Journal articles on the topic 'South Asians' sleep'

Abstract Introduction The COVID-19 pandemic has resulted in substantial changes in social interactions, work schedules, and socioeconomic factors that may negatively impact sleep onset, maintenance, and quality. The ongoing stress of the pandemic also may exacerbate existing racial/ethnic disparities in sleep health. In this study, we examined the effects of COVID-19 related distress on sleep-related impairment and sleep disturbances among trauma-exposed South Asian adults. Since a health advantage among foreign-born individuals has been previously noted in the literature (the “immigrant paradox”), we also assessed whether generational status (i.e., being born in the U.S. or not) moderated associations between COVID-19 related distress and sleep outcomes. Methods Participants were recruited through Amazon’s Mechanical Turk and completed online surveys on demographic information, the COVID-19 Stress Scale, The Life Events Checklist for DSM-5 (LEC-5), and PROMIS™ Sleep-Related Impairment and Sleep Disturbances Scale. The final sample included 316 South Asian adults residing in the U.S, who had been exposed to a traumatic event at some point in their lifetime. Most participants were male (55%) and U.S.-born citizens (64%), with an average age of 35.32 (SD = 9.52) years. Results Examination of t-scores for PROMIS™ sleep-related and sleep disturbances revealed that our sample endorsed slightly higher values than the general U.S. population. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.09, p < .001, sr2 = .04) and sleep-related impairment (b = 0.20, p < .001, sr2 = .12). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep. Conclusion In our sample, we found that psychological distress triggered by the pandemic (e.g., fear of contamination, fear of the dangerousness of the virus, socioeconomic worries) was associated with greater sleep difficulties. Our findings highlight the importance of developing targeted interventions to cope with stress and sleep disturbances during the pandemic, particularly among vulnerable populations, such as those exposed to trauma. Our results did not support the immigration paradox: stress and sleep associations were similar regardless of generational status. Future studies are needed to better understand the role of generational status on sleep across different immigrant subgroups. Support (If Any)

Abstract Objectives South Asians, including Bangladeshis have a high incidence of chronic disease. The Metro-Detroit area has one of the largest populations of Bangladeshi-Americans in the USA. There is insufficient research on their dietary habits and lifestyle which are important determinants of health. The objective of this research was to investigate the dietary and lifestyle behaviors of Bangladeshi-Americans in Michigan, and compare them with the recommended dietary guidelines. Methods A culturally appropriate cross sectional survey with 25 questions was created and completed by residents (n = 49, 18 + years) of Bangladeshi descent living in Michigan. Quantitative and qualitative data regarding socioeconomic status, diet, physical activity, sleep and health were gathered. Data were analyzed using excel. Fruit and vegetable intakes were compared to the Dietary Guidelines for Americans recommendations. Results The majority (69%) of survey respondents were women. Only 36% of the participants consumed fruits daily; 62% of participants consumed vegetables every day. Rice was a daily staple consumed by 75% of respondents. Thirty seven % of participants reported that they were overweight while 66% were trying to lose weight. Barely 37% of participants exercised for 30 minutes or more daily. Only 16% reported getting the required 8 hours of sleep daily. Cardiovascular disease, hyperlipidemia, hypertension and diabetes were commonly present and 53% reported taking medication daily. Conclusions Most participants did not meet Dietary Guidelines recommendations for fruit and vegetable consumption or for physical activity. Further research into culturally appropriate lifestyle interventions and health education strategies to reduce the burden of disease in this vulnerable population is needed. Funding Sources NA.

ObjectivesTo investigate associations of parent-reported sleep characteristics with adiposity levels in a biethnic sample of young children.DesignA cross-sectional observational study.SettingThe Born in Bradford 1000 study, UK.ParticipantsChildren aged approximately 18 months (n=209; 40.2% South Asian; 59.8% white) and 36 months (n=162; 40.7% South Asian; 59.3% white).Primary and secondary outcome measuresChildren’s body mass index (BMI) z-score, sum of two-skinfolds (triceps and subscapular) and waist circumference. Adjusted regression was used to quantify associations of sleep parameters with adiposity stratified by ethnicity and age group. The results are beta coefficients (95% CIs) and unless otherwise stated represent the difference in outcomes for every 1-hour difference in sleep parameters.ResultsThe average sleep onset time was markedly later in South Asian (21:26±68 min) than white children (19:41±48 min). Later sleep onset was associated with lower BMI z-score (−0.3 (−0.5 to −0.0)) and sum of two-skinfolds (−1.5 mm (−2.8 mm to −0.2 mm)) in white children aged 18 months and higher BMI z-score in South Asian children aged 36 months (0.3 (0.0–0.5)). Longer sleep duration on weekends than weekdays was associated with higher BMI z-score (0.4 (0.1–0.8)) and waist circumference (1.2 cm (0.3–2.2 cm)) in South Asian children aged 18 months, and later sleep onset on weekends than weekdays was associated with larger sum of two-skinfolds (1.7 mm (0.3–3.1 mm)) and waist circumference (1.8 cm (0.6–2.9 cm)). Going to sleep ≥20 min later on weekends than weekdays was associated with lower waist circumference in white children aged 18 months (−1.7 cm (−3.2 cm to −0.1 cm)).ConclusionsSleep timing is associated with total and central adiposity in young children but associations differ by age group and ethnicity. Sleep onset times and regular sleep schedules may be important for obesity prevention.

The number of foreign students is increasing worldwide, and they suffer from acculturation to different environments or cultures. This pilot study examined the difference in overweight or obesity, changes in dietary habits after studying abroad and sleep quality according to acculturative degree among 225 Asian foreign students in South Korea. Most subjects (61.8%) experienced a low acculturative degree. The change in dietary habits after studying abroad showed a significant difference according to the acculturative degree (p < 0.001); however, there were no differences observed in sleep quality (p = 0.090) and prevalence of overweight or obesity according to acculturative degree (p = 0.101). Interestingly, a difference in the risk for being overweight or obese by sleep quality after being stratified into groups according to acculturative degree was observed. Among the groups with a low acculturative degree, subjects reporting poor sleep quality had a 2.875-fold (95% CI = 1.167–7.080) higher risk of being overweight or obese than those reporting good sleep quality. However, the risk of being overweight or obese was not different among the high acculturative group regardless of their sleep quality. The results showed that the degree of acculturation could influence the risk of being overweight or obese according to sleep quality among Asian foreign students.

Since commercial aviation started, fatigue among pilots and aircrew has been acknowledged as a human factor safety issue. This survey was conducted between September and December 2009 among airlines pilots. The three main objectives of this study are: to identify sleep patterns, their promoting and interfering factors of airlines pilots. This survey results revealed that most of the pilots do not have any problem to get to sleep and majority of them had never taken any sleeping aids, such as: alcohol or medication. The five sleep interfering factors, which include environmental (i.e. heat, noise and lighting) and physiological (i.e. nature’s call and personal worries) were investigated in this survey. It was found out that personal worries top the list. From this study, it can be concluded that fatigue issue is significant among South East Asian airlines pilot.

Background: Physical activity and sleep are important for health; whether device-measured physical activity and sleep differ by ethnicity is unclear. This study aimed to compare physical activity and sleep/rest in white, South Asian (SA), and black adults by age. Methods: Physical activity and sleep/rest quality were assessed using accelerometer data from UK Biobank. Linear regressions, stratified by sex, were used to analyze differences in activity and sleep/rest. An ethnicity × age group interaction term was used to assess whether ethnic differences were consistent across age groups. Results: Data from 95,914 participants, aged 45–79 years, were included. Overall activity was 7% higher in black, and 5% lower in SA individuals compared with white individuals. Minority ethnic groups had poorer sleep/rest quality. Lower physical activity and poorer sleep quality occurred at a later age in black and SA adults (>65 y), than white adults (>55 y). Conclusions: While black adults are more active, and SA adults less active, than white adults, the age-related reduction appears to be delayed in black and SA adults. Sleep/rest quality is poorer in black and SA adults than in white adults. Understanding ethnic differences in physical activity and rest differ may provide insight into chronic conditions with differing prevalence across ethnicities.

ObjectivesWe analysed association between short sleep duration and prevalence of cardiovascular disease (CVD) in a multiethnic population living in the Netherlands, and the contribution of short sleep to the observed ethnic differences in the prevalence of CVD, independent of CVD risk factors.Methods20 730 participants (aged 18–71 years) of the HELIUS (Healthy Life in an Urban Setting) Study were investigated. Self-reported sleep duration was classified as: short (<7 hours/night) and healthy (7–9 hours/night). Prevalence of CVD was assessed using the Rose Questionnaire on angina pectoris, intermittent claudication and possible myocardial infarction. Association of short sleep duration with prevalent CVD and the contribution of short sleep to the observed ethnic differences in the prevalence of CVD were analysed using adjusted prevalence ratio(s) (PRs) with 95% CI.ResultsResults indicate that short sleep was associated with CVD among all ethnic groups with PRs ranging from 1.41 (95% CI 1.21 to 1.65) in Moroccans to 1.62 (95% CI 1.20 to 2.18) in Dutch after adjustment for age, sex and conventional CVD risk factors. The independent contributions of short sleep (in percentage) to ethnic differences in CVD compared with Dutch were 10%, 15%, 15%, 5% and 5% in South-Asian Surinamese, African-Surinamese, Ghanaian, Turkish and Moroccan, respectively.ConclusionShort sleep contributed to ethnic differences in CVD independent of well-known CVD risk factors particularly in Surinamese and Ghanaian groups. Reducing sleep deprivation may be a relevant entry point for reducing increased CVD risks among the various ethnic minority groups.

