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FIFTH CONFERENCE ffi HEALTH PROBLEMS
RELATED TO THE CHINESE
IN NORTH AMERICA
1 990
sponsored by THE CHINESE CANADTAN MEDTCAL SOCTETy (ONTARTO) and THE FACULTY OF MEDICINE, UNIVERSITY OF TORONTO
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vcHltnv H.ruoN Nt lrs3iltltc :il{t ol q3$n3u sffiraoud HrTv:Il{ uo ocuo.raluoc t{illJ aql THE CONFERENCE ON HEALTH PROBLEMS RELATED TO THE CHINESE IN NORTH AMERICA
National Steering Committee Organizations Harry Lee, M.D., Chairman
American Center for Chinese Medical Sciences, Washington, D.C. Association of Chinese Community Physicians, San Francisco, California canadian chinese Medical society of British Golumbia, Vancouver, B.c. Chinese American Medical Society, New York, New york Ghinese American Physicians Society, East Bay, California Chinese Ganadian Medical Society, Ontario Chinese Hospital Medical Staff, San Francisco, California Chinese Medical Society, Quebec chinese Physicians for Ghinatown, (Los Angeles), Alhambra, california Chinese Physicians Society of Southern California, Monterey Park, California
1 990 Conference Committee John H.C. Chiu, M.D., Chairman Peter Lee, M.D., Scientific Programme Chairman Yvonne Y. Chiu, M.Sc. Conference Coordinator Paul S.K. Chan, M.D. Peter P. Chang, M.D. Ming C. Chiu, M.D. Stephen Chow, M.D. Angela Huang, M.D. Robert Jin, M.D. Michael W.H. Kwan, M.D. Tak S. Lau, M.D. K.S. Kenneth Lee, M.D. Lap Cheung Lee, M.D. Pat Lee, S.R.N. Fay F.V. Liu, M.D. Randall Low, M.D. Ken H. Ng, M.D. Ying S. Seid, M.D. Gloria M. Siu, D.D.S. Cecilia Tam, B.A. Paul Y. Tam, M.D. Henry Wong, M.D. Wilda Chang Wong, B.Sc.
Special Acknowledgements to Nordic Laboratories Inc. for their generous support in printing the 1990 Proceedings. oal Jelod nlqc'c'H urlol oauluruo3 euurerOord clllluolcs
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srN3nfoqrrrnoN)cv THE CHTNESE CANADTAN MEDTCAL SOCTETY (ONT.)
The Medical Section was the first section formed when the Federation of Chinese Canadian Professionals (F.C.C.P.) was established in 1975. ln 1984 the Medical Section was formally incorporated under the name of the Chinese Canadian Medical Society (Ontario). The aims of the society are to bring together Chinese Canadian physicians of diverse backgrounds for professional, educational and social activities. The C.C.M.S. has flourished has flourished and it now members over 500 active members. lt has always been the most active section of the F.C.C.P. ln fact, half of the Presidents of the Board of Directors of the F.C.C.P. come from the Society. Since 1981 the C.C.M.S. has been organizing 1-day seminars in Toronto on diseases of the Chinese. lt was also one of the founding members of the Steering Committee of the National Conference of Health Problems Related to the Chinese in North America, and has actively participated at all past Conferences. Other activities of the Society include regular education dinners (sponsored by pharmaceutical companies), joint symposiums with the Biomedical Professionals and participation in the annual F.C.C.P. Conference. The members are regularly invited on radio and television programs to educate the Chinese community on health problems. They have also sponsored free clinics for refugees, and have supported Chinese outreach programs in hospitals and other agencies (like the Cancer Society, Red Cross Society etc). Two extensive tours to China had been organized for the members and they established ties to distinguished Chinese Medical universities and hospitals. Since 1988, and with the generous support of Nordic Laboratories lnc., the C.C.M.S.(Ont.) has organized annual Chinese Canadian Health Forums, which provided opportunities for the various Chinese Canadian Medical groups across Canada to come together, to discuss common problems and issues, and to create a nation-wide organization. There is a very active student membership. The medical students sit on the committee and help in organizing orientation meetings, guidance talks, and they fund- raise on their own for the Toronto hospitals. 96"""""" ...^ilnceJ acuoraluoC
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8""""""" spre^ V luoua^olrlcv bulpuelsno 2...... uer6o.rd 9""""""" se4pa[qg pue steog ocuoroluoC slN:rrNoc lo f-tsvr CONFERENCE GOALS AND OBJECTIVES
This is a Biennial Conference started in 1982 by the Chinese Hospital in San Francisco, which brought together the various Chinese American and Canadian Medical Societies, as well as other North American and international physicians interested in the Health Problems of the Chinese in North America.
The OBJECTIVES of the Conference are:
1. To Congregate physicians and scholars to discuss common and related health problems in the Chinese in North America.
2. To establish a database of incidences of disease patterns in the Chinese in North America.
3. To establish comparative data on North American Chinese health problems related to cultural assimilation.
4. To encourage clinical and/or basic research in health problems affecting the Chinese in North America.
5. To publish a proceeding of the meeting as a means of continuing medical resource material.
Previous Gonferences
May 22-23, 1982 - San Francisco, California. August 18-19, 1984 - Los Angeles, California. August 23-24,1986 - New York, New York. April22-23, 1988 - San Francisco, California.
Present Gonlerence
June 23-24, 1990 - Toronto, Ontario, Canada.
Next Conference
To be announced.
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Outstanding Achievement Awards are presented to people for their extraordinary contribution to the conferences on Health Problems Related to the Ghinese in North America.
Previous recipients in 1988 were:
Huo Chen, M.D., Los Angeles Lillian Chen, M.D., New York David T.W. Chiu, M.D., New York Edward A. Ghow, M.D., San Francisco Stuart Quan, M.D., New York Collin P. Quock, M.D., San Francisco Hsueh-hwa Wang, M.D., New York
The 1990 Outstanding Achievement Award will be presented to:
Harry Lee, M.D., San Francisco.
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HEALTII PROBLEIVTS Rg.AlED TO THB CHINESB IN NORTII AI\{ERICA 50 MrcxrABL DRI1a' WtrI.OC|DNJ, (r(RONTO) oNT RIO.CINADI"IrOIt2 5 1l&r (alQ a9{-3217 FAX: ('lt6) 2507395 ffi Coolbrcacc Chdrmel Joho lLC. Ctiu, It[.D. Sdcntlllc ho3renrc C-hrlrun PGtGr LcG, lrfD.
Confcrcncc Coudttc June 2?-?4r 1990 Parl S.K. Ctrn, ItLD. Fc.crP. Chry, MD. lfing C. Chiq IrLD. Yvonr Y. Ctiu, M.Sa Dear Colleagues and Friends: Strphco Ctow. Ir[.D. Aqgcb ltulng, M.D. Welcome RobccJio M.D. to the vibrant city o{ Toronto. The organizing committee is working herd Itfichrl W.H. Kwaq lr'f,D. to make sure that youn TrLS.LrrMD. stey will be an exciting anA en.loyable one. KS. Kcnncth lac, lLD. L^eCbungLoCM.D. This is the first time the Con{erence is being held in Canadar since inception Pdlrc,S-R"N. its in 19S2. It is panticularly heartwanming for mE to welcome panticipants coming Fry F.V. Liu, Ir[.D. all parts +nom Ro&lllaw, Irf,.D. o{ North Americar {nom New{oundland and New Yonk to British Coiumbia Kcn Ng, IrLD. and California; Il as well as.+Fom other parts of the world such as Hong Rongp Chinal Ying S. Sd4It[.D. Australia and New Zealand. clod!ld. Siu D.D.S. C.ccilia Trm, B.A. We pnomise PulY. Tan. MD. that you will {ind the Conference a vepy interesting and rewapding Ilcory Wong, lvLD. expePience. It will continue to {oster better undenstanding o+ the health problemi unique peculiar Netloort Stccrlry or to the Chinese settling in various comminitieE in North America. Codttcc Oryrnlzrtloor From the enthusiagtic response in abstract submissionsr it seems to indicate that IIEry t cc, MD. Chdrno we have indeed chosen a few timely topicss namely, GeriatricEr l,{ental Health and Aurlcu Ccotcr lor Chlnc* Community Health Promotion Strategies. Medlcel Sdcncca, Warhington lale also have a very eager hospitality csmmittee waiting to Eerve you. Do call on Arcoclrtloo dChlncc them you your Cournnlty PtyrlchnC if or family need any in{onmation or help inat would mal{E youn stay San Francicoo in Toronto a moFe pleasant one. Crnrdhn Chlne* Medlcd $oclctydBrlfi Cdudlq Thanlr you fon Vancowcr all comingr and I look forward to renewing old acquaintances and Chlnccc Amrlceu meetinq new {riends Mcdlcd Soclcty, llcw Yod C-blwAmrlcrn PtyCclrnr Soclctn Sincerelyr Brrt Bay Ctloc* Crnrdhn Mdlcd Soclety, (Onsio) /fo-f- ft,c d;- Chlnerc Eospltd t6nn g.c. chiu, M.D. Mcdlcrl Stdl, Confenence Chainman San Prrnciro 6hcrc Mcdlcel Soclctn (Qncbcc) Chlnerc PhyCclrrr fc ChbdoryD (Lor Angclcr), Alhamb'rr Chlncec Phyrldrnr Sodcty d Southcrn Crllfcnh, Itilontcrcy Pd Spooron Cbloccc Cenedlro Mcdlcd Sockfy (Ontrio) Frculty of Medlclnc, UolvdrdtydTaoilo
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June 23, 1990 8:45 A.M' REGENCY EAST & CENTRE
MOLECUI-AR GENETICS CONTROL OF A GENETIC DISEASE THROUGH
and Diagnostics' Yuet wal Kan, M.D., F.R.S., Ghief, MOlecular Medlcine of California, san Louls K. Dtamono irotessor of Hematology, University Franclsco
by Stuart H'Q' Quan' M'D' Sponsored by The Ghinese Hospital Medical Statf, funded
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'q6noroqreted ''O'rld ''V'y1; ''V'g 'oS r{dosot srcfdsoud oNV snrvls 'AuorstH JO /n3ln]u V :AUTVIHCASd Nt (yUC$ 3NtCtO]l,\t 3SSN|HC'|VNO|I|OVUI
'qceeg 6uo'l '(C)'d'C'U'l ''o'r.,ld ''S'g ''g'yrl '6ue1 'p1'g tN3llvd 3s3 Nt t{c 3Hr oN rrvSul - Aco]odou HlNvocvylruvlld
'oluoJol'(C)'a'C'U'3''qclb6'O''yl'd'C''S'g''g'1lI'6ueqg Jeled :UIVHC
qceodde qpepe uv :3s3NtHg 3HI Nt INShIVSUr cturvtHc^Sd lctdot
IS\rJ ACN ltv9t 0661 'ez eunr v:t3Nvd PHARMAcoANTHRopoLoGY.TFEATlNGT}|EcH|NEsEPAT|ENTs
S.W.Tang,M,B.,B.s.,Ph.D.,F.R.c.P.(c)'LcingBeach
Therapeutlcally, we are all quhe the same but we are also qufte different from each other. In medical school, we learned to treat the diseases. Practlslng as a physiclan, we learned to treat the lndlvldual. Our body machineries or'hardware" are manufactured to specificatlons which are pre- determlned. Although such specificatlons are largely slmllar between indivkluals, making it possible for physiclans to learn how to treat a disease, interindlvldual differences in such specifications sometimes . can be substantial. Metabollsm polymorphlsm ls a sclence that has great relevance to modern psychopharmacology. Metabollsm polymorphism could result In quantitatMe and qualitatMe differences' in drugs glven to dlfferent Indivlduals. Genetlcally determlned varlations In our body machlnerles also predetermlnes our rosponses to pharmacologlcal agents. Recent advances suggest that the Chinese patlents dlffer from thelr Caucaslan counterpafis, sometlmes substantlally ln drug metabollsm as well as in their responses. Most drugs nowadays are developed by Western companles whlle studies In pharmacoanthropology seem to be lagglng behind. Practltloners treatlng the Chlnese subJects may help to contrlbute to such knowledge by observlng and repoillng'unexpected responses'.
