The declining prevalence of hepatitis B virus infection among Asian and Pacific Islander children

PURPOSE

This article provides a review of the literature on the decline of hepatitis B virus (HBV) infection in Asian and Pacific nations having universal hepatitis B immunization programs.

METHODS

Papers on the epidemiology of HBV infection and hepatitis B immunization programs in Asian and Pacific nations were located by searching MEDLINE and libraries for publications in English, and by contacting hepatitis B experts.

PRINCIPAL FINDINGS

High endemicity for HBV in Asian and Pacific nations was partly caused by a cycle of high infectiousness, perinatal transmission, and chronic infection from early ages. Higher prevalence of infection has been found in men, some families, communities, and ethnic groups, and in people with high risk behaviors and situations, such as attending day care, getting injections, or sharing personal items. Incidence of acquisition of infection is about 2%-5% per year. Prevalence of HBV infection was declining in some nations before commencing hepatitis B immunization programs, probably because of improvements in medical practices and living conditions. Twenty-seven of 34 Pacific and East and Southeast Asian nations have attained >70% hepatitis B vaccination coverage in infants, and twelve have documented reducing infection or liver cancer to fractions of their former rates. But the immunization programs may be causing natural selection of mutant hepatitis B viruses, necessitating study of the mutants, and modification of serological tests and vaccines.

CONCLUSIONS

Practical implications for U.S. health professionals are: increasing HBV screening and hepatitis B vaccination of adolescents and adults from Asian and Pacific nations can prevent many infections and disease cases; most children coming from high coverage Asian and Pacific nations will be immune and few infected; we can learn much from these successful programs; and we should still make efforts to immunize Asian and Pacific children in the United States, and help Asian and Pacific nations which do not yet have highly successful hepatitis B immunization programs.

Breast and cervical cancer screening among Chinese American women

PURPOSE

The purpose of this study was to describe breast and cervical cancer screening knowledge and practices of a representative sample of Chinese American women and to examine the factors associated with screening practices.

DESCRIPTION OF STUDY

A random sample of 332 Chinese American women, 40 to 69 years of age, from the Chinatown area of Chicago, Illinois, were interviewed face to face, using both Chinese Mandarin (or Putunghua) and Cantonese versions of the National Health Interview Survey (NHIS) Cancer Control Supplement Questionnaire. Knowledge and use of mammogram, clinical breast examination (CBE), breast self-examination (BSE), and Pap smear test were assessed.

RESULTS

The results showed a low level of knowledge of cancer screening tests and low use rates. Multiple logistics regression analysis showed that women with spoken English fluency were more likely to have knowledge and use of CBE, BSE, Pap test, and mammograms. Women with better than an elementary education were more likely to have knowledge and use of CBE, BSE, and Pap test. The source of medical care was statistically significant for having had a mammogram. Knowledge of cancer warning signs and symptoms was significant for knowledge of mammogram and BSE and for the use of BSE.

CLINICAL IMPLICATIONS

Multiple strategies are needed. These might include the following: 1) integration of research with population-based care by physicians and scientists; 2) coordinated public health education on cancer screening and postscreening support in Chinese languages; and 3) replication of the NHIS survey methodology and adaptive application of these instruments across several states and regions, combined with the assessment of screening performance in Chinese American populations.

Results on preemptive or prophylactic treatment of lamivudine in HBsAg (+) renal allograft recipients: comparison with salvage treatment after hepatic dysfunction with HBV recurrence

BACKGROUND

Lamivudine has been reported to be able to stabilize liver enzyme and hepatitis B virus (HBV) replication with recurrent hepatitis that has been regarded as a frequent and major risk factor for hepatic dysfunction and chronic liver disease in renal transplant recipients. Because large number of hepatitis antigenemia patients among renal transplant patients experience recurrent hepatic dysfunction with HBV recurrence and permanent histological deterioration, preemptive or primary prophylactic use of lamivudine before transplantation may be more beneficial than a trial for the treatment of advanced hepatic dysfunction.

METHODS

We conducted a double arm study to compare the efficacy of lamivudine between the preemptive (HBV DNA positive) or prophylactic (HBV DNA negative) trial for the maintenance of stable liver function (n=10) and the trial for the salvage of advanced hepatic dysfunction developed after renal transplantation (n=6) in hepatitis B viremia carrier renal transplant recipients.

RESULTS

Hepatic dysfunction with recurrent HBV antigenemia developed in 11 of 36 (30.6%) hepatitis antigenemia patients with a mean duration of 8.4 months (range 5-19.4 months). In six patients treated with lamivudine after hepatic dysfunction from recurrent hepatitis B viremia, serum AST and ALT level normalized within 1 month and HBV-DNA disappeared in all cases. HBV-DNA, however, reappeared in three (50%) without any discontinuation of lamivudine. Liver biopsy revealed recurrent chronic active hepatitis with severe activity of fibrosis in four cases, cholestatic fibrosing hepatitis in one, and permanent cirrhotic change in one. In seven patients who had preemptive lamivudine treatment at 9, 6, 2, 2, 1, 0, 0 month before the transplantation, HBV-DNA had converted to negative with a mean follow up of 1.2 months (range 1-2 month) in all case. Three patients who had prophylactic trials with lamivudine have all remained HBV-DNA negative. The recurrence rate of HBV viremia in the preemptive or prophylactic lamivudine treated group is 10.0% (1/10), which is significantly lower than that (42.3%, 11/25) in the nonlamivudine-treated group. The re-recurrence rate of HBV viremia was significantly higher (3/6, 50.0%) in the reactive lamivudine treated group than in prophylactic or preemptive group (1/10, 10%).

