'Reputation, reputation, reputation! Oh, I have lost my reputation!'; A literature review on alcohol addiction in the British Sikh and/or Punjabi community and the barriers to accessing support

AIMS

The literature review aimed to identify the barriers the Punjabi and/or Sikh community have in accessing support for alcohol addiction.

METHOD

A systematic review of the literature was undertaken of four scholarly databases, Google Scholar and grey literature on UK-based research conducted after 1980 into alcohol addiction in the Punjabi and/or Sikh community. Fourteen papers met the inclusion criteria outlined in the paper and were included in the review.

RESULTS

Ten main barriers to accessing support were found; stigma, religion, lack of understanding of addiction, over reliance on a medical model of treatment and disregard of therapy, cultural implications of being a member of the Punjabi and/or Sikh community and the addiction community, gender and generational differences and a lack of government commitment to alcohol support for BME communities with a lack of culturally specific services.

CONCLUSION

Despite the many barriers explored, the role of stigma remained a powerful theme throughout often underpinning other barriers. A key recommendation across many papers was the need for culturally sensitive support services. Several areas for future research were identified.

COVID-19 Education and Resource Development for Punjabi-Speaking Sikh Farmworkers in California

OBJECTIVE

While the vast majority of farmworkers in California are Latinx, a small proportion of the farmworkers are Asian Indian who primarily speak Punjabi. To date, there are few COVID-19 resources developed that specifically target Punjabi-speaking farmworkers. This study examines the COVID-19 educational needs of Punjabi-speaking farmworkers in California and aims to inform future development of educational materials for Punjabi-speaking farmworkers.

METHODS

During early 2021, a two-phase qualitative study was conducted. In Phase 1, five key informant interviews were conducted using a semi-structured interview guide to assess the content, visual, and cultural relevance of current COVID-19 educational resources. Based on informant feedback, new agriculture-specific COVID-19 educational resources were developed in Punjabi. In Phase 2, three focus groups were conducted (in Fresno and Yuba Counties) with five participants in each group to evaluate the newly developed COVID-19 resources.

RESULTS

Informant interviews showed that Punjabi-speaking farmworkers preferred printed handouts, videos, and radio messages to receive COVID-19 related information. Participants preferred 8-1/2"x11" sized printed handouts that were colorful and had culturally relevant photographs. Participant video preferences included live action videos that were short (1-3 mins) with characters representing the Punjabi community. A substantial majority of focus group participants approved the newly developed COVID-19 educational and safety resources.

CONCLUSION

Current COVID-19 resources are not meeting the educational needs of Punjabi-speaking farmworkers. This community needs COVID-19 educational and safety materials that are culturally relevant and linguistically appropriate to be available in different formats: handouts, videos, and radio messages.

Translation and Validation of ID-Migraine Questionnaire to North-Indian Vernacular Languages

Background

ID-Migraine is an established screening tool for migraine. Translation and validation in more languages can increase its reach and scope.

Aim

To translate and validate ID-Migraine for screening migraine patients in two North-Indian vernacular languages, that is, Hindi and Punjabi.

Methods

ID Migraine was translated into Hindi and Punjabi. Subjects with headaches in outpatient clinics were administered the questionnaire according to their preferred language of choice and referenced clinical evaluations, performed by an experienced neurologist, based on current the ICHD-3 diagnostic criteria.

Results

One hundred subjects with complaints of headaches and 60 healthy controls were recruited after informed consent. Of the 100 subjects with headaches, 73 (73%) screened positive with a translated version of ID-Migraine, and 60 (60%) were eventually diagnosed with migraine without aura. The sensitivity of the Hindi version of ID-Migraine was 94% (95% confidence intervals, 79% to 99%); specificity, 56% (95% CI, 31% to 78%); positive predictive value, 79% (95% CI, 69% to 86%) and negative predictive value, 83% (95% CI, 55% to 95%). The Punjabi version demonstrated a sensitivity of 86% (95% CI, 68% to 96%); specificity, 43% (95% CI, 23% to 66%); PPV, 68% (95% CI, 58% to 76%); and NPV, 69% (95% CI, 44% to 86%).

Conclusion

The translated versions of ID-Migraine demonstrated high sensitivity and fair specificity for screening migraine in Indian subjects who speak and understand Hindi and Punjabi.