14 9t
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Acuapuat aseurqC aLll qllM 0urdaa>1 u! sr slql 'pluaqlsernou Ou;aq auo apelou lsou aL{l 'BulqC u; palsslacl olpq lsam aql ur esn u1 rabuo; ou sapo6alec crlsou0elp ulpuac 'raAa/'AoH 'plppupls aql ssal Jo aJoul auocoq spq lll-y\S6 s,uollelcossv cplegqcls; upcpaurv aql lo asn aq1 'sreeA luaceJ ul 'popplap ssa,[ sp lp/n se sauobalec c;1sou0egp ulalsal urorl luora1;lp Al1e1gue1sqns arall tsed aqt u! asn ul sailo6alec cllsouberp oqf 'stsolnau pup 'slsoqcAsd a4ssardep-c1uelu 'elua.rqdozlqos uraqlOuoure 's.tapJoqp cplelqc^sd uoumoc lsou aql leajl ol pasn s! y!M-y\CL leql po/v\or.ls oJnlpjall aql lo /v\a!Aal V 'luatuleall ot qceotdde y,{M-l lCI eq1 ;o Acecrga oLll olpJlsuotuap ol lduage up u! salpnls p.rluoc-aspc pud sleg:1 lpclullc sP t{oris spoqlau qo:posor cryluatcsolq ulalsa^A p asn eq1 unDeq eneq (q pue uollsnqlxoru pue 'a:nlcundnce 'sleqraq se qcns spoqlau f{CL ql!,r uoglcun[uoc u! posn ere sbnrp uJalsa^ qctq/'A u! autotpsur ualsa/'A pup ourctpaur asaulqC lpuo!ilperl paterbetul up 'y{M-hlCI pallec qcpordde uB pedopnap anal (e srauollgcerd ylCI aql 'lc!Uuoc slql to Inlpull l 'Ou1uor1sanb pallplap pus 'Dulllaus '6u14e1-aslnd '6uuloot 1o saldlcurrd lnol aql uo paspq 'pebueqcun i{1a0:e1 paureural aneq sesouDelp kl1ol- 'sluauracue^pe ;ecgDopuqcel lee.rD euoblapun aneq sasouOplp uraFo/n allLlM 'srauorillcerd leclpau uralsa/n ot Dutgmd anold pue u61pe.red c4lualcsolq uralsa/v\ rl1r'a aplteduocul Ipnolnqo arp slsouOe;p qcng '.tb rarql aqt bulqtoos. pue .u0a1qd Ourn1osar' sanlonur luarrlearl pue ,,Acue1c1;ap uaeps pue uogleu0ets !b raryl ol panqilue s1 uolsserdaq ',,(SUCgd) srsBts aloual ol uollelnc:lc poog Ou11oulord,, pue 'r(cue;cgap :an1 Durnar;al pue A11e1n 6u1p1nbar,, sanlonul egue.rqdozlqcs p luaulparl pup sgsou6erp 'a;dtuexa ro3 'ssaull! lpluaur ol peal {eur 'uolleupquloc u! ro Ag6uls 'anoqe aql;o Auy 'uporl or.ll u! poolq ;o Acuetcgag (l puB i(rb) Abraua pil^ pue poog to acuBlequrl(e :leeq pup arll ssacxf (7 :u0egqd Aq uoltcrulsqo puupqC ueaH (t :sapoaql 0ugmolpl aql Aq peulepxa roLlunl eq {eu A0olotta aseaslg 'Du;aqlpr'a pcgbopqc,{sd tcale osp Aanr sraproslp crueOro rorllo pue ',,{11pe:aq,, 'funlul 'anO!te; '[cuercgap/ssacxa fuplalp sB qcns srolcPl Jaqp leql sa^olloq osle li{Cl '1q0p1 pue 'rpal '/'^oros 'Alalxue 'A;oqcueletu 'rabue 'Ao[ 'a'; ',,(6u1bgb) suoltouxt ua^os,, :arl pup ssaufup 'ssaudurep 'lpaq rauuns 'ploc 'pur/'A 'a'! 'suaooqled snoueooxa:o .(ufnn) sassacxa x!s,, aql ate saclol asaql '1nse: Aetu aseaslp 'ssacxo u! ro lualcgop are asaql ll 'luauluoJ! lJa aql u! pup srulol all llp u! lualaqur ale leqt ,,sa16Joua ro sacrol pl!A' lo ,,ocuepq,, p sldacuoc aql uo pospq ppoui p ol saloqpp y1g1 '[6op1la aspaslp 1o uogleuepxa cllslprnlpu 'paseq-ura0 B ol saqpcscltls aulclpour uralsoM allq6 'oulclpauron ol acuplquasar ou sJpaq y{CI u1 sgsou0egp 'aspaslp p A6oppe aql p uotleleld:alur eqt ou{uapun slseq pcllaloag aql ul sacuotaJllp lpluauppunl lo.asnili?o ,*, ", s1 6u1pn1cu1 'suol1puoc lpclpaul lle lo uaulea/l p supau etetull0al B sp yICf papurord luar.uulanoO lqunuuoc asaulq3 aql uaq^A '6t6t lllun 'esd;pa ue auo0lapun peq nCI p osn aql 'PultlC tl aulcrpotuolq uralsaM lo ocuangu! luanbesqns aLll pup aslr aql qUM ',,sassau;;; cplegqcAsd,, 1ea:g ol pasn aJa/,i\ 001 lsoruls 'pauolluau saulclpaur pqraq oot ol.ll lg '(au;c;pey\ pulalul lo loo€ s,loladuu3 /nolp^) oulf laN lO OueM 'Uol lPclpaul asaulq] $lll aql ol IcPq pacPrl oq uPc t/'{CI ro asn lsolpea aql 'A1s.ran1up par1 "g'q6'oS') qdasof src3dsoud olw SflIVIS'AUOISIH JO Att3lA3U V :AHMHCASd Nl ftCD :lNlCl0fhl :|SSNIHC'lVNOlllOVu! into four treatment groups: a) low dose of anti-psychotic drugs; b) lowdose antipsychotics + PBCRS drugs; c) highdose anti-psychotics; and d) highdose anti-psychotics + PBCRS drugs. Hemorrheological observationindicatedtheuseof antipsychoticsalone, (P<.005). Theuseof PBCRS drugs might improve the result and shorten the course of treatment (P<.01). Manicdepressive psychosis is the next most common form of psychosis in China. according to TCM, mania may be caused by a) liver-fire; b) stagnation of heat of liver-gallbladder; c) type of excessive heat causing yin deficiency. Depression is said to be caused by a) liver-vital energy stagnation and spleen deficiency; b) liver-blood stasis; c) heart-spleen deficiency; and d) spleen-kidney yang deficiency. Treatment for mania involves administering herbal medicines to clear away excess "heart heat" and tranquillize the liver-wind. The use of PBCRS drugs has also been demonstrated effective. In a clinical trial of depression patients, Luo (1988) compared two groups, one receiving double amitripyline medication, with the other group receiving electro-acupuncture in the Baihui and Yintang points. The acupuncture group was found to be as effective as the drug group. Among neurotic disorders in China, the most common are anxiety, hysteria, and "neurasthenia". A number of herbal decoctions are used, such as Ganmai Dazo (Glycyrrhizae Praeparata. Fructus Ziziphi Lujubae. Fructus Tritici levis); Baihe Dihuang (Lilli lancifolium. Rehmannia glutinosa); Banxia Houpu (Pinellia ternata and Maqnolia officinalis). From clinical obseryations on 405 patients as well as animal studies, Luo (1986) reported the presence of sedative and hypnotic effects of the Chinese rhizome and root of Patrinia scabiosaefolia used in the treatment of neurasthenias, with insomhia as the main symptom. No adverse side effects were observed. For the treatment of hysteria, the use of needle acupuncture and electro-acupuncture at the Yongquan point have proven effective, even in those patients with chronic hysterical paralysis. A follow- up study revealed only 18.4% recurrence (Zhang 1986). In recent years, laser acupuncture has been used for treating schizophrenics with auditory hallucinations and depressive patients with encouraging results. In addition to these "traditional" methods used in TCM, the role of qigong in psychiatry is being explored. Qigong, literally translated as "breathing skill", refers to the practice of regulating one's "qi" or vital energy. An imbalance or blockage of this energy contributes to the onset of illness. The "quiet" or "internal qigong" has been successfully used to treat hypertension, and claims have been made that it is useful in the treatment of various forms of cancer. ln psychiatry, the opinion is divided. While some feel that it is useful as part of the course of treatment for neurotic disorders, particularly those patients suffering from psychoses, such as schizophrenia; in fact, the practice of qigong is said to bring on the symptoms. The TCM-WM model in psychiatry, while not used as a matter of course, does appear to be fairly
widespread. A review of the record of the psychiatric outpatient clinic at Suzhou Medical College No. 1 Hospital in 1988 showed that while western drugs made up a majority of the prescriptions, herbal medicines and acupuncture were occasionally prescribed, usually depending on the type of disorder, the age, sex, and education of the patient. In those patients suffering from stress-related symptoms, qigong and western-originated "biofeedback" were often prescribed (So 19gg). In conclusion, the TCM-WM model has demonstrated its effectiveness in most medical specialties, and its use in psychiatry has kept pace. However, its acceptance in the west is limited due to the fundamentaltheoretical dichotomy between TCM and western biomedicine. To gain wider acceptance, future directions must include a strengthening of the methodological rigor in basic science research, including the use of animal models, with the goal being the explanation of TCM theories within the western scientific paradigm. This, coupled with continued clinical research into the effectiveness of the Chinese materia medica, will go a long way in establishing the TCM-WM approach as a viable alternative.
Selected Bibliograohy Chen, Chiao "Wenden decoction in the treatment of mania: 30 clinical case observation" Journal of TCM 1984: 25(11): 31. (in Chinese).
16 LI
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June 23, 1990 10:15 AM' TUDOR STUART
TOPIG: GENETICS
CHAIR: Lap-Chee Tsui, B.Sc., M.Phil., Ph.D., Toronto.
-1
USE OF'REVERSE GENETICS IN D]SEASE STUDY Lap:Chee Tsui, B.Sc., M.Phil., Ph.D., Toronto.
FROM DISEASE TO GENE AND BACK AGAIN: LESSONS LEARNED FROM RETINOBLASTOMA Brenda L. Gallie, James M. Dunn, Xiaoping Zhu, Robert A. Phillips, Toronto.
MUSCULAR DYSTROPHY (DUCHENNE) Ronald G. Worton, B.Sc., M.Sc., Ph.D., F.C.C.M.G., Toronto.
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-E LUNCH
June 23, 1990 11:45 A.M. REGENCY WEST & CENTRE
CHINESE VIEWS OF LIFE AND DEATH Julia Ching,8.A., M.A., Ph.D. Toronto.
ldeas of life and death are usually intertwined, just as the hospital can be viewed both as a place where death occurs and as a place where life begins. Such intertwining is even reflected in myths about the beginning of the cosmos. ln the Chinese case, old man Antiquity's (P'an-ku) death allegedly led to the beginning of the natural world, and illustrates the organicity of the universe. Human beings, after all, see themselves and their bodies as the microcosm of a larger nature which is the macrocosm, and the dramatic setting for both life and death in an unceasing cycle of renewal. Looking more closely into various schools of thought, we find a moralist answer to questions of life and death in the Confucian school. Confucius allegedly refused to answer questions of death on account of his preoccupation with questions of life, and the school named after him has continued to promulgate the sense of family and social responsibility with which it became associated. lmflicitly, this has meant continuing efforts to improve the quality of life, both on the individual and social levels, even if certain of the Confucian preferences and taboos have set the Chinese behind in physiological and medical research. Philosophically, the Taoist response can be characterized as a naturalist one. Taoists prefer the contemplation of the universe to social responsibility. Their efforts have been aimed at harmony with nature rather thdn harmony with society, and these included accepting life as it is and death when it comes. But there are also the so called "religious" Taoists who engaged in a quest for physical immortality, a quest which involved alchemical research and pharmacological findings. lt confirmed the basic Chinese contentment with life and their desire to avert death. Religiously, there have also been Buddhists, with an lndian-inspired philosophy preaching transcendence of both life and death, sometimes implying a desire to escape from the responsibilities of the former and the fears of the latter. The Chinese transformed Buddhism sufficiently to promote the cult of the Kuan-yin as a goddess who grants children to those who pray for them, and the cult of Milo as the Laughing Buddha who draws people to meals and restaurants. Here too, we witness the reverse of the Indian ideal of asceticism and the Indian preference for deliverance from life and death. lf, so far, we have spoken as though life and death are clearly separate states, we should acknowledge nevertheless that the harmony projected with nature as well as the cult of ancestors have sometimes obscured their separateness, to the extent that the dead are treated as though still alive. This too can be regarded as a clear manifestation of the preference for life and attachment to life. The Jewish philosopher Martin Buber found this phenomenon disturbing to a mind accustomed to the radical separation of life and death, self and other. lmplications of the Chinese preference and attachment point to a sublimation of one's own life in the life of the family or the clan, in the group that has always functioned as one's "safety net." The above discussion points out a few distinctly Chinese notions of life and death, and highlights the inherent pluralism of these notions. What effects do these views and notions continue to produce in the Chinese community in what regards their health needs? Here I have more to learn than to say.
Julia Ching, Professor of Religious Studies and East Asian Studies at the University of Toronto, was recently elected to the Royal Society of Canada. She is the author of eight books, including the recent Probing China's Soul: Religion. Politics, Protest (Harper & Row, 1990).
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rsvS AcN3eSu l,Id 08:L 066[ '82 eunr c'tfNvd THE CHINESE DIET
Collin P. Quock, M.D., F.A.C.P., F.A.C.C., San Francisco.
Chinese food is marvellously diverse and versatile. The depth of regional and local cuisine make it easy to construct meals that are interesting and still fitted to individual health needs. Conferees are urged to make creative use of ingredients at the local supermarket and at the Chinese grocery stores we all patronize. The American Heart Association recommends the following dietary guidelines for healthy American adults which are easily adaptable to Chinese foods for Chinese-Americans.
DIETARY GUIDELINES:
1. Saturated fat intake should be less than 10% of calories. 2. Totaf fat intake should be less than 30oi of cbloties. .' j 3. Cholesterol intake should be less than 100 mg/1..000 cal, not to exceed 300 4. Protein intake should be approximately 1506 of calories. 5. Carbohydrate intake should constitute 50-50% or more of calories, with emphasis on increased complex carbohydrates. 6. Sodium intake should be reduced to approximately 1 g/1,000 cal, not to exceed 3 g/day. 7. lf alcoholic beverages are'consumed, the oaloriO intake from this source should be limited to 1506 of total calories but should not exceed 50 ml of ethanol per day. L Total calories should be sufficient to maintain the individual's best body weight. 9. A wide variety of foods should be consumed.
To these we add fibre to reduce the risk of colonic cancer, which has high incidence among Chinese-Americans. Our food retailers can provide you with fibrous vegetables even exceeding what the supermarket has to offer. We also have the following helpful hints:
1. You are allowed up to 6 ozs of red meat per day and this can be cooked in many different Chinese techniques. 2. Make liberal use of fresh vegetables including tofu' g. Make liberal use of fresh Chinese flavours with such ingredients'as ginger, scallions, garlic, and peppers. 4. Minimize the use of prepared sauces but be aware they do exist for variety. 5. Make use of the flavours and cuisines of related Chinese cultural groups such as the vegetarian dishes in Buddhism, and the flavours of Southeast Asia and the Pacific.
* Dietary Guidelines for Healthy American Adults, American Heart Association, Publication No. 71-003-C, 1986.
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fSSNlHC A-lU:lO'l:l ]HI ONV SClNlIVl,l3H Table ll: Dietary Intake of Elderly Chinese Users and Non-users of Western Supplements with reference to Caucasians* MALE FEMALE Users Non-users Users Non-Users N Median N Median N Median N Median
lron Chinese 3 11 121 13 6 1't 201 11 (mg) Caucasian 44 15 195 14 108 ',t2 344 11
Vit.B-12 Chinese 13 2.2 111 2.5 29 1.4 178 1.4 (mg) Caucasian 65 3.6 174 3.3 168 2.7 284 2.6
Folate Chinese 11 184 113 168 23 148 184 147 (mg) Caucasian 47 259 192 253 104 235 348 208
* Data on Caucasians was derived from three-day dietary records.
Caucasians. This may contribute to a positive iron balance, because calcium phosphate salts are known to inhibit non-heme iron absorption (7). In conclusion, the elderly Chinese Americans had more than adequate iron and vitamin B-12 stores, which may be related to their high animal protein diet and chronic ingestion of Chinese tea and certain traditional tonics. lron overload may increase the risk of cancer (8), especially in the liver (9). The gene frequency of idiopathic hemochromatosis in the Chinese is unknown (10). The possible effects of Chinese tea and tonics on iron metabolism should be considered when counselling elderly Chinese Americans about nutritional health.
References:
(1) Choi, E.S.K., McGandy, R.8., Dallal, G.E., et al. The prevalence of cardiovascular risk factors among elderly Chinese Americans. Arch Intern Med 1990; 150:413-418. (2) Jacques P.F., Sulsky, S., Hartz, S.C., Russell, R.M., Moderate alcohol intake and nutritional status in nonalcoholic elderly subjects. Am. J. Clin. Nutr. 1989;50:875-883. (3) Hartz, S.C., Otradovec, C.L., McGandy, R.8., et al. Nutrient supplement use by healthy elderly. J. Am. Coll. Nutr. 1988;7:119-128. (a) McGandy, R.8., Russell, R.M., Hartz, S.C., et al. Nutritional status survey of health non- institutionalized elderly: energy and nutrient intakes from three-day diet records and nutrient supplements. Nutr. Res. 1986;6:785-798. (5) Jacob, R.A., Otradovec, C.L., Russell, R.M., et al. Vitamin C status and nutrient interactions in a healthy elderly population. Am. J. Clin. Nutr. 1988;48:'1436-1442. (6) Cook, J.D., Monsen, E.R. Food iron absorption in human subjects lll. Comparison of the effect of animal protein on non-heme iron absorption. Am. J. clin. Nutr. 1976;29:859-867. (7) Monsen, E.R., Cook, J.D. Food iron absorption in human subjects lV. the effects of calcium and phosphate salts ontheabsorption of non-heme iron. Am. J. Clin Nutr. 1976;29:1142-1148. (8) Stevens, R.G., Jones, Y., Micozzi, M.S., Taylor, P.R. Body iron stores and the risk on cancer. N. Negl J. Med. 1988;3'19:1047-52. (9) Stevens, R.G., Beasley, R.P., Blumberg, B.S. lron-binding proteins and risk of cancer in Taiwan. JNCI 1986;76:605610. (10) Fairbanks, V.F., Baldus, W.P. Hemochromatosis: the neglected diagnosis. Mayo. Clin. Proc. 'l986;61 :296-298.
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vctHfulrv HruoN NtA'lu:to'I3 3ssNtHC fHr JO SUIE-I8oUd I I I I DIETARY FACTORS IN BREAST CARCINOMA AMONG THE CHINESE
Marion M. Lee, Ph.D., San Francisco.
Among world populations, Chinese women have low breast cancer incidence and mortality rates. However, these rates are increasing with migration, industrialization and the adoption of western lifestyles. Chinese women who immigrate to the United States exhibit breast cancer mortality and incidence rates markedly higher than Asian Chinese (1). These observations suggest that some features of western culture increase breast cancer risk. The major breast cancer risk factors have been found to be similar for chinese and Caucasian women (i.e. age at menarche, age at first full term pregnancy, number of live birth, previous benign breast disease and family history of breast disease). Therefore, it is likely that differences in dietary and environmental factors account for the variation and gradients of breast cancer incidence and mortality (2). International comparisons show a strong positive correlation of breast cancer incidence with per capita intake of fat and high-fat foods (3). Studies of the role of dietary fat in the etiology of breast cancer have demonstrated little or no noticeable effect of dietary fat on breast cancer risk among whites. However, a study in Shanghai reported an elevated risk of breast cancer associated with a high intake of fat and protein (+). An earlier study of breast cancer risk in Chinese-Americans in.the San Francisco Bay Area suggested increased consumption of beef as a risk factor (5). However, the number of breast cancer cases in that study was small. Preliminary data from an on-going study of Oriental breast cancer in the U.S. indicate that Asian American women with breast cancer reported a higher intake of beef and pork compared with controls. Odd ratios associated with the highest beef consumption quaftiles were close to 2.0. Epidemiologic data relating micronutrient intake and risk of breast cancer are sparse. In several case-control studies, total vitamin A intake has been associated with a reduced risk of breast cancer (2). More recent reports on breast cancer risk in Australian women and on Chinese women from Shanghai showed a protective effect of dietary beta-carotene. A negative association of green leaf vegetables and breast cancer was reported in the Shanghai and Tianjin studies and the on-going Asian American breast cancer study. An elevated risk of breast cancer was correlated with moderate levels of alcohol consumption in Caucasian women (2). However, no data have been published on alcohol consumption and breast cancer risk in Chinese. The colorectal cancer studies of Chinese-American immigrants in North America suggest that dietary fat is positively correlated with length of residence in the U.S. (6). Chinese migrants were found to have changed their diets after migration, and there were considerable differences in the amount of nutrients consumed by Chinese-Americans and greater variation in Chinese-American diets compared with Caucasian diets.