CONCLUSION

Although lamivudine treatment after hepatic dysfunction can be a sound conventional treatment modality, this preliminary study may suggest that preemptive or prophylactic trial of lamivudine before hepatic dysfunction might be a more effective strategy for prevention of permanent histological deterioration and recurrence of hepatitis B viremia.

Nutritional status of Korean Americans: implications for cancer risk

PURPOSE/OBJECTIVES

To examine nutrient intake of Korean Americans, especially those foods and supplements implicated in cancer.

DESIGN

Cross-sectional survey and descriptive analysis.

SETTING

Chicago, IL.

SAMPLE

103 Korean Americans who were between 40 and 69 years of age.

METHODS

An Instrument, culturally and linguistically adapted from the Health Habits and History Questionnaire, was administered to assess nutrient intake from food and vitamin and mineral supplements. Bilingual interviewers collected data at respondents' homes.

FINDINGS

Relative to their diet in Korea, more than one-third of the respondents reported an increase in the consumption of beef, dairy products, coffee, soda, and bread, as well as a decrease in the intake of fish and rice and other grains. Compared to the general U.S. population included in the National Health Interview Survey (NHIS), Korean Americans had a greater intake of carbohydrates and vitamins A and C and lower intake of total fat, cholesterol, and saturated fat. Moreover, the percentages of calories were higher from carbohydrates and lower from fat, sweets, and alcohol for Korean Americans than those reported by NHIS respondents. Gender, education, and marital status were significantly associated with nutrient intake. The use of daily vitamin and calcium supplements was similar between respondents and those from NHIS.

CONCLUSIONS

At their stage of cultural adaptation, the incorporation of a larger quantity of Western food items did not make for a less healthy dietary pattern among respondents. Data showed that Korean Americans continued to consume diets more consistent with Korean than with American food patterns, in as much as greater than 60% of their calories came from carbohydrates and about 16% of calories from fat. As a group, respondents met the recommended dietary guidelines for most nutrients, except for dietary fiber and calcium.

IMPLICATIONS FOR NURSING PRACTICE

Variation in dietary intake by age, culture, gender, and years in the United States is well accepted. Effective cancer prevention and initiatives for dietary reform call for the incorporation of available research findings and considerable attention to data gaps regarding Korean Americans and other Asian Americans and Pacific Islander populations. Culturally competent, community-based programs should include the reinforcement of positive traditional dietary habits, encourage the adaptation of healthy Western food items, as well as assist minority populations in developing strategies that will effectively correct likely deficiencies in diet.

Smoking behavior, knowledge, and beliefs among Korean Americans

PURPOSE

The purpose of the study was to examine smoking behavior, knowledge, and beliefs among Korean Americans.

DESCRIPTION OF STUDY

One hundred four Korean American men and 159 women, 40 to 69 years old, living in Chicago, Illinois, served as study respondents. The National Health Interview Survey (NHIS) Cancer Control Supplement Questionnaire was used to collect data. The NHIS was translated into Korean with minor modifications to develop a culturally appropriate instrument.

RESULTS

This study suggests that smoking is almost exclusively a male behavior (38.5%) and that Korean American men smoke mostly cigarettes. Almost 90% of women have never smoked, whereas 23% of men reported never smoking. Respondents with a non-Christian background or no religious affiliation were 16.5 times more likely to be current smokers. Respondents who had lived in the United States less than 10 years were 12.5 times more likely to be current smokers. More than 90% of men, regardless of smoking status, were able to identify an association between smoking and major chronic diseases.

CLINICAL IMPLICATIONS

The prevalence of smoking among these Korean American men places them at considerable risk for smoking-related disease. Healthcare providers must be better informed about smoking behavior in this group, and specific attention to recently migrated men and those reporting religions other than Christianity is recommended. Health-protecting strategies for women and children who fall victim to secondhand smoke, or who may be targeted by tobacco advertising, are also an important step in disease prevention for this population.

Individual or combined effects of enalapril and verapamil on chronic cyclosporine nephrotoxicity in rats

Previous studies have demonstrated that enalapril and verapamil seem to attenuate the cyclosporine nephrotoxicity. However, the mechanisms have not been completely understood, especially on molecular events. The aim of this study was to examine the effect of individual or combined treatment on osteopontin, TGF-beta, endothelin-1 and procollagen alpha 1(I) mRNA expressions. Enalapril (50 mg/L in drinking water) and verapamil (0.5 mg/kg/day, subcutaneously), alone or in combination, were administered to rats with chronic cyclosporine nephrotoxicity (cyclosporine, 25 mg/kg/day, subcutaneously) (n = 5 each). Five rats treated with olive oil vehicle were used as control. After 4 weeks, biochemical parameters were measured, and renal cortical mRNA levels were evaluated by Northern blot analysis. Cyclosporine reduced renal creatinine clearance significantly and induced renal cortical osteopontin, TGF-beta, endothelin-1 and procollagen alpha 1(I) gene expressions around 13.5 +/- 1.3, 2.4 +/- 0.2, 1.5 +/- 0.1, 1.9 +/- 0.1 folds, respectively. Individual treatment with enalapril or verapamil significantly suppressed the osteopontin and TGF-beta mRNA expression, but not endothelin-1 and procollagen alpha 1(I). Combined treatment also inhibited the osteopontin and TGF-beta mRNA expression but there was no difference between combined and individual treatment. In conclusion, enalapril or verapamil significantly blunted the cyclosporine-induced osteopontin and TGF-beta gene expressions. However, combined treatment did not show any additive effect.

