Zinc Status in South Asian Populations—An Update

This article attempts to highlight the prevalence of zinc deficiency and its health and economic consequences in South Asian developing countries and to shed light on possible approaches to combating zinc deficiency. A computer-based search was performed on PubMed, Google, and ScienceDirect.com to retrieve relevant scientific literature published between 2000 and 2012. The search yielded 194 articles, of which 71 were culled. Studies were further screened on the basis of population groups, age and sex, pregnancy, and lactation. The most relevant articles were included in the review. Cutoffs for serum zinc concentration defined for zinc deficiency were 65 µg/dL for males and females aged <10 years, 66 µg/dL for non-pregnant females, and 70 µg/dL for males aged ≥10 years. Population segments from rural and urban areas of South Asian developing countries were included in the analysis. They comprised pregnant and lactating women, preschool and school children. The analysis reveals that zinc deficiency is high among children, pregnant and lactating women in India, Pakistan, Bangladesh, Sri Lanka, and Nepal. Diarrhoea has been established as a leading cause to intensify zinc deficiency in Bangladesh. Little has been done in Sri Lanka and Nepal to estimate the prevalence of zinc deficiency precisely. A substantial population segment of the South Asian developing countries is predisposed to zinc deficiency which is further provoked by increased requirements for zinc under certain physiological conditions. Supplementation, fortification, and dietary diversification are the most viable strategies to enhancing zinc status among various population groups.Key words: Growth, Infection, Malnutrition, Zinc, South Asia     

Journal of Asian Natural Products Research 的办刊实践

随着文化体制改革的深入,国内众多科技期刊出版了英文版或翻译版,以期提高该刊在国内和国际同行中的影响力,并在竞争激烈的期刊丛林中生存和谋求发展。 Journal of Asian Natural Products Research创刊伊始即被SCI收录,并在十年内成长为月刊。作为月刊出版后,本刊的SCI影响因子逐年回升,在国际同行的声望和影响力与日俱增,这得益于该刊编委会和主编制定的正确发展策略,主编、编委、编辑部工作人员能紧跟形势、主动出击、积极寻找和组织优秀稿源。     

Will feeding mothers prevent the Asian metabolic syndrome epidemic?

Evolutionary pressures have probably amplified the mechanisms for minimizing the impact of environmental factors through compensatory maternal mechanisms. Nevertheless, experimentally there are clear long-term programming effects of manipulations to the maternal diet on the likelihood of neural-tube defects associated with folate deficiency The fat/lean ratios of the newborn, and subsequent development, seem to be linked to amino acid or folate supply. An altered balance in the hypothalamic-pituitary-adrenal axis, which experimentally has profound effects on brain development, is induced by low-protein maternal diets. Such diets are linked to a reduced pancreatic capacity for insulin production and to an altered hepatic architecture, with a change in the control of glucose metabolism. Human studies suggest that what happens in pregnancy is modified by the child's diet in the first months of life. Low birthweight is linked to early stunting, and predisposes to abdominal obesity and metabolic syndrome in later life. Metabolic syndrome amplifies the risks of diabetes, hypertension, coronary heart disease and probably some cancers. Mothers with gestational diabetes are themselves prone to early type 2 diabetes and produce heavier babies prone to childhood obesity and adolescent type 2 diabetes. There is increasing evidence of an intergenerational effect, with big babies being prone to excess weight gain, which then, in girls, predisposes them to diabetes in pregnancy, which, in turn, promotes an accelerating cycle of early diabetes in subsequent generations. Essential fatty acids and fat soluble vitamins are important, but we need early interventions and monitoring systems to justify coherent policies.     

What role for state health care in Asian transition economies?

The main findings of a study of the impact of changes to communism on health care in Asian transition economies are summarized. © 1997 John Wiley & Sons, Ltd.     

Assessment of health professional education across five Asian countries—a protocol

Background

There is an increasing consensus globally that the education of health professionals is failing to keep pace with scientific, social, and economic changes transforming the healthcare environment. This catalyzed a movement in reforming education of health professionals across Bangladesh, China, India, Thailand, and Vietnam who jointly volunteered to implement and conduct cooperative, comparative, and suitable health professional education assessments with respect to the nation’s socio-economic and cultural status, as well as domestic health service system.