References 1. Waterhouse, J., Muir, C., Shanmugaratnan, P.J., (eds). Cancer Incidence in Five Continents, vol. lV. Lyon: IARC Scientific Publications, 1982. 2. Kelsey, J.L. and Berkowitz, G.S. Breast cancer epidemiology, Cancer Res 48:5615-5623, 1988. 3. Armstrong, B. and Dole, R. Environmental factors and cancer incidence and mortality in different countries with special reference to dietary practices. Int. J. Cancer 15:617€31, 1975. 4. Meeting highlights presented at the Fifth Symposium on Epidemiology and Cancer Registries, November 1986. JNCI 79:899-908, 1987. 5. Yeung, K.S., King, M.C, Epidemiology of breast cancer among Chinese women in the San Francisco BayArea. Am. J. Epidemiol. 122:621,1985, (abstract). 6. Whittemore, A.S., Wu, A., Lee, M., Gillenger, R., Paffenbarger, R.S., Jr. Diet, physical activity an colorectal cancer among Chinese in North America. JNCI (in press).
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I-HVNIS HOCIfIT y{d 0g:} 0661 '82 aunr o't3Nvd ETHNICITY AND NEONATAL JAUNDICE
Dr. Apostolos Papageorgiou, M.D., F.R.C.P.(C)' F.A.A'P', Montreal'
Neonatal jaundice is a universal problem and far the most common condition observed in this period of life. yet, all the mechanisms involved in the development of neonatal hyperbilirubinemia have jaundice still not been completely elucidated. Furthermore, the incidence and severity of neonatal varies with many factors among which ethnicity, geographical and gender distribution are very important' nitnough particular emphasis wil Ol given to the role that ethnicity plays in the development of neonatal jaundi-ce'(because of ine predominance of this problem among Asiatics, Hispanics, Middle and Far Easterners, Mediteraneans and some Africans), the question of diagnosis, investigation and therapy will be addressed in general terms. The following plan of presentation is proposed:
1. The problem: The universality and specificity of neonataljaundice. 2. The question: Physiologic vs Pathologic 3. Pathologic (non-Physiologic) Jaundice in the term infant - Clinical Jaundice in the first 24 hours of life - Total serum bilirubin > '12.9 mg/dl - Direct serum bilirubin > 1.5 mg/dl - Clinical jaundice for > 1 week' 4. Investigation for Pathologic Jaundice. - Total and direct serum bilirubin - Hgb, peripheral smear, red cell morphology, reticulocyte count' - Blood groups - Coombs test. 5. Factors associated with higher levels of jaundice: - Ethnicity and geographic distribution - Breast feeding vs breast milk jaundice - Male sex - Percent weight loss - Oxytocin induction - Maternal diabetes - Gestational age - Bruising and polycythemia. 6. Indications for Investigation: - Before 24 hours of age: Any signs of jaundice. - After 72 hours of age: Bilirubin > 14 mg/dl (breast fed) Bilirubin > 12 mg/dl (bottle fed) Baby sick or other reason for concern Prolonged jaundice (> 1 week). 7. The Therapy - Phototherapy - Phenobarbital - Sn-Protoporphyrin - Exchange-transfusion 8. CONCLUSIONS
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OOlHSd'lVlVNlH:ld ]HI Nl NOIIVNICCVA SnHn I SIllIVd:lH TROPHOBIASTIC DISEASES
Dr. P. L. Chan, M.D., F.R.C.S.(C), F.R.C'O'G', Toronto' and its incldence In A review of histology, pathology and genesis of trophoblastic dlsease sudden influx of Chinese from Hong Kong Ghinese ls presented, with special reference t6 tne hrge and into the Greater Toronto area. of trophoblastic disease as - Further discussion of new developments ln diagnosis and follow'up is given. well as the presentation of Toronto protocol for treatment disease among the chinese Final discussion on tne possible impact in incidence of trophoblastic generations as a result of changes in population who are transptanteci in Canada and thelr subsequent proposed' diet, environment and lnter+acial marriages is
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r Norssfs lcvHlssv SELF ASSESSMENT OF HEALTH BY AGED CHINESE CANADIANS
K. Victor Ujimoto, Ph.D., Lawrence lam, Ph.D., PaulWong, Ph.D., Harry K. Nishio, Ph.D., Guelph, Trent and Toronto, Ontario.
This paper reports on aspects of aging Chinese Canadians which are based on a national survey of aging Asian Canadians. Explanations for the variations in the subjective evaluation of perceived health status are provided in terms of several key variables. Our survey revealed that an extremely high proportion,74.9o/o of our respondents (N=227) were satisfied with their own health. Of the remainder, 15.4% were dissatisfied, 7.9o/o had mixed feelings and only 1.8"/o failed to provide any answer. Are all these aged Chinese respondents leading a life without much health problerns, physical or mental? Because we are unable to secure reliable empirical data that has been systematically collected by the health services, we have attempted to examine the combined effect of socio-demographic variables and cultural factors. It was observed that the aged Chinese invariably accepted the fact that one should be content with one's lot, especially when one becomes old, in order to lead a happy life. As such, various ailments are believed to be only normal and natural as one reaches a certain age. Furthermore, cultural concepts such as reserue, self-control, self effacement, resignation to fate and the emphaSis on modesty about one's abilities, provides for a less demanding expectation in later life, as long as medical services are perceived to be adequate. The paper concludes with a discussion on the social context of daily activities and the role of social support in the Chinese Canadian community.
EVOLUTION OF HOME HEALTH SERVICES IN SAN FRANCISCO'S CHINATOWN
Kelvin Quan, M.P.H., Marilyn Baker-Venturini, Anni Chung, M.S.W., Collin P. Quock, M.D., San Francisco, California.
Since 1983, Self-Help for the Elderly HomeCare has provided bilingual and bicultural skilled nursing, physical therapy and other home health and in-home supportive services to frail home- bound seniors. As statistics indicate, the need for these seruices is ongoing in both the medical acuity and cultural aspects. HomeCare's staff continually face the "normal" challenges facing all home health agencies such as the shrinking pool of qualified professionals, higher patient acuity from shorter hospital stays, increased demands for skilled home care and complicated third-party financing. Concurrently, HomeCare must contend with recruitment of bilingual/bicultural professionals, the changing dynamics ol Chinese immigrants and the combination of Western and traditional Chinese modalities and treatment. Annual data trends will be presented and analyzed for this maturing health care service. These will highlight industry trends and restraints. Other information will be considered as it applies to an elderly Chinese population. A comparison of the Average Visits Per Patient indicates an increasing level of need. In 1986, the average patient received 12.3 visits; this increased steadily each yearto 15.5 visits in 1989. The medical necessity of higher levels of service is indirectly confirmed by a special waiver granted to Self-Help by Medicare. In 1989, the leading diagnoses were cerebrovascular disease (24olo) and fractures (16%). 43o/o of the patients were 75 to 84 years or older. A comparison of payment sources reflects the industry's trend towards a new concept now referred to as "managed care" relationships (i.e. Health Maintenance Organizations or "HMO's"). In 1985 Medicare represented 82o/o of totalvisits and HMO 22o/".|n particular, HomeCare's statistics are partly dependent upon the parallel growth of a medicare pilot proEram based in the San Francisco Chinese community. Our current reimbursement formulae are cost-based and fixed rated per visit. Changes in these formulae impact directly on delivery and growth of services.
32 ee
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'llunruuloc asaulqC aql qUrn Eullloan u!A6aterts uollecnpa uollppu V .SUOIN3S 3S3N|HC fHL UOJ rS3rNOC nNSUlr - NOrrVCnOf NOTIUTnN AI|NnUU'IOC lvunr-lnCtrlnn SOCIO-PSYCHOLOGICAL WELL.BEING, DRUG USE AND HEALTH AMONG THE ELDERLY CHINESE IN TORONTO
Yuet W. Cheung, Ph.D., Christine Leonard, M.A., Toronto, Ontario.
Based on data from the Chinese subsample of a 1987 study of alcohol and drug use among 349 (N=51) elderly subjects in Toronto, this paper examines the physical health of the Chinese elderly and (i) its socio-pjychological corielates. bocio-psychological correlates included the following scales: social (iii) life-events support (Gwton, e1 al, 1982), (ii) social activities (creecy, et al, 1985), negattue (Liang, 1985), (v) personal control (Llnn and Linn, lOoirrendwend, et al, igZA),'(iu) subjective well-being iSenl anO (vi) ioneliness (Creecy, ef al, 1985). A "drug use" scale (use of alcoholand tobacco, and non' medical usi of prescription drugs) was employed as an intervening variable between the socio- psychological variables and health. The results show that, on the whole, physical health of the Chinese elderly was associated with the socio-psychological variables but not with drug use. Among the Chinese elderly, the level oldlg psychological well- use was low-and diug use was not a means of coping with the lack of social and being.
ll 34 9e
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-IvrNfo srNSllYd clHrvlHs9 uoJ sNolssfjoHd oNV'rvcto3tT f Hr N33IAJ_3S SNOICVHsrN| 9nHO K.W. Cheng, B.Soc.Sci., M.B.A., M.R.S.H. Toronto. Aged, to see The presentation will recaptitulate the beginning of the Mon Sheong Home For The relatively few resources in the how a few concerned people 25 years ago could mobilize successfully the in need. The early days of Chinatown to do something meaningful for the seniors and those presentation w1l also show how sincere efforts are being pursued to ensure that life inside the only needs of the ilome for the Aged in Toronto is comfortable, and fulfilling in meeting the specific cultural facing. What residents. Finally the presentation will also outline the challenges that the Home is now years lies ahead would seem more demanding than what they were facing 25 ago' The Mon Sheong Home For the Aged is the only Home for the Aged serving the Chinese serving the full community in Ontario. ihe Hore is situated at the heart of Chinatown, currently by The Mon capacity of os residents, with a dedication in delMering "holistic" care. lt is operated Sheong Foundation, the first Chinese Canadian charitable organization in Ontario.
36 LE
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II NOISSsS ICVUIS8V HEART DTSEASE IN THE CHINESE IN OTTAWA. AN ANALYSIS OF PATIENTS REFERRED FOR ECHOCARDIOGRAPHY
Kwan-Leung Chan, Ottawa, Ontario.
Echocardiography is an important investigationaltool in assessing cardiac structure and function. This study is an analysis of the Chinese patients referred for echocardiography at our institution, in order to obtain a perspective of heart disease in the Ottawa Chinese community' From January to December 1989, 5,796 echocardiograms were performed at our Institute' There were 63 (1.1olo) Chinese patients. ln comparison, the Chinese makes up for about 2o/o ollhe population in this region. Of the echocardiographic studies performed, 2,078 (360/.) were on hospitalized patients, whereas most of the Chinese examined were ambulatory outpatients and only five (8oA) were hospitalized. The mean age of the Chinese patients was 40 + 18 (range 0 - 78) years with a male to female ratio of 3:2. The major reason for referral was for the assessment of heaft murmurs. Structural heart disease was preseni in 33 (52%) of the Chinese patients. Patients over the age of 40 years made up for 460/o of the referred group, but accounted for 64% of those found to have structural cardiac abnormalities. The heart diseases seen most frequently were rheumatic valvular disease (9 pqtients), other forms of valvular disease (1 1 patients) and congenital heaft disease (9 patients). Evidedce of coronary artery disease, such as myocardial infarction and its complications were not detected. Thus, Chinese patients referred for echocardiographic assessment tend to be younger' Rheumatic valvular disease continues to be a prevalent cardiac disorder in the Ottawa Chinese population. On the other hand, these findings suggest that coronary artery disease is uncommon.
38 6e
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'elurclllEc'ocslcusrl ues "S'g 'aa1 sl1la'l "l'UI "V'g'6uelng uuv of' ''V'g '!oEN 'p 6uoeq3 ''S'g '!nqC 6ung ;nqg ''q'y1 '1con9 'd ullloC ''g'g 'nr1 uqop
ocslcsNvHJ Nvs Nt sNvctu3uuv-3s3NIHc ro sotdt-l y{nH3s ro ASAuns v CORREI.ATION OF PLASMA ASCORBIC ACID WITH CARDIOVASCUI.AR RISK FACTORS
Elaine S. K. Choi, Gerard E. Dallal, Paul F. Jacques, Robert M. Russell, Robert B. McGandy, Robert A. Jacob, Boston, Massachusetls.
In a cross-sectional nutrition study, plasma ascorbic acid (PM) was measured in 93 male and 148 female healthy elderly Chinese Americans by the modified dinitrophenylhydrazine method. Multiple regression analysis showed that PM correlated positively with vitamin C intake and plasma folate, but negatively with alcohol intake and percent energy intake as carbohydrate. PM was higher in females than in males and lower in current cigarette smokers than in past or non-smokers. Age, physical activity and anthropometric measures were unrelated to PM. Using the above variables except vitamin C intake, multiple regression analysis was performed with each of four primary cardiovascular risk factors as the dependent variable:
Change in risk factor due Significance to one S.D. rise in PM (p)
Systolic BP -4.8 mm Hg 0.004 Diastolic BP -2.9 mm Hg <0.001 Log HDL-cholesterol +3.7 Vo 0.029 Fasting glucose 4.27 mmol/L 0.073
Our results suggest that PM is closely associated with these cardiovascular risk factors independent of sex, age, lifestyle, obesity and other nutrients.
40 lv
'sluallPd OVC asaulqC paOB p luaurleorl oql ul lplc|lauoq aq plnoqs slql 'Alpolreut uollcunlod^r{ slrll ocnpar uec (APp/6ur OZt) uazel1lp pue'dnor0 purrou aql ut leql ueqllalealO s!stuelted OVC asaulqC {papp ur uolpunl aseapr pue uoglebal60B toleteld leql opnpuoc aM 'to'g>d 'e'ZTe'gl s^ t'e-+0'6t tJd pup iSO'O>d'g'0t-+g'Bt sn 6'9lTg'29 eI-€ 'to'g>d '9'gtFt'6e s^ Z'OZ-+e't9 au;lqdeu;de 1o VyI :t0'0>d 'g'tt-+6LZs^SZZ-+Z'89 dClV lo VyI :ara/'^ sllnsal aq1'sAep 0t rol uazpl1lp qil/,^ luaurlparl loUB pue arolaq 'sluagpd OVC rol 'sualted OVC asaulqC pa6e u; ptulouqe s! uolpunl ospalar pue uol1eber0Oe laplPld lpql alpclpu! plep asaql '(too'o>d '{pn;1cedsa.r z'tTtL s^ 9'gT6'2t pue g'zTv'tz s^ Z'9tFt'99) tJd pue gl-g lo ospapr pue (16'9>d '|OZTrOI sn e'lZTg'2g eu;:qdeulda to Vyr{ il0O'O>d 'slpu.uou rot g'etTg'ee sn stuelted OVC rot 0'gZ-+t'6t dOV lo V4) YRIA1suatu! uoltBDe.rODB o1 p:ebel qlm Alp;cadso 'sleuuou o1 pereduroc pacuequa s! stualted OVC ul uollcunl1ap1e1d teqt alpclpu! sunsar ot{I '(V ONy) ecuqlen p s;sA;eue pue lsal-l pal;ed aql papnlcul s;sApue pcllsllpls pue 'OS-+NVS1AI se peluesard ara^ plpp 1;y 'sgue1led GVC aql uorl plep q1rn pe.reduoc oro^ etep lapted Itaql 'sOutpug Aery pue asocn;6 poon 'gy3 'arnssard poog lpurrou r{l!/v\ (epr.r.ral 0g 'alpul gg) epoad paDB gg popnpul dno:0 ;eutrou aql 'lsel qblurano uB ra1p uale1 arai sepures poo;g 'fuessecau I pasn alan sollrllu pup sJalcog Btag 'sAep g lspal 1e Jol ul pJpqil/' ara/n slquo0elue unlcpc laqlg 'uollcunl leplep pale ol !mou>1 s6nrp Aue ualel pBl{ tualted ou 'ppl eq16u1peca.rd s>1eenn o,tru oLll ulq16 'eu16ue snogas Z pue uollcrplu! lplprecoAur sno6ald B g! 'uollclplug ;egplecoAu apce ue pPq stualtBd g 'srBeA 6 T99 sBfir a6e ueayl '(epr.r.rol I 'sapu ZZ i6t elruas 't acuacsauas) pe;pnts 0lo^ slualled OVO Apepp eZ 'luaulea.rl;o sAep 0l JaUe stualtBd (6yg) aseaslp fuauB fuBuoloc osaulqC paOe u; uollcunl lapgeld uo (r.uaz;prec) r.uazq11p uo slcalla ural uoqs oql pessarppe Apnls s;q1
'Bu!tlC'np6uaq3 'nX leC nqC '!-l 6u;1 6uaq2 .IVIHI U3AOSSOUC 'O!1-IOHTNOC€83C\nd 'ONt18 flgnoo 'O3ZIUTOONVU V-SlN3[Vd 3SV3SIO AUSIUV AHVNOUOC 3SgNlHC OSCV Nl NOIICNnJ l3-t3l\nd NO lllSZVtI-llO JO ICSJJ:I 3Hl GEROPROTECTIVE STUDIES OF "JIE YE LIN" ON AGING. I. PHARMACOLOGICAL STUDY
Jia-ju Zheng, Yu-Ming Wang, et al, Suzhou, China.