Cervical cancer screening knowledge and practices among Korean-American women

Cervical cancer is one of the most common cancers of American women. The Papanicolaou (Pap) smear test for cervical screening is a widely used and effective means to reduce the morbidity and mortality rate from cervical cancer through early detection. Despite these benefits, many women have never been screened or are not screened at regular intervals. The purpose of this study was to examine cervical cancer screening knowledge and practices of Korean-American women. The sample consisted of 159 Korean-American women, 40 to 69 years of age. The 1987 Cancer Control Supplement questionnaire was translated into Korean and used to collect data. Twenty-six percent of the respondents never heard of the Pap smear test. Only 34% of respondents reported having had a Pap smear test for screening. The most frequently cited reason for not having had a Pap smear test was absence of disease symptoms. Results indicate that education and usual sources of health care were significant factors related to having heard of or having had a Pap smear test. The findings from this study have important implications for health practitioners and policy makers who serve this ethnic population.

Intestinal tuberculosis with abdominal complications: radiologic and pathologic features

BACKGROUND

To investigate radiologic and pathological features of intestinal tuberculosis with abdominal complications.

METHODS

Twenty-two patients with 23 surgically proven complications (nine intestinal obstructions, eight perforations, three fistulae, and three intestinal bleeds) were analyzed. Medical records, radiologic studies, and pathologic examinations were reviewed with special emphasis on searching for the common features in each group of complication.

RESULTS

The most important single feature in seven of the nine patients with intestinal obstruction was the presence of stricture. In the remaining two patients, bowel adhesion was a primary cause of obstruction. In eight patients with intestinal perforation, both obstruction and ulcerations in the dilated proximal loop were the important features in six, and multiple deep ulcerations without obstruction was a primary cause in the remaining two. The common features in three patients with fistulae were focal or multiple strictures, severe adhesions, and fibrotic bowel wall. Intestinal bleeding originated from diffuse mucosal ulcerations. The abdominal complications occurred during antituberculous therapy in 10 of the 22 patients.

CONCLUSION

Understanding the radiologic and pathologic features of intestinal tuberculosis with complications help in making an appropriate clinical decision for the treatment strategy. Close observation is necessary, especially in those patients who are acutely ill during antituberculous medical therapy. Enteritis-Intestines, diseases-Intestines, infection-Intestines, perforation-Intestines, stenosis or obstruction.

Time course of cell cycle-related protein expression in diethylnitrosamine-initiated rat liver

BACKGROUND/AIMS

Cell cycle control and the relationship that exists between cellular proliferation, the expression of cell cycle control proteins and cancer have been reported. This study was designed to decipher the timing of cell cycle control protein expression during the initiation of diethylnitrosamine-induced rat hepatocarcinogenesis.

METHODS

Three-week-old female Sprague-Dawley rats were intraperitoneally injected twice in 1 week with diethylnitrosamine; after the second injection, all animals were sacrificed at 1, 2 and 24 h, and 3 and 7 days. The expression of cell cycle-related proteins such as CDK2 and 4, cyclin proteins (D1, E and cdc2), proliferating cell nuclear antigen, tumor suppressor proteins (p53 and Rb), CDK inhibitory proteins (p21waf1 and p27Kip1), and apoptosis-inhibiting protein (bcl-2) following diethylnitrosamine treatment was examined.

RESULTS

The peak induction time of each cell cycle-related protein during DEN-induced cellular proliferation was diverse, and expressions of CDK2, CDK4, cdc2, p53, bcl-2, p21Waf1 and p27Kip1 appear to be of the greatest interest.

CONCLUSIONS

Data generated from this study may provide information about cell cycle-related protein expression in the initiation stage of hepatocarcinogenic signaling pathways stimulated by a genotoxic agent such as diethylnitrosamine.

Colorectal cancer screening. Knowledge and practices among Korean Americans

PURPOSE

The purpose of this study was to examine knowledge and practices of colorectal cancer screening among Korean Americans.

DESCRIPTION OF STUDY

The sample consisted of 104 Korean American men and 159 women, 40 to 69 years of age, living in the Chicago area. The National Health Interview Survey (NHIS) Cancer Control Supplement Questionnaire, prepared by the National Center for Health Statistics, was used to collect data regarding colorectal cancer screening knowledge and practices. The NHIS questionnaire was translated into Korean with minor modification.

RESULTS

The percentage of male respondents ever having had a digital rectal exam (DRE) and fecal occult blood test (FOBT) were 13.5% and 10.6%, respectively. Only 11.3% of women reported DRE and 8.8% FOBT. Multiple logistic regression analysis results indicate that gender, education, knowledge of the seven cancer warning signals, and length of residence in the United States were significantly related to having heard of DRE. For those having had DRE, knowledge of the seven cancer warning signals, and length of residence in the United States were the only significant variables. Gender and education were significantly related to having heard of FOBT. None of the variables were found to be significantly related to having had FOBT. The findings indicate that a majority of respondents were unaware of these cancer screening examinations and forego these tests due to an underestimation of their importance.

CLINICAL IMPLICATIONS

The findings of this study underscore the importance of cancer education and further research addressing the cancer screening needs of Korean Americans. Currently, Korean Americans do not see healthcare providers or health brochures as valuable sources of health information. Therefore, healthcare professionals need to target this population by 1) coordinating their efforts with church and other community leaders and 2) developing health brochures that are in the Korean language and sensitive to the Korean culture.

Self-perceived health and 5-year mortality risks among the elderly in Shanghai, China

Studies of the elderly worldwide over the last 3 decades have reported that a self-rating of "poor" compared with "excellent/good" health increases the relative risk of dying. The authors tested the strength of this association by performing age-stratified Cox regression analyses on a 5-year longitudinal study of a representative sample of noninstitutionalized elderly aged 65 years and older (n=3,094) in a district of Shanghai, China. More than 20 potential confounders that were only partially controlled in other studies and threats to response validity due to cognitive impairment or diagnosed dementia that were not considered in previous studies were taken into account in this analysis. The results showed that among those aged 65-74 years, "poor" perceived health increases the adjusted relative risk of death by 1.93 (95% confidence interval 1.20-3.11) compared with "excellent/good" health. The adjusted relative risk of a "fair" rating of health is 2.16 (95% confidence interval 1.44-3.25). In the older age group, mortality risks for the ratings of fair as well as poor compared with excellent/good health were not statistically significant. The authors posit that several mechanisms related to host vulnerability markers and greater-than-expected utilization of health services may explain the association between self-assessed health and mortality risks. Future research should strive to develop more precise measures of these and related variables.

