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Bhattacharyya M, Stevenson F, Walters K. Exploration of the psychological impact and adaptation to cardiac events in South Asians in the UK: a qualitative study. BMJ Open 2016; 6:e010195. [PMID: 27401355 PMCID: PMC4947723 DOI: 10.1136/bmjopen-2015-010195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE There is little research on how different ethnic groups adapt after an acute cardiac event. This qualitative study explores between-ethnicity and within-ethnicity variation in adaptation, and the psychological impact of an acute cardiac event among UK South Asian and white British people. SETTING We purposively sampled people by ethnic group from general practices in London who had a new myocardial infarction, angina or acute arrhythmia in the preceding 18 months. PARTICIPANTS We conducted 28 semistructured interviews for exploring the psychological symptoms, experiences and adaptations following a cardiac event among South Asians (Indian and Bangladeshi) in comparison to white British people. Data were analysed using a thematic 'framework' approach. RESULTS Findings showed heterogeneity in experiences of the cardiac event and its subsequent psychological and physical impact. Adaptation to the event related predominantly to life circumstances, personal attitudes and employment status. Anxiety and low mood symptoms were common sequelae, especially in the Bangladeshi group. Indian men tended to normalise symptoms and the cardiac event, and reported less negative mood symptoms than other groups. Fear of physical exertion, particularly heavy lifting, persisted across the groups. Some people across all ethnic groups indicated the need for more psychological therapy postcardiac event. Socioeconomic circumstances, age and prior work status appeared to be more important in relation to adaptation after a cardiac event than ethnic status. CONCLUSIONS Heterogeneity in views and experiences related to the socioeconomic background, age and work status of the participants along with some cultural influences. Rehabilitation programmes should be flexibly tailored for individuals in particular and where relevant, specific support should be provided for returning to work.
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Affiliation(s)
- Mimi Bhattacharyya
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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Farrukh A, Mayberry J. Patients with ulcerative colitis from diverse populations: The Leicester experience. Med Leg J 2016; 84:31-35. [PMID: 26078265 DOI: 10.1177/0025817215590769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Ulcerative colitis is common in migrant communities. There is evidence that access to care in general is impaired among such communities. The purpose of this study was to investigate whether South Asians experienced the same quality of care as English patients with ulcerative colitis. METHOD The study assessed clinical care in the decade subsequent to diagnosis through a retrospective review of case notes. Newly diagnosed patients who lived in Leicester were identified and the frequency and type of consultation, in-patient admissions, surveillance colonoscopies, discharge rates, surgery and death were recorded. RESULTS Of 372 candidate cases identified, 70 met the criteria to be included in the study. Forty-two were of English origin and 28 South Asian. South Asian patients were significantly less likely to see a consultant and more likely to be discharged. South Asian patients were admitted to hospital more often but had significantly fewer tests than European patients. This trend was also seen in surveillance colonoscopy, although it did not reach significance. Despite these differences in the provision of care, surgical and death rates were comparable. CONCLUSIONS Patients with ulcerative colitis who are of South Asian origin receive poorer quality clinical care than their European counterparts.