Bystander LECT2 amyloidosis in tumor nephrectomy

Pathologic evaluation of the non-neoplastic renal parenchyma in tumor nephrectomy specimens is critical and can detect both renal-limited and systemic pathologies. We report the case of a 69-year-old Punjabi male who underwent cytoreductive nephrectomy for advanced renal cell carcinoma after immunotherapy. We detected clinically unexpected leukocyte chemotactic factor 2 (LECT2) amyloidosis during pathologic analysis of the surrounding non-neoplastic renal parenchyma, which was confirmed by mass spectrometry. LECT2 amyloidosis occurs predominantly in Hispanic patients and has only rarely been described in Punjabi patients. This case highlights the importance of careful pathologic evaluation of the non-neoplastic renal parenchyma of nephrectomy specimens and raises awareness that LECT2 amyloidosis can occur outside of the typical demographic of Hispanic patients.

Genetic diversity and forensic application of Y-filer STRs in four major ethnic groups of Pakistan

17 Y-chromosomal STRs which are part of the Yfiler Amplification Kit were investigated in 493 unrelated Pakistani individuals belonging to the Punjabi, Sindhi, Baloch, and Pathan ethnic groups. We have assessed the forensic parameters and population genetic structure for each group. Among the 493 unrelated individuals from four ethnic groups (128 Baloch, 122 Pathan, 108 Punjabi, and 135 Sindhi), 82 haplotypes were observed with haplotype diversity (HD) of 0.9906 in Baloch, 102 haplotypes with HD value of 0.9957 in Pathans, 80 haplotypes with HD value of 0.9924 in Punjabi, and 105 haplotypes with HD value of 0.9945 in the Sindhi population. The overall gene diversity for Baloch, Pathan, Punjabi, and Sindhi populations was 0.6367, 0.6479, 0.6657, and 0.6112, respectively. The results had shown us that Pakistani populations do not have a unique set of genes but share the genetic affinity with regional (Central Asia and Northern India) populations. The observed low gene diversity (heterozygosity) values may be because of endogamy trends and this observation is equally supported by the results of forensic parameters which are mostly static across 4 combinations (minimal STRs, extended 11 Y-STRs, Powerplex 12 Y System, and Yfiler 17 Y-STRs) of STRs in these four populations.

'Diabetes doesn't matter as long as we're keeping traditions alive': a qualitative study exploring the knowledge and awareness of Type 2 diabetes and related risk factors amongst the young Punjabi Sikh population in the UK

Objectives: It is well known that Sikhs are at an increased risk of Type 2 Diabetes (T2DM) due to a genetic predisposition. High level of education is associated with lower incidence of T2DM. Young Sikhs are well educated compared to other South Asian sub-groups. Despite this, T2DM rates remain high in Sikhs. The uptake of preventative services is also low within Sikhs. At present, no research has been conducted with the young Punjabi Sikh population on diabetes awareness in the UK. To address this gap, this study explores the knowledge and awareness of T2DM and related modifiable risk factors in the UK Punjabi Sikh community. Views surrounding T2DM health-seeking behaviours are also explored.Design: A qualitative design comprising of 1-to-1 semi-structured interviews was adopted. Thirteen Punjabi Sikh participants between the ages of 18-30 took part. Participants were recruited through a Sikh temple and University of Manchester Sikh Society using purposive and snowball sampling in West Yorkshire and North West England. Data were analysed using inductive thematic analysis taking a critical realist stance.Results: Three themes were identified: (1) Perceptions of the causes of T2DM, (2) Perceptions of factors impacting physical activity and diet, and (3) Attitudes towards health-seeking behaviours.Conclusions: The findings show that although well educated, participants overlooked physical activity as contributing factor towards T2DM onset. Additionally, gender and cultural norms influenced physical activity and diet, as these are passed through generations to preserve the collectivist Sikh culture. Exploration of health seeking behaviours also found young Punjabi Sikhs perceived the internet to be the preferred tool to seek T2DM information. These findings hold implications for health professionals, as the information and preventative services provided to Sikhs can be tailored to be culturally appropriate and in line with cultural and gender norms, such as bhangra dancing for physical activity.

Acoustic classification of coronal stops of Eastern Punjabi

Punjabi is an Indo-Aryan language which contrasts a rich set of coronal stops at dental and retroflex places of articulation across three laryngeal configurations. Moreover, all these stops occur contrastively in various positions (word-initially, -medially, and -finally). The goal of this study is to investigate how various coronal place and laryngeal contrasts are distinguished acoustically both within and across word positions. A number of temporal and spectral correlates were examined in data from 13 speakers of Eastern Punjabi: Voice Onset Time, release and closure durations, fundamental frequency, F1-F3 formants, spectral center of gravity and standard deviation, H1*-H2*, and cepstral peak prominence. The findings indicated that higher formants and spectral measures were most important for the classification of place contrasts across word positions, whereas laryngeal contrasts were reliably distinguished by durational and voice quality measures. Word-medially and -finally, F2 and F3 of the preceding vowels played a key role in distinguishing the dental and retroflex stops, while spectral noise measures were more important word-initially. The findings of this study contribute to a better understanding of factors involved in the maintenance of typologically rare and phonetically complex sets of place and laryngeal contrasts in the coronal stops of Indo-Aryan languages.