Cancer risk among Scandinavian immigrants in the US and Scandinavian residents compared with US whites, 1973-89

Studies of migrants can generate hypotheses on the aetiology of cancer. Such studies are most informative when cancer incidence data are available both in the source and host country. We compared the incidence rate ratio of cancers (stomach, lung, female breast, colorectal and prostate) in Scandinavian immigrants to the US to US-born whites, using data from the SEER registry, 1973-89. Odds ratios (OR) for cancer sites in relation to birthplace were estimated using logistic regression. We also compared rate ratios (RR) for Scandinavian and US residents, using Poisson regression. Compared with US whites, most Scandinavian migrant groups had elevated OR for stomach cancer (1.58 to 3.92), and lower OR for lung cancer (0.38 to 0.88). Similarly, compared with US whites, residents of most Scandinavian countries had elevated RR for stomach cancer (1.47 to 3.33) and lower RR for lung cancer (0.27 to 0.97). Therefore, risk factors for lung and stomach cancers, such as smoking habits and Helicobacter pylori infection, respectively, may have been retained upon migration. Risks for breast, colorectal and prostate cancer among immigrants approached risks in the US (contrasting Scandinavian risks) suggesting assimilation of environmental and/or lifestyle factors.

Effects of apolipoprotein E on dementia and aging in the Shanghai Survey of Dementia

We investigated the status of the apolipoprotein E allele in 538 participants in the incidence phase of the ongoing Shanghai Survey of Dementia, including 103 demented subjects, 72 with mild cognitive impairment and 363 cognitively normal. The apo E epsilon 4 allele was present in 10.2% of control subjects and the allelic frequency did not change between ages 60 to 96 years. The apo E epsilon 4 allelic frequency was increased both in those wiht Alzheimer's disease (AD) (25.4%) and those with vascular dementia (VaD) (22.2%), but not in those with other dementing illnesses or the cognitively impaired. All of the subjects homozygous for apo E epsilon 4 were demented, three were diagnosed as having AD, and three met NINDS/AIREN criteria for VaD. The increased apo E epsilon 4 allelic frequency in clinically diagnosed VaD patients suggests that some of the infarcts are secondary to congophilic angiopathy. The adjusted odds ratio of developing AD in this community-derived study for persons with at least one apo E epsilon 4 allele was 4.1 (95% CI: 2.2, 7.7). Thus, the apo E epsilon 4 risk of developing AD in this Chinese cohort is similar to that in western community studies.

A cross-cultural validation of coping strategies and their associations with caregiving distress

Coping strategies were compared among family caregivers of Alzheimer's disease patients in Shanghai, China (n = 110) and San Diego, California (n = 139). Four coping factors were reliably consistent in both samples, supporting their widespread relevance to life adversity; behavioral confronting, behavioral distancing/social support, cognitive confronting, and cognitive distancing. Shanghai and San Diego caregivers endorsed similar rates of coping, but Shanghai caregivers reported fewer symptoms of depression and anxiety. Although coping strategies were similar, cultural ideals promoting family interdependence, veneration of elderly family members, and acceptance of traditional family roles may have reduced the psychological impacts of caregiving in the Shanghai sample.

Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gallbladder carcinoma

PURPOSE

To evaluate the computed tomographic (CT) features of xanthogranulomatous cholecystitis (XGC) and to distinguish it from gallbladder carcinoma.

MATERIALS AND METHODS

Retrospective analysis was performed in 11 patients with XGC and 17 patients with gallbladder carcinoma in which the wall was thickened. The following CT features were analyzed: maximum wall thickness, intramural hypoattenuated nodules, mucosal line, patterns of wall thickening and enhancement, and the presence of stones. The changes outside the gallbladder were also compared.

RESULTS

The mean thickness of the gallbladder wall was 1.8 cm in patients with XGC and 2.1 cm in patients with gallbladder carcinoma. Intramural hypoattenuated nodules were seen in all patients with XGC but in only seven patients with gallbladder carcinoma (P = .008). The mucosal line was observed in nine patients with XGC and in six with gallbladder carcinoma (P = .02). The gallbladder wall was more diffusely thickened in patients with XGC (10 of 11 patients) than in patients with gallbladder carcinoma (seven of 17 patients) (P = .01). The occurrence of changes outside the gallbladder did not differ statistically significantly.

CONCLUSION

Because of a statistically significant overlap of CT features, only when intramural hypoattenuated nodules occupy a large area of the thickened gallbladder wall can the diagnosis of XGC be highly suggestive. The diagnosis of XGC at CT may indicate a less aggressive surgical approach.

HIV infection and AIDS in China, 1985 through 1994

OBJECTIVES

This paper analyzes data on the distribution of and risk factors for the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in China.

METHODS

Ten years of data on persons tested for HIV infection and AIDS and the proportion who tested positive were analyzed against the background of China's population count. The Chinese- and English-language literature on HIV and AIDS from 1985 through 1995 was also reviewed.

RESULTS

Overall, more males than females had HIV infection. Intravenous drug use was the primary source of transmission, followed by heterosexual contacts. Only a small number of the persons tested were homosexual, but their proportion of HIV seropositivity ranked third to that of drug users; that of general hospital patients ranked fourth.