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Affiliation(s)
- Affifa Farrukh
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - John Mayberry
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
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Kendall H, Marley A, Patel JV, Khan JM, Blann AD, Lip GYH, Dwivedi G. Hospital delay in South Asian patients with acute ST-elevation myocardial infarction in the UK. Eur J Prev Cardiol 2012; 20:737-42. [DOI: 10.1177/2047487312447844] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Heather Kendall
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Alexandra Marley
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Jeetesh V Patel
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Jawad M Khan
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Andrew D Blann
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gregory YH Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Girish Dwivedi
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
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Patel JV, Dodani S, Gill PS. Considerations for equity in cardiovascular healthcare: the South Asian example. Int J Clin Pract 2012; 66:234-7. [PMID: 22340445 DOI: 10.1111/j.1742-1241.2011.02843.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- J V Patel
- Sandwell Medical Research Unit & University of Birmingham Centre for Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
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Cultural factors facilitating cardiac rehabilitation participation among Canadian South Asians: A qualitative study. Heart Lung 2010; 39:494-503. [DOI: 10.1016/j.hrtlng.2009.10.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 10/23/2009] [Accepted: 10/30/2009] [Indexed: 11/20/2022]
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Muennig P, Jia H, Khan K. Hospitalization for heart disease, stroke, and diabetes mellitus among Indian-born persons: a small area analysis. BMC Cardiovasc Disord 2004; 4:19. [PMID: 15509299 PMCID: PMC529471 DOI: 10.1186/1471-2261-4-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Accepted: 10/27/2004] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND We set out to describe the risk of hospitalization from heart disease, stroke, and diabetes among persons born in India, all foreign-born persons, and U.S.-born persons residing in New York City. METHODS We examined billing records of 1,083,817 persons hospitalized in New York City during the year 2000. The zip code of each patient's residence was linked to corresponding data from the 2000 U.S. Census to obtain covariates not present in the billing records. Using logistic models, we evaluated the risk of hospitalization for heart disease, stroke and diabetes by country of origin. RESULTS After controlling for covariates, Indian-born persons are at similar risk of hospitalization for heart disease (RR = 1.02, 95% confidence interval 1.02, 1.03), stroke (RR = 1.00, 95% confidence interval, 0.99, 1.01), and diabetes mellitus (RR = 0.96 95% confidence interval 0.94, 0.97) as native-born persons. However, Indian-born persons are more likely to be hospitalized for these diseases than other foreign-born persons. For instance, the risk of hospitalization for heart disease among foreign-born persons is 0.70 (95% confidence interval 0.67, 0.72) and the risk of hospitalization for diabetes is 0.39 (95% confidence interval 0.37, 0.42) relative to native-born persons. CONCLUSIONS South Asians have considerably lower rates of hospitalization in New York than reported in countries with national health systems. Access may play a role. Clinicians working in immigrant settings should nonetheless maintain a higher vigilance for these conditions among Indian-born persons than among other foreign-born populations.
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Affiliation(s)
- Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY 10003, USA
| | - Haomiao Jia
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA, 31207, USA
| | - Kamran Khan
- Inner City Health Research Unit, St. Michael's Hospital and the University of Toronto, Toronto, ON, M5V2M4, Canada
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Abstract
Therapeutic angiogenesis, in the form of growth factor protein administration or gene therapy, has emerged as a new method of treatment for patients with severe, inoperable coronary artery disease. Improved myocardial perfusion and function after the administration of angiogenic growth factors has been demonstrated in animal models of chronic myocardial ischemia. A recent clinical study reported beneficial long-term effects of therapeutic angiogenesis using FGF-2 protein in terms of freedom from angina and myocardial perfusion on nuclear imaging and suggested that protein angiogenic therapy has the potential to extend treatment options to patients who are not optimal candidates for conventional methods of myocardial revascularization. The ultimate role that angiogenesis will play in the treatment of ischemic heart disease will, however, be determined from adequately powered, randomized, double-blind, placebo-controlled trials. It is likely that endogenous antiangiogenic influences, intrinsic lack of response of patients with severe endothelial dysfunction, and other limitations will have to be overcome before angiogenesis becomes standard therapy for the treatment of coronary artery disease.
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Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
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Rastogi SS, Singh RB. Antioxidants, free radical stress and diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2002; 498:201-11. [PMID: 11900369 DOI: 10.1007/978-1-4615-1321-6_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S S Rastogi
- Endocrine Point and Centre for Diabetes and Nutrition, Delhi, India
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Tod AM, Wadsworth E, Asif S, Gerrish K. Cardiac rehabilitation: the needs of South Asian cardiac patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2001; 10:1028-33. [PMID: 11907452 DOI: 10.12968/bjon.2001.10.16.9371] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2001] [Indexed: 11/11/2022]
Abstract
There is an indication that South Asian people in the UK experience greater delays than white British populations in obtaining appropriate treatment and intervention despite experiencing higher levels of coronary heart disease (Chaturvedi et al, 1997). Evidence suggests that access to and uptake of UK cardiac rehabilitation services is disproportionately low in South Asian populations (NHS Centre for Reviews and Dissemination, 1998). This article examines the results of an audit of cardiac rehabilitation among cardiac patients of South Asian origin who were admitted to a large city teaching hospital in Sheffield. The results are discussed in the light of current concerns about the adequacy of communication with non-English speaking NHS patients. The implications for access to services and clinical practice are considered.