Health behaviors of higher education students can be negatively influenced by stressful events. The global COVID-19 pandemic presents a unique opportunity to characterize and compare health behaviors across multiple countries and to examine how these behaviors are shaped by the pandemic experience. Undergraduate and graduate students enrolled in universities in China, Ireland, Malaysia, South Korea, Taiwan, the Netherlands and the United States (USA) were recruited into this cross-sectional study. Eligible students filled out an online survey comprised of validated tools for assessing sleep quality and duration, dietary risk, alcohol misuse and physical activity between late April and the end of May 2020. Health behaviors were fairly consistent across countries, and all countries reported poor sleep quality. However, during the survey period, the COVID-19 pandemic influenced the health behaviors of students in European countries and the USA more negatively than Asian countries, which could be attributed to the differences in pandemic time course and caseloads. Students who experienced a decline in sleep quality during the COVID-19 pandemic had higher dietary risk scores than students who did not experience a change in sleep quality (p = 0.001). Improved sleep quality was associated with less sitting time (p = 0.010). Addressing sleep issues among higher education students is a pressing concern, especially during stressful events. These results support the importance of making education and behavior-based sleep programming available for higher education students in order to benefit students’ overall health.

<p><strong>Objective.</strong> To investigate sleeping problems, sleep duration and associated factors in a national probability sample of older South Africans who participated in the Study of Global Ageing and Adult Health (SAGE) in 2008.</p><p><strong> Methods.</strong> In 2008 I conducted a national population-based cross-sectional study with a sample of 3 840 South African individuals aged ≥50 years. A questionnaire was used to survey sociodemographic characteristics and health variables, and anthropometric and blood pressure measurements were recorded.</p><p><strong> Results.</strong> Of the participants, 9.1% reported having a sleeping problem at the time of the study. The average number of self-reported hours of sleep was 8.6 (SD ±2.1), with 11.6%, 45.1%, 20.0%, and 23.5% reporting ≤6, 7 - 8, 9, and ≥10 h, respectively. In multivariable analysis, depression, cognitive impairment, lack of social cohesion, and moderate or severe activity limitations were associated with having a current sleeping problem. In terms of sociodemographic and health variables, a short sleep duration was associated with: white, Indian/Asian or coloured ethnicity; daily tobacco use; and moderate and severe activity limitations. In participants aged 60 - 79 years, lower wealth, hypertension, risky drinking and lower health-related quality of life were associated with a long sleeping duration.</p><p><strong> Conclusion.</strong> This study robustly characterised the prevalence of sleeping problems and specific associated risk factors in a large sample in South Africa. This can help to direct future healthcare efforts.</p>

Background:Clinical efficacy and safety of golimumab (GLM) for patients with ankylosing spondylitis (AS) who have not received prior biologic therapy were studied in two phase-3 clinical trials (NCT00265083 - GO RAISE and NCT01248793). In both studies, a greater proportion of patients treated with GLM 50 mg every 4 weeks achieved improvement in clinical signs and symptoms measured by ASAS20 and in patient-reported outcomes, such as Health Related Quality of Life (HRQoL) and sleep disturbance when compared with placebo (PBO) at Weeks 14 and 24.Objectives:To assess the effect of GLM on HRQoL, back pain, and sleep disturbances in phase-3 studies in Asian patients with AS.Methods:Post-hoc sub-analysis to examine HRQoL, measured with the Short Form 36 (SF-36) Physical and Mental Component Summary (PCS and MCS), total back pain (VAS) and sleep disturbance, assessed with the Jenkins Sleep Evaluation Questionnaire (JSEQ) in active AS patients enrolled from Asian countries (China, including Taiwan region and South Korea). Improvement from baseline to Week 24 was expressed as mean and standard deviation (SD) for SF-36 PCS and MCS and total back pain. Reduction of sleep disturbance was expressed as the proportion of patients with improvement from baseline ≥2 points in the JSEQ, defined as baseline value minus post-baseline value with lower scores indicating the better sleep evaluation.Results:At Week 24, active AS patients treated with GLM 50 mg had greater mean improvements in SF-36 and total back pain than PBO. The pooled results were comparable with patients enrolled from other regions (Table 1). A higher proportion of Asian patients who received GLM had reduced sleep disturbance (JSEQ ≥2) after 24 weeks than PBO (59.7% [83/139] vs 38.5% [47/122]; Δ21.2) and the results were similar with AS patients on GLM (67.4% [64/95] vs 45.6% [26/57]; Δ21.8) pooled from other regions.Conclusion:Asian patients with AS treated with GLM demonstrated improved HRQoL, total back pain, and reduced sleep disturbance. The pooled results were comparable with other regions.Table 1.Mean Improvement from Baseline in HRQoL and total back pain at Week 24: Randomized Patients in AS Studies Pooled for Asia and all other regionsPooled AS in APACPooled AS in All Other RegionsParameterPlaceboGLM 50 mgPlaceboGLM 50 mgNMean (SD)NMean (SD)NMean (SD)NMean (SD)SF-36 PCS1222.51 (6.372)1397.10 (8.434)581.91 (8.268)9910.12 (11.096)SF-36 MCS1220.22 (9.609)1393.32 (9.280)581.20 (9.705)991.98 (8.032)Total Back Pain1201.86 (2.469)1352.73 (2.607)580.79 (2.688)993.39 (3.210)APAC, Asia-Pacific; AS, ankylosing spondylitis; GLM, golimumab; HRQoL, Health Related Quality of Life; MCS, mental component summary; PCS, physical component summary; SD, standard deviation; SF-36, Short Form 36Disclosure of Interests:Wen-Chan Tsai Consultant of: Pfizer, AbbVie, Roche, and Eli Lilly, Chunde Bao: None declared., Daniel Furtner Shareholder of: Johnson & Johnson, Employee of: Johnson & Johnson Pte. Ltd., Singapore, Kim Hung Lo Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Yiying Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC.

BACKGROUND: Taxi drivers, an immigrant male population, may exhibit poor health behaviors and increased health risks. OBJECTIVE: The current study examined stress and demographics as predictors of physical activity (PA), nutrition, sleep, and smoking, and the co-occurrence of these behaviors among taxi drivers. METHODS: A cross-sectional needs assessment was conducted in New York City. The sample (n = 252) was comprised of male taxi drivers, 98%of whom were born outside of the U.S., with the majority from South Asian countries (62%), and 45 years old on average (SD = 11). RESULTS: We found low rates of fruit/vegetable consumption and PA. Rates of stress, PA, and smoking varied by demographic factors. Stress was positively associated with sleep disturbances and negatively associated with smoking. Aside from a relationship between sugar consumption and smoking, other health behaviors were not associated. CONCLUSIONS: While stress appears to impact some indicators of modifiable health behaviors, its lack of relationship with others points to more persistent health issues. Demographic differences found for PA and smoking also point to groups that may especially benefit from interventions. These findings suggest the need for targeted health interventions for taxi drivers in large metropolitan cities.

Depression in idiopathic Parkinson’s disease is highly prevalent that can significantly impair the quality of life. Its exact mechanism of development is still poorly understood. It is well studied in western population but data from Asia especially in the South Asian region is limited. Considering this, to identify the potential risk factors of depression,a cross-sectional study was conducted among Parkinson’s disease patients attending a tertiary care hospital in Bangladesh between July 2013-June 2014, in the Department of Neurology, ShaheedSuhrawardy Medical College and Hospital in Dhaka, Bangladesh. One hundred thirtyseven cases of Parkinson’s disease were enrolled, based on UK Parkinson's Disease Society Brain Bank criteria. Brain MRI was done in all cases, and patients with aphasia, significant cognitive deficits, secondary Parkinsonism were excluded. The overall prevalence of depression in the study population was 42%. There were no significant differences in gender, residence, education, smoking and marital status. In univariate analysis, age≥70 years, un-employed, right side predominantly involved, disease duration ≥5 years, sleep disturbance, postural instability, dose of levodopa ≥500 mg/day, Hoehn and Yahrstage ≥III and moderate to severe disability were significantly associated with depressive disorder. Whereas in multivariate linear stepwise regression model, age ≥70 years), p=0.044), right side predominant involvement (p<0.001); sleep disturbance (p=0.006) and dose of levodopa ≥500 mg/day (p<0.001) were the major risk factors for depressive disorder. A significant proportion of Parkinson’s disease patients suffer from depression. It was identified that depression in Parkinson’s disease was significantly associated with advancing age, predominate right side involvement, sleep disturbance and higher daily dose of levodopa.Bangladesh Med Res Counc Bull 2018; 44(1):9-14