CONCLUSIONS

HIV infection and AIDS in China began as a highly regionalized and largely rural problem in Yunnan Province. However, HIV infection and AIDS have become an emerging urban problem. HIV seropositivity is low among several groups thought to have an elevated risk.

Tuberculosis in San Diego county: a border community perspective

OBJECTIVES

To describe the epidemiology of active disease caused by Mycobacterium tuberculosis in San Diego County from 1989 to 1993 and to identify the specific subgroups for whom the impact of the disease was most pronounced.

METHOD

The authors reviewed all 1860 reports of verified tuberculosis (TB) cases included in the surveillance database maintained by the San Diego County Health Department's TB Control Program. Data were analyzed by age, gender, ethnicity, nativity, HIV co-infection, major site of infection, and drug resistance.

RESULTS

Between 1989 and 1993. San Diego County witnessed a greater increase (77.7%) in the number of incident TB cases than the state of California as a whole (22.8%) or the United States (9.9%). The local resurgence of TB was reflected in increasing case counts among specific subpopulations--immigrants from countries with high endemic rates of TB (62.5% of the new cases), U.S.-born members of minority groups, the elderly, and young adult males.

CONCLUSIONS

Tuberculosis cases in San Diego County have increased each year since 1989, with certain population subgroups exhibiting more dramatic increases in case rates than those reported nationally. San Diego County is one of the principal entry points for the western United States and a popular travel destination. These factors have led to a dramatic increase in the incidence of TB in the county. A range of tailored surveillance, treatment, and control strategies--some of which have already been implemented--will be needed to control the spread of the disease.

ADL dependence and medical conditions in Chinese older persons: a population-based survey in Shanghai, China

OBJECTIVE

To describe the prevalence of activities of daily living (ADL) dependence and medical conditions and the relationship between illnesses and ADL performance in the older population of Shanghai, China.

DESIGN

Probability sample survey of community residents.

SETTING

The Jing An district of Shanghai, China. The interviews were carried out at the homes of the older persons.

PARTICIPANTS

There were 3763 noninstitutionalized elders screened, 3745 of whom completed the interview.

MEASUREMENTS

The dependent variables were the five basic ADL items: eating, dressing, transferring, toileting, and bathing. The independent variables were dementia and 19 self-reported medical conditions, along with age, gender and education level.

MAIN RESULTS

Of those in Shanghai aged 65 and older, 8.28% (6.52% of males, 9.17% of females) were functionally dependent in one or more ADLs. The most prevalent self-reported illness was cardiovascular disease, including hypertension (29.12%) and heart disease (26.65%). ADL performance was associated with dementia and a number of medical conditions in univariate analysis. The best predictors of functional dependence in both age groups (65-74 years; 75 years and older), based on the multiple logistic regression analysis and after controlling for age, gender, and education, were stroke, dementia, Parkinson's disease, diabetes, and emphysema.

CONCLUSIONS

The authors have successfully applied five ADL items selected and culturally adapted from Older Americans Resources and Services to the study of older Chinese. A consistent and reliable estimate of functional dependence among older persons is obtained. The prevalence of dementia and many self-reported illness, as well as the ADL status by medical condition, are reported. The findings reveal certain patterns of relationship between illness conditions and ADL performance.

The malignancy of dementia. Predictors of mortality in clinically diagnosed dementia in a population survey of Shanghai, China

OBJECTIVE

To evaluate the effect of dementing illnesses on the risk of dying, taking into account other conditions that would shorten survival.

DESIGN

Five-year follow-up of community survey of dementia.

SETTING

Five-year data were obtained for the 3531 subjects, aged 65 years and older, who participated in the 1987 population survey of dementia in Shanghai, China.

MAIN OUTCOME MEASURE

Time to death. Relative risks of dying were calculated for demographic variables, dementia diagnoses based on findings of clinical evaluations, and 15 reported prevalent medical conditions using the proportional hazards model.

RESULTS

In those subjects aged 65 to 74 years, the mortality risk ratio was 5.4 (95% confidence interval, 2.0 to 14.6) for Alzheimer's disease and 7.2 (95% confidence interval, 3.6 to 14.4) for vascular dementia. The risk ratio for Alzheimer's disease was similar to the mortality risk ratio for cancer (5.6 [range, 2.9 to 10.9]). In this age group, dementing illnesses were uncommon, and few deaths were therefore attributable to the dementing illnesses. In those subjects aged 75 years and older, the mortality risk ratios were 2.8 (95% confidence interval, 2.1 to 3.6) for Alzheimer's disease, 3.5 (95% confidence interval, 2.4 to 5.1) for vascular dementia, and 3.6 (95% confidence interval, 2.0 to 6.7) for "other dementias." Because these dementing disorders were common in those subjects aged 75 years and older, 23.7% of the risk of death could be attributed to these disorders.

CONCLUSIONS

Both Alzheimer's disease and vascular dementias are truly malignant and constitute major risk factors for death in persons older than 75 years.

Nutritional status of Chinese-, Korean-, and Japanese-American elderly

OBJECTIVE

To examine the nutritional status of three major subgroups of Asian-American elderly.

SUBJECTS

The sample consisted of 169 Chinese, 90 Korean, and 50 Japanese elderly who lived in five apartment buildings for senior citizens in Chicago, Ill.

MAIN OUTCOME MEASURES

Twenty-four-hour dietary recalls were used to evaluate dietary intake. Anthropometric measures of height, weight, and triceps skinfold thickness were also obtained.

RESULTS

Many Asian-American elderly consume an inadequate amount of dietary calcium. A large percentage of Korean elderly also consume inadequate amounts of protein and vitamins A and C. Underweight was more common than obesity among these ethnic elderly groups.

APPLICATIONS

The information in this article provides valuable data to the Asian-American community for program planning as well as to health providers who work with individual Asian-American elderly to meet their nutrition needs.