"Jie Ye Lin" (JYL) is an ancient Chinese secret recipe, from the lmperial Palace in the later Qing Dynasty, consisting of 17 kinds of herbs such as American ginseng, astraglus root (Radix Astragali), fleece-flower root (Radix Polygoni Multiflori) and human placenta (Placenta Hominis), etc. The myth of the recipe was recently studied by us in Suzhou. The preliminary results of pharmacological studies showed that: 1. Both the maximal and mean survival time (MST) of Drosophilas (American wild type, N=90) with JYL treatment (ova incubated in standard media with or without 1o,6 JYL for 10 hrs) were significantly prolonged (79 and 64.9 + 0.9 vs 70 and 58.3 + 1.1 d, p<0.01 and <0.001). 2. Lipofuscin (LF) level in Wistar rat heafts (N=8) was decreased from 100.3 + 13.6 in controls (N=9) to 69.2 + 2.4 u/g in the JYL-fed group (25 mg/100 gx24 d, p<0.05). 3. Red blood cell superoxide dismutase (RBC-SOD) of Wistar adult rats gavaged with JYL for two months (25 mg/100 g, N=10) was significantly higher (5204 + 4'10 u/g Hb) than in controls (3974 + 205 u/g Hb, p<0.02) The incidence of cataract formation in guinea pigs (N=12) after retrobulbar injection with D- gafactose (12 mg/g) fortwo months was much lower (58o/o) than in controls (Wo/o,X2 = 4.858, p<0.05). 5. An anti-radiation effect (5a.9 rad/min, total 700 rad) of JYL gavage (1 mg/g x 7d) in mice was also observed. The data from the pharmacological studies suggests a geroprotective effect of JYL. The results may provide further insights on the actions of JYL.
GEROPROTECTIVE STUDIES OF "JIE YE LIN" ON AGING. II. CLINICAL STUDY
Jia-ju Zheng, Yu-Ming Wang, et al, Suzhou, China.
Pharmacological studies showed a beneficial effect of JYL on aging. A clinical study of treatment with JYL for six months was then conducted among 200 healthy elderly Chinese (age 55-85 yrs) in Suzhou. The results showed that: 1) nonspecific symptoms with aging, such as fatigue, insomnia, night diuresis, shortness of breath, tinnitus and anorexia, were remarkably improved by JYL (1.0 g tid), compared to placebo (scores significantly increased, all pvalues <0.001); 2) the ratio of scores after JYL treatment - scores before JYL treatment/ scores before JYL treatment (a-b/b) of grip strength (both hands) increased from 0.030 + 0.018 to 0.109 + 0.017 (p<0.01); e) the ratio a-b/b for the memory test improved (0.514 + 0.046 vs 0.'104 + 0.022 (p,0.01); a) the ratio a-b/b for the scores of equilibrium ability was also improved (0.617 + 0.075 vs 0.248 + 0.064 (p,0.01); 5) the ratio a-b/b for serum lipid peroxides was decreased (0.313 + 0.117 vs -0.00+0.056 (p<0.01), while the ratio for RBC-SOD was increased (0.021 + 0.028 vs 0.116 + 0.020 (p<0.01); 6) the ratios a-b/b for serum cholesteroland triglyceride decreased (0.061 + 0.105 vs {.152 + 0.027, and -0.113 + 0.036 vs -0.214 + 0.037 (p<0.0S). In the light of the hypothesis that tissue damage by free radicals may be one of the contributing factors to the aging process, the finding that JYL has a clinically beneficial effect on the elderly Chinese population is of great interest. However, further studies are needed to elucidate the mechanism of this geroprotective effect of JYL.
42 EV
'e!ulol!leC'ocsgcuell ueg ''O'[U 'e6eUO'd pue ,.O.nl ,rno] .H ..O.l l ,1cong .d.C ,.O.Ull ,6unqg .3 sINStIVd r JO IUOdf U :;tS3NtHC Nt STSOOTOCUVS
'e!utol!leC'ocslcuel3 ueg .g.yg ,6uno1 ''O'l l 'ueqC 'O tllouua) pue .A p.tei oH SUfXOI/tlS'NON NVCIUf l/llv-:lsf NIHC JO CNIISfI NOIISNnJ AUVNOUlllnd otJeluo 'qlteeH leJnllnclllnyu uo aauluruo3 fuos;npv s,qlleaH lo Jalslull l 'o1ue;1 llan pue 'o!d.reC ereqreg ,n!qC uqof ,Uolqes allaqeuuv ALil30S lvunt-lnclllnuu v Nl NorrcS'noc vrvq oNV HcHVsSf U SUVC Hl'lVfH 'ouelug'oluolol '6uo41 au;qdasop 'un1 [11q 3NI'IIOH SOIV HI]VAH JO AHrSlNlvu oluvlNo fl{I Jo No|l\zt]trn sSt^ufs Jo Notrvn'tvn3
'coqanO ';eat1uo111; "O'tld ''O'UU 'qeas [alue6 Norrvctovuf slt uoJ ACSIVUIS V ONV NOII\nndOd fSfNlHC :lHI Nl NOIICfJNI g SlilIVd3H 's11osnqcesseU1 'uolsog pue eulqC ,noqzng 'braquesog 'H ullt Jl '6uaqz n[-p!f 066r sNoE\nndod fS:lNlHc Nl SfcN=lUSJJlo f cV oNv clNHIf :Notlduosg\nvuu Jsorc\n
'IJoA map '1,rotr ma1; ''O'UU 'o!66!U 'U UaqoH ''O'rld ''O'l^l ,6ue41 .-l .C uqof 686r 'nl6l SUfXUOA /n3N 3S:lNlHC f 1,1lOS gNOtAlV NOIIVIN\fldSNVHI A:lNOl)
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IIVMNUOC - UOSONIM l^trd 9L:e 0661 '82 aunr lll uolssas lcejlsqv KTDNEY TRANSPI-ANTATION AMONG SOME CHINESE NEW YORKERS 197't-1989
John C. L. Wang, M.D., Ph.D., Robert R. Riggio, M.D., New York, New York.
Kidney transplantation has become the treatment of choice for most patients with end-stage renal disease, following the recognition that the quality of life for a patient with a successful transplant can be superior to that for a patient on dialysis. At the Rogosin Kidney Center, The New York Hospital/Cornell Medical Center, 1,300 kidney transplants were performed in the past two decades. We report here the experience of Chinese patients who received a kidney transplant at our Center from 1974 to 1989. Twenty-seven Chinese patients with end-stage renal disease received a kidney transplant during this period. The etiology of renal disease was unknown in most cases and presumably glomerulonephritic in nature. Of these patients, 24 received a cadaveric kidney transplant and three received kidneys from living related donors. Either azathioprine or Cyclosporin-A was used for immunosuppression. All patients were on corticosteroids. Eleven cadaveric kidney transplants received azathioprine and prednisone. The five-year patient suruival rate was 91% and graft sulival was 61olo. Thirteen cadaveric kidney transplant patients were placed on Cyclosporin-A and prednisone. The five-year patient sulival was 8406 and graft survival was 760/o. All three living related transplants are functioning. In comparison, 600 caucasian patients received cadaveric kidney transplants during the same period. Of these patients, 434 were on the azathioprine/prednisone protocol and had a five-year patient survival rate of 74oA and graft survival rate of 3106. One hundred and sixty-six patients received Cyclosporin-A and prednisone and had five-year patient and grafi survival rates of 82o/" and 6106 respectively. This report shows that Chinese patients with end-stage renal disease enjoy similar, if not better, success in kidney transplantation and should be encouraged to receive such therapy.
TACTOSE MAT.ABSORPTION: ETHNIC AND AGE DIFFERENCES IN CHINESE POPULATIONS 1990
Jia-ju Zheng, lrwin H. Rosenberg, Suzhou, China and Boston, Massachusetts.
Using the hydrogen breath test, lactose malabsorption was investigated among 337 normal subjects from the Chinese mainland, comparing three groups of adults and two groups of children. Thirty-eight healthy Han adults, with rice as their staple food, were residents in the Suzhou area of East China; twenty-eight other Han adults who were born and grew up in the Xingjiang area of North-west China had adopted a milk or dairy produce dietary habit from childhood; 46 Uighur ethnics, indigenous to Xingjiang, were milk drinkers. The prevalence of lactose malabsorption and symptomatic lactose intolerance were obtained. There were significant differences in prevalence of lactose malabsorption between the Han and Uighur populations (76.3 and 67.9 vs 43.5o/oi P<0.01 and <0.05) but not between the two Han groups. However, symptomatic lactose intolerance was much less in the Han subjects from Xingjiang (31.606) than those from Suzhou (65.5o6, p<0.01). The results also showed that there was no statistically significant relationship between milk drinking habit and the prevalence of lactose malabsortion or intolerance. A study conducted among two age groups of Han children (2.5 - 5 and 5 - 7 years) showed that factose malabsorption was neither statistically different between the groups (66.7 vs 76.3o/0, p>0.05) nor from the Han adults (66.7 and 76.30/o vs 76.3 and 67.906, p>0.05). l-actose intolerance was however, remarkably lower in the children (20.3 and 20.7Vo) than adults (65.5010, p<0.01).
44
- 9V
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'caqanO ';ea4uoy1; ''O't{d ''O'}rl 'qeas Aaluets NOlrvclovus sil uol Ac3IvHrs v oNV No[\nndod 3sSNrHc 3Hr Nt NollcSJNl g slIlvd3H I EVALUATION OF SERVICE UTILIZATION OF THE ONTARIO MINISTRY OF HEALTH AIDS HOTLINE F
Lilly Lum and Josephine Wong, Toronto. H s The Ontario Ministry of Health AIDS Hotline operated by the City of Toronto, Department of Public Health began seruice in April, 1988. The purpose of this seruice is to: * g Provide AIDS information for the citizens of the province of Ontario. c * Provide counselling, support and referral regarding HIV/AIDS related concerns. c In the fall of 1988, the bilingual seruice was expanded to include multicultural outreach for p Chinese, Greek, ltalian, Portuguese and Spanish communities. A comparison of Chinese in speaking a and non-speaking service utilization will be discussed. Current data method of advertisement types of problems presented. callers, resources available and of outreach will be n n s
HEALTH CARE RESEARCH AND DATA COLLECTION IN A MULTICULTURAL SOCIETY
Annabelle Sablotf, John Chiu, Barbara Carpio, and VeliYlanko, Ontario
As pressures toward providing culturally appropriate health care service increase in Ontario, and as policy makers, planners and service providers struggle to meet these needs, all parties are growing more aware of the scarcity of information describing the ethnic makeup of their target populations. The absence of such information makes it extremely difficult to plan, implement, or evaluate culturally responsive policies or programs. 11 In 1990, the Minister of Health's Advisory Committee on Multicultural Health conducted a key '1 informant survey to gain an overview of this problem in Ontario, with the aim of preparing a report for the Ministry of Health. They consulted 40 health care data collectors, users, and monitors of information 'l use and misuse. The questions asked included: I
- What needs do you have for multicultural/ethnospecific health-related information in your work? - What difficulties have you experienced in collecting or accessing such information? - What are the consequences for your work of not having this information? - What concerns do you have about possible misuse of such information? - What action do you recommend to facilitate responsible multicultural/ethnospecific data collection?
Preliminary results indicate that key informants agree overwhelmingly on the need for ethnospecific and multicultural health-related information, and for its responsible collection and dissemination. May informants recommend that the ethnic groups in question actively participate in research design, implementation, data analysis, and distribution.
46 LV
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'elurclllsc'ocslcuerS ueg 'O'yt1 'uErlC 'O qlauuay pue 'O'UI '6uno1 'A prer oH
sufvol,lts-NoN Nvctu3uuv-3s3N|Hc lo INtrs:tr No[cNnl AuvNou[]nd Suggestions for further study would include a larger subject population in order to create regression equations capable of accurately predicting lung volumes in the Ghinese population, an analysis of previous exposure to environmental tobacco smoke, and analysis of nutritional status of the subject populations.
SARCOIDOSIS lN CHINESE: REPORT OF 4 PATIENTS
C. Chung, M.D., C.P. Quock, M.D., R. Low, M.D., and P. Ortega, M.D., San Francisco, California
Sarcoidosis, considered to be rare among the Chinese, was seen in four of our patients in the last few years. Patient L.L was a 34 year old Chinese woman presenting with a productive cough. A chest film revealed bilateral hilar lymphadenopathy. Biopsy disclosed non-caseating granulomata. Acid fast studies were negative and angiotensin converting enzyme (ACE) was normal. Patient R.W. was a 24 year old Chinese woman who presented with cough associated with mediastinal and left hilar adenopathy. She had tuberculosis while in Malaysia ten years previously. She was lost to follow-up until five months later when she returned with new left supraclavicular adenopathy. Chest x-ray showed bilateral paratracheal and anterior mediastinal adenopathy. Supraclavicular node biopsy yielded non-caseating granulomata. Acid fast studies were negative. Chest film and ACE were normal. Patient N.L. was a 35 year old Chinese woman presenting with supraclavicular masses of seven years duration. Biopsy revealed non-caseating granulomata. Acid fast studies were negative. Chest film and ACE were normal. Patient Q.B. was a 28 year old Chinese woman who complained of dyspnea and cough. Her chest x-ray showed bilateral interstitial infiltrates. Transbronchial biopsy revealed non-caseating granulomata. She was treated for nine months with anti{uberculosis medicines without any change in her symptoms or radiologic findings. Ten years previously, mediastinoscopy was done but the results were not available. ACE levels were normal" Sarcoidosis has certain clinical, radiologic, and histologic features often indistinguishable from tuberculosis, carcinoma, or lymphoma. However, sarcoid has been rarely reported in the Chinese. The reasons for this are debatable but must be related in part to the much higher incidence of tuberculosis relative to sarcoid in native as well as immigrant Chinese populations. Some cases with compatible clinical findings and negative acid fast studies are treated for presumed tuberculosis. Other cases may be missed because biopsies were not readily obtained. We make the following observations after review of our patients and those in the literature:
1. There is a preponderance of females. 2. The age at diagnosis is similar to that in other populations. 3. Histologic material is most often mandatory. 4. Otherwise typical presentations, such as bilateral hilar adenopathy with erythema nodosum, are seldom seen.
We consider the following points in our approach to sarcoidosis: 1. Sarcoid is a well defined entity with distinct features and is not solely a diagnosis of exclusion. 2. Sarcoid and tuberculosis may coexist simultaneously or sequentially. 3. It is prudent to give a full course of anti-tuberculosis treatment in most cases of undefined tissue granulomata. 4. Because of the high incidence of tuberculosis in our population, the positive predictive value for sarcoidosis, given positive findings, remains low.
48 6t
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N NOTSSSS TCVUTS8V COMPARISONS BETWEEN ORIENTAL AND NON.ORIENTAL PATIENTS TREATED BY THE STRATHCONA MENTAL HEALTH TEAM IN THE VANCOUVER DOWNTOWN EAST-SIDE CORE
Allan P. G. Wong, B.Sc.(Pharm.), M.D., Kwok-Chu Li, M.8.,8.S., Vancouver, British Columbia.
The Strathcona catchment area includes the downtown east-side core, or "skidroad" area, home to many of the most chronically disturbed patients with psychiatric illnesses. The Vancower Chinatown area is included and the team mandate offers treatment and programs in a variety of languages including Cantonese, Mandarin and Toisanese. Although beyond the scope of this paper, Spanish, French and many lndian languages are also available, in addition to English. This paper demonstrates similar levels of psychopathology amongst the Oriental and non- Oriental patients. Oriental patients have a significantly delayed "age at first diagnosis" due to the influence of an extended family support system. Orientals require significantly lower doses of neuroleptic medication, require fewer rehospitalizations (possibly due to increased compliance with care) and demonstrate reduced utilization of community resources, again probably due to the involvement of the extended family.
PSYCHIATRIC DISORDERS AND ITS RELATIONSHIP TO LEVEL OF PSYCHOSOCIAL FUNCTIONING IN A CHINESE OUTPATIENT POPUI.ATION
Raymond A. Liang, M.D., F.R.C.P.(C), Vancouver.