Methods

The 5C network undertook a multi-country health professional educational study to provide its countries with evidence for HRH policymaking. Its scope was limited to the assessment of medical, nursing, and public health education at three levels within each country: national, institutional, and graduate level (including about to graduate students and alumni).

Results

This paper describes the general issues related to health professional education and the protocols used in a five-country assessment of medical, nursing, and public health education. A common protocol for the situation analysis survey was developed that included tools to undertake a national and institutional assessment, and graduate surveys among about-to-graduate and graduates for medical, nursing, and public health professions. Data collection was conducted through a mixture of literature reviews and qualitative research.

Conclusions

The national assessment would serve as a resource for countries to plan HRH-related future actions.

     

Do they look after their own? Informal support for South Asian carers

Policy on care in the community was founded on the premise that the care of frail elderly people with disabilities would be a joint responsibility for health and social care professionals, and family carers, supported by people within their social networks. The policy assumes that such social networks are common features of all communities in contemporary Britain, containing a reserve of people who can be called upon to provide support to carers. The present paper draws on material gathered for a qualitative study of the experiences carers in South Asian communities to examine the quality and quantity of informal support that was available in different types of households. Male and female carers were selected from the Punjabi Sikh, Gujarati Hindu, and Bangladeshi and Pakistani communities. A total of 105 carers participated in the project. Participants were caring for people in all age groups with physical and/or mental distress, and in some cases, with multiple and complex impairments. The analysis of carers' accounts suggested that, for a variety of reasons, the main carer, irrespective of gender, had limited support both in nuclear and extended households. In addition, societal attitudes towards disability and the fear of obligation prevented the seeking and accepting of help from wider social networks. The paper concludes that the evidence does not support the assumption about extended families, and their willingness and ability to support carers. Many issues highlighted in this paper have far-reaching implications for policy makers in many countries in the West where South Asian people have made their homes.     

Cervical Cancer among Asian American Women: A Neglected Publica Health Problem?

PURPOSE OF THE PAPER: Relatively little attention has been paid to cervical cancer control in Asian American populations. We summarize available cervical cancer incidence and mortality dat, present information on levels of Pap testing use, and review factors that may be associated with cervical cancer screening participation. METHODS: We reviewed the literature pertaining to cervical cancer and Pap testing among Asian populations in North America. PRINCIPAL FINDINGS: Cancer registry data suggest that women from Southease Asia have a nearly five­fold increased risk of invasive cervical cancer (when compared to non­Hispanic White women). Filipino and Korean populations also have elevated risks. The excess invasive cervical cancer burden appears to be concentrated among women aged 40 and older. Pap testing use by Asians is less than for all toher racial/ethnic groups in the U.S., and recent studies suggest that over one­third of Vietnamese immigrants have never been screened. Barriers to Pap testing participation by less acculturated Asian women include a lack of familiarity with Western preventive concepts, a lack of knowledge concerning cervical cancer, embarrassment in association with gynecologic exams, the role of women in some Asian cultures, the cost of health care, and language difficulties. CONCLUSIONS: There is a considerable need for ethnoculturally appropriate cervical cancer control programs targeting Asian American populations. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: This paper is relevant to Asian American women from East, South, Southeast, and Island Asia.     

Comparison of the measurement properties between a short and generic instrument, the 5-level EuroQoL Group’s 5-dimension (EQ-5D-5L) questionnaire, and a longer and disease-specific instrument, the Functional Assessment of Cancer Therapy—Breast (FACT-B), in Asian breast cancer patients

Purpose

To compare the measurement precision and related properties between the 5-level EuroQoL Group’s 5-dimension (EQ-5D-5L) questionnaire and the Functional Assessment of Cancer Therapy—Breast (FACT-B) questionnaire in assessing breast cancer patients.

Methods

An observational study of 269 Singaporean breast cancer patients. To compare discriminative ability and responsiveness, the effect sizes (in standard deviation) of the EQ-5D-5L and the FACT-B in relation to health indicators and the change in performance status or quality of life were estimated. Test–retest reliability was examined using the intraclass correlation (ICC).