Early allograft function in canine single lung transplant

An assessment of early graft function in canine single lung transplant recipients was made by analysing early postoperative radiographic progression, lung perfusion, bronchial patency and bronchial anastomotic wound healing and histopathology of the allografted lung. Eighteen mongrel dogs weighing 15kg on average were used. Donor lung bloc with a generous atrial cuff, the pulmonary artery and left bronchus were taken and flushed with Euro-Collins solution which implanted in the pneumonectomized recipient dog. Anastomosis was done with the atrium, pulmonary artery and bronchus in that order. To assess an early graft function, a protocol for a grading system was designed into the chest roentgenogram, lung perfusion scan, bronchial patency and histopathologic progression of the bronchial anastomosis and allografted lung (Table 1). The results were obtained as follows: Radiographically, clear to infiltrate was seen in 67% (8/12), 33% (5/15), 30% (3/10) and 33% (2/6) on postoperative day 0, 1, 2 and 3 respectively. Lobar to total opacification was 33% (4/12), 67% (10/15), 70% (7/10) and 67% (4/6) on days 0 to 3 (Table 2). Perfusion scan showed normal to mild defect in 43% (3/7) and moderate to severe defect in 57% (4/7) on day 0 and 100% (5/5) on day 2 (Table 3). The bronchial anastomotic site showed patent to mild stenosis in 100% (8/8) on day 0 and mild stenosis in 2/2 on day 9 bronchofiberscopically, and showed normal wound healing in 38% (3/8), cellular infiltration in 38% (3/8) and infarction in 25% (2/8) up to day 9 postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Functional status, education, and the diagnosis of dementia in the Shanghai survey

We examined the relationship of culturally adapted Chinese versions of the Mini-Mental State Examination (CMMS) and several functional measures to the effect of education on the clinical diagnosis of dementia in 554 subjects (55 to 95 years; median, 74) who had undergone intensive evaluation during the Shanghai survey of dementia. Low education was associated with increased prevalence of clinically diagnosed dementia. The standardized history and one functional scale (Pfeffer Outpatient Disability Scale [POD]) clustered closely with clinical diagnosis on factor analysis, whereas the CMMS, Instrumental Activities of Daily Living scale (IADL), and Activities of Daily Living scale (ADL) loaded additionally onto an education-weighted component. A logistic equation based on the CMMS, history, POD, and IADL was the best predictor of the clinical diagnosis of dementia, but history, POD, and IADL without a mental status score also predicted the diagnosis with a sensitivity of 88.6%, a specificity of 89.3%, a positive predictive value of 66.0%, and a negative predictive value of 97.1%. When dementia was diagnosed using an algorithm based on the three functional scales alone, low education continued to be associated with increased age-specific risk of dementia.

US National Health Data on Asian Americans and Pacific Islanders: a research agenda for the 1990s

OBJECTIVES

In spite of over 30 years of periodic nationwide surveys, we have thus far only the most rudimentary estimates of the determinants of the health of Asian Americans and Pacific Islanders. This paper explores ways to improve the capability of the National Center for Health Statistics (NCHS) to collect national health data on these populations.

METHODS

The NCHS "race" coding practices are reviewed, their limitations stated, ways to improve the numerator and denominator data discussed, and a research agenda presented.

RESULTS

Resources can be intensified to produce better denominator data, and to improve the collection of detailed ethnicity information for the numerators, in at least the three states (California, New York, and Hawaii) where the majority of Asian/Pacific Islanders lived in 1990. Subsequently, these efforts should be extended to the 10 states where 79% of these individuals reside or to the top 15 metropolitan areas where they are concentrated.

CONCLUSIONS

If the recommendations are implemented, several coordinated multisite, multiwave epidemiologic surveys can be conducted using standardized interview instruments and data collection procedures that will capitalize on the geographic distribution of Asian/Pacific Islanders.

Hepatic arterial color Doppler signals in Caroli's disease

Three siblings with congenital dilatation of the intrahepatic bile ducts (Caroli's disease) are presented. Bile duct pathology was associated with congenital hepatic fibrosis and polycystic renal disease in all three patients. On color Doppler imaging (CD imaging), multiple small color Doppler signals were observed in the vascular radicles within the dilated bile ducts or in the center of the lumen apart from the vascular radicles, as well as in other well-known sonographic findings such as bile duct dilatations and bilary calculi. Doppler frequency spectral analysis confirmed all these color signals as arterial in origin in all patients, revealing pulsatile wave patterns. In spite of the fact that portal venous radicles have been well described on conventional sonograms or computed tomography (CT), continuous wave patterns of venous flow on spectral analysis were not detected in all patients. Identification of such less emphasized arterial flow may add another clue in the diagnosis and pathogenesis of this rare disease entity. In conclusion, color Doppler signals of arterial wave pattern within the dilated bile ducts are another helpful diagnostic criteria in previously reported sonographic findings, and these color signals are easily depicted on sonograms with color mapping.

Cytogenetic analysis of meningiomas

Cytogenetic analysis of 4 cases of meningiomas from 3 male and 1 female patients is reported. One of male patients suffered from neurofibromatosis type 2. Histologically, the meningiomas were meningotheliomatous (1), transitional (2), and psammomatous (1). Chromosomal abnormalities were found in all cases with a karyotype 45,XY,-22, 45,XY,-16, 45,XX,-2, and 45,XY,t (15p;22q), respectively. Monosomy of chromosome 22 was detected only in the patient with neurofibromatosis type 2. These cytogenetic analysis demonstrates that variable clonal karyotype aberrations exist in meningiomas.