Inadequate attention has been given to the level of functioning in assessments of psychiatric patients, not alone in the Chinese population. More recently, the revised edition of DSM lll published in 1987 has provided us with a scale that enables psychiatrists to globally assess patients' current and previous level of funclioning using the GAF Scale. (Ihe GAF Scale Level is a hypothetical scale on mental health, based on the patient's social, occupational and school functioning). In this naturalistic study, the author attempts to establish a baseline level of functioning in an outpatient Chinese psychiatric population and to correlate the effects of psychiatric illnesses, psychosocial stressors on the level of functioning in a Chinese population. As the morbidity of psychiatric illnesses is high, and treatment requires relatively long duration and course, the author recommends using the GAF Scale in establishing a baseline level of functioning as part of the initial assessment. Further prospective studies in validating the efficacy of this scale in monitoring treatment response is encouraged.
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SCIAUSS HI1V3H 1VIN3II1I )ooJ 9NoH 3Hl - orNouor Nt Ss3NtHc 3Hl Jo so33N HflV:tH lVrNSUlt 3Hr CNtr:tfl'rl USE OF THE SELF.HELP MODEL TO RESTORE THE PHYSICAL AND MENTAL WELL BEING OF THE CHINESE BEREAVED PARENTS
Rosemary Young, Toronto, Canada.
The Chinese tradition does not encourage overt emotional expressiveness. In the event of the death of a child, ritual performance and kinship support are the mechanisms in coping with grief, but these support systems are not generally available in their new country. Whhout the ability to externalize their grief, many of these bereaved parents tend to repress their sorrow and manifest them in physical and mental illness. The functions of the self-help model are to provide social support to the bereaved parents through a caring group, and to increase bereaved parents' coping skills through provision of information, sharing of experience and solutions to the problems. There are I sessions for each group. Topics for each session may vary according to the needs of the parents. Suggested topics are funeral, how to get through the day, anger/guilt, emotional unrest, social, extended family and spousal relationships, sexuality, siblings, keeplng the memories, supports and belief system. A total of nine parents registered and two withdrew before the group started in April, 1990. six mothers and one father participated. Each parent completed a self-rating of 30 grief responses/ symptoms prior to the group sessions. The same self-rating sheet will be completed at the end of the series. The results of the rating will then be compared. At the end of the sessions, the parents will also complete a questionnaire evaluation of the entire programme. The results of the programme are not available at this time because the group is still meeting, but will be available in May, 1990. However, there are several characteristics in this group: - the parents are not reserved in their feelings. More than half wept in the first session. - the parents have no support from relatives in Toronto; they rely a lot on overseas emotional support e.g. by letters or telephone. - the parents are articulate in their feelings, however they could not find appropriate 'feeling' vocabulary. They used descriptions of behaviour. - the parents tended to use herbal medicine or traditional remedies to alleviate or cope with their physical symptoms. None had used drugs or alcohol.
52 89
'BpPuec ul Dulpoqss lo slpa^ qil/v\ stolcsl Jnot llB to puP ppBuPC u! sJPoA p laqutnu qil/n srolcPl aql lo aarql lo suollplaJroc anlle0au aql ut petpu! s! uolts1r11lssg plnllnc;o ssaco.td y 'a6e q1/n uollpproc e41sod B pa/noqs slolcpl Jnot llv 'slouop uou uorl slouop palBlluaJagp 'Jana,v\oq 'alecs dgHI aql lo srolcpl Jnol lo on l AluO 'sesaqlod^q oql paurJuuoc sgsr{pue 'epEuPC luPultuIcslq u! uroq alai uoq/n 1o 97 Aluo 'srouop uou gig pup slouop 64 rol paz6leue oJan apcS dgHl oql puP allPuuolFanb e;o suols.tan osaulqC pue qsr16u3 a^llpulallp o1 sasuodsag 'palcedxa spr,/\ uollBuop poon ol ocuB^apl ,llrBlo ssol sarpr.ul poog lo ssol aculs 'poolq puP maclol all aql lo /v\olt aql uaa/nloq uollelcosse asop aql se^ apcs aql ul popnpu!saplcuud ;eleue0 6uor.uy '6ffipue Ujf,lo saprcuud ;ecrDopusoc aql ug pessaldxa Apcar;p ueql raqlBJ pool ul salyepd fup/lam pue ppc/pq p acupruasqo oql u! pelpur; Apleurud aq plno/'^ asJaAlun q1/vr sql Iuouueq 6u;pre6a.r sFlpq leuorlrperl lpql paurnsse sen U eculs 'aseasrp 1o uorluanard puP UaulPall aql u! 6uoy DuoH u! so3llce.rd fup1elp 1o Apnls (?B6t) s,ooy uo paseq aran sulau lolaqunuB.apcs(aexJaqllouo!lcnllsuocaqlul 'srouop uou uloJl slouop poon ale[uaro#rp plnoi Ailunuuoc aql u! uausryo^u! lo pnallaqbrq e pue 'preua0 u! suelpPueC ol p{lE suElpPuPO asaulqC raqp ol a^llppJ uollJBlsllps pluauluoll^ua raq61q 'secrlcerd pue slalpq qpaq puolllppjl lo luouJasJopua ra/'Aol lBql pazlsaqpd[q servr ll 'uolleuop poog fuelunpn o1 poululexa p uollEpl u! sean Alunutuoc uerpeupC osaulqC u! uotlellllsse lpJnllnc ;o ssacord aql ouetuo lro^ rtuoN [11slan;ug ryotr'ong BaA q!'l -lvunr-lnc AI|NnWWOC NVIOVNVC SSsN|HC V Nr NOtI\nrWrSSV oNV NotrvNoo oools ABSTRACT SESSION V
June 24, 1990 8:30 AM REGENCY EAST
CHAIR: Ruth Le6, M.Sc.N., Toronto CO-CHAIR: Ken H. Ng, M.D., Toronto
PAPERS PRESENTED:
A STRATEGY FOR COMMUNITY HEALTH EDUCATION. MONTHLY HOSPITAL BASED CHINESE HEALTH SEMINARS Amy Kwok Ghan, B.A.(Hon), M.S.W., C.S.W., Toronto, Ontario.
A CULTURALLY SENSITIVE MODEL OF PATIENT EDUCATION Edward A. Chow, 8.S., M.D., Priscilla Choy, R.N., B.S.N., M.P.A., and Angela Sun, 8.S., M.P.H., San Francisco, Galifornia.
HEARING HEALTH PROBLEMS AND PROMOTION PROGRAMS IN THE ONTARIO GHINESE COMMUNTTTES 1 98s-1 990 Sybil Lee, B.Sc., Toronto, Ontario.
ON LOK: REPLICATING AN INNOVATIVE HEALTH DELIVERY SYSTEM Catherine Eng, M.D. and Harry Lee, M.D., San Francisco, California.
70 YEARS OF LOVE . DEVOTION AND CARE Peter H.S. Tang, President, Pierre Boucher, Executive Director, The Montreal Chinese Hospital, Montreal, Quebec.
RESPONDING TO ACCESS IN THE SAN FRANCISCO CHINESE COMMUNITY Edward A. Chow, 8.S., M.D., San Francisco, Galifornia.
CHINESE AMERICAN AND OTHER ASIAN PACIFIC ISLANDER POPUI-ATION STATISTICS, 1980 WITH FUTURE PROJECTIONS BY DECADES Harry Lee, M.D., San Francisco, Galifornia.
54 99
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'elurol!lBC'ocslcugrJ ueS "H'd'ytl ''s'g'uns e1a6uy puP "v'd'l,ll "N's'g ''N'H lAoqc elllcslrd "o'uu "s'g prer p3 ^oqc'v NOllVCnoS INSIIVd lO I:IOOUU SA|I|SNSS A'l'IVUnIlnC V
'olEc qupoq uJalso/y\ pue uollBzlpldsotl burpreoar suolldacuocslul pue rBol aql p Llcnul aleululp .uaql dpq 111m acuapadxa oql lpql pedoq sl ll ol arec qllpaq lo A1;11q;ssacce aqt acupqua puB soc!ruas sil q1/n Alunuruoc asaulr.lC aql azrptltuel ol s! ule aq1 .{1;unuruoc osaulqC aql Jol slnol papnO qlln asnoH uadg ue sppq oslp geldsop ulapog oluolof aql 'r{ilunuuoc osaulqC aq1 ur uorlotuo.rd qllPall ul apr ueuodu! uB soruas puP pollacar lp/v\ uaaq anpq s:puluas oql 'Aluntuunoc aql u1 secep luauluto.td puP sacl$o AcueDB u! palsod pup saclllo s,Jolcop ol luas slatg pup qpau ssput aqt q6nolr.lt polPuluasslp s! s.lpultuos aqlbulpre6al uollerrlolul 'slool leuorlotuold queoq lnlasn ale pup panqlrlstp ' osls alB uollPulopl asuodsar flunu:u.toc pue slagqdrued qleaq puollpcnpa asoulr]C 'sulocuoc qlleat{ cg;cads enps dpq ol sudlclued aql Aq panp^ lsour s! rpuluas qcea lo pua arll le por.rad uolisenb 'saAllpluaseldar aql Acua0B Alunulutoc pue srolron lplcos 'soslnu 'slstuotlunu 'sprdaaqlolsfqd pue puo;pdncco 'slslplcads ;ecrpeu p uoltedlclued paleurp.rooc orll qpn qceordde fueu1p;cs1p -!lnu e q peluasa:d aJB sJPuluas aqg 's1ued;c1ued uorl lsenbal uo pup oluolol u; uollegndod asaulqC eql pbuor.ue punol sulano.rd qleeq uoutuoc uo paseq uasoqc ale scgdol ..reai( qynol s1 u1 A;par:nc tuB.r6o.rd oql qlrn asauoluec u! srpuluas q11eaq {;qluotu sazuebro sHcc aql 'Alunutuoc asaulqC oql Jol ualsAs olpc r.lllpaq aq1;o Alprqrssacce aql6unodu!lo urlB lpra^o aql qil/'^ paupls ser'n (gpg3) ac!ruas qllpaH prnllnc asaulqc aqr 'u/v\olPulqc s,oluoJol p aopa aql uo eare c16e1el1s p u! polBcol sr pldsog uraFaM oluoror oqr 'ouEluo'oluorol ''lh'S'C'7tA'S't/U '(uod'V'g 'uBqC lomy Iuy
suvNtuu3s HI'IV3H fs3NlHc ossvg'lvlldsoH AlHrNolluNorrvcnof Hr-tv3H AI|NnWWOC HOI A9srVUlS V HEARING HEALTH PROBLEMS AND PROMOTION PROGRAMS IN THE ONTARIO CHINESE CoMMUNITIES 1985-1990
Sybil Lee, B.Sc., Toronto, Ontario.
Since 1985, the Canadian Hearing Society (CHS) Multicultural Services has implemented three pioneer programs for the Chinese: the Toronto Chinese Community Outreach Program, Chinese Hearing Health Technician Training Program and the Chinese Community Hearing Health Promotion Program (Ontario). Chinese/English speaking workers were hired for these programs and trained to reach out to and educate Chinese people on hearing health awareness and provide interpretation for non-English speaking Chinese patients. Pamphlets and a video on hearing loss have been produced in Chinese and made available to the public. A Chinese direct telephone line has been installed and a Chinese qudiologist hired to serve the Chinese patients (and other cultural groups). A Chinese Advisory Council, made up of consumer groups, professionals, business persons and representatives of various Chinese community organizations has been established to act on a consulting basis and resource group. These programs were reviewed to obtain information on the hearing health of the Chinese in Ontario. From a random sample of 1609 hearing screening tests carried out in the province, it was obserued that 56% of Chinese seniors over the age of 60 failed the test, while 440,6 of adults over 40 failed. The failure rate was higher in Chinese males than females. Based on 168 clinical cases, the most common hearing problems were presbycusis, middle ear infection and noise induced hearing loss. Hearing loss in Chinese people from Hong Kong was mainly related to aging, whereas poor hygiene was a more prevalent cause in immigrants from Vietnam and China. From this suruey, it is apparent that hearing loss amongst the Chinese population in Ontario is not an insigniflcant problem. ln fact hearing loss is the largest chronic, fastest growing disability in North America because of the aging population and increasing noise pollution. lt is estimated that 100,6 of the Canadlan population (approximately 2.5 million people) have some degree of hearing loss. A continued effort is needed to educate the public about the potential hearing problems amongst them.
56 L9
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WAISAS AU3All3O HllV3H :lAllVAONNl NV gNlIVCl-Id3U :yo't NO 70 YEARS OF LOVE. DEVOTION AND CARE
Peter H.S. Tang, President, Pierre Boucher, Executive Director, The Montreal Chinese Hospital, Montreal, Quebec.
* The Chinese immigration in Montreal * The Montreal Chinese Hospitalfrom 1919 to 1990 * From newborn to eldedies * Geriatric care is our specialtY * A hospital for a community and a community behind its hospital * A Chinese Community in a French speaking world * Management problems? No Recruiting problems? Yes * The return of the Hospital to Chinatown * The Montreal Chinese Hospital and the future.
RESPONDING TO ACCESS IN THE SAN FRANCISCO CHINESE COMMUNITY
Edward A. Chow, 8.S., M.D., Executive Director, Chinese Heahh Care Association, Medical Director, Chinese Community Health Plan. San Francisco, California.
The United States today is studying the problem of accessibility in the health care system. As many as 39 million Americans may have limited access to health care due to being underinsured or uninsured. This is a particularly important problem in an ethnic community with many first generation immigrants, and monolingual Chinese Americans who are unable to obtain affordable health care. The San Francisco Ghinese community faced the problems of access nearly seventy years ago when those of Chinese ethnic background were not welcomed in any private hospital in The City. The Chinese Hospital was built by the community in response to that need. Over a decade ago, the community recognized a new, more subtle access issue. As employers moved towards alternative care models with limited access, bilingual and culturally sensitive providers were not accessible. lndemnity insurance also became more expensive, making it less affordable. In response, the Chinese Hospital and its medical staff developed alternative delivery programs to address these needs. Today, these programs serve over 7500 members and families in a bilingual, culturally sensitive setting. The hospital has sponsored its own health maintenance organization, the Chinese Community Health Plan. The medical staff has formed a 100 member individual practice association, the Chinese Community Health Care Association (CCHCA) which provides the bulk of medical service to these members. Both the hospital and the CCHCA are network providers for a regional health plan. Certain key elements have led to the success of this bilingual, culturally sensitive alternative health care program. These include: Community commitment by a major health facility; Community commitment by physicians; Development of an appropriate physician structure; Joint venture for hospital and physician services; Meeting the perceived needs in a definable market; complementary, not duplicative, programs. An important challenge to health access is making culturally sensitive health care available and affordable to the monolingual Chinese population. This is a model that responds to this challenge.
58 69
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aql rol eredard ol pup 'snsuoc 0g6r oql ur pailruap! sdnorb cluqla rapuprsr cllrcpd pup uelsv JFo.ffif,l clulouocoolcos pue c;qdel6or.uap aql qu/'i\ JPllll.uBl A1qonO:oql aurocaq ol Apea pa^our 'salBls pallun aql u! uollsndod 13y aql u! luauono:dur1 snlsp r{llpoq rol a}econpe ol9g6t ul pol1slne1sa 'uogle4ue6to d;qsraquraur gord-uou 'puollpu e sB '(:UW) cul 'unrol qusaH uecpotlv uelsv aql 'parlncso '81861 a^Bq ll!/,^ sabueqc tuecgluD;s 'Elep snsuac 066 t aql ;o sts{pue uodn u! poseopl etam (14y) sueclraurv.rapuelsl cllced puP suelsv uo Blep,snsuac 0861 solBls pouun aql lo soHPl pallPlao
'slurollleC'ocsgcuetg ues''O'llI'aa1 Lue;-;
SSOVC:|O Ag SNOIICSTOUd 3Hnlnl HIUIA 086r 'scEstlvls No[\nndod utoN\nst clJlcvd Nvtsv HsHIo oNV NvcluSullv SsSNlHc ABSTRACT SESSION VI
June 24, 1990 8:30 AM REGENCY CENTRE
CHAIR: Cindy Chang, M.D., Vancouver CO-CHAIR: Tak S. Lau, M.D., Toronto
PAPERS PRESENTED:
PRIMARY NASOPHARYGEAL CARCINOMA. REPORT OF FOUR SELECTED EARLY SYMPTOMATIC CASES AND USE OF A NEW INVESTIGATORY TEC|-|NrQUE (NASOPHARYNGAGRAM) Tong K. Lye, M.8., 8.S., Toronto, Ontario.
PROLIFERATIVE BREAST FLUID EPITHELIUM AND CERUMEN PHENOWPE AMONG U.S.. AND FOREIGN.BORN ASIAN WOMEN M. Lee, N. Petrakis, M. Wrensch, E. King, R. Miike, San Francisco, Galifornia.
THE INCREASED INCIDENCE OF CERVICAL CANCER AMONG ETHNIC CHINESE CANADIANS IN B.C. AND THE USE OF A SCREENING PROGRAM Frances Wong, Chris Archibald, Richard Gallagher, Andrew Goldman, Pierre Band, Diane Raynor, Joanne Moody, Vancouver, British Golumbia.