Abstract INTRODUCTION Post Traumatic Stress (PTS) is a chronic psychological condition that occurs in response to a traumatic event, and includes symptoms of re-experiencing, avoidance behaviors, changes in mood, and hyperarousal. Left untreated, PTS is associated with poor outcomes and significant impairments in quality of life (HRQoL). Recent studies find 20-30% of IBD patients report significant PTS symptoms due to IBD experiences. The majority of participants in these studies are white, non-Hispanic making results difficult to generalize to other populations. As such, we aim to characterize IBD related PTS in under-represented minority (URM) patients. METHODS Adult patients 18+ who identify as a URM (Latino/a, African American, Asian, Middle Eastern, Native American or Native Pacific Islander) recruited via social media and researchmatch.org website completed an anonymous online survey: demographics, disease information, Harvey Bradshaw Index (HBI) or simple clinical colitis activity index (SCCAI) with &gt;4 = active IBD, NIH-PROMIS QoL module (fatigue, sleep disturbance, social isolation, pain interreference), and PTSD Checklist-5 (PCL5) with &gt;30 = suggested IBD-PTS, with subscale scores. Independent samples t-Test, Pearson’s correlation, and hierarchical linear regression statistics were used. RESULTS 67 participants: 46% UC, 79% female, 73% South/Southeast Asian, 6% Hispanic, Age (Mean±SD) = 35.42±9.79 years. 55% had active IBD (HBI/SCCAI &gt; 4; 5.57±4.51). 43% scored &gt;30 on PCL5. Specifically, 55.2% reported re-experiencing trauma, 59.7% avoiding trauma triggers, 62.7% mood changes/irritability, and 67.2% autonomic hyperarousal. Patients with active IBD reported higher IBD-PTS (p=.001) as well as more fatigue, sleep disturbance, pain interference, and social isolation (all p&lt;.001); no differences by IBD diagnosis, gender, or age. When controlling for HBI/SCCAI score, IBD-PTS severity was a significant predictor, but smaller than disease severity, of fatigue (β=.223, p=.025) and pain interference (β=.254, p=.006), and a larger predictor of sleep disturbance (β=.424, p&lt;.001) and social isolation (β= -.417, p&lt;.001). Only the PTS symptoms of hyperarousal and mood contributed to these relationships. CONCLUSION 43% of URM met criteria for PTS, and scored above 50% in each symptom category of the PCL-5, suggesting URM patients are at even higher risk for IBD-related PTS. Despite disease severity, IBD-PTS severity predicted fatigue, pain interference, sleep disturbance, and social isolation domains of HRQoL; mood changes or hyperarousal presence appear to be the most important symptoms to address. IBD-PTS could have a greater influence on HRQoL than disease activity and should be assessed in patients with both active and inactive disease. More research is necessary to evaluate this relationship and the prevalence of IBD-PTS in URM.

Abstract INTRODUCTION Disease-related stigmatization is present in IBD, with a substantial proportion of patients reporting that they perceive discriminatory attitudes or behaviors from others because of their IBD status. These perceptions are associated with poor outcomes. However, stigma perceptions are not well studied in patients from underrepresented racial and ethnic minority (URM) groups. As such, we aim to assess stigma perceptions in URM IBD patients and their relationship to Health Related Quality of Life (HRQoL). METHODS Adult patients 18+ recruited via social media and researchmatch.org website completed an anonymous online survey: demographics, disease information, Harvey Bradshaw Index (HBI) or simple clinical colitis activity index (SCCAI) with &gt;4 = active IBD, NIH-PROMIS QoL module (anxiety, depression, fatigue, sleep disturbance, pain interreference, social function), and the Perceived Stigma Scale for IBS (“IBS” replaced with “IBD”). Elevated stigma was identified via median split (Median=28). Independent samples t-Test, Pearson’s correlation, and hierarchical linear regression statistics were used. RESULTS 90 participants: 50% UC, 79% female, 66% South/Southeast Asian, 10% Hispanic, Age (Mean±SD))=34.8±9.8 years. 52% had active IBD (5.77±4.22) with “biologic” medications most used (38.9%). 59% reported high levels of perceived stigma (Mean IBD-PSS score: 30.57±16.3); no differences by IBD type, age, gender, race, or ethnicity. Patients with active IBD reported significantly more stigma experiences (36.0±2.7 vs. 23.3±10.9, p&lt;.001). Stigma perception was significantly correlated with all HRQoL domains: anxiety r=0.414, depresison r=0.471, fatigue r=0.424, sleep disturbance r=0.293, pain interference r=0.474, social function r= -0.439 (all p&lt;.01). When controlling for HBI/SCCAI, stigma was a larger predictor of anxiety (β=.365, p=.002), depression (β=.386, p&lt;.001), social function (β= -.341, p=.003) than symptom severity, and smaller but significant predictor of fatigue (β=.254, p=.014) and pain interference (β=.290, p=.003). Stigma perceptions did not predict sleep disturbance (p=.087). CONCLUSION Approximately half of URM IBD patients reported high levels of stigma experiences. These perceptions were associated with negative outcomes across all HRQoL domains with the exception of sleep disturbance. Our results show stigma perceptions are an important consideration when evaluationg these outcomes in IBD, rather than disease activity alone. Further research on a larger scale and with more diverse population is needed in order to better understand the effects of disease stigmatization in URM IBD patients.

Abstract INTRODUCTION Disease-related stigmatization is present in patients with IBD and includes internalization of discriminatory attitudes or behaviors. Prior studies show IBD-related stigma is associated with worse clinical outcomes. However, this has not been well-studied in underrepresented racial and ethnic minority populations (URM). The aim of the current study is to evaluate levels of internalized stigma in URM IBD patients and its relationship with the health-related quality of life (HRQoL) domains of anxiety, depression, fatigue, sleep disturbance, social functioning, and pain interference. METHODS Adult patients 18+ recruited via social media and researchmatch.org website completed an anonymous online survey: demographics, disease information, Harvey Bradshaw Index (HBI) or simple clinical colitis activity index (SCCAI) with &gt;4 = active IBD, NIH-PROMIS QoL module (anxiety, depression, fatigue, sleep disturbance, pain interreference, social function), and the Internalized Stigma for Mental Illness scale (ISMI) (“mental illness” replaced with “IBD”). High internalized stigma on ISMI is weighted average &gt; 2.50 on both the total score and each subscale (Alienation, Social Withdrawal, Discrimination, Stereotype Endorsement, Stigma Resistance). Independent samples t-Test, Pearson’s correlation, and hierarchical linear regression statistics were used. RESULTS 90 participants: 50% UC, 79% female, 66% South/Southeast Asian, 10% Hispanic, Age (Mean±SD))=34.8±9.8 years. 52% had active IBD (5.77±4.22) with “biologic” medications most used (38.9%). 27% reported high levels of internalized stigma: 54% reported alienation, 39% social withdrawal, 27% discrimination, 3% stereotype endorsement; 19% reported stigma resistance. No differences by age, IBD type, gender, race, or ethnicity. Patients with active IBD reported more internalized stigma (2.33±0.44 vs. 2.10±0.38, p=.008). Internalized stigma was significantly correlated with all patient outcomes: anxiety r=0.595, depression r=0.620, fatigue r=0.356, sleep disturbance r=0.328, pain interference r=0.421, and social function r= -0.566 (all p&lt;.01). When controlling for HBI/SCCAI score, internalized stigma was a larger predictor of anxiety (β=.560, p&lt;.001), depression (β=.567, p&lt;.001), sleep disturbance (β=.272, p=.010), and social function (β= -.341, p=.003) than symptom severity, and smaller but significant predictor of fatigue (β=.255, p=.006) and pain interference (β=.308, p&lt;.001). CONCLUSION Stigma internalization is prevalent in URM IBD patients, with alienation and social withdrawal most reported. Stigma was associated with negative outcomes, and is possibly a stronger predictor of HRQoL in IBD than the disease activity of IBD itself. Further research with larger cohorts and more diverse populations is needed in order to further elucidate the role of disease stigma in URM IBD patient experiences.

INTRODUCTION: Insomnia is a risk factor for various physical and mental disorders as well can affect the academic performance of a student(s). AIM: To assess the prevalence of insomnia among university going students (medical, dental and nursing streams) in the South Asian continent during the lockdown due to the COVID-19 pandemicMATERIALS AND METHOD: The present study was conducted amongst 743 medical, dental and nursing undergraduate students residing in South Asia using convenience sampling. Data was collected using a pre-tested and pre-validated questionnaire [the Athens Insomnia Scale (AIS)] using google forms and had a total of 8 questions (score range 0-3) . Final scores (the individual AIS score) were obtained by adding the scores for each question (range 0 -24). The higher the score was, the worse was the sleep quality; students with score of ≥ 6 were considered insomniac. Data Analysis was done using SPSS version 21.012 by using the independent samples t-test, and multiple logistic regression.RESULTS: A total of 921 entries were recorded, out of which 743 were complete and hence, were included in the study (response rate: 80.7%). Insomnia was reported in 421 (56.7%) students, out of which, the highest was seen among dental (62.7%), followed by medical (59.8%) and nursing (45.3%) undergraduates. The highest range of AIS was observed among females (6-22) and dental students (6-21). Gender differences revealed a significant association among females in both range obtained (t-test) (p=0.03) as well as the multiple linear regression analyzing insomnia in relation to gender (p=0.03).CONCLUSION: There is a need to regularly assess insomnia among students and to take preventive measures incase of high prevalence is found among them, especially while pursuing academics online and from their homes due to the pandemic.