Inter-ethnic genetic variations and novel variant identification in the partial sequences of CYP2B6 gene in Pakistani population

Background

Some single nucleotide polymorphisms (SNPs) in the cytochrome P450 (CYP)2B6 gene lead to decreased enzyme activity and have an impact on drug metabolism. The present study was designed to investigate the patterns of genetic distinction across a hypervariable region of the CYP2B6 gene, known to contain important SNPs, i.e. rs4803419 and rs3745274, among five major ethnic groups of the Pakistani population.

Methods

Arlequin v3.5.DnaSPv6.12. and network 5 resources were used to analyze population genetic variance in the partial CYP2B6 gene sequences obtained from 104 human samples belonging to Punjabi, Pathan, Sindhi, Seraiki and Baloch ethnicities of Pakistan. The partial CYP2B6 gene region analyzed in the current study is previously known to possess important SNPs.

Results

The data analyses revealed that genetic variance among samples mainly came from differentiation within the ethnic groups. However, significant genetic variation was also found among the various ethnic groups. The high pairwise Fst genetic distinction was observed between Seraiki and Sindhi ethnic groups (Fst = 0.13392, P-value = 0.026) as well as between Seraiki and Balochi groups (Fst = 0.04303, P-value = −0.0030). However, the degree of genetic distinction was low between Pathan and Punjabi ethnic groups. Some SNPs, including rs3745274 and rs4803419, which are previously shown in strong association with increased plasma Efavirenz level, were found in high frequency. Besides, a novel SNP, which was not found in dbSNP and Ensemble databases, was identified in the Balochi ethnicity. This novel SNP is predicted to affect the CYP2B6 splicing pattern.

Conclusion

These results may have significant implications in Pakistani ethnicities in the context of drugs metabolized by CYP2B6, especially in Seraiki and Balochi ethnicity. The novel heterogeneous SNP, found in the present study, might lead to altered drug-metabolizing potential of CYP2B6 and, therefore, may be implicated in non-responder phenomenon.

Reliability and Validity of Cross Culturally Adapted Punjabi Version of NDI (NDI-P) in Patients with Neck Pain: A Psychometric Analysis

BACKGROUND

Neck disability index (NDI) is one of the commonest patient-reported outcome measures used to evaluate disability related to neck pain. Its application to non-English-speaking Punjabi population is limited as a validated and cross-culturally adapted Punjabi version of NDI is not available. The purpose of the study was to analyze the psychometric properties of Punjabi version of neck disability index (NDI-P) in patients with neck pain.

MATERIALS AND METHODS

The translation and cross-cultural adaptation of Punjabi version of NDI was done according to well-recommended guidelines. The pre-final version was tested on a set of 15 patients and suitable modifications were made. The final version was administered to 100 patients with neck pain of more than 2 weeks duration. Psychometric properties comprising internal consistency, test-re-test reliability, construct validity and factorial structure of the questionnaire were determined.

RESULTS

The developed NDI-P showed excellent internal consistency (Chronbach alpha of NDI-P is 0.87), test-re-test reliability (ICC 0.840) and construct validity (Spearman correlation coefficient with VAS 0.547). Factor analysis proved the questionnaire to be having a 2-factor structure with a total variance of 56.58%.

CONCLUSION

NDI (P) is a reliable and valid instrument for measurement of disability related to neck pain in Punjabi population. It can be used both in research and clinical care settings in future.

Reliability and validity of Punjabi version of Oswestry Disability Index in patients with mechanical low back pain

OBJECTIVE

Oswestry disability Index(ODI) is the commonest patient reported outcome for assessment of disability due to low back pain. Its application to non-English speaking Punjabi population is limited as a validated and cross culturally adapted Punjabi version of ODI is not available. The purpose of the study was to analyse the psychometric properties of Punjabi version of Oswestry disability index (ODI-P) in patients with mechanical low back pain.

MATERIALS AND METHODS

The translation and cross-cultural adaptation of Punjabi version of ODI was done according to well recommended guidelines. The prefinal version was tested on a set of 15 patients and suitable modifications were made. The final version was administered to 113 patients with mechanical low back pain of more than two weeks duration. Psychometric properties comprising of internal consistency, test retest reliability, floor and ceiling effect, construct validity and factorial structure of the questionnaire were determined.