Results

Using performance status, evidence of disease, and treatment status as the criteria, the differences (FACT-B minus EQ-5D-5L) in the effect size for discriminative ability were negative or closed to zero, and the 90 % confidence intervals totally fell within the zone that indicated the non-inferiority of the EQ-5D-5L. For responsiveness and test–retest reliability, the confidence intervals of the differences in effect size and ICC overlapped the non-inferiority margin; thus, non-inferiority in these two aspects could neither be confirmed nor rejected.

Conclusions

The EQ-5D-5L was non-inferior to the FACT-B in discriminating breast cancer patients with different health conditions cross-sectionally. The EQ-5D-5L serves as a reasonable alternative or supplementary instrument to the FACT-B in assessing breast cancer patients’ health outcomes.     

Prime–boost vaccination with a fowlpox vector and an inactivated avian influenza vaccine is highly immunogenic in Pekin ducks challenged with Asian H5N1 HPAI

The efficacy of different vaccination schedules was evaluated in 17-day-old Pekin ducks using an experimental inactivated whole virus vaccine based on the H5N9 A/chicken/Italy/22A/98 isolate (H5N9-It) and/or a fowlpox recombinant (vFP-H5) expressing a synthetic HA gene from an Asian H5N1 isolate (A/chicken/Indonesia/7/2003). Full protection against clinical signs and shedding was induced by the different vaccination schemes. However, the broadest antibody response and the lowest antibody increase after challenge were observed in the group of ducks whose immune system was primed with the fowlpox vectored vaccine and boosted with the inactivated vaccine, suggesting that this prime-boost strategy induced optimal immunity against H5N1 and minimal viral replication after challenge in ducks. In addition, this prime-boost vaccination scheme was shown to be immunogenic in 1-day-old ducklings.     

Relationship between perception of self‐competence and parenting attitudes of Asian Indian preschoolers

The purpose of the present study is to examine the relationship between parenting attitudes of Asian Indian mothers living in the United States and their preschool children’s perception of self‐competence. Twenty‐eight Asian Indian mothers and their preschool‐aged children living in the United States participated in the study. The parenting attitudes of the mothers were measured using the Adolescent–Adult Parenting Inventory. The participating preschoolers’ perceived self‐competence was measured using the Pictorial Scale of Perceived Competence and Social Acceptance. Correlation of the parenting attitudes subscales and the perception of self‐competence subscales indicated that there was significant correlation between cognitive competence and inappropriate expectations (r = 0.45, p < 0.05), corporal punishment (r = 0.46, p < 0.05), and role reversal (r = 0.59, p < 0.01). Role reversal was also significantly correlated with peer acceptance (r = 0.46, p < 0.05). The correlation between inappropriate expectations, corporal punishment, role reversal and cognitive competence among the Asian Indian children could be attributed to the values their parents place on cognitive skills.     

Young Asian Americans’ Knowledge and Perceptions of Cervical Cancer and the Human Papillomavirus

Cervical cancer is a major health disparity among Asian Americans, with cervical cancer rates of Vietnamese women being significantly higher than for the general US female population and low screening rates reported for Asian American females. Focus groups and interviews were conducted with young Vietnamese, Filipino, and Korean adults (ages 18–29) to collect information on knowledge, perceptions and sources of information regarding cervical cancer, Pap tests and the human papillomavirus. 16 Korean, 18 Vietnamese, and 18 Filipino (50% female) adults participated in the study. Many participants had never heard of HPV, cervical cancer and Pap testing. Cervical cancer screening rates were low for Korean and Vietnamese females and were influenced by moral beliefs and lack of awareness. Culturally relevant education materials that consider specific Asian ethnicity and language are needed to increase awareness of cervical cancer, Pap testing, and HPV among Asian American young adults     