Infection of Megalocytivirus cause serious mass mortality in marine fish in South East Asian countries. The aim of this study was to produce recombinant of GSDIV capsid protein and its protection to humpback grouper Cromileptes altivelis against grouper sleepy disease iridovirus (GSDIV). A major capsid protein (MCP) was selected for use as a crude subunit vaccines. This gene target (MCP) was inserted to the protein expression system vector of pET SUMO and cloned in cells bacteria Escherichia coli strain BL-21. The MCP was succeded to be induced using 1 mM of IPTG. Results of protein analysis using MALDI TOF-TOF indicated that the MCP has measurement of 49.566 kDa with PI index of 6.00, and contained 453 amino acids. BLAST homology analysis exhibited that the amino acid sequence of the MCP showed high similarity with MCP of Red Sea Bream Iridovirus (RSIV). E. coli expressing MCP protein was inactivated using 0.03% formalin overnight and washed using PBS. The inactivated E. coli as a crude subunit vaccine was then injected intramuscularly to humpback grouper juveniles. Subsequently, the juveniles were challenged tested with GSDIV. The juveniles vaccinated with the MCP recombinant bacteria showed significantly higher survival rates than control those vaccinated with PBS. Thus, the MCP fusion protein is considered as a potential vaccine against GSDIV infections in grouper.

Caprimulgus affinis is an endemic species commonly known as the Taiwan nighthawk, forest nighthawk, or South Asian nighthawk. In recent years, the C. affinis population has gradually moved outward from river habitats into the metropolitan areas of Taiwan. Because male birds’ booming sounds at night can reach up to 90 dB or higher and they can be intermittently tweeting for more than 10 hours, they often disturb the sleep of urban residents and can even cause nightmares. In this study, we analyzed long-term survey data to assess the distribution history of C. affinis in Taiwan. By using 1738 entries of observation data collected from 1999 to 2014, a model of C. affinis distribution was constructed, and a geostatistical method was used to improve the accuracy of the model estimate. In addition, the Mann–Kendall trend test was applied to predict future C. affinis distribution. Based on the results, four variables were selected to construct the C. affinis distribution matrix. Urban population, coastal proximity, and distance to upstream river location represented positive driving forces, whereas city elevation was a negative driving force. C. affinis is currently distributed on the plains of central and southern Taiwan and in eastern Taiwan. The C. affinis emergence trend diagram was plotted using the time–space trend diagram, which showed yearly increases in the C. affinis populations in urban and settled areas including central, western, northeastern, and southeastern Taiwan and yearly decreases in the populations in rural areas including northern and southern Taiwan, especially in fragmented riverine habitats. Regression kriging can correctly describe the distribution of the entire C. affinis population, which leads to the correct understanding of the biological corridor of C. affinis in their migration through the graphical contours in GIS. The analytic model in this study contributes to the establishment of the time–space trend diagram.

Antibody responses to SARS-CoV-2 vaccines vary for reasons that remain poorly understood. A range of sociodemographic, behavioural, clinical, pharmacologic and nutritional factors could explain these differences. To investigate this hypothesis, we tested for presence of combined IgG, IgA and IgM (IgGAM) anti-Spike antibodies before and after 2 doses of ChAdOx1 nCoV-19 (ChAdOx1, AstraZeneca) or BNT162b2 (Pfizer-BioNTech) in UK adults participating in a population-based longitudinal study who received their first dose of vaccine between December 2020 and July 2021. Information on sixty-six potential sociodemographic, behavioural, clinical, pharmacologic and nutritional determinants of serological response to vaccination was captured using serial online questionnaires. We used logistic regression to estimate multivariable-adjusted odds ratios (aORs) for associations between independent variables and risk of seronegativity following two vaccine doses. Additionally, percentage differences in antibody titres between groups were estimated in the sub-set of participants who were seropositive post-vaccination using linear regression. Anti-spike antibodies were undetectable in 378/9101 (4.2%) participants at a median of 8.6 weeks post second vaccine dose. Increased risk of post-vaccination seronegativity associated with administration of ChAdOx1 vs. BNT162b2 (adjusted odds ratio (aOR) 6.6, 95% CI 4.2–10.4), shorter interval between vaccine doses (aOR 1.6, 1.2–2.1, 6–10 vs. >10 weeks), poor vs. excellent general health (aOR 3.1, 1.4–7.0), immunodeficiency (aOR 6.5, 2.5–16.6) and immunosuppressant use (aOR 3.7, 2.4–5.7). Odds of seronegativity were lower for participants who were SARS-CoV-2 seropositive pre-vaccination (aOR 0.2, 0.0–0.6) and for those taking vitamin D supplements (aOR 0.7, 0.5–0.9). Serologic responses to vaccination did not associate with time of day of vaccine administration, lifestyle factors including tobacco smoking, alcohol intake and sleep, or use of anti-pyretics for management of reactive symptoms after vaccination. In a sub-set of 8727 individuals who were seropositive post-vaccination, lower antibody titres associated with administration of ChAdOx1 vs. BNT162b2 (43.4% lower, 41.8–44.8), longer duration between second vaccine dose and sampling (12.7% lower, 8.2–16.9, for 9–16 weeks vs. 2–4 weeks), shorter interval between vaccine doses (10.4% lower, 3.7–16.7, for <6 weeks vs. >10 weeks), receiving a second vaccine dose in October–December vs. April–June (47.7% lower, 11.4–69.1), older age (3.3% lower per 10-year increase in age, 2.1–4.6), and hypertension (4.1% lower, 1.1–6.9). Higher antibody titres associated with South Asian ethnicity (16.2% higher, 3.0–31.1, vs. White ethnicity) or Mixed/Multiple/Other ethnicity (11.8% higher, 2.9–21.6, vs. White ethnicity), higher body mass index (BMI; 2.9% higher, 0.2–5.7, for BMI 25–30 vs. <25 kg/m2) and pre-vaccination seropositivity for SARS-CoV-2 (105.1% higher, 94.1–116.6, for those seropositive and experienced COVID-19 symptoms vs. those who were seronegative pre-vaccination). In conclusion, we identify multiple determinants of antibody responses to SARS-CoV-2 vaccines, many of which are modifiable.

As we approach the last quarter of the year, it is time that Fellows of the Philippine Society of Otolaryngology-Head and Neck Surgery (PSOHNS) receive this report from the President and the Board of Trustees. Following the successful staging of the midyear congress at EDSA Shangrila and distribution of the coffeetable book-- another chronicle of our rich history-- we also witnessed the launching of the advocacy campaign “Change is in the Air” led by Philippine Academy of Rhinology (PAR) Chair Dr. Tony Chua with Drs. Mari Enecilla and Joel Romuladez that even saw print in the newspapers. Despite the challenges, the support we received from our pharmaceutical friends was tremendous and the avowed fund support for advocacy from the proceeds of that congress amounting to a little over P2 million will certainly go a long way for our future campaigns. Our new home and headquarters at 27 Manga Road, Quezon City was finally inaugurated last July 8. Legal ownership with the title of the property under the name of PSOHNS has been effected as has been approved by the general assembly with the funds related to our transfer and total expenses for minor renovation and transfer and other taxes amounting to an expenditure of almost P29 million. The tax-exempt certificate filed from our Medical Plaza Ortigas business address will be transferred to Quezon City with the application for a change in business address. There have already been activities, meetings and functions held at our new headquarters. As approved by the Board, we have invited the Philippine Board of Otolaryngology - Head and Neck Surgery (PBOHNS) to hold their meetings there and also hold office in one of the rooms. We expect full transfer by the time this tax-exempt certificate and occupancy permit have been obtained. The work on becoming a recognized specialty by the Philippine Medical Association (PMA) is still a work in progress but the task is in hand more than ever with about 5000 more votes during the last congress and hopefully the final turnover of these votes before the next PMA convention in May 2017 will make the campaign a success. I urge all the Fellows and Chapters to continue to rally their colleagues and use the proxy forms available at the secretariat. We have written the PMA to inform us of the number of votes still needed. It is on record that our society in fact submitted the most number of proxy votes for this campaign during the last PMA convention. Let us all work even harder to make this a reality by May 2017. The Professional Regulations Commission (PRC) and Philippine Regulatory Board of Medicine (PRBOM) required us last May to develop and submit an Outcomes Based Education (OBE) Curriculum. We submitted the required curriculum to the PRBOM led by Dr. Miguel Noche in cooperation and close collaboration with the PBOHNS led by Dr. Rodolfo Nonato through the commendable hard work of Drs. Agnes T. Remulla, Elmo Lago and Ed Alfanta as well as other committed fellows from the different subspecialties and institutions. Welcome changes to the required list and number of procedures for resident trainees as a result of the formulation of this new curriculum were approved. Our core values of Professionalism, Service with Excellence, Outstanding Education and Research, Honor and Integrity, Nationalism and Solidarity stood as pillars that guided the whole process of crafting this OBE. It will now be incumbent upon the institutions to tweak their instructional designs and particular curricula to conform to or even surpass the common minimum standards. We will bring to the table this curriculum and standards when we talk with our Association of South East Asian Nations (ASEAN) counterparts in the move to ASEAN Harmonization and Integration. The next midyear congress will be held in Laoag City under the leadership of Dr. Jose Orosa III. The next Annual Congress will be jointly held with the 10th International Symposium on Recent Advances in Rhinosinusitis and Nasal Polyposis from November 29- December 2, 2017 with PAR and Dr. Gil Vicente as prime mover. The Philippines will also host the 10th Otorhinolaryngology International Academic Conference (ORLIAC) on March 1-3, 2018 with myself as co-chair. The theme will be “East Meets West: The Future of ORLHNS” with Prof. Jan Veldman and Prof. Lokman Saim helping organize this with world renowned ORL clinician-researchers willing to share their expertise on issues relevant to our country and the region. We hope this will inspire our young ENT diplomates and fellows to embark on academic and innovative strategies in the interest of achieving better care in ORLHNS. The 60th Annual Congress at Marriott Grand Ballroom from December 1-3, 2016 will culminate the celebration of our diamond jubilee year. The PSOHNS will host the 6th Pan Asia Academy of Facial Plastic and Reconstructive Surgery in this joint Congress. We are excited at this year’s theme: Restoring Form and Function and the record number of speakers for the congress with its interesting scientific and social programme will be astounding. As we close the year more projects are forthcoming such as the updated Clinical Practice Guidelines (Sleep Surgery has been disseminated with Otitis Media and Sinusitis to follow). On its 35th year, the Philippine Journal of Otolaryngology Head and Neck Surgery’s continued moves toward open access will make our research work more accessible and available to scientific circles worldwide. We have recognized the loyalty and service of our personnel Mia, Sharon, Melissa and Kiko by a windfall increase in salaries and benefits that have long been overdue. We are now in the process of digitizing our records along with other housekeeping functions that we have embarked on this year. We also foresee a constitutional amendment to accommodate an expanded membership programme to be attuned with the mandate and direction of the Philippine Medical Association to be as inclusive as possible. The kind approval of the Fellows in the general assembly meeting is prayed for considering the fact that our scientific calendar and a lot of PSOHNS activities have been geared towards preparing the resident trainees, diplomates and non-diplomates and board eligibles to be dedicated Fellows of PSOHNS in the future, imbued with the core values we so cherish.