CT features of histiocytic medullary reticulosis

Five cases of histiocytic medullary reticulosis (HMR) are presented and the computed tomographic (CT) findings described. All patients were young adults in their early twenties with fever, malaise and weight loss as their chief complaints. Survival was less than 5 months in all cases. The CT findings were hepatosplenomegaly (5), abdominal lymphadenopathy (5) and bilateral renal enlargement (2). Patchy low attenuation areas in the liver (2), wedge shaped splenic infarcts (2) and focal low attenuation areas in the kidneys (1) were also noted. Ascites (3) and pleural effusion (3) were associated findings.

Cross-cultural studies of dementia: use of a Chinese version of the Blessed-Roth Information-Memory-Concentration test in a Shanghai dementia survey

A culturally adapted Chinese version of the Blessed-Roth Information-Memory-Concentration test (CIMC) was used in a dementia screening survey of a probability sample of 5,055 elderly Shanghai residents. The individual items on the CIMC that best predicted the overall score were similar to the best predictor of an American version of the IMC. Performance on the CIMC was markedly affected by the level of education or lack thereof. In a subsample for whom clinical diagnoses were obtained, it was possible to establish cutoff values on the CIMC by stratifying the sample according to education.

Single-stage cluster sampling with a telescopic respondent rule: a variation motivated by a survey of dementia in elderly residents of Shanghai

In this report, we consider the situation in which one wishes to identify a cohort of a specified number of individuals within each of several domains for future follow-up studies based on a single-stage cluster sampling design. We develop sample size formulae relevant to this situation and introduce a variation of single-stage cluster sampling that seems more suitable in this situation than is ordinary single-stage cluster sampling. The basis for this variation is the concept that the definition of eligible respondents is not the same for all clusters. The use of this modified respondent rule (which we call telescopic) enables one to meet specified sample sizes in all domains of interest without the need to sample extra individuals in some domains. We used a version of this sampling design successfully in the field with a survey of elderly persons conducted in Shanghai, People's Republic of China.

Cognitive impairment among elderly adults in Shanghai, China

This study reports the methods and initial findings of the first longitudinal study of Alzheimer's disease and dementia in China. A probability sample of 5,055 noninstitutionalized elderly persons in Shanghai was tested directly during the first phase of the study using a Chinese version of the Mini-Mental State Examination (MMSE). Details of sampling design and data collection procedures are described. Overall, some 4.1 percent of adults 55 years or older may be classified as having severe cognitive impairment, and 14.4 percent are mild cases. The rates for females are higher than for males by a ratio of 3.75 in the severe category, and 2.6 in the mild group. Within each age group, cognitive impairment rates vary by education. Multiple logistic regression was used to examine, within each age group, the nature of the association between the presence of a cognitive impairment and educational level controlling for sex. The results showed that educational attainment has a highly significant inverse relationship with prevalence of cognitive impairments (severe vs others). On the other hand, when educational attainment was controlled for in the logistic regression model, sex was significantly associated with prevalence of cognitive disorders for the age groups 65-74 and 75 years or older, but not for the group 55-64 years. These findings suggest the impact that basic educational deficits have on human cognitive functioning as measured through tests like the MMSE. Cross-tabulations of impairment rates according to marital status, economic status, and health-related problems are also presented.

Intraductal variant of peripheral cholangiocarcinoma of the liver with Clonorchis sinensis infection

Peripheral cholangiocarcinoma arises from the small bile ducts and presents with an infiltrative growth, but intraductal growth in the peripheral large duct tributaries is an extremely unusual manifestation, especially in cases with Clonorchis sinensis infection. A case of surgically resected intraductal variant of peripheral cholangiocarcinoma of the liver in a 46-year-old Korean man who had eaten raw fresh-water fish is described. The tumors were entirely confined within the dilated peripheral tributaries of the left intrahepatic bile duct, and no tumorous extension beyond the bile duct walls into the hepatic parenchyma or to the hilum was found. Microscopically, the tumor was a well-differentiated papillary adenocarcinoma of large duct origin, and the major branches were plugged with multiple tumor casts. A histologic feature of a C. sinensis infection with fully developed adenomatous hyperplasia was associated in the peripheral septal ducts, and the nonneoplastic large duct showed focal epithelial dysplasia. The authors assume that intraductal cholangiocarcinoma is a distinct macroscopic subtype, and that a C. sinensis infection may also be responsible for its development.

Cross-cultural studies of dementia: Use of a Chinese version of the Blessed-Roth Information-Memory-Concentration test in a Shanghai dementia survey

A culturally adapted Chinese version of the Blessed-Roth Information-Memory-Concentration test (CIMC) was used in a dementia screening survey of a probability sample of 5,055 elderly Shanghai residents. The individual items on the CIMC that best predicted the overall score were similar to the best predictor of an American version of the IMC. Performance on the CIMC was markedly affected by the level of education or lack thereof. In a subsample for whom clinical diagnoses were obtained, it was possible to establish cutoff values on the CIMC by stratifying the sample according to education.

Urban-rural migration: uncertainty and the effect of a change in the minimum wage

"This paper extends the neoclassical, Harris-Todaro model of urban-rural migration to the case of production uncertainty in the agricultural sector. A unique feature of the Harris-Todaro model is an exogenously determined minimum wage in the urban sector that exceeds the rural wage. Migration occurs until the rural wage equals the expected urban wage ('expected' due to employment uncertainty). The effects of a change in the minimum wage upon regional outputs, resource allocation, factor rewards, expected profits, and expected national income are explored, and the influence of production uncertainty upon the obtained results are delineated." The geographical focus is on developing countries.

Exogastric cystic gastric leiomyoblastoma with unusual CT appearance

Gastric leiomyoblastomas are rare tumors between leiomyomas and leiomyosarcomas in terms of their malignant potential. This article describes 2 cases of exogastric cystic gastric leiomyoblastoma with unusual location and computed tomographic (CT) appearance. The CT findings of these cases were unlike those of usual smooth muscle tumors, but closely simulated cystadenomatous tumor of the ovary or pancreas.