SURVEY OF CANCER CASES SEEN AT A UNIVERSITY HOSPITAL AMONG PATIENTS OF ASIAN DESCENT Nefson l. Adamson, M.D., Michael P. Thirlwell, M.D., Montreal, Quebec.
SILICONE MASTOPATHY PRESENTING AS A BREAST PSEUDOMALIGNANCY Ellen Warner, M.D., Michael Lipa, M.D., David Pearson, M.D., Ruth Lee, R.N., and Harold Weizel, M.D., Toronto, Ontario
TRANSCULTURAL HEALTH CARE FOR ETHNIC CHINESE ONCOLOGY PATIENTS Amy Kwok Ghan, B.A.(Hon), M.S.W., C.S.W., Toronto, Ontario.
60 t9
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'Buroulcrec pabfueqdoseu;o dn-nnolpl pue srsouberp pclullc 'suolsalApea p uo{raolale.tncop all u; dpq o1 pedopnap se^n ujer6e0ufueqdoseu lsJlulolpup 'pc;qdel6odol y '7o08 upUl oroul lo alpr arnc p q1/n lualpcxa s; Acueu0lleu slqt:ol sgsoubo.rd aql 'AUEo popalap s! uolsal fuetrlpd aql ll 'uolssncslp pue uollepasald Jol palcaps uaaq alpq sasec {pee {pn;1epr l}ol 'dno:6 slql uoll pue (066!-ZZ6t) uoltelndod esaurqg oluolol aql u! uaas uoaq o^pr.l sasH) QtZ raqynl V '696! pue Z96t uaa^ laq e[e1ey1 u! osaulq3 aqt Dulpal;e puloulcrpc leabufueqdoseu fuarpd ,o saspc OOe upql a:otu Dulsou6egp 1o ecuepadxa aql ppr,l ser.l ror.lme aql 'oUBluO'oluorol "S'g "g'UI'aA1 'y 6uo1
(nvucvcttluvHdosvN) fnorNHc3l AuorvgusfnNt /naN v ro fsn oNV s3svc cllvwordn^s A'lu\t:l o3rc3'l3s unoj Jo rHodsu 'vuuoNrcHvc]vS9AHVHdosvN Auvu!ilud THE INCREASED INCIDENCE OF CERVICAL CANCER AMONG ETHNIC CHINESE CANADIANS IN B.C. AND THE USE OF A SCREENING PROGRAM
Frances Wong, Chris Archibald, Richard Gallagher, Andrew Coldman, Piene Band, Diane Raynor, Joanne Moody, Vancouver, British Columbia.
All incident cancer cases diagnosed in British Columbia are recorded in the B.C. Cancer Registry. The dala for the period of 1985-1988 inclusive were efiracted for analysis. A total of 706 cases were diagnosed; the ethnic origin was known for 660 cases from which zt6 were Chinese. Annual incidence rates of cervical cancer were calculated for the ethnic groups of Chinese, native lndian and others (referred as caucasian), based on the denominator data obtained from the 1986 Canada Census data. lncidence rate increased slightly with age in the caucasian group: 12.9/100,000 in 15-39 year olds to 16.5/100,000 in >55 year olds. In contrast, the rate increased dramatically in the ethnic Chinese group from 6.1/100,000 to 61.9/1000,000 for the same age groups. Medical charts of 34 of the rt6 ethnic Chinese cases were reviewed. Nineteen had never had any screening tests. To examine the participation of the screening program by the ethnic Chinese women, the 1986 cervical smear files were examined. The estimated percentage of ethnic Chinese among women having cervical smears was less than the percentage of ethnic Chinese among the general female population (1.72oA versus 4.20oA for all women > 15 years). Questionnaires to evaluate the knowledge of ethnic Chinese women about the Pap smear screening program were distributed in two Chinese community agencies in Vancouver. Ninety-two were completed and the most common reason for not ever having a screening test was ignorance of the test. The significance of these findings will be discussed.
SURVEY OF CANCER CASES SEEN AT A UNIVERSIW HOSPITAL AMONG PATIENTS OF ASIAN DESCENT
Nelson l. Adamson, M.D., Michael P. Thirlwell, M.D., Montreal, Quebec.
The recent influx of people from Hong Kong and other parts of Ash to Canada may have an impact on the case mix seen at certain hospitals. To assess any change in the number and types of oncology cases seen, we reviewed all patients entered on the tumour registry at a university hospital. The diagnosis of all patients with Asian surnames was determined over a 10 year period (1980€9). The number of cases registered each year averaged approximately 1100. Cancers of the lung, breast, colon, rectum, and prostate represented 45o/o of the entire group. These tumour types were under represented in the subset of patients with Asian surnames. Carcinomas of the esophagus, stomach, liver, head and neck were better represented in this group. The number of patients of Asian descent entered during the survey period remained cgnstant at about 1.60,6 each year. This type of analysis could be useful for predicting the health care needs of a population undergoing rapid demographic change.
62 e9
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ACNVNCnVnOOnSSd rSV3U8 V SV 9N[NSSfUd AHrVdOlSVlfl 3NOCtltS ABSTRACT SESSION VII
J,rne 24, 1990 8:30 AM TUDOR STUART
CHAIR: Simon Huang, M.D., F.R.C.P.(C), Vancouver CO-CHAIR: Stephen Chow, M.D., Toronto
PAPERS PRESENTED:
PATTERNS OF ALLERGIC DISEASES AMONG CHINESE IN THE SAN FRANCISCO BAY AREA: 1. Onset and nature of allergic symtoms from date of immigration. 2. Most common allergens incriminated. Enoch C. Y. Ghoi, Benjamin C. M. Choi, Eugene Y. C. Choi, M.D., San Francisco, Galifornia.
THE SPECTRUM OF RHEUMATIC DISEASES IN THE TORONTO CHINESE Peter Lee, M.8., Ch.B., M.D., Toronto, Ontario.
SYSTEMTC SCLEROSTS (SCLERODERMA) rN THE CHTNESE. REPORT OF A CASE SECONDARY TO BREAST AUGMENTATION Peter Lee, M.B., Ch.B., M.D., Toronto, Ontario.
CoMPARTSON OF THREE SYSTMIC LUPUS ERYTHEMATOSUS (SLE) CR|TERIA lN CHINESE PATIENTS: CHINESE I (Cl), CHINESE ll (Cll) AND ARA CRITERIA D. Hu, N. Zhan, G. Bombardier, C.H. Chang, and J. Yian, University of Toronto, PUMC, Beijing, China, and McMaster University, Hamilton, Ontario.
RHEUMATOID ARTHRITIS IN THE VANCOUVER CHINESE Simon H. K. Huang, Vancouver, Ganada.
VASCULITIC PERIPHERAL NEUROPATHY AMONG CHINESE CANADIANS. A REPORT OF TWO CASES Joseph Y. Chu, M.D., F.R.C.P.(G), Toronto, Ontario.
MYOPIA IN THE CHINESE AND ITS TREATMENTS Shiu Y. Kwok, M.D., Ph.D., Nikkie Ho and Wendy Kwok, San Francisco, California
64 99
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'pateu!u!!rcu; sua6lagle uouluoc lso11 .7 'uog1er6;ulu! lo alBp uorl suolruls c;6la11e lo alnleu puB lasuo .t :V3HV AVS ocslcNvul Nvs 3Ht Nt fs3NtHc cNol,ltv s:tsv3sto ct9H3-l'lv Jo sNu3ttvd sysTEMtc scLERosts (SCLERoDERMA) rN THE CHTNESE. REPORT OF A CASE SECONDARY TO BREAST AUGMENTATION
Peter Lee, M.8., Ch.B., M.D., Toronto, Ontario.
Systemic sclerosis is an uncommon collagen disorder. Of 250 patients enroled in the Wellesley Hospital Scleroderma Clinic between 1979 and 1990, four (1.60lo) were Chinese. The pattern of disease in these four patients was not different from that seen in other ethnic groups. Repofted here is a case of systemic sclerosis occurring secondary to a breast augmentation procedure.
f n 1950, aS2year old Chinese woman underwent breast augmentation with paraffin injections in Hong Kong. She developed severe local granulomatous reactions resulting in severe pain and skin ulceration. Bilateral rnastectomies were eventually carried out. Three years after the initial procedure, she developed Raynaud's phenomenon which led to the subsequent partial or complete amputation of four fingers. She was first seen in the Scleroderma Clinic at the age of 65 years and had a definite diagnosis of systemic sclerosis based on the following findings: sclerodactyly, telangiectases, extensive calcinosis of her chest, esophageal hypoperistalsis, impaired CO diffusion (28% predicted normal) and a positive test for antinuclear antibodies. Death occurred at age 71 years from an infected toe, ascending sepsis and pneumonia. The cause of systemic sclerosis is unknown but the disease has been reported to occur following breast augmentation with both silicone and paraffin. The possible disease mechanisms will be discussed.
CoMPARTSON OF THREE SYSTEMTC LUPUS ERYTHEMATOSUS (SLE) CRTTERTA rN CHTNESE PATIENTS: CHINESE | (Cl), CHINESE ll (Cll) AND ARA CRITERIA
D. Hu, N. Zhan, C. Bombardier, C.H. Chang, and J. Yian, University of Toronto, PUMC, Beijing, China, and McMaster University, Hamilton, Ontario.
Three sets of SLE criteria are currently used in China. We compared their sensitivity (sens), specificity (spec) and'positive predictive value (pos PV) in 1,393 Chinese patients from Beijing, Shanghai, and other cities. Half of the patients interviewed had SLE and half had other rhematic diseases (RA, DM/PM, PSS, SS, Behcet's AS, Still, Takayasu's). Overall demographic characteristics included: female/male = 5/1. SLE patientswere slightlyyoungerand included morefemales, but had similar disease duration. Among the 3 criteria, the ARA had slightly lower sensitivity, but had the highest specificity and predictive value. The Cll criteria had the lowest specificity and predicative value. The Cl criteria had the highest sensitivity, but also the highest percent of missing values (both the Cl and Cll criteria required the presence ol immunological tests which were frequently not available in current practice). Receiver operand characteristics (ROC) curve analysis which compare sensitivity and specificity for different cutoff points (from 0 to 14 positive items), indicate that the 3 sets of criteria performed well, but that Cl and ARA criteria are'slightly more efficient than the Cll criteria. This study validates the use of the ARA criteria in non-Caucasian population.
Criteria Total # Ie!d_#_al o/o Ot of ltems Pos.ltems Sens Spec Pos PV Missing Data ARA 11 3+ 93.1 96.4 96.6 2 4+ 72.3 98.6 98.3 cl 13 3+ 97.4 93.7 94.4 11 4+ 88.0 98.0 98.0 crl 14 3+ 96.8 86.9 88.9 7.8 4+ 89.2 94.6 54.7
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SSSNIHC USAnOCNV 3Hr Nr SIilUHTHV OIOTVUUnSHU MYOPIA IN THE CHINESE AND ITS TREATMENTS
Shiu Y. Kwok, M.D., Ph.D., Nikkie Ho and Wendy Kwok San Francisco, California
It has been generally accepted that there is a high prevalence of myopia in the Chinese ethnic group. A study of 3&11 Chinese patients in our private practice shows 1540 (44.5%) are myopic with refractive error2-1.00 D. The age distribution varies with the ma 68 69 'eluroilleC'ocsgcuetl ueg ''o'|ru 'lotlC 'O 'A aueEnf ''q'tld 'aa'l 'C uouen ''O'lrI 'u!l 'l oeqC '!oqC'nl 'C ueutelueg 'lotlC 'A'3 qcouS cNrrsSl AHlflNoHlds 9Ntsn NSuqltHc NvctuSt/uv Nvtsv'tvuluoN Nt NotrcNnJ AuvNol/u'lnd 'caqanO 'leerluotN ';enueu3 u!/r^Jl 'ua/V\ n/n lqs sfrvrs o3ilNn 3Hr Nl slllgvg 3ilH/n oNv 3s3NlHC JO SNUSITVd IHOIS/N HIUIS NI S]CNSU3JJIq 3HI IO SISA1VNV NV 'e!uJolllBC'ocsgcuerg ueg '!n'l parJ'!'l puolufieH'ueqC'n ouef '886t JO HVfA:tHl UOJ'tVildSOH AI|SUSNNn OUOJNVTS ,)S|U-HC|H,' oNV 3sSNtHc ,,xstu-/nol,, fHl N:l3n^l3g fHr ocstcNvul Nvs lo]vildsoH -lVIVNlufd SSl lOCrnO 'lVMlUfd JO NOSlUVdtrllOC V :SCllSlIVlS 'oueluo 'uolduerg "O'l,U'uosqog'UU"l'/n ''cS'O 'n!S'O'I ''S'g ''g'l,I '6una1 'O'y'V ''S'g ''g'U[ 'e|N.H'C tllguuay SINVJNI NUOgtnSN :lsllNll{C Nl HICNS'I SU0SSIJ'lVUgSdlVd 'IroA meN '>lro^ meN 'le la ''g'6ue1y1 ''f'O 'fipeoC ''f'd 'eulprelC u:lrNf c Hl'lv3H AItNnUltUuOC ]S3N||{O NVSHn NV Nl Vll'I3SS\nVHl UOI CNINf3UCS 'caqano 'leerluouu ''N'u 'ptolpeu el|als ''l'u 'ny uoo11y [o ''o']ttl 'etooyg fiqtoroo;'ttt'c ''o'l,u 'ueA[oUU 'f Aaluets ''lrT'C ''O'l,U 'rloUU ,tlatpuv ''lrI'C "O'U[ 'd;,tr'ueqg ocllv s3l'llmvl cNuvfds-SsitNtHc uol ultvucoud lvrvNlufd cHlcsds' sHnr'lnc :C3LN:lS=lUd SUfdVd oluorol ''C'Ut1 'pgag'g 6u1 :UIVHC-OO pe4uot l ''UI'9 ''C'ytl 'Iohl /v\elpuv :UIVHC YTOOU INIHd NV OE:8 0661 'tZ aunr iln Norssfs rcvurssv CULTURE. SPECIFIC PERINATAL PROGRAM FOR CHINESE-SPEAKING FAMILIES Alice Chan-Yip, M.D., C.M., Andrew Mok, M.D., C.M., Stanley J. Moyyen, M.D., C.M., Dorothy Moore, M.D., Oy Moon Au, R.T., Stella Radford, R.N., Montreal, Quebec. In a pediatric practice in the Chinese community, prevalent health problems were identified. These included low breast feeding rate, suboptimal nutritional practice during pregnancy and infancy, post-panum depression and the lack of awareness of health promotional services in the community (e.9. prenatal courses and hepatitis B and thalassemia screening). We therefore developed a unique, culturally appropriate program to promote health education and improve accessibility in these areas. The program includes: 1. Family-centered child birth education. 2. Breast feeding promotion and education. 3. Enhancement of post-partum support in liaison with the regional home visiting nurses. 4. Information sessions and support on: a. Hepatitis B screening and its prevention. b. Thalassemia screening and the advantages of antenatal screening. The presentation will illustrate the comprehensive development of this multidiscipline program in three phases: 1. Program planning. 2. Community promotional campaign. 3. Evaluation of its effectiveness. Rational planning, improvisation according to the changing needs of the target population and appropriate funding from either private or public sources are essential in the development of such a program. SCREENING FOR THAI..ASSEMIA IN AN URBAN CHINESE COMMUNITY HEALTH CENTER Giardina, P.J., Coady, D.J., Wang, G., et al. New York, New York. Mainland China estimates an alpha thalassemia carrier prevalence of 3 - 7% based on cord blood samples and in certain areas of Southeast Asia the incidence is as high as 20-30% while the incidence of beta-thalassemia trait is from 5-10o/o. The Chinatown Health Clinic is a community health center providing primary care services to the indigent Chinese immigrant community in New York City. Between October of 1985 and December of 1989, 1902 pregnant women were screened for thalassemia trait during their first prenatal visit. Hemoglobin (Hb), hematocrit and mean corpuscular volume (MCV) were measured. When the MCV was less than or equal to 80 cubic units hemoglobin electrophoresis were performed on the subject and her partner. 