RESULTS

ODI-P showed excellent internal consistency (Chronbach alpha of ODI-P is 0.72), test retest reliability (ICC 0.891) and construct validity (Spearman correlation coefficient with VAS 0.424). Factor analysis proved the questionnaire to be having a 1-factor structure with a total variance of 48.61%.

CONCLUSIONS

ODI (P) is a reliable and valid instrument for measurement of disability related to mechanical low back pain in Punjabi population. It can be used both in research and clinical care settings in future.

HLA-A*02 repertoires in three defined population groups from North and Central India: Punjabi Khatries, Kashmiri Brahmins and Sahariya Tribe

The allelic family of HLA-A*02 with a repertoire of approximately 1022 alleles represents the predominant and most heterogeneous group at the HLA-A locus. This remarkable diversity signifies its evolutionary relevance. Its population-specific diversity is attributed to environmental factors and pathogen pressure and can be harnessed in biology and medicine, particularly in disease association and for HLA-based vaccination approaches. We therefore investigated the HLA-A*02 repertoire in two North Indian caste populations, viz Punjabi Khatries (PK, N = 250), Kashmiri Brahmins (KB, N = 160) and a Central Indian tribe Sahariya (ST, N = 100) using Luminex-based high-resolution rSSO method. When required, results were confirmed with high-resolution PCR-SSP and/or next-generation sequencing (NGS). In the three populations evaluated, HLA-A*02 was observed with an overall high phenotypic/allelic frequency, however, A*02 repertoire differed among them. A total of six alleles were observed (A*02:01, *02:03, *02:05, *02:06, *02:07 and *02:11) in the caste groups, compared with four (except *02:05 and *02:07) in the tribals. Our striking observation was the high occurrence of A*02:11 at the repertoire level (80.6% in ST, 39% in PK, 31.8% in KB). Globally, this allele is rare, observed with low frequencies in limited ethnic groups. The primordial A*02:01 allele, representative A*02 allele in most ethnicities was observed as the second predominant allele (PK = 27.3%, KB = 31.8% and ST = 11.9%). Extremely high occurrence of A*02:11 in ST may be representation of ancient Austro-Asiatic genetic pool. In caste populations, the observed A*02 repertoire may be a consequence of natural selection and/or admixture from different populations.

Population data of 17 Y-STRs (Yfiler) from Punjabis and Kashmiris of Pakistan

Pakistan harbors 16 major ethnic groups including Punjabis (56% of total population) and Kashmiri (6% of total population). Here, we report data of 17 Y-chromosomal short tandem repeats (Y-STRs) genotyped with the AmpFlSTR Y-filer™ PCR Amplification kit in 94 Punjabis and 101 Kashmiris. The estimated haplotype diversity was higher in Punjabis (0.996) than that in Kashmiris (0.983). Furthermore, we performed population genetic analyses by including data from six other Pakistani groups. The presented haplotype data were recently included in the Y-Chromosome Haplotype Reference Database (YHRD) for future forensic and other usage.

Genetic variants of ADAM33 are associated with asthma susceptibility in the Punjabi population of Pakistan

OBJECTIVE

A disintegrin and metalloproteinase 33 (ADAM33) gene has been considered as an asthma susceptibility gene due to its possible role in airway remodeling, abnormal cell proliferation, and differentiation. Association of this gene with asthma has been reported in several genetic studies on various populations. The current study aims to evaluate the association of ADAM33 gene polymorphisms with the risk of asthma in the Punjabi population of Pakistan.

METHOD

A total of 101 asthma patients and 102 age-matched healthy controls from Lahore, a city in Punjab, were recruited. ADAM33 single nucleotide polymorphisms (SNPs) T + 1[rs2280089], T2[rs2280090], T1[rs2280091], ST + 5[rs597980], ST + 4[rs44707], S2[rs528557], Q - 1[rs612709], and F + 1[rs511898] were genotyped in both patients and controls using single base extension and capillary electrophoresis-based genetic analyzer. The basic allelic and genotypic model was analyzed for association of the SNPs with asthma using SHEsis software. Haploview software was used to calculate pairwise linkage disequilibrium (LD) among six of the genotyped SNPs.

RESULTS

Of the 8 SNPs genotyped, only S2[rs528557] showed significant association with asthma (Allele p = 0.0189, Genotype p = 0.021). SNPs T + 1[rs2280089], T2[rs2280090], T1[rs2280091], ST + 4[rs44707], S2[rs528557], and Q - 1[rs612709] were found to be in moderate to strong LD. The significantly higher frequency of haplotype "AAGTCG" in healthy controls suggests a protective effect against asthma risk in the studied population (p = 0.0059).

CONCLUSION

These findings suggest that genetic variants of ADAM33 gene may play important roles in asthma susceptibility in the Punjabi population of Pakistan.