Sex ratio patterns according to Asian ethnicity in Québec, 1981–2004

Elevated ratios of male to female births are emerging in Asian countries due to selective abortion of female foetuses. Little research has evaluated the possibility of sex selection among Asians in the West. We evaluated patterns in the secondary sex ratio (SSR, number of male per 100 female births) according to ethnicity in Québec, Canada. We performed a population-based retrospective analysis of live and still births in urban Québec, 1981–2004 (N = 1,612,614 live births). Outcomes included: (1) first and second order SSR over four consecutive 6-year intervals analysed according to parental mother tongue, parental birth region, and mothers still speaking her mother tongue at home, (2) adjusted relative risk (RR) of female birth by parental ethnicity, and (3) estimated number of unborn females. For the period 1987–1992, first order SSRs were elevated (range 118–121) for Indo–Pakistani parental mother tongue and mothers currently speaking Indo–Pakistani at home. Second order SSRs were not elevated. For Indo–Pakistani mother tongues, the RR of female birth was lower than French/English in the same period (adjusted RR 0.96, 95% CI 0.92–0.99). SSRs were not imbalanced in the late 1990s among Indo–Pakistani parents, or among Chinese ethnicity in any study period. The SSR in Québec was elevated in the 1980s and early 1990s among firstborn relative to subsequent born infants of Indo–Pakistani descent. The reason for this imbalance is unclear. Further research in other Western settings is necessary to evaluate the possibility of sex selection.     

用药注意5先5后

先看病，后用药“老毛病”，“小问题”，这是人们常挂在嘴边的话，也因此总喜欢自作主张或听熟人的推荐自己买药治病。殊不知，自己用药缓解了症状，却可能掩盖了病情，延误了大病的治疗。而且别人用了有效的药，放在您身上并不一定适合。因此，有了病还是应该先看医生，再根据处方用药。这样不仅能做到对症下药，也可以在医生的指导下避免药物的不良反应。     

Discrimination and Mental Health�CRelated Service Use in a National Study of Asian Americans