Political and social polarization is the division of people in to distinct groups with contrasting viewpoints and minimum likelihood to converge on a uniform agenda. It has varied connotations in the field of social science. However, the given political climate of polarization and its impact on mental health, it is imperative to focus the issue in a scientific way. Furthermore, in recent years the situation has been made more volatile and complicated by social media amplifications with greater effects on psychosocial well-being of people. There is plenty of literature, suggesting that polarization is widely perceived as a loss or gain of social status, which has a direct link with psychological disorders.1 There is scarcity of research in developing world about the psychosocial effects of polarization. Most of the research looking at the psychological adverse implications of this phenomenon has been carried out in the west. For example, a study conducted by Smith KB, reported that adverse effects of recent American polarization in politics and contrasting political views on psychosocial well-being were not less than a public health concern, leading to damaged friendships, persistent fatigue and even suicidal behavior in significant number of population.2 Similarly, the stress associated with political disagreements has the add-on effect on psychosocial well-being of people holding diverse political views leading to deleterious effect on mental and physical health. The harming effects of political polarization is a known perpetuating stressor, cluttering society and traversing daily life through media, various internet platforms and persisting news feed.3 Additionally, the American Psychological Association identified politics as a major source of stress for American adults.4 The findings of a recently conducted survey showed that nearly 40% Americans reported that they were stressed out because of politics and nearly 20% had lost sleep due to the effects of social upheaval and almost same number were tired of political news.5 In addition to psychological consequences political stress, French JA et al, reported increased blood cortisol, increased skin conductance and decreased testosterone levels in people engaging in emotionally draining political debates.6 It’s equally, important to understand the mechanism through which the polarized politics harm the psychological health, and how it should be managed in order to ward off its deleterious consequences? The mechanism is well understood that people can’t isolate themselves from politics bearing in mind the vast array of information feed on daily basis. Secondly, as part of human society one can’t get away with social network and individual identity. As far the negative effects are concerned, they, permeate through various means, irrespective of people being either actively involved in politics or passive only observer. For, instance, the harassment, bullying, grandstanding attitude on social media is not uncommon while personal political debates, demeaning comments and its association with psychosocial sickness is well documented.7 The cult indoctrination is another distressing phenomenon, where the leaders coerce the followers through persuasions, thoughts reformation and brainwashing leading to immense suffering of exposed population to such condition, at times along with their family, friends and community at large.8 There is large body of research pointing towards the abusive effects of cultic politics and its adverse emotional consequences. The psychological damages perpetrated by cultic indoctrination, fake and occult information have been extensively reported in scientific publications over the last many years.9 Pakistan is a South Asian Muslim country of more than 220 million population with relatively unstable political history and abysmal socio-economic and health indicators. Mental health statistics are staggering with a wide treatment gap and no dedicated budgetary allocation of annual gross domestic product (GDP).10 In addition to the existing heavy burden of mental health issues and traditional entrenched religious intolerance in Pakistan, the recent wave of political intolerance has polarized the society to an unprecedented level. This wave of political polarization has permeated into all stratums of society, with sporadic reports of violence, which is likely to deteriorate further in the presence of unregulated and excessive use of social media. The widespread consumption of social media reports without verification of its authenticity could be one of the sources of social and political polarization which may cause further deterioration in near future.11 Regrettably, the young population constitute about 60% of the Pakistani population has been found to be affected more easily by the polarized environment in the country, which otherwise should be the most productive segment of society. As a matter of fact, depriving them of critical thinking and ability to formulate and ask appropriate questions tantamount to a huge social capital loss. Scientific literature shows that younger population is more impressionable and highly vulnerable to become radicalized easily in a polarized a society, unfortunately, Pakistan is not an exception, currently a fertile ground to support the growth of such tendencies.12 The recent published reports in lay press pointing to a shocking situation of violence in various part of the country due to political rivalry and contrasting posts on social media. The vulnerability of people being affected psychologically by political polarization has been reported extensively by previously published research. Various reports indicate that perpetuating exposure to political stress is associated with increased rates of psychiatric disorders like anxiety, depression and even suicidal behavior.1 Similarly, mental health professionals are also facing the dilemma of unfriendly environment generated around politics, which highlights the need for further training to deal with such issues without being judgmental or biased in clinical setting.13 It is the right time that scientific community, social scientists, political and religious opinion makers open a dialogue to raise awareness about the possible causes and devastating effects of polarization on the society. Country like ours with entrenched religious intolerance, economical inequalities, social disparity and alarming mental health statistics can’t afford to get plunged into yet another social and psychological chaos in the background heated polarized political discourse. We need to encourage our younger generation to be more tolerant and equipped with critical thinking to meet the social challenges with grace and scientific reasoning in order to ward off the impending onslaught of polarization, radicalization and psychosocial sickness. There is dire need to bring back the lost political sanity and put a full stop to the rising psychosocial turmoil in Pakistan.

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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BackgroundThe risk of developing type 2 diabetes associated with poor sleep quality is comparable to other lifestyle factors (eg, overweight, physical inactivity). In the UK, these risk factors could not explain the two to three-fold excess risks in South-Asian and African-Caribbean men compared with Europeans. This study investigates (1) the association between mid-life sleep quality and later-life type 2 diabetes risk and (2) the potential modifying effect of ethnicity.MethodsThe Southall and Brent REvisited cohort is composed of Europeans, South-Asians and African-Caribbeans (median follow-up 19 years). Complete-case analysis was performed on 2189 participants without diabetes at baseline (age=51.7±7 SD). Competing risks regressions were used to estimate the HRs of developing diabetes associated with self-reported baseline sleep (difficulty falling asleep, early morning waking, waking up tired, snoring and a composite sleep score), adjusting for confounders. Modifying effects of ethnicity were analysed by conducting interaction tests and ethnicity-stratified analyses.ResultsThere were 484 occurrences of incident type 2 diabetes (22%). Overall, there were no associations between sleep exposures and diabetes risk. Interaction tests suggested a possible modifying effect for South-Asians compared with Europeans for snoring only (p=0.056). The ethnicity-stratified analysis found an association with snoring among South-Asians (HR 1.41, 95% CI 1.08 to 1.85), comparing those who snored often/always versus occasionally/never. There were no elevated risks for the other sleep exposures.ConclusionThe association between snoring and type 2 diabetes appeared to be modified by ethnicity, and was strongest in South-Asians.

