Assuntos
COVID-19 , Adolescente , Adulto , África do Norte , Ásia Ocidental , Surtos de Doenças , Europa (Continente) , Exercício Físico , Feminino , Humanos , Masculino , SARS-CoV-2 , Adulto Jovem
12.
Artigo em Inglês | MEDLINE | ID: mdl-33921852

RESUMO

BACKGROUND: The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults. METHODS: A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire. RESULTS: Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F(2, 514) = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R2: 0.20). CONCLUSION: COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.


Assuntos
COVID-19 , África do Norte , Idoso , Ásia Ocidental , Controle de Doenças Transmissíveis , Europa (Continente) , Exercício Físico , Humanos , SARS-CoV-2 , Sono , Inquéritos e Questionários
13.
Science ; 372(6538): 165-171, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33833119

RESUMO

The brains of modern humans differ from those of great apes in size, shape, and cortical organization, notably in frontal lobe areas involved in complex cognitive tasks, such as social cognition, tool use, and language. When these differences arose during human evolution is a question of ongoing debate. Here, we show that the brains of early Homo from Africa and Western Asia (Dmanisi) retained a primitive, great ape-like organization of the frontal lobe. By contrast, African Homo younger than 1.5 million years ago, as well as all Southeast Asian Homo erectus, exhibited a more derived, humanlike brain organization. Frontal lobe reorganization, once considered a hallmark of earliest Homo in Africa, thus evolved comparatively late, and long after Homo first dispersed from Africa.


Assuntos
Evolução Biológica , Encéfalo/anatomia & histologia , Lobo Frontal/anatomia & histologia , Hominidae/anatomia & histologia , África , Animais , Ásia Ocidental , Fósseis , Humanos , Crânio/anatomia & histologia
14.
Am J Cardiol ; 148: 157-164, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33675770

RESUMO

The American College of Cardiology / American Heart Association pooled cohort equations tool (ASCVD-PCE) is currently recommended to assess 10-year risk for atherosclerotic cardiovascular disease (ASCVD). ASCVD-PCE does not currently include genetic risk factors. Polygenic risk scores (PRSs) have been shown to offer a powerful new approach to measuring genetic risk for common diseases, including ASCVD, and to enhance risk prediction when combined with ASCVD-PCE. Most work to date, including the assessment of tools, has focused on performance in individuals of European ancestries. Here we present evidence for the clinical validation of a new integrated risk tool (IRT), ASCVD-IRT, which combines ASCVD-PCE with PRS to predict 10-year risk of ASCVD across diverse ethnicity and ancestry groups. We demonstrate improved predictive performance of ASCVD-IRT over ASCVD-PCE, not only in individuals of self-reported White ethnicities (net reclassification improvement [NRI]; with 95% confidence interval = 2.7% [1.1 to 4.2]) but also Black / African American / Black Caribbean / Black African (NRI = 2.5% [0.6-4.3]) and South Asian (Indian, Bangladeshi or Pakistani) ethnicities (NRI = 8.7% [3.1 to 14.4]). NRI confidence intervals were wider and included zero for ethnicities with smaller sample sizes, including Hispanic (NRI = 7.5% [-1.4 to 16.5]), but PRS effect sizes in these ethnicities were significant and of comparable size to those seen in individuals of White ethnicities. Comparable results were obtained when individuals were analyzed by genetically inferred ancestry. Together, these results validate the performance of ASCVD-IRT in multiple ethnicities and ancestries, and favor their generalization to all ethnicities and ancestries.


Assuntos
Aterosclerose/epidemiologia , Predisposição Genética para Doença , Fatores de Risco de Doenças Cardíacas , Adulto , Idoso , Ásia Ocidental , Aterosclerose/etnologia , Aterosclerose/genética , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
15.
Med Leg J ; 89(2): 128-132, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33715522

RESUMO

Transnational commercial surrogacy is a form of medical tourism undertaken by intended parents in an attempt to seek surrogates in other countries. Most intended parents are from developed countries and seek their surrogates from developing countries, predominantly from South and Southeast Asia. This arrangement led to the establishment of surrogacy businesses in South and Southeast Asia, in countries such as India and Thailand. Subsequently, the business was banned in these countries, which led to a trend of moving it to neighbouring countries where there were no regulations or restrictions. This paper maps the movement of the industry and calls for attention to re-consider or re-frame commercial surrogacy in an international framework.