4.8% of our screened population has alpha thalassemia trait, 3.0olo has beta thalassemia trait, 0.05% has HB E disease and 0.05 has Hb H disease. Genetic counselling was provided for the subjects with trait. Eight couples identified at risk for having a homozygous affected fetus were offered genetic counselling and prenatal diagnosis by amniocyte or chorionic villus sampling DNA analysis. In 1990, the Genetics Seruices Education Prograrn was developed to train clinic personnel to provide genetics information as pan of piimary care seruices. The 7.9o/o frequency of the thalassemia gene within our study population supports the need for continued efforts to provide education, screening and counselling regarding this genetic disorder. 70 IL 'paraplsuoc aq lllls lsnu slPildsoq luarallp fua^ o,\rl aql lB suraF^s Aranlpp lplpuoau 6u11e1cunue sacuaJo$lp 'snUI '(ZoZt'6t) suoltcesg buprnolpl sAets pldsoq pa6uop:d pup '(7otl'0> 's^ %gt'tg) suollcerye urnncen qU/'A polelcosse seulolptuaqoleqdec '(%le'O> sA Zogg'gz) soga^lpp snoaueluods prnlsu qqr'n Oulrncco sqruaqy(cApd se gpm sB '(yo9o'0 'sn 7o06't t) suolpe.rxa ulnncp^ pue (propets le %99'z I 's^ o/ogv'ez) suolpas-C Acue0laua p acuaplcul raq61q E aleclpu! pldsog asoulr.lC le para^ocslp sarnlpal opelou aql 'JaAo^ oH 'spldsoq oA l oql uaon 1aq sacupppn tuecl1ubls p acuasqe ue polprlsuor.uap (sager ftpglotu pue Ailpuoul 's1q6;ann qulq 'salocs rebdy ''6'a) peugelqo sanlel uecrad pup pozpetuurns arai sloaqs fuan1pq 'fua4pp snoaueluods pJnlpu puE 'uollcelua ulnncen'sdaclo; 'uollcos-C Acuebreuta '(uo;1cas-g) uollcos -ueaJpsoeC leadal :apouJ r{.ran;pp aql ol anlleloJ paplllpqns aran scllsllpls leleupad aql lalul ol pautelqo ssnls^ aql 'spldsoq Du;puodsaJroc aql ol anllppl srlulq osaql0urplnlp ol uoluppe ul 'uollenils olPc fueluat e 6upnsu; uoltemdal cluJappcp sU qlf'A pJotugls 1e araqdsorule ,21spq0gq,, aql uloJl U alptlualagp plnoqs snlPls ,)lsu-,1,\o1,, su 'ajolajeql 'alec fueurpd u! uollelluacuoc P qu/n fi11cel pe;A1s-Allunuuoc peseq-41;ec;uqla ue sP pouauo s! ocslcuBlJ uPs lo pldsog osaulqc eq1 'sleldsoll o/vu aql uaa^qaq uospeduoc p alenurls ol lapJo u! 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While the low birth weight of U.S. Chinese is less than that of whites, the Chinese mean birth weight is also less than whites. The possible reasons for this disparity were investigated using the 1983 U.S. National Birth Tape. There are relatively fewer Chinese babies at both the low and high e)dreme values of gestational age and birth weight. The comparison of the distribution of risk factors between Chinese and whites, the univariate, stratified and multivariate analyses for low birth weight and mean birth weight in Chinese and whites indicated that the differential influence of much larger percentages of teenage and unmarried mothers in whites on low birth weight and mean birth weight might be a partial explanation for this disparity. Common maternal risk factors had less influence on the birth weight of Chinese babies compared to whites. Further, it was also shown that early fetal growth of Chinese babies tends to be more rapid than that of whites. These two findings may be a partial explanation for the better infant mortality experience of Chinese babies in the United States. This analysis, as well as work by others, suggests that the LBW rate is primarily influenced by environmental factors while average birth weight is more influenced by genetic factors. PULMONARY FUNCTION IN NORMAL ASIAN AMERICAN CHILDREN USING SPIROMETRY TESTING Enoch C. Y. Choi, Benjamen C. M. Choi, Chao l. Lin, M.D., Marion C. Lee, Ph.D., Eugene Y. C. Choi, M.D., San Francisco, Calilornia. Normal standards of pulmonary function presently used are based almost entirely on children of white race, as published b), Polgar, et al (1), using regression curves and prediction equations to adapt for pediatric use for all races. Hsu, et al challenged this presumption and reported differences between Mexican-American, white and black children (2). Neukirch, et al found significant differences between European, Polynesian and Chinese school teenagers in Tahiti (3). We studied 91 Asian American school children (50 girls, 41 boys; age range 10-18 years) living in San Francisco and the Bay area. The differences between the Asian American children and their caucasian peers were not significant. Equations for Asian American lung functions (FVC, FEV-1 and FEF25-75oA) will be presented. References: 1. Polgar, G., Promadhat, V.: Pulmonary Function Testings in Children. Techniques and Stands. Philadelphia: WB Saunders Company, 1971. 2. Hsu, K.H., et al: Ventilatory functions of normal children and young adults Mexican-American, white and black. J Pediatr 1979; 95:14-23. 3. Neukirch, F., et al: Spirometry and maximal expiratory flow volume curve reference standards for Polynesian, European and Chinese teenagers. Chest 1988; 94:792-798. 72 EL pup sLpnllaILalu! pup uauJaqsrJ 6uoue lseq6rq spM li 'slcalqns osaqo u! ;aq61q qrnul sem of,ualp^ard aql 'applap q1/ aql ul 6u rlead 'abe q1 1r,r ,( ldreqs psopaJlu r l l ' OZ Jo a6e aq1 Japun arpr sp^{ salaqp!0 'I:80'I sprl orler aLpua1:aLpl^l aql '00/0 60'9 sp^,1 i(rlunoo at.1l u! alua;.ena;d lLpra^o aql pup 00/0 g0't sem 6uop6ueng u! alualenard aq1'noqzlnS ul 00/0 Ig'I Jo tsamoI aql o1 e1x6u1p u ! 0O/0 Z9'Ol Jo 1saq61q aql uorJ pe6uer af,ua Lp^ard eql lpr.l1 si/ror.ls z alqpl 'u161.r0 upH Jo,(11;oceu aq1 ,pa1pn1s alam slcafqns /gg'tgt Jo LpXol V 'pultll ur sa!1!l e6;e1 pup saculnord tI ut fan;ns snllLIail salaqer0 e pal]npuor (7) lL-anx 6uoq7 (y) 'sarpnls t uroJJ sllnsoJ aql Xuasa;d o1 aIlL plnom I suerspf,np3 pue asaulqJ uaa14laq su0!Xpl1 lduor lrloqprp pup salaqplp Jo salpJ arualp^ard aql u! saluaraJJrp aq1 alprlsnLLr oI ' (z'r) ag'o st putqJ u! af,ualpAaJd aq1 pup plsV ut lpql sorulX t sr pf,rJauv N ul af,uaLp^ard a,lt 'I alqpl ur. u^toqs sV '(4OAtru) luapuadap -utLnsu!-uou aJp s1ua11ed crlaqprp Jo fllrofeu aqI 's,(anrns uo r.lp lndod ruoJJ pau rpXqo aJp salpu t Xsa olpJnf,f,p aJohl 's1;oda.r ospf, rxoJJ paA!Jap aJp faqt uaqM fLLelcadsa paXpurlsaJapun fllensn aJp salJlunol luaJaJJlp ut saXpJ af,uaIplaJd aqI .ua1qo.rd ap !,'1- p LJor{ e pup uo ! 1t puot snoua6orelaq p s ! salaqe !0 '6uoy 6uog 1o r$;sran;u1 'au;c;pay1 lo pauyeda6 '6una1 'I'I'U SS3N|HC 9NOUltV S3r38VtO JO SSUnrVSJ'tVtCSdS 3UIN3C 8 ISV:I ACN393U 'l'1'V 0Z:01 06i61 'tz aunf Sunrc3l tvtcSds lowest among peasants. Even within the same region e.g. Ningxia, th'ere v'rere marked di fferences i n preval ence among di fferent ethnic groups. It was higher. in the Mosl'ims (19.46 0/00) than Hans (11.46 0/00). In Neigmongol Hans had higher prevalence (7.80 0/00) than Mongolians (1.86 0/00). Thjs extensive survey in China confirms the findings in other studies eg. S'ingapore and Pacific Islands wh'ich suggest that genetic and environmental factors are important 'in the pathogenesjs of d'iabetes. The following conclusions were drawn from the survey in China:- a) Dl"l preva'lence is lower in China than in many other countri es . b) Even with'in the same country it varies wjde]y c) It is higher in urban than rural areas. d) It correlates with ige, sex' weight, occupat'ion, nationality and regional factors. Insulin Dependent Diabetes (IDDM) is much less common than NIDDM worldwide. It is rare in most As'ian countrjes (3). In Hong Kong, IDDM constjtutes less than 37o of the total diabetic population compared to l07o in European countries. It js jnteresting to note the HLA associatjons wjth IDDM in different ethnic groups (4). Among Caucasians, 'it is associated wjth DR3 & DR4, jn Chinese it is associated with DR3 & DRt^lg and in Japanese with DR4 and DRW9. (B) In 1975 a multjnational study of vascular disease jn Diabetes (MSVDD) was undertaken with the support of trHO. The results were publjshed jn Djabetologia jn 1985 (5).A total of 14 centres from 3 continents participated 'in the study. 3301 men and 3394 women between 35 and 54 years of age were examined. Hong 74 9L auss aql s ! aoua len.aJd e1o,r1s J laql lnq 'aseas 1p lassal 6aI pue uo!l]JpJul [elp;erofu'eu16ue ;o acualenald lsemoI aql a^eq s]llaqp!0 asauedep pue asau!ql'Z 'suo!XeJ1lduroc Jplnf,spn sno!JpA aql roj salpJ arualela;d xuaraJJlp o^eq sa!J1un0r luaJaJJlp rxoJ} salaqe!0'I -:aJail r(pn1s [Puo!leut1lnu aql uoJJ suo!sn[]uol 'palradxaun sPA of1o1 pue 6uo; 6uog uaanlaq fqledorqdau pue ,tqledoulXaJ 'aJalas Jo aruelenald eqX u! frueda.lrstp slr,ll '(g 'g 6lf ) a6e"lane gHfi Jo lprfl upr{l Jai,lo I Jo aues aq1 sen 6uo.;; 6uop u ! af,ue lenerd aql pue )0AS pup l0AS Jo selruanbarl a6eranp aloqp f11eraua6 pelrodar o,t1o1 Xeql alou oX 6u11sara1u1 s! 1I '(lgnS) afe Jo oseastp lassa^ [lsrrs Jo lprlX ueqt laleer6 s ! (l0nS) faup11 Jo asps !p Iassa^ [ Lprus JoJ sarluer tPnp!^tpu! uaanlaq uollPlJsA aql 'serluac [[e u! uo!lpJnp lllaqptp rll!r{ sosEoJru! 'saseaslp lassa^ tlprxs [EuaJ pup leutleJ z[A suo!18]11dtnoc Je[nf,sEAoJJllu Jo a]ualelald aql '(l '6tf) suPlssf,nPJ eql sp luolxa euEs aqX ol 6uo) 6uo;1 u! asaulql aqX pallaJJe uolsualradfq pue oloJls pupq Jeqlo oqX u0 'aspaslp Jplnf,sp^ leraqdl;ad Jo saleJ af,ualelerd ;anoI peq s1ua11ed ]paqetp of1o1 pue 6uo;; 6uog 1eq1 s^,ror4s t 6tJ ',f 1re LlutS '(sa1euatr u! tJag ul %g'OI pu? salpueJ 6uo;6uog ul %t'0 I],1) gll pue arleuuollsanb fq uo!llJpJut t?!pJelor(u pue s1.to1cad eu16ue Jo salpJ ecualenald Jamo I ppr.l o,{101 pup 6uo; 6uop lptlX rlor.ls Z pue I 6lJ 'slsal aulJn puP p00[q pup uo!leuJupxo (arleuuollsanb 1ec1s,tqd p 30. 6u!lslsuot,aJluaf, 6ulled1c11red qrea rtq pa^{o[[oJ spn 1oco1o.rd prppupls V '(g atqel) aseulq] [[p aran sltrafqns eq1 pue saJluar bu11ed1r11red rqt Jo auo sem 6uo; ft as tllH0 average. 3. Chjnese and Japanese dj abetics have I ower serum cholesterol and BMI than WHO average. 4. There js a strik'ing and inexp'licable djfference in the prevalence of severe retinopathy and nephropathy between the Hong Kong (Chinese) and Japanese samples. (C) A survey was conducted jn China (Beijing and Tianj'in) 'in l98l usjng the same protocol as the MSVDD for 610 subjects (6). It showed the same low prevalence of coronary heart disase as Hong Kong and Tokyo but much higher prevalence of proteinuria (Table 4). This disparity js unexpected and cannot be explained by the known risk factors. What are the possible explanatjons for the low prevalence of coronary heart d'isease among Ch'inese diabetjcs. Table 5 shows the Standardjsed Multjvarjate Logist'ic Regression Coefficjents between certajn risk factors and dependent varjables jn the tllH0 Study. Whereas stroke was signifjcantly correlated wjth age and systolic BP, coronary heart disease was sign'ificantly correlated with Body Mass Index (BMI) and serum cholesterol. Table 6 shows the mean values for BMI, systolic and diastoljc BP, cholesterol and smoking habits in the r^|HO study as a group, London, Berlin which has the highest prevalence of coronary heart disease and Hong Kong, which has the lowest prevalence. It js noted that whereas systofic and djastoljc BP, and smok'ing habjt were the same in these 4 groups, BMI and cholesterol were much lower jn Hong Kong. Apart from genetic factsrs, these 2 parameters are related to ljfe style and dietary habits. Table 7 gives the total Calorie, CHO, protein, fat, and cholesterol content of average 76 LL .uO!Suouad/cq 'suB!sP3nPJ SE aSEaStp [0SSaA [[PruS pUE OIOJlS Jo asuals^ord oups srll o^pr{ s]llaqetp asaulq3 aql Ja^afioH 'lalp esaulql aFBroAE up Jo 1ua1uo3 loJ.also[oq] pup t!"lo[pJ JailoI oqx pup Il,lg roxrol aql se [[aA sp 'sJoX]pJ r11euo6 ol anp flqeqo"rd s1 oluaJaJJlp s!r,ll 'sloafqns ?llaqelp-uou esaulql atll u! suolllpuol osaql Jo aluatEAaJd uoI aql l]alJaJ rtlqeqo;d r4rlqn aseas!p Jp lnf,sel leraqd lrad pue aspos ]p 1"teaq rt"rluo"roc Jo aoue lenard rano I e a^pq os [p f,atll 'sue lssf,ne] uerll 'N00I pup N00IN qXoq 'selaqegg Jo alualetald lamoI aAEq osoulr{],uolsnLtuol itl 'lanbuuq asaulqf, aq+ JoJ ples aq Xouupf, orues aql JaAaAoH 'loJalsa[oqJ pup IEJ .u1a1o"rd .sa1lo1ec lelol u! JafloI qf,nur st JaIXEI aql 'slatp asau!q] pue ueedorn3 Referehces l. Leo P Krall. The Wide World of diabetes. In World Book of Djabetes in Practice, edited by L R Krall, volume 2,209-?12, 1986, Elsevier, Amsterdam - New York - 0xford. 2. Zhong Xue-l'i. Diabetes me'll jtus survey 'in China. Ch jnese Medical Journal, 95: 423-430' 1982. 3. P Zimmet and H King. World trendsin djabetes ep'idemiology in Wor"ld Book of Diabetes in Practice, edited by L P Krall, Vol 2,38-44,1986, Elsevier, Amsterdam - New York - 0xford. 4. B R Hawkins, K S L Lam, J T C l4a, L C K Low, P T Gheung, S t,l Serjeanbon and R T T Yeung. Strong association of HLA DR3/DRW9 heterozygosity wjth insul in dependent diabetes mel'fitus of early onset jn Chinese. Diabetes, 36: 1297- 1300, 1987. 5. Prevalence of small vessel and large vessel d'isease jn. djabetic pat'ients from t4 centres; The World Health 0rganisation Multinational Study of Vascular Disease in Diabetjcs, prepared by Diabetes Drafting Group. Diabetologie (Supplement) ?8: 615-640' 1985. 