Objective: Several studies have shown that engaging in moderate-to-vigorous physical activity (MVPA) and avoiding prolonged sedentary time leads to beneficial effects on cardiometabolic disease risk. However, the associations between physical activity (PA) intensity and cardiometabolic risk have not been examined in population-based studies in South Asian populations. Hypothesis: We hypothesize that substituting sedentary time for MVPA will be associated with reduced cardiometabolic risks in South Asians. Methods: Cross-sectional data of 6,428 participants aged from 30 to 59 years (53.2% female) from New Delhi, India and Karachi, Pakistan that were enrolled in the CARRS Cohort study in 2010-11 were analyzed. We used the International Physical Activity Questionnaire (IPAQ, short form) culturally adapted to South Asian context, to classify respondent’s activities as sedentary, light activity (walking), and MVPA. We examined associations between time spent at different PA intensities and cardiometabolic diseases (defined as heart disease (including heart attack, angina and heart failure), stroke or Type 2 diabetes). Relevant risk factors (body weight, HDL-C and HbA1c) were examined using isotemporal substitution models, which drops one of three PA intensities and adjusts for total time of PA and covariates (i.e. outcome=PA 1+ PA 2 + total time for PA + covariates). Linear regression models were used to examine the associations between different PA intensities with risk factors of cardiometabolic diseases, and logistic regression models were used to examine the association between different types of PA intensities and prevalence of cardiometabolic diseases, adjusted for age, sex, sleep duration, status of depression, hypertension, hyperlipidemia and chronic kidney disease. Results: Isotemporal substitution models showed that replacing 1-hour/day sedentary time with a similar amount of MVPA at the population level was associated with 0.35 kilograms lower in body weight (95% CI: -0.50, -0.20, p<0.0001), 0.02% lower in HbA1c (95% CI: -0.04, -0. 003, p=0.02) and 0.20 mg/dl higher level in HDL-C (95% CI: 0.08, 0.32, p=0.003). Replacing 1-hour sedentary time with a similar amount of MVPA was associated with a lower prevalence of cardio-metabolic diseases (POR=0.95, 95% CI=0.91 to 0.98, p=0.01), while replacing 1-hour MVPA with an amount of sedentary time was associated with a higher prevalence of cardiometabolic diseases (POR=1.06, 95% CI=1.02 to 1.10, p=0.01). Conclusion: Substituting sedentary time with MVPA was associated with favorable cardiometabolic health, while time spent sedentary may be detrimental to cardiometabolic health among young and middle-aged South Asians. Future intervetions aiming at promoting increases in MVPA and reductions in sedentary time may show benefits in terms of preventing cardiometabolic diseases in South Asia.

$150,000 fundraiser launched to sequence South Asian genomes. United States dominates biosimilars market. Icon Group signs MoUs with two Vietnam hospitals. Philips opens Southeast Asia’s first Sleep and Respiratory Education Center. BlackBerry helps to secure and advance melanoma research in Australia. Asia-Pacific is fastest growing region for Bayer’s pharmaceuticals sales globally. Invion secures research alliance with Hudson Institute of Medical Research. New digital laboratory to provide tailored early life nutritional care. Johnson & Johnson Innovation announces S$5.1 million in World Without Disease Research Grants.

AbstractThis study is the first to document how older adults in East Asian and Western societies spend their time, across four key dimensions of daily life, by respondent’s gender and education level. To do this, we undertook a pioneering effort and harmonized cross-sectional time-use data from East Asian countries (China, Japan, South Korea, Taiwan) with data from the Multinational Time Use Study (Canada, Denmark, Finland, France, Italy, The Netherlands, Norway, Spain, United Kingdom, United States; to which we refer as Western countries), collected between 2000 and 2015. Findings from bivariate and multivariate models suggest that daily time budgets of East Asian older adults are different from their counterparts in most Western countries. Specifically, gender gaps in domestic work, leisure, and sleep time were larger in East Asian contexts, than in Western countries. Gender gaps in paid work were larger in China compared to all other regions. Higher levels of educational attainment were associated with less paid work, more leisure, and less sleep time in East Asian countries, while in Western countries they were associated with more paid work, less domestic work, and less sleep. Interestingly, Italy and Spain, two Southern European welfare regimes, shared more similarities with East Asian countries than with other Western countries. We interpret and discuss the implications of these findings for population aging research, and welfare policies.