Assuntos
Comércio/economia , Comércio/legislação & jurisprudência , Técnicas de Reprodução Assistida/legislação & jurisprudência , Mães Substitutas/legislação & jurisprudência , Ásia Sudeste , Ásia Ocidental , Comércio/tendências , Feminino , Humanos , Gravidez
16.
Circ Heart Fail ; 14(3): e007537, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33724884

RESUMO

BACKGROUND: Clinical studies of hypertrophic cardiomyopathy are over-represented by individuals of European ethnicity, with less known about other ethnic groups. We investigated differences between patients in a multiethnic Australian hypertrophic cardiomyopathy population. METHODS: We performed a retrospective cohort study of 836 unrelated hypertrophic cardiomyopathy probands attending a specialized clinic between 2002 and 2020. Major ethnic groups were European (n=611), East Asian (n=75), South Asian (n=58), and Middle Eastern and North African (n=68). The minor ethnicity groups were Oceanian (n=9), People of the Americas (n=7), and African (n=8). One-way ANOVA with Dunnett post hoc test and Bonferroni adjustment were performed. RESULTS: Mean age of the major ethnic groups was 54.9±16.9 years, and 527 (65%) were male. Using the European group as the control, East Asian patients had a lower body mass index (29 versus 25 kg/m2, P<0.0001). South Asians had a lower prevalence of atrial fibrillation (10% versus 31%, P=0.024). East Asians were more likely to have apical hypertrophy (23% versus 6%, P<0.0001) and Middle Eastern and North African patients more likely to present with left ventricular outflow tract obstruction (46% versus 34%, P=0.0003). East Asians were less likely to undergo genetic testing (55% versus 85%, P<0.0001) or have an implantable cardioverter-defibrillator implanted (19% versus 36%, P=0.037). East Asians were more likely to have a causative variant in a gene other than MYBPC3 or MYH7, whereas Middle Eastern and North African and South Asians had the highest rates of variants of uncertain significance (27% and 21%, P<0.0001). CONCLUSIONS: There are few clinical differences based on ethnicity, but importantly, we identify health disparities relating to access to genetic testing and implantable cardioverter-defibrillator use. Unless addressed, these gaps will likely widen as we move towards precision-medicine-based care of individuals with hypertrophic cardiomyopathy.


Assuntos
Cardiomiopatia Hipertrófica/fisiopatologia , Disparidades em Assistência à Saúde/etnologia , Adulto , África do Norte/etnologia , Idoso , Ásia/etnologia , Ásia Ocidental/etnologia , Austrália , Miosinas Cardíacas/genética , Cardiomiopatia Hipertrófica/etnologia , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/terapia , Proteínas de Transporte/genética , Desfibriladores Implantáveis/estatística & dados numéricos , Extremo Oriente/etnologia , Feminino , Testes Genéticos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Oriente Médio/etnologia , Cadeias Pesadas de Miosina/genética , Estudos Retrospectivos , /genética
17.
Diabet Med ; 38(2): e14494, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33617033

RESUMO

BACKGROUND: South Asians are at higher risk for diabetes (DM) than many other racial/ethnic groups. Circulating metabolites are measurable products of metabolic processes that may explain the aetiology of elevated risk. We characterized metabolites associated with prevalent DM and glycaemic measures in South Asians. METHODS: We included 717 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, aged 40-84 years. We used baseline fasting serum for metabolomics and demographic, behavioural, glycaemic data from baseline and at 5 years. We performed LC-MS untargeted metabolomic and lipidomic analysis with targeted integration of known signals. Individual linear and ordinal logistic regression models were adjusted for age, sex, BMI, diet, exercise, alcohol, smoking and family history of DM followed by elastic net regression to identify metabolites most associated with the outcome. RESULTS: There were 258 metabolites with detectable signal in >98% of samples. Thirty-four metabolites were associated with prevalent DM in an elastic net model. Predominant metabolites associated with DM were sphingomyelins, proline (OR 15.86; 95% CI 4.72, 53.31) and betaine (OR 0.03; 0.004, 0.14). Baseline tri- and di-acylglycerols [DG (18:0/16:0) (18.36; 11.79, 24.92)] were positively associated with fasting glucose and long-chain acylcarnitines [CAR 26:1 (-0.40; -0.54, -0.27)] were inversely associated with prevalent DM and HbA1c at follow-up. DISCUSSION: A metabolomic signature in South Asians may help determine the unique aetiology of diabetes in this high-risk ethnic group. Future work will externally validate our findings and determine the effects of modifiable risk factors for DM.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus/metabolismo , Hemoglobina A Glicada/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Ásia Ocidental/etnologia , Betaína/metabolismo , Carnitina/análogos & derivados , Carnitina/metabolismo , Cromatografia Líquida , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Diglicerídeos/metabolismo , Feminino , Humanos , Modelos Lineares , Lipidômica , Modelos Logísticos , Masculino , Espectrometria de Massas , Metabolômica , Pessoa de Meia-Idade , Prolina/metabolismo , Esfingomielinas/metabolismo , Triglicerídeos/metabolismo , Estados Unidos
18.
Prep Biochem Biotechnol ; 51(1): 1-8, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32921222