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Affiliation(s)
- A M Tod
- Northern General Hospital, Sheffield Teaching Hospitals NHS Trust
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Abstract
The potential role of haemostatic risk markers is largely unexplored in South Asians, who have increased morbidity and mortality from cardiovascular disease and an increased prevalence of insulin resistance. To investigate differences in thrombotic risk markers between South Asian and White populations, 42 Asian and 50 White males and 96 Asian and 80 White females, clinically free from vascular disease, were recruited. Venous blood samples were taken for measures of haemostasis and determination of blood lipids. South Asian females showed lower fasting blood glucose than White females (4.6 vs. 4.8 mmol/l, P<0.008). In the South Asian population, total cholesterol was lower in females, with a similar trend in males (females 5.0 vs. 5.5 mmol/l, P<0.001; males 5.1 vs. WM 5.5 mmol/l, P=0.09), but no difference in triglyceride levels. South Asian subjects of both genders had markedly higher levels of fibrinogen (females 3.3 vs. 2.8 mg/dl, P<0.0005; males 3.0 vs. 2.5 mg/dl P<0.002) and PAI-1 activity (females 14.6 vs. 8.7 ng/ml, P<0.0005, males 21.3 vs. 12.2 ng/ml, ) P<0.0005). Factor VII:C was lower in both South Asian groups (females 110.9 vs. 122.4%, P<0.005; males 103.3 vs. 125%, P<0.0005). Factor XII was lower in South Asian females and there were no differences in Factor XII levels in male populations. These results suggest that elevated PAI-1 and fibrinogen in Asians of both genders may contribute to the increased vascular risk experienced in this population; however, the role of dyslipidaemia and Factor VII are not clear in these processes.
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Affiliation(s)
- K Kain
- Academic Unit of Molecular Vascular Medicine, G-Floor, Martin Wing, Leeds General Infirmary, LS1 3EX, Leeds, UK.
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Trevelyan J, Needham EW, Halim M, Singh H, Been M, Shiu MF, Mattu RK. Evaluation of patient characteristics and utilisation of invasive cardiac procedures in a UK ethnic population with unstable angina pectoris. Int J Cardiol 2001; 77:275-80. [PMID: 11182192 DOI: 10.1016/s0167-5273(00)00444-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate patient characteristics and utilisation of invasive cardiac procedures in a UK ethnic population with unstable angina pectoris (UAP). DESIGN Retrospective, observational study. SETTING Tertiary referral cardiology centre in the United Kingdom serving a large Asian ethnic population. SUBJECTS White and Asian patients undergoing PTCA for UAP over a 2.5-year period at a UK referral cardiology centre from a comprehensive PTCA database. Data were also collated for all emergency admissions with unstable angina, or angina (type unspecified), to our institute. MAIN OUTCOME MEASURES Demographic and angiographic characteristics of patients undergoing PTCA. Frequency of usage of invasive cardiac procedures was determined in emergency angina admissions. RESULTS From January 1997 to July 1999, 435 White and 36 Asian patients underwent PTCA for UAP at our institute. Asian patients were on average 4.4 years younger (P=0.015), had 19.3% more diabetes (P=0.003) and 19.7% less smoking (P=0.007). Trends to more single vessel disease in Whites and more double vessel disease in Asians were observed, with similar rates of triple vessel disease. Interestingly, Asians also had trends towards more left-sided coronary artery disease and revascularisation, smaller vessels and less bail-out stenting. Asian patients were significantly less likely to undergo coronary angiography, OR 0.64 (CI 0.45-0.91, P=0.012), during the index admission, and showed a trend to less PTCA. CONCLUSIONS Asian patients with unstable angina pectoris appear to have clinical and angiographic differences from their White counterparts, and are less likely to have invasive cardiac procedures deployed. The reasons for these observations require elucidation and the prognostic significance of these findings is uncertain.