When characters in the Fox Television sitcom The Mindy Project call Mindy Lahiri fat, Mindy sees it as a case of misidentification. She reminds the character that she is a “petite Asian woman,” that she has large, beautiful breasts, that she has nothing in common with fat people, and the terms “chubbster” and “BBW – Big Beautiful Woman” are offensive and do not apply to her. Mindy spends some of each episode on her love for food and more food, and her hatred of fitness regimes, while repeatedly falling for meticulously fit men. She dates, has a string of failed relationships, adventurous sexual techniques, a Bridget Jones-scale search for perfect love, and yet admits to shame in showing her naked body to lovers. Her contradictory feelings about food and body image mirror our own confusions, and reveal the fear and fascination we feel for fat in our fat-obsessed culture. I argue that by creating herself as sexy, successful, popular, sporadically confident and insecure, Mindy works against stigmas that attach both to big women – women who are considered big in comparison to the societal size-zero ideal – and women who have historically been seen as belonging to “primitive” or colonized cultures, and therefore she disrupts the conflation of thinness to civilization. In this article, I look at the performance of fat and ethnic identity on American television, and examine the bodily mechanisms through which Mindy disrupts these. I argue that Mindy uses issues of fat and body image to disrupt stereotypical iterations of race. In the first part of the paper, I look at the construction of South Asian femininity in American pop culture, to set up the discussion of fat, gender and race as interrelated performative categories. Race, Gender, Performativity As Judith Butler says of gender, “performativity must be understood not as a singular or deliberate ‘act,’ but, rather as the reiterative and citational practice by which discourse produces the effects that it names” (Bodies, 2). Bodies produce and perform their gender through repeating and imitating norms of clothing, body movement, choices in gesture, action, mannerism, as well as gender roles. They do so in such a way that the discourses and histories that are embedded in them start to seem natural; they are seen to be the truth, instead of as actions that have a history. These choices do not just reflect or reveal gender, but rather produce and create it. Nadine Ehlers takes performativity into the realm of race. Ehlers says that “racial performativity always works within and through the modalities of gender and sexuality, and vice versa, and these categories are constituted through one another” (65). In this sense, neither race nor gender are produced or iterated without also producing their interrelationship. They are in fact produced through this interrelationship. So, for example, when studying the performativity of black bodies, you would need to specify whether you are looking at black femininity or masculinity. And on the other hand, when studying gender, it is important to specify gender where? And when? You couldn’t simply pry open the link between race and gender and expect to successfully theorize either on its own. Mindy’s performance of femininity, including her questions about body image and weight, her attractive though odd clothing choices, her search for love, these are all bound to her iteration of race. She often explains her body through defining herself as Asian. Yet, I suggest in a seeming contradiction that her othering of herself as a big woman (relative to normative body size for women in American film and television) who breaks chairs when she sits on them and is insecure about her body, keeps the audience from othering her because of race. Her weight, clumsiness, failures in love, her heartbreaks all make her a “normal” woman. They make her easy to identify with. They suggest that she is just a woman, an American woman, instead of othering her as a South Asian woman, or a woman from a “primitive”, colonized or minority culture.Being South Asian on American Television Mindy Lahiri (played by writer, producer and actor Mindy Kaling) is a successful American obstetrician/gynaecologist, who works in a successful practice in New York. She breaks stereotypes of South Asian women that are repeated in American television and film. Opposite to the stereotype of the traditional, dutiful South Asian who agrees to an arranged marriage, and has little to say for him or herself beyond academic achievement that is generally seen in American and British media, Mindy sleeps with as many men as she can possibly fit into a calendar year, is funny, self-deprecating, and has little interest in religion, tradition or family, and is obsessed with popular culture. The stereotypical characteristics of South Asians in the popular British media, listed by Anne Ciecko (69), include passive, law-abiding, following traditional gender roles and traditions, living in the “pathologized” Asian family, struggling to find self-definitions that incorporate their placement as both belonging to and separate from British culture. Similarly, South Asian actors on American television often play vaguely-comic doctors and lawyers, seemingly with no personal life or sexual desire. They are simply South Asians, with no further defining personality traits or quirks. It is as if being South Asian overrides any other character trait. They are rarely in lead roles, and Mindy is certainly the first South Asian-American woman to have her own sitcom, in which she plays the lead. What do South Asians on American television look and sound like? In her study on performativity of race and gender, Ehlers looks at various constructions of black femininity, and suggests that black femininity is often constructed in the media in terms of promiscuity and aggression (83), and, I would add, the image of the mama with the big heart and even bigger bosom. Contrary to black femininity, South Asian femininity in American media is often repressed, serious, concerned with work and achievement or alternatively with menial roles, with little in terms of a personal or sexual life. As Shilpa S. Dave says in her book on South Asians in American television, most South Asians that appear in American television are shown as immigrants with accents (8). That is what makes them recognizably different and other, more so even than any visual identification. It is much more common to see immigrants of Chinese or Korean descent in American television as people with American accents, as people who are not first generation immigrants. South Asians, on the other hand, almost always have South Asian accents. There are exceptions to this rule, however, the exceptions are othered and/or made more mainstream using various mechanisms. Neela in ER (played by Parminder Nagra) and Cece in New Girl (played by Hannah Simone) are examples of this. In both instances the characters are part of either an ensemble cast, or in a supporting role. Neela is a step removed from American and South Asian femininity, in that she is British, with a British accent – she is othered, but this othering makes her more mainstream than the marking that takes place with a South Asian accent. The British accent and a tragic marriage, I would say, allow her to have a personal and sexual life, beyond work. Cece goes through an arranged marriage scenario, full with saris and a South Asian wedding that is the more recognized and acceptable narrative for South Asian women in American media. The characters are made more acceptable and recognizable through these mechanisms. Bhoomi K. Thakore, in an article on the representation of South Asians in American television, briefly explains that after the 1965 Immigration and Nationality act, highly-educated South Asians could immigrate to the United States, either to get further education, or as highly skilled workers (149) – a phenomenon often called “brain-drain.” In addition, says Thakore, family members of these educated South Asians immigrated to the States as well, and these were people that were less educated and worked often in convenience stores and motels. Thakore suggests that immigrants to the United States experience a segmented assimilation, meaning that not all immigrants (first and second generation) will assimilate to the same extent or in the same way. I would say from my own experience that the degree to which immigrants can assimilate into American society often depends on not only financial prospects or education, but also attractiveness, skin tone, accent, English-speaking ability, interests and knowledge of American popular culture, interest in an American way of life and American social customs, and so on. Until recently, I would say that South Asian characters in American television shows have tended to represent either first-generation immigrants with South Asian accents and an inability or lack of desire to assimilate fully into American society, or second-generation immigrants whose personal and sexual lives are never part of the narrative. Examples of the former include South Asians who play nameless doctors and cops in American television. Kal Penn’s character Lawrence Kutner in the television series House is an example of the latter. Kutner, one of the doctors on Dr. House’s team, did not have a South Asian accent. However, he also had no personal narrative. All doctors on House came with their relationship troubles and baggage, their emotional turmoil, their sexual and romantic ups and downs – all but Kutner, whose suicide in the show (when he left it to join the Obama administration) is framed around the question – do we ever really know the people we see every day? Yet, we do know the other doctors on House. But we never know anything about Kutner’s private life. His character is all about academic knowledge and career achievement. This is the stereotype of the South Asian character in American television. Yet, Mindy, with her American accent, sees herself as American, doesn’t obsess about race or skin colour, and has no signs of a poor-me narrative in the way she presents herself. She does not seem to have any diasporic longings or group belongings. Mindy doesn’t ignore race on the show. In fact, she deploys it strategically. She describes herself as Asian on more than one occasion, often to explain her size, her breasts and femininity, and in one episode she goes to a party because she expects to see black sportsmen there, and she explains, “It’s a scientific fact that black men love South Asian girls.” Her production of her femininity is inextricably bound up with race. However, Mindy avoids marking herself as a racial minority by making her quest for love and her confusions about body image something all women can identify with. But she goes further in that she does not place herself in a diaspora community, she does not speak in a South Asian accent, she doesn’t hide her personal life or the contours of her body, and she doesn’t harp on parents who want her to get married. By not using the usual stereotypes of South Asians and Asians on American television, while at the same time acknowledging race, I suggest that she makes herself a citizen of the alleged “melting pot” as the melting pot should be, a hybrid space for hybrid identities. Mindy constructs herself as an American woman, and suggests that being a racial minority is simply part of the experience of being American. I am not suggesting that this reflects the reality of experience for many women in the USA who belong to ethnic minorities. I am suggesting that Mindy is creating a possible or potential reality, in which neither size nor being a racial minority are causes for shame. In a scene in the second season, a police officer chastises Mindy for prescribing birth control to his young daughter. He charges out of her office, and she follows him in to the street. She is wearing a version of her usual gear – a check-pinafore, belted over a printed shirt – her shoulders curved forward, arms folded, in the characteristic posture of the big-breasted, curvy woman. She screams at the officer for his outdated views on birth-control. He questions if she even has kids, suggesting that she knows nothing about raising them. She says, “How dare you? Do I look like a woman who’s had kids? I have the hips of an eleven-year-old boy.” She then informs him that she wolfed down a steak sandwich at lunch, has misgivings about the outfit she is wearing, and says that she is not a sex-crazed lunatic. He charges her for public female hysteria. She screams after him as he drives off, “Everyone see this!” She holds up the citation. “It’s for walking, while being a person of colour.” She manages in the space of a two-minute clip to deploy race, size and femininity, without shame or apology, and with humour. It is interesting to note that, contrary to her persona on the show, in interviews in the media, Kaling suggests that she is not that concerned with the question of weight. She says that though she would like to lose fifteen pounds, she is not hung up on this quest. On the other hand, she suggests that she considers herself a role model for minority women. In fact, in real life she makes the question of race as something more important to her than weight – which is opposite to the way she treats the two issues in her television show. I suggest that in real life, Kaling projects herself as a feminist, as someone not so concerned about size and weight, an intelligent woman who is concerned about race. On the show, however, she plays an everywoman, for whom weight is a much bigger deal than race. Neither persona is necessarily real or assumed – rather, they both reveal the complexities by which race, gender and body size constitute each other, and become cruxes for identification and misidentification. Is It Civilized to Be Fat? When Mindy and her colleague Danny Castellano get together in the second season of the show, you find yourself wondering how on earth they are going to sustain this sitcom, without an on-again/off-again romance, or one that takes about five years to start. When Danny does not want to go public with the relationship, Mindy asks him if he is ashamed of her. Imagine one of the Friends or Sex in the City women asking this question to see just how astonishing it is for a successful, attractive woman to ask a man if he is ashamed to be seen with her. She doesn’t say is it because of my weight, yet the question hangs in the air. When Danny does break up with her, again Mindy feels all the self-disgust of a woman rejected for no clear reason. As Amy Erdman Farrell suggests in her book on fat in American culture and television, fat people are not expected to find love or success. They are expected to be self-deprecating. They are supposed to expect rejection and failure. She says that not only do fat people bear a physical but also a character stigma, in that not only are they considered visually unappealing, but this comes with the idea that they have uncontrolled desires and urges (7-10). Kaling suggests through her cleverly-woven writing that it is because of her body image that Mindy feels self-loathing when Danny breaks up with her. She manages again to make her character an everywoman. Not a fat South Asian woman, but simply an American woman who feels all the shame that seems to go with weight and body image in American culture. However, this assumed connection of fat with immorality and laziness goes a step further. Farrell goes on to say that fat denigration and ethnic discrimination are linked, that popularity and the right to belong and be a citizen are based both on body size and ethnicity. Says Farrell, “our culture assigns many meanings to fatness beyond the actual physical trait – that a person is gluttonous, or filling a deeply disturbed psychological need, or is irresponsible and unable to control primitive urges” (6) – psychological traits that have historically been used to describe people in colonized cultures. Farrell provides an intriguing analysis of Oprah Winfrey and her public ups and downs with weight. She suggests that Winfrey’s public obsession with her own weight, and her struggles with it, are an attempt to be an “everywoman”, to be someone all and not only black women can identify with. Says Farrell, “in order to deracinate herself, to prove that ‘anyone’ can make it, Winfrey must lose weight. Otherwise, the weight of all that fat will always, de facto, mark her as a ‘black woman’, with all the accompanying connotations of inferior, primitive, bodily and out of control” (126). She goes on to say that, “Since the end of the 19th century, fatness has … served as a potent signifier of the line between the primitive and the civilized, feminine and masculine, ethnicity and whiteness, poverty and wealth, homosexuality and heterosexuality, past and future” (126). This suggests that Winfrey’s public confrontations with the question of weight help the women in the audience identify with her as a woman, rather than as a black woman. In a volume on fat studies, Farrell explains that health professionals have further demarcated lines between “civilization and primitive cultures, whiteness and blackness, sexual restraint and sexual promiscuity, beauty and ugliness, progress and the past” (260). She suggests that fat is not just part of discourses on health and beauty, but also intelligence, enterprise, work ethics, as well as race, ethnicity, sexuality and class. These connections are of course repeated in media representations, across media genres and platforms. In women’s magazines, an imperative towards weightloss comes hand-in-hand with the search for love, a woman’s ability to satisfy a man’s as well as her own desires, and with success in glamorous jobs. Sitcom couples on American television often feature men who are ineffectual but funny slobs, married to determined, fit women who are mainly homemakers, and in fact, responsible for the proper functioning of the family, and consequentially, society. In general, bigger women in American and British media are on a quest both for love and weight loss, and the implication is that deep-seated insecurities are connected to both weight gain, as well as failures in love, and that only a resolution of these insecurities will lead to weight loss, which will further lead to success in love. Films such as My Big Fat Greek Wedding and Bridget Jones’s Diary are examples of this prevailing narrative. Thakore investigates the changing image of South Asians on American television, suggesting that South Asians are represented more and more frequently, and in increasingly more central roles. However, Thakore suggests that, “all women of colour deal with hegemonic skin tone ideologies in their racial/ethnic communities, with lighter skin tone and Caucasian facial features considered more appealing and attractive … . As media producers favour casting women who are attractive, so too do the same media producers favour casting women of colour who are attractive in terms of their proximity to White physical characteristics” (153). Similarly, Lee and Vaught suggest that in American popular culture, “both White women and women of colour are represented as reflecting a White ideal or aesthetic. These women conform to a body ideal that reflects White middle class ideals: exceedingly thin, long, flowing hair, and voluptuous” (458). She goes on to say that Asian American women would need to take on a White middle class standing and a simultaneous White notion of the exotic in order to assimilate. For Mindy, then, fat allows her to be an everywoman, but also allows her to adopt her own otherness as a South Asian, and make it her own. This trend shows some signs of changing, however, and I expect that women like Lena Dunham in the HBO comedy Girls and Mindy Kaling are leading the march towards productions of diverse femininities that are at the same time iterated as attractive and desirable. On The Hollywood Reporter, when asked about the more ludicrous questions or comments she faces on social media, Kaling puts on a male voice and says, “You’re ugly and fat, it’s so refreshing to watch!” and “We’re used to skinny people, and you’re so ugly, we love it!” On David Letterman, she mentions having dark skin, and says that lazy beach holidays don’t work for her because she doesn’t understand the trend for tanning, and she can’t really relax. Mindy’s confusions about her weight and body image make her a woman for everyone – not just for South Asian women. Whereas Kaling’s concern over the question of race – and her relative lack of concern over weight – make her a feminist, a professional writer, a woman with a conscience. These personas interweave. They question both normative performances of gender and race, and question the historical conflation of size and minority identity with shame and immorality. Butler suggests that gender is “the repeated stylisation of the body” (Gender, 33). She argues that gender roles can be challenged through a “subversive reiteration” of gender (Gender, 32). In this way, women like Dunham and Kaling, through their deployment of diverse female bodies and femininities, can disrupt the normative iteration of gender and race. Their production of femininity in bodies that are attractive (just not normatively so) has more than just an impact on how we look at fat. They bring to us women that are flawed, assertive, insecure, confident, contradictory, talented, creative, that make difficult choices in love and work, and that don’t make an obsession with weight or even race their markers of self worth.References Bridget Jones’s Diary. Dir. Sharon Maguire. Miramax and Universal Pictures, 2001. Butler, Judith. Gender Trouble. London: Routledge, 1990. Butler, Judith. Bodies That Matter: On the Discursive Limits of Sex. London: Routledge, 1993. Ciecko, Anne. “Representing the Spaces of Diaspora in Contemporary British Films by Women Directors.” Cinema Journal 38.3 (Spring 1999): 67-90. Dave, Shilpa S. Indian Accents: Brown Voice and Racial Performance in American Television. U of Illinois, 2013. Ehlers, Nadine. Racial Imperatives: Discipline, Performativity, and Struggles against Subjection. Bloomington: Indiana University Press, 2012. ER. Warner Bros. Television. NBC, 1994-2009. Farrell, Amy. “‘The White Man’s Burden’”: Female Sexuality, Tourist Postcards, and the Place of the Fat Woman in Early 20th-Century U.S. Culture.” In Esther Rothblum and Sondra Solovay (eds.), The Fat Studies Reader. New York: New York University Press, 2009. Farrell, Amy Erdman. Fat Shame: Stigma and the Fat Body in American Culture. New York: New York University Press, 2011. Friends. Warner Bros. Television. NBC, 1994-2004. Girls. HBO Entertainment and Apatow Productions. HBO, 2012-present. House. Universal Television. Fox, 2004-2012. Lee, Stacey J., and Sabina Vaught. “‘You Can Never Be Too Rich or Too Thin’: Popular and Consumer Culture and the Americanization of Asian American Girls and Young Women.” The Journal of Negro Education 72.4 (2003): 457-466. My Big Fat Greek Wedding. Dir. Joel Zwick. Playtone, 2002. New Girl. 20th Century Fox. Fox, 2011-present. Nicholson, Rebecca. “Mindy Kaling: ‘I Wasn’t Considered Attractive or Funny Enough to Play Myself.’” The Observer 1 June 2014. ‹http://www.theguardian.com/tv-and-radio/2014/jun/01/mindy-kaling-project›. Sex in the City. Warner Bros. Television and HBO Original Programming. HBO, 1998-2004. Strauss, Elissa. “Why Mindy Kaling – Not Lena Dunham – Is the Body Positive Icon of the Moment.” The Week 22 April 2014. ‹http://theweek.com/article/index/260126/why-mindy-kaling-mdash-not-lena-dunham-mdash-is-the-body-positive-icon-of-the-moment›. Thakore, Bhoomi K. “Must-See TV: South Asian Characterizations in American Popular Media.” Sociology Compass 8.2 (2014): 149-156. The Mindy Project. Universal Television, 3 Arts Entertainment, Kaling International. Fox, 2012-present. Ugly Betty. ABC Studios. ABC, 2006-2010. YouTube. “Mindy Kaling on David Letterman.” 29 April 2013. 21 Oct. 2014 ‹http://www.youtube.com/watch?v=z8K1ye2gnJw›. YouTube. “Mindy on Being Called Fat and Ugly on Social Media.” The Hollywood Reporter 14 June 2014. 21 Oct. 2014 ‹http://www.youtube.com/watch?v=Ockt-BeMOWk›. YouTube. “Chris Messina: ‘I Think Mindy Kaling’s Beautiful.’” HuffPost Live 24 April 2014. 21 Oct. 2014 ‹http://www.youtube.com/watch?v=3HtCjGNERKQ›.