RESUMO

Biosimilars are the biological drugs that are granted after the expiry of the patent of an affirmed innovator. Asia Pacific countries are characterized by significant demand as they account for majority of the world population and poor affordability due to low per capita income in most regions. Some of these countries offer potential to emerge as global suppliers of affordable, safe and efficacious biosimilars. This article highlights the prospects of biosimilars in the Asia Pacific market. Regulatory framework in the various countries is also discussed.


Assuntos
Medicamentos Biossimilares/economia , Medicamentos Biossimilares/provisão & distribuição , Aprovação de Drogas/economia , Aprovação de Drogas/legislação & jurisprudência , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Ásia Sudeste , Ásia Ocidental , Extremo Oriente , Humanos , Marketing/economia , Marketing/legislação & jurisprudência
19.
J Clin Pathol ; 74(3): 157-162, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32605921

RESUMO

AIMS: Congenital sideroblastic anaemias (CSAs) are a group of rare disorders with the presence of ring sideroblasts in the bone marrow. Pathogenic variants are inherited in an autosomal recessive/X-linked fashion. The study was aimed at characterising the spectrum of mutations in SLC25A38 and ALAS2 genes in sideroblastic anaemia patients, exploring the genotype-phenotype correlation and identifying the haplotype associated with any recurrent mutation. PATIENTS AND METHODS: Twenty probable CSA patients were retrospectively analysed for genetic variants in ALAS2 and SLC25A38 genes by direct bidirectional sequencing. Real-time PCR was used to quantify gene expression in a case with promoter region variant in ALAS2. Three single nucleotide polymorphisms were used to establish the haplotype associated with a recurrent variant in the SLC25A38 gene. RESULTS: Six patients had causative variants in ALAS2 (30%) and 11 had variants in SLC25A38 (55%). The ALAS2 mutated cases presented at a significantly later age than the SLC25A38 cases. A frameshift variant in SLC25A38 (c.409dupG) was identified in six unrelated patients and was a common variant in our population exhibiting 'founder effect'. CONCLUSION: This is the largest series of sideroblastic anaemia cases with molecular characterisation from the Indian subcontinent.


Assuntos
5-Aminolevulinato Sintetase/genética , Anemia Sideroblástica/genética , Doenças Genéticas Ligadas ao Cromossomo X/genética , Proteínas de Transporte da Membrana Mitocondrial/genética , Adolescente , Adulto , Anemia Sideroblástica/patologia , Ásia Ocidental , Criança , Pré-Escolar , Feminino , Mutação da Fase de Leitura , Estudos de Associação Genética , Doenças Genéticas Ligadas ao Cromossomo X/patologia , Predisposição Genética para Doença , Haplótipos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Int J Rheum Dis ; 24(2): 170-182, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33244895

RESUMO

The burden of axial spondyloarthropathy (axSpA) in the Asia-Pacific region is substantial. The management of axSpA has been revolutionized with the advent of biological therapy where the disease activity, functional disability and negative psychological affect can be mitigated to a great extent. On the other hand, exercise remains an essential component of the treatment of axSpA at all stages, which is often discounted or underused. This is compounded by a gap in demand and supply between increasing number patients with axSpA and paucity of trained specialists and rehabilitation personnel in the Asia-Pacific countries. The acceptability and uptake of therapeutic exercise is strikingly poor in this region because of multiple factors such as lack of awareness among health professionals and the general population, poor healthcare infrastructure, lack of resources and limited accessibility to rehabilitation services. Health authorities and professional bodies in these countries need to work in tandem to expand healthcare facilities, encourage training opportunities and promote safe and effective exercise interventions which is accessible to the general population and individuals with axSpA. Adequate patient education, optimum control of disease activity and strict adherence to therapeutic exercise is essential to predict the best clinical outcome. In this narrative review we have appraised the impact of therapeutic exercise in this era of biological therapies in axSpA and have explored the challenges of rehabilitation services in the Asia-Pacific countries. Overall, the available quality of evidence is mixed, acknowledging the beneficial role of exercise and optimum usage and protocols pertaining to axSpA specific exercises and therefore further research is warranted.


Assuntos
Terapia por Exercício/métodos , Espondiloartropatias/reabilitação , Ásia Ocidental/epidemiologia , Humanos , Morbidade/tendências , Espondiloartropatias/epidemiologia
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