Objectives. We examined the association between perceived discrimination and use of mental health services among a national sample of Asian Americans.Methods. Our data came from the National Latino and Asian American Study, the first national survey of Asian Americans. Our sample included 600 Chinese, 508 Filipinos, 520 Vietnamese, and 467 other Asians (n=2095). We used logistic regression to examine the association between discrimination and formal and informal service use and the interactive effect of discrimination and English language proficiency.Results. Perceived discrimination was associated with more use of informal services, but not with less use of formal services. Additionally, higher levels of perceived discrimination combined with lower English proficiency were associated with more use of informal services.Conclusions. The effect of perceived discrimination and language proficiency on service use indicates a need for more bilingual services and more collaborations between formal service systems and community resources.Asian Americans are one of the fastest-growing racial groups in the United States and also one of the most understudied.¹ Recent data from the National Latino and Asian American Study (NLAAS), the first national study of Asian Americans, show that they have a sizeable burden of mental illness, with a 17.30% overall lifetime rate of any psychiatric disorder and a 9.19% 12-month rate.² At the same time, low utilization rates of mental health services by Asian Americans are well documented.^3–7 Nationally, Asian Americans/Pacific Islanders are one third as likely as Whites to use available mental health services.³ Low use rates have been reported for emergency and inpatient services^4–6 as well as outpatient services.^4,7,8In the United States over a 12-month period, only 3.1% of Asian Americans use specialty mental health services, compared with 5.59% of African Americans, 5.94% of Caribbean Blacks, 4.44% of Mexicans, 5.55% of Cubans, and 8.8% of the general population.^9–11 In a study by Abe-Kim et al., only 8.6% of Asian Americans sought any mental health services compared with 17.9% of the general population.¹² Kimerling and Baumrind found that Asian American women were less likely than White women to report perceived need for mental health services, even when accounting for frequency of mental distress. Among women who did perceive a need to seek mental health services, Asian American women were less likely to use services even when health insurance was controlled.¹³Despite low use rates for formal services, research has established that Asian Americans are more likely to use informal support systems for help with mental health issues as to use formal services. Data from the Chinese American Epidemiology Study (CAPES) found that of Chinese Americans experiencing mental health problems in the past 6 months, fewer than 6% saw mental health professionals, 4% saw medical doctors, and 8% saw a minister or priest.¹⁴ A study using data from the Filipino American Community Epidemiological Study (FACES) found that of the 25% of Filipino Americans who used any type of care in the past 12 months, 17% went to the lay system (a friend or relative), 7% used medical doctors, 4% saw a clergy member or indigenous healer, and only 3% saw a mental health specialist.¹⁵ In a study using data from the CAPES, negative attitudes toward formal mental health services were correlated with more informal service use.¹⁶Discrimination is a major stressor experienced by American ethnic groups.¹⁷ Experiences with discrimination shape one''s appraisal of the world and hinder the ability to control one''s environment, thus reinforcing secondary social status and internalizing negative stereotypes.^18–20 There are many well-documented examples of policies and practices that have systematically discriminated against Asian Americans throughout US history.^21,22 Contemporary forms of discrimination include the model minority stereotype (which highlights the aggregation of success indicators while masking the challenges of immigrant populations), hate crimes, racial profiling, and employment discrimination.^23–28 Increasingly, researchers have demonstrated an association between racial discrimination and mental disorders among Asian Americans.^29–38Discrimination also may be a barrier to help seeking among Asian Americans. Indeed, research has found that perceived discrimination is significantly correlated with underuse of mental health care among Asian Americans.³⁹ Further, it is possible that discrimination may interact with other barriers to treatment. For example, Spencer and Chen found that discrimination based on speaking a different language or speaking with an accent was associated with use of more informal services among Chinese Americans.¹⁶ Uba cites racial and cultural biases—such as culturally inappropriate services, differential receipt of services, a history of institutional discrimination, and a suspicion of the service delivery system—as critical barriers to service use for Asian Americans.⁴⁰Other immigrant-related factors are important correlates of service use. For example, rates of use were found to vary by generation: US-born, third-generation or later Asian Americans had higher rates of use of specialty mental health services than did first- or second-generation individuals.¹² Other studies that have examined correlates of service use among Asian Americans have identified cultural factors, such as shame and loss of face^41–44; lack of ethnic match between provider and client, bilingual providers, knowledge of available services, and insurance coverage; socioeconomic factors; and neighborhood poverty.^{12,25,45–49} Language is a particularly important correlate of service use for Asian Americans: those who have poor English skills may be less likely to use mental health services. For example, a study of East Asian immigrants found that English fluency was positively related to willingness to use psychological services.⁵⁰We examined the association between perceived discrimination and service use, controlling for demographic characteristics, poverty status, immigration status, and barriers to services related to access and attitudes, in a national representative sample of Asian Americans using data from the NLAAS. Specifically, we examined rates of formal and informal service use. We hypothesized that discrimination would be associated with less use of formal services and more use of informal services. We also hypothesized that individuals with low English proficiency in addition to higher rates of self-reported discrimination would be less likely to use formal services and more likely to use informal services for mental health problems.     

Volunteers’ Experiences Delivering a Community-University Chronic Disease Health Awareness Program for South Asian Older Adults

Volunteers and voluntary organizations can connect preventative health care programs to communities and may play an important role in addressing the health needs of older adults. Despite this, tensions may exist in the structures that drive volunteers and voluntary organizations representing immigrant communities to provide unpaid labour to augment and supplement health care services. Furthermore, organizational challenges may exist for community agencies relying on volunteers to sustain a health screening and education program. The intervention program was led by one voluntary agency specifically for South Asian communities in partnership with the university and five local organizations. This paper draws on volunteer surveys (n?=?22) and key informant interviews (n?=?12) to detail volunteer experiences providing this intervention. Volunteers were university students and other community volunteers. A total of 810 adults participated in the intervention within the Greater Toronto Area, Ontario, Canada between October 2014 and June 2016. We found that volunteers often used their experience as a ‘stepping stone’ position to other education or work. They also gained from the knowledge and used it to educate themselves and their family members and friends. This paper provides a critical reflection on the role of volunteers in a preventative and educational healthcare intervention program for older adults from the South Asian community. Tensions exist when relying on volunteer labour for the implementation of preventative community health care programming and must be explored to ensure program sustainability as well as equity within the health care system.     

8th Asian Congress of Nutrition（Aug．29-Sept．2，1999）

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