AbstractHealth-related quality of life (HRQoL) is lower in people with NAFLD compared to the general population. Sleep disturbance resulting in daytime sleepiness is common in patients with NAFLD, but the effect of daytime sleepiness on HRQoL in NAFLD is unclear. The prevalence and natural history of NAFLD vary in different ethnic groups, but there has been limited ethnic diversity in HrQoL studies to date. We aimed to assess whether daytime sleepiness is independently associated with reduced HRQoL in an ethnically diverse UK population. We conducted HRQoL assessments using SF-36 version 2 and Epworth Sleepiness Scale (ESS) questionnaires in 192 people with NAFLD. Multivariate linear regression was used to identify factors independently affecting HRQoL scales. People with NAFLD reported significantly reduced physical health-related SF-36 scores compared to the general UK population. South Asian NAFLD patients reported impairment in physical health, but not mental health, approximately a decade before White NAFLD patients. In multivariate linear regression, daytime sleepiness (ESS score > 10), was the most significant independent predictor of reduced physical health. Age, BMI and liver stiffness score were also significantly associated. HRQoL is impaired earlier in patients of South Asian ethnicity. ESS score > 10, indicative of excessive daytime sleepiness, is an independent predictor of reduced HRQoL in people with NAFLD regardless of ethnicity. Daytime sleepiness should be considered as a contributing factor to reduced HRQoL in clinical practice and when evaluating patient-related outcomes in clinical trials.

ABSTRACT Itching is a common complaint in pregnancy, occurring in up to 14 to 23% of women. Pruritus may be so severe that it affects sleep and quality of life. It has a prevalence of 0.7 to 5% in different populations.1 Prevalence is influenced by genetic and environmental factors and varies between populations worldwide. In Chile, 2.4% of all pregnancies are affected with a 5% prevalence in women of Araucanian-Indian origin.1 Obstetric cholestasis (OC) (also referred to as intrahepatic cholestasis of pregnancy) is a multifactorial condition of pregnancy characterized by pruritus in the absence of a skin rash with abnormal liver function tests (LFTs), neither of which has an alternative cause and both of which resolve after delivery.2 Investigations to exclude other causes of pruritus and of abnormal LFTs should be performed. Obstetric cholestasis has a potential for fetal risks, which may include spontaneous preterm birth, iatrogenic preterm birth and fetal death. Intense pruritus causes. Maternal morbidity and sleep deprivation. An interdisciplinary management of intrahepatic cholestasis of pregnancy by dermatologists, hepatologists, gynecologists and pediatricians is absolutely mandatory. How to cite this article Malhotra J, Agrawal P, Garg R, Malhotra N. Pruritus in Pregnancy. J South Asian Feder Obst Gynae 2013;5(3):142-146.

The study explores the perception of parents about their children’s social, emotional, and academic behavior during the pandemic, moreover explores the change in parenting style throughout the second wave of COVID-19 pandemic in South Asia. A phenomenological survey was used in the study. 171 parents from South Asia were selected through convenience and purposive sampling technique. An electronic selfdeveloped phenomenological survey questionnaire was distributed through Whatsapp/Email, Moreover 10 parents were also interviewed for triangulation. Descriptive data was analyzed on SPSS-24 and qualitative data was analyzed through thematic analysis. It is found that during the first wave of pandemic COVID-19 lockdown, children were very happy, excited, and active. However, due to long-term school closure, now they are not as much happy but frustrated and they become bored as well. The parents also observed friendly, respectful, and helpful behavior in the children. It is also found that the children love to play, to spend time watching T.V. and on social media, but they didn’t show much interest in online study. Parents are also not satisfied with the online classes as the children do not understand content properly. However, this COVID-19 lockdown polished parents’ technical skills, and they spend their quality time with children by discussing education and social wellbeing. Findings suggest that children sleeping timing have changed as before lockdown, children used to sleep around 10 p.m. to 11 p.m., but during the lockdown, this routine has changed, and they are sleeping around midnight. The study recommends that adults must be provided with correct information and advice about how their personal well-being and children's well-being can be impacted by this stressful situation.