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Affiliation(s)
- J Trevelyan
- Department of Cardiology, Walsgrave Hospitals NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
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Ahmad W, Atkin K. Primary care and haemoglobin disorders: A study of families and professionals. CRITICAL PUBLIC HEALTH 2000. [DOI: 10.1080/713658226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Parikh CR, Karnad DR. Quality, cost, and outcome of intensive care in a public hospital in Bombay, India. Crit Care Med 1999; 27:1754-9. [PMID: 10507594 DOI: 10.1097/00003246-199909000-00009] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the quality, cost, and benefits of intensive care in a public hospital in Bombay, India. DESIGN Prospective collection of data. SETTING Seventeen-bed medical-neurology-neurosurgery intensive care unit (ICU) of a municipal teaching hospital. PATIENTS A total of 993 consecutive ICU patients during a 16-month period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 993 patients aged 36.5 +/- 16 yrs (mean +/- SD) had a day-1 Acute Physiology and Chronic Health Evaluation (APACHE) II score of 14.9 +/- 9.6 (mean +/- SD), with a predicted mortality of 21.7%; the observed mortality was 36.2% (standardized mortality ratio = 1.67). The day-1 Therapeutic Intervention Scoring System (TISS) points were 17.7 +/- 6.2 (mean +/- SD), and total TISS points per patient were 87.6 +/- 110 (mean +/- SD). Nurse-to-patient ratio in the ICU was 3:17 and the average workload per nurse was 64.2 TISS points. The average length of stay was 5.5 days (SD = 7.1 days). The overall cost of treating 993 patients was, in Indian rupees (Rs), Rs 107,79,209 (U.S. $307,997), and cost per patient per day was Rs 1,973 (U.S. $57). The cost per survivor was Rs 17,029 (U.S. $487) and cost per TISS point was Rs 90.14 (U.S. $2.57). The low cost per TISS point was attributable to the reuse of disposable equipment and lower cost of drugs and salaries for medical and paramedical staff. CONCLUSIONS Intensive care in India is cheaper than in the West; however, mortality is 1.67 times that for patients with similar APACHE II scores in ICUs in the United States. This finding may be attributable to the lesser intensity of care per patient (lower day-1 TISS points), lower nurse-to-patient ratio because of shortage of trained personnel and budgetary constraints, and higher workload per nurse (64.2 TISS points per nurse, compared with 40 points per nurse in the West). In addition, the APACHE II scores may underestimate mortality for Indian patients because of differences in case mix, higher lead time between onset of admission and treatment before ICU admission, and possible inappropriateness of age points derived from American patients for Indian subjects because of a higher burden of diseases at lower ages in Indian patients.
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Affiliation(s)
- C R Parikh
- Department of Nephrology, University of Colorado Health Science Center, Denver CO, USA
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Chaturvedi N, Rai H, Ben-Shlomo Y. Lay diagnosis and health-care-seeking behaviour for chest pain in south Asians and Europeans. Lancet 1997; 350:1578-83. [PMID: 9393336 DOI: 10.1016/s0140-6736(97)06243-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND South Asian people in the UK experience greater delays than Europeans in obtaining appropriate specialist management for heart disease, but the causes are not known. We investigated whether south Asians and Europeans interpret and act upon anginal symptoms differently. METHODS We randomly selected 2000 people from general practitioners' (family physicians) lists in London, UK, to receive a questionnaire that included a short fictional case history of an individual with possible anginal pain and asked how respondents would react to experiencing it. A second questionnaire seeking information on medical history, attitudes to health, and demography was sent later. The main outcome measure was the proportion who said they would seek immediate care (hospital emergency department or general practitioner) for the pain described in the case scenario. FINDINGS The rate of response to both questionnaires was 60.2% (903 of 1500 who received both), 553 responders were of European origin, 124 were Hindu, and 235 were Sikh. There were no differences between the ethnic groups in the proportion identifying the pain as cardiac, but south Asians would be more anxious about the pain than would Europeans. Of the men, 55 (23%) Europeans, 20 (38%) Hindus, and 52 (47%) Sikhs said they would seek immediate care (p < 0.0001 for heterogeneity); of women, 77 (24%), 25 (35%), and 58 (46%), respectively, would seek immediate care (p < 0.0001). After adjustment for confounding variables the odds ratio for seeking immediate care in Hindus compared with Europeans was 2.67 (95% CI 1.49-4.73) and that for Sikhs compared with Europeans was 3.18 (1.98-5.12). INTERPRETATION Hindus and Sikhs reported a greater likelihood of seeking immediate care for anginal symptoms than Europeans; this finding indicates that barriers to cardiology services for south Asians are unrelated to difficulties in interpretations of symptoms or willingness to seek care. Improvement of awareness of heart disease may not decrease delays in obtaining care. Service-related explanations must be explored, such as general practitioners' difficulties in arriving at a diagnosis or differences in management because of ethnic origin.
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Affiliation(s)
- N Chaturvedi
- EURODIAB, Department of Epidemiology and Public Health, University College London, UK
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