Peripheral cholangiocarcinoma and clonorchiasis: CT findings

Sixteen patients with peripheral cholangiocarcinoma of the liver were examined with computed tomography (CT). None of the 16 patients presented with jaundice or had documented cirrhosis. On scans obtained both before and after the injection of contrast material, the tumors were depicted as low-attenuation masses in all cases, with wide variations in homogeneity. The tumor margin was irregular in 12 cases, and there was minimal contrast enhancement of the tumor in 14 cases. In 11 (69%) patients, CT demonstrated masses of markedly low attenuation, which corresponded to areas of diffuse microcystic change seen at histologic examination of resected specimens. In ten (63%) patients, the results of stool or intradermal tests for Clonorchis sinensis were positive. In all ten cases of clonorchiasis, mild, diffuse dilatation of the intrahepatic bile ducts was seen in addition to the low-attenuation masses, but there was no dilatation of the extrahepatic biliary tree. In five of the ten patients with clonorchiasis, stippled or aggregated, powderlike areas of high attenuation were seen on precontrast CT scans; at pathologic examination, those areas were found to be mucin. Extrahepatic metastases were demonstrated in ten (63%) patients. Peripheral cholangiocarcinoma should be the primary diagnostic consideration when these characteristic CT findings are detected in a noncirrhotic patient.

Retained surgical sponge: diagnosis with CT and sonography

The diagnosis of a retained surgical sponge was made by CT and sonography in four patients. The plain abdominal radiograph was normal in all cases. In each of four cases of gauze granuloma, CT showed a well-defined round mass with a thick wall; internal heterogeneous densities with a wavy, striped, and/or spotted appearance; mottled calcifications; and gas bubbles. Sonography disclosed a well-defined hypoechoic mass containing highly echogenic foci with a strong posterior shadow. In these cases, CT and sonographic findings, together with a history of surgery, permitted the correct preoperative diagnosis of a retained foreign body.

Dedifferentiated liposarcoma of the liver

Among the rare occurrences of primary malignant mesenchymal tumors of the liver, the development of liposarcoma has been only theoretically listed--there is no proven example in the literature. This article documents a case of primary liposarcoma of the liver in a 30-year-old woman who presented with a huge intrahepatic tumor in the left lobe measuring 14 X 10 X 6 cm. It was composed of two distinct macroscopic and histologic features--the well-differentiated liposarcoma and the cellular, nonlipogenic pleomorphic sarcoma. The former was a mature, lipomatous tumor with various stages of lipoblasts. The latter was much more cellular, made up of pleomorphic cells admixed with a few areas of spindle cells with many mitotic figures, resembling a pleomorphic variant of malignant fibrous histiocytoma. Oil red O stain revealed multifocal, but a scanty amount, of fat-storing tumor cells in both compartments aside from large fat globules in the differentiated area. This is the first reported case of primary liposarcoma of the liver.

Dedifferentiated liposarcoma of the liver

Among the rare occurrences of primary malignant mesenchymal tumors of the liver, the development of liposarcoma has been only theoretically listed--there is no proven example in the literature. This article documents a case of primary liposarcoma of the liver in a 30-year-old woman who presented with a huge intrahepatic tumor in the left lobe measuring 14 X 10 X 6 cm. It was composed of two distinct macroscopic and histologic features--the well-differentiated liposarcoma and the cellular, nonlipogenic pleomorphic sarcoma. The former was a mature, lipomatous tumor with various stages of lipoblasts. The latter was much more cellular, made up of pleomorphic cells admixed with a few areas of spindle cells with many mitotic figures, resembling a pleomorphic variant of malignant fibrous histiocytoma. Oil red O stain revealed multifocal, but a scanty amount, of fat-storing tumor cells in both compartments aside from large fat globules in the differentiated area. This is the first reported case of primary liposarcoma of the liver.

Health of the Chinese elderly in America

This article examines the mortality and morbidity patterns of Chinese elderly in America by using two established data sources: (1) the most recent vital statistics maintained by the National Center for Health Statistics, and (2) the cancer registry program called SEER (Surveillance, Epidemiology, and End Results) maintained by the National Cancer Institute at the National Institute of Health. The results suggest that Chinese Americans are relatively healthier than white Americans, the average age-adjusted death rate being lower for Chinese than for white Americans. Likewise, the age-specific death rates for all causes of death are lower for Chinese than for the majority white population. Details of statistics on rates of suicide, heart disease, neoplasms, and various forms of cancer are presented.

Visits to physicians by Asian/Pacific Americans

The purpose of this paper is to disseminate some of the findings from the 1979 National Ambulatory Medical Care Survey (NAMCS) where, for the first time in its history, data are available on the characteristics of visits to office-based physicians by Asian/Pacific Americans. The NAMCS Program is the only source for such data which is based on a national probability sample survey of physician-patient encounters. Among the findings are: 1) no significant difference was observed between Asian/Pacific Islanders and the white majority with regard to the patient's sex, return-visit ratio, or the kinds of diagnostic and therapeutic services rendered by the sampled physicians. 2) Children appear to be the major utilizers of ambulatory medical care among Asian/Pacific Americans. 3) In every age group, the visit rate to office-based physicians is lower for Asian/Pacific Americans when compared with white Americans. 4) A significantly smaller percentage of Asians or Pacific Islanders, in contrast to other specified race/ethnic groups, had visited a physician for injury or poisoning, and a substantial proportion of their visits were apparently made for preventive care. 5) Significantly fewer visits were made by Asian/Pacific Americans to the office of a surgeon or a psychiatrist. The demographic antecedents and cultural underpinnings of these findings are discussed.