6. Beijing and Tianiian Diabetes Research Corporation Group. Study of the cardiovascular complicatjons in diabetes mellitus according to WHO protocol. Chjnese J Int Med' ?0: 513, 1981. 78 6L 'lpurlulrx E laJalas I lxas pue aJluaf, fq rtaupll aql Jo aspas !p lassal [ [?tus JoJ a]ua lpnald 9'6U 'unlpau $l taranas | :xas pu? aJlual rtq arta oql Jo 'esEas!,p, Lassaa. ltetus -loJ , a]uelplald 9 '6tJ ,. ,'uolsg€Xradfqg[!l !eloJlsl 'xas puP alluao r(q. uo1sua14ad,tq pue ,,alGrls JgJ af,ua [E^a"td t '6H 'uo!lpalpnp[] lualllulralul B luollelndue ! 'xas puP aJlual ,{q eseaslp 4?[nf,s?A 6a1 lol af,ualP^aJd t'6tJ alqlssod OlE !alqeqord ,fueuo"roo gJl% "xas pup soJluar r(q elqeqord freuo"tol gll pup ,a[qlssod g3l, 'sa1ro6a1e] gll JoJ af,ualp^aJd z '6tJ 's1"ro1cad eu16ue [1 !uo11ore;u! Le!prp]ofu alqgssod @ ' 'xes pue aJlual fq elep 'a;1euuo11sanb uoJJ uollJJeJu! 1e l pleoofru pus s 1"ro1ced eu 16ue JoJ af,ua IpAaJd I '6U Fu56ET Table I l,forld Pre$alence of Diabetes (/") N America 4 S America 3 Africa 2 Europe 4 Australia (+ N Z) 2 Asla (except China) I *ch i na 0.6 Leo P Krall in World Book of Diabetes in Practice Vol. 2, * Zhong Xue-li, CMJ 95: 423-430, 1982 8o t8 60'9 lel0l I9'I noqz !n9 /8'8 lxbueng 80't 6uopOueng 9r'8 6ue 1 fn1 96'9 6ue 1 feqT Is'9 6uopueq5 /0't !xuPqs I9'9 nsuP9 /9'9 1 eqbu 1[ z9'01 e lxbu 11'1 6I'€ 1o6uou1ap 6Z'L 6ue1f6uo11eg 6Z'I 6u1!1ag 0070Eru€TP^-afii W EUIqJ Ul 5Al11J PUE ,sAou[Ao"Id. gI ,Ub asue[€^?{rd: sa4aqBl0 z ol.gEI Table 3 Participatirio Gentres in MSVDD (l,lHO) Ari zona Moscow Berl i n New Dhl i Bern 0kl ahama Brussel s Sofia (Bulgaria) Havan a Tokyo Hong Kong Warsaw London Zagreb (Yugosl avi a) 82 g8 I'f g t'gl 9't9 I'nz P !Jnu I aloJd 9,'0I 8't 9'9 z'9 0J€A0s - gr"tt 0'z€ 0'f9 t'9r f,qledou 11ag T'II 0'6I I'I 8'9I luat6es lS lsur-rouqv - 9'I 6'0 6'0 9't b te$douqv - e3s€sto TdBq{ rfueuo"ro3 buo) buoH OFft foalns Eutqt ? 00il9t{ u! ElJnutelo.td p'ue &{il$ffiF mm,''r, n, ?.tts& #ffim$&J Jo :4** deff0tqtc"td.,' ' f 6t4sfl, Table 5 Standardised llnltiva'r,iate Logistic Regression Goefficiqn'Ls Dependent Varj abl e Stroke ECG coronary probabl e M :| Age XX X Durat'ion x Systo'l j c BP XX YY BMI XXX XX Chol esterol XX X=0.01 0H3 Jo % e)ualP^ard = ( I '98 I '98 L'iL L'ZB 6u 11out5 O'9I Z 0'tnz 0'9zz 0'8zz Ioralsa Ioq] €. IB z'98 I'28 I '18 d8 llLolsP!0 z'Itl 0'ftI 9'9tI 9'8rI dg I I 1o1s,t5 t'bz n'92 g'92 6'92 I!'lB (o'o) (o'z) (s't) (g'u) )H uluaS u0puol 0HI'1 Table 7 Diet Composition Calories CH0/gm Protein/gm Fat/gn Chol esterol /ng Ch i nese 2t89 273 86.6 82 t77 (50%') (rs%) (35%) European 3480 310 t26 195 746 (36%) (t4%) (so%) Chi nese t626 183 71.5 72 306 Banquet (42%) (r8%) (40%) 86 L8 'alqtssod Areuo.roc o93 [ :Alqeqold Aleuo.toc a}:lvz 'xos puE olluoc Aq ,elqeqol6 solPJ ocualeloJd :A'6lJ Areuo.rog e 03, pue ,e1q;sso3 l(leuolog e 33, sal.ro6elec OC3 Jol N31,.[OM N31^l 09 ovoS0zo!o%o0toz0e0t09 NOH vor -ln8 IUV '1vo AVH -130 evz u38 UVM sol l nu8 rMs NO-1 's;Jo1ced euroue 3 :uollcrelu! lPlplEco^ur olqlssod lZ 'xos puE elluac {q elep aJtpuuo!lsonb uo1; fo;gcrelu; lerprecoAtu pue sl.to]cod eu16ue Jol seleJ acualeleld lt'6ll N3hloM N3v{ 09 0t o8 0z ol % or oz 0e 0? NOH )or 'ln8 luv -tvo AVH "t30 evz u38 HVM sor{ nHg rMs NO'1 I Leg Vascular Disease London Switzerland B russel s Moscow Warsaw Berl i n Zagreb Bulgaria Havana O klahoma A rizona New Delhi Tokyo Hong Kong ? 6 Men Women ! Amputation fi Intermittent Claudication Proportion of Stroke and Hypertension by Sex and Centre London Switzerland B russels Moscow Wa rsaw Berl i n Z agreb Bulgaria Havana Oklahoma A ri zona New Delhi Tokyo Hong Kong a 0 10 20 30 Women frl Hypertension 88 68 teutu!W El ara^as I (%) uaulo^ Otr 0€ 0Z 0t E 6uoy 6uop oA>1o1 lqloo ^raN euoz !Jv eurollell o eueAeH e1re6lng qa.r6e7 u rlraS MesJei /rAOf,soW slassnr S puelJez l!/r\s uopuo'l erluec puB xas Aq Aeupl) lo asBaslo lasson llBurs lo uoluodot6 unlpow El a.ra,rag I t 6uoy 6uog oA1ol rqleo |^eN euoz !Jv euoqello PUen eH e1.re6;ng qarbeT u llraE AresJeM of,sol^l ^ slassnJ g puelJaz]!,t s uopuo'l erluog puE xes Aq aA3 aql lo asBaslo lessen llBtus lo uoluodo.td PANEL E June 24, 1990 11:30 A.M. REGENCY EAST TOPIC: GERIATRIGS - Some Glinical Problems in the Ghinese Elderly CHAIR: Fai Liu, M.D., F.R.C.P.(C), F.A.G.S DRUGS AND THE ELDERLY Barry Goldlist, M.D., F.R.C.P.(C), F.A.C.P., Toronto. DEPRESSION IN THE ELDERLY Francis Ho, M.D., C.C.F.P., F.C.F.P., Vancouver. THEY ARE AFTER ME . A CLINICAL REVIEW OF PARANOID DISORDERS IN THE ELDERLY Peter Chang, M.8., 8.S., D.P.M., D.Psych., F.R.C.P.(C), Toronto. CANCER PAIN MANAGEMENT Wen-Hsien Wu, M.D., M.S., Newark. 90 t6 'Apappe aql ur uorssardap 1o s1sou0or4 '8 slcaJla apts slt puP luaulPaJl .L sassaullr lecrsAqd palelcossv '9 sJolcel 6ur1e1rdrcer4 '9 sasnec ,, elluouap uao^Aloq acuajaJllo '8 sarnleol 'z A6olo1uaprd3 't 'ro^nocueA ''d'J'C'l ''d'J'C'C ''o'uU 'oH slcuerJ A'1U3013 fHr Nt NOtSSSUdfO 'acuerpuroc acuequa ll!/v\ sa^rtepr o1 suolleuepxo pue suollcn:lsul ual1lM '0uueaq lood pue uolsl^ outseelcep 'plluauap 1o suago.rd aql Aq palpqJacpxa are Apaple aql ul sualqold acuer;du.roc 'osly 'aDe aldoad sp (A1ll1suas 0nrp 'e'1) sclureuApoceu:eqd u! saouara#lp Ilurepac lsotup arp araql lp/n sy 'Alburp.rocce pacnpar aq Fnur (u;xobgp '0'e) sOnrp palarcxo Alleuer ;o seOesop pup 'Ulg u! uorlcnper %09 e upaur uec Apapp aql u! oululleaJc urnras .leurou. E snqf 'p1;e:ed u! aullcap ol pual (uotlercxe eugurlearc) uollcunl leual pup (uoltcnpo"rd eugurlearc) sseul alcsnu 'abe eldoad sV '(r.unllen '6'e) peOueqcun oq Aeur acuB:ea;c eurse;d qOnoqt uane {pepla oql ur olrl-}leq rloql u! osearcu! up a^eq lll/y\ sbnrp apnps qd;| 'Allerauag 'son.rp cryceds uo pailurl s! uolleuilolu1 Alaleunyolun 'uollarcxa lpuor pup sOnrp 1o uornqulslp aql u! Jncco scllaulloceu:eqd ur seOueqc elqelclperd loleu eql (pep1a poz!lpuolnillsur aql u; stualqord lprol^eqa€ '/ 0ur6e qlrr ocupqlnls!p daep luenbarS '9 luaurleoll sno6ard Oulssesseer noqil/v\ sOnrp 6urppy 'g stroldru{s lenp4pu! }o luaLulearl 't luorussassPal Dnrp lo lcel 'e slsou6erp lcarocul 'z aseaslp lo ocuale^ard paseercul '1 :suolleclpour aldllnu uo aq ol Apepla aql Jol suoseau 'uo;1seDu1 6nrp ptot Jlaql lo yo09 sluasaJdal {1uo Apeqord srql uo^a leql pup 'suollpclpoul uo;ldpcsa:d lo sraqunu ebre; uo ere apoad Apaple ,,Aq11eeq. ua^a lpql oruasqo o1 Ourleurcse; s! ll 'suollcpratu! 6nrp lo IslJ laleal0 aql pup uollceor Onrp es:anpe ue lo acueqc aql rollolrl aql 'uo s1 uoslad e s6nrp aiou sqt 'Aueu are slr.ll to secuenbasuoc eq1 's1ua;1ed ra0unoA ueql sbnrp arorx uo aq lll/v\ Apep;e aql lpql aqelhaul s! l! 'luourlea:t On:p uroll illauaq op salpp aseaslp osor.ll lo Aueu asnecaq pue 'salels aspaslp cluoLlc arorx Jo auo aneq ol gg lo ebB aql rapun asoql se [1a1;1 sp acr^ ] e.re Apeple eq1 'A;:apla aq1 ug esn 0n:p eleudordde Duunsua lo auo s1 Algee: ualqold aql pue uoglecg;ldtu;sreno sso.rO B sr slql 'lensn sy 'ssald :elndod aq1 u1 Apapp aq1u1 .Aceu:eqdApd ;o uagqord' aql lo applu uaaq seq Llcnyl oUPluO'o1uorol "O'Utl 'lsllplog fureg A-ru30'r3 3s:rNtHc 3Hl oNV S9nUO I "THEY ARE AFTER ME" - A Clinical Review of Paranoid Disorders in the Elderly Peter Chang, M.8., 8.S., D.P.M., D.Pysch., F.R.C.P.(C). Toronto, Ontario. The idea of being persecuted by others is a universal phenomenon. lt exists in all age groups and in all cultures. Clinical experience shows that the incidence of paranoid thinking increases with age. Psychodynamic explanation of this phenomenon is based on the concept of projection, which means the process of externalizing inner psychic conflicts as a defence mechanism. Another way of looking at paranoid thinking is proposed, namely, to conceptualize it as a defect in information processing by the brain. An increase in paranoid thinking is seen in people with defects in sensory input, for example, patients with partial hearing or visual impairment. Disorders of neuro- transmitters, such as schizophrenia and depressive disorders, often give rise to paranoid thinking. Brain disorders with associated structural changes are even more likely to give rise to paranoid ideas. There is a qualitative difference in the paranoid ideas associated with organic brain disorders, which are common in the elderly. While delusions involving personal integrity are more frequent in functional disorders, delusions involving property are more common in organic brain disorders. ldentifying the underlying cause of paranoid symptoms is important in the planning of treatment and predicting outcome for an individual patient. CANCER PAIN MANAGEMENT Wen-Hsien Wu, M.D., M.S., Newark. The magnitude of the cancer pain problem is enormous. The prevalence of severe pain in advanced cancer is high. A significant number of cancer patients die with inadequate pain control. Reasons for this unfortunate situation have been analyzed, and various types of cancer pain with the associated pathophysiology and problems have been outlined. Management of cancer pain is initiated by a complete assessment of the patient's status in pain, medication, emotion, family dynamics and communication skills. Successful treatment requires an integrated team approach transcending the effort of the patient, family, family physician, various medical specialists, para-professionals, and chaplain. This orchestrated treatment plan under the direction of one central person would include drug therapy, non-drug therapy, physiotherapy, and supportive therapy. Pharmacology of different classes of drugs and various routes of administration including oral, rectal, intramuscular, subcutaneous, intravenous, epidural or intrathecal have been discussed, and adjuvant drug therapy for pain and symptomatic relief has been included. Drug dependence and potential addictive aspects of chronic medication should be de-emphasized in order to achieve a reasonable level of pain control. Non-drug therapy includes radiotherapy, surgery, acupuncture, transcutaneous electrical nerve stimulation, sympathetic stimulation, dorsal column stimulation, central nervous system stimulation, neural blockade, neurolysis (sensory and sympathetic), cryoanalgesia, transcutaneous cervical cordotomy, thermocoagulation and pituitary ablation. A brief description of physiotherapy and supportive therapy is included in the discussion. 92 e6 'cul xoluAg Aq peyoddns Apnoreue6 s; pued s;q1 puelwo 'sec!ruos wpeH uelsv 's'y\l 'oy uJn ueelLllpy ''c'y\| 'uetlc 'yI Jnlluv '!eL[ Eon ''H'd'y! 'n sl pou AltNnwnoc N/norvNtHc oN\n)vo ]HI Nl NOEOUIIOHd ]ll'IVAH ' ltllVUCOUd 'HI'lV3/n Sl Hl'lV3H,' 3HI 'oluoJoI eeuluujoc uoltBcnp3 qileeH eseulqc oluoJol eql orNouol Nl rc3roud lu]'tv solv 'lBe4uoyI 'd'V'V'l '(C)'a'C'U'J ''t/rl'C ''C'rtl 'd1-ueq9 ec;y 'lvSurNou\t Nt s!il'ilu[vJ rNvHcrulruu 3sfNtHc or HcvSurno AllNnululoc 'oluoJol "l'S'3'I ''V'g '6N eluul1tr Aonrs su3)uo/n rNvunvrsSu llsSNlHC 'A 'S'C ''M'S'yI 'ee1 e1leyl l(lrunutuoC esoull.lC eL$ u! se!6e1e4s uolloulo.ld qileeH :HI1V'1H AJNnUII IOC fUINfC ACN:193U llv08:Il. 0661 'tz'eunr I't3NVd CHINESE RESTAURANT WORKERS STUDY Winnie Ng, 8.A., T.E.S.L., Toronto. Conducted by the University Settlement House in Toronto in 1988, the Ghinese Restaurant Workers Study interviewed one hundred workers to suruey their particular needs for social and community services. Since the release of the Report in May 1988, several initiatives have been taken by the government, the community and the industry. The study and its follow-up activities has played an advocacy role in promoting the well-being of one target group of the Toronto Chinese Canadian community. The presentation will focus on the occupational health and safety issues of the restaurant workers. Recommendations to the Department of Public Health, the medical and health care professionals and the industry will be related. COMMUNITY OUTREACH TO CHINESE IMMIGRANT FAMILIES IN MONTREAL Alice Chan-Yip, M.D., C.M., F.R.C.P.(C), F.A.A.P., Montreal. The recognition of prevalent health problems in a pediatric practice amongst Chinese immigrant families led me to participate in various community health promotion projects. In order to reduce the frequency of prevalent diseases in this target population, culturally appropriate health services are required to improve nutritional practices, maternal child health, parenting skills, school adaptation processes and education programs. Community outreach involves collaboration with allied health professionals and establishing organizations and groups to develop comprehensive health seruices. Community research projects are important tools which help towards identifying and resolving existing problems. This presentation will include problem case illustrations, the process of community outreach and the evaluation of some of the community programs. 94 96 'lorluoc aspaslo rol sJaNaS pup (UU3H) sac!ruos qilpaH lo luauJuedag qurollpC lo alels Aq ued ut papunl sem utelDo.rd sg1* 'sac!ruas qilpaH uppv lo pauodruo3 uollpcnpf q1eaH aql pue erEqBlO Bpu!'1 suocse Aarung :ulrl lcptsq pup 'aa'1 e6roag '!E l ppuaJg 'upqC allcpf 'aa1 upqC s:a/'Ao!rualul :sluatua6paprrou4cy 'Ayunurur.roc asoulLlg aql ut srolcE IsU qpaq .taqlo pue Duplours lo uolpnpor oql uo tcBdr.r.r! 6u;gse16uog pue aru1sod p aleru ot OuluuBd Plcos punos qpn uogpdlclUed A1unuluoc elerod.rocu! 1snut uollouto.rd r{llpoq ol qceo.rdde InO 'Jaqunu u! /{\al arB surB:Dord qcns pue 'suecpaluv osoulLlC 6urleads-qs1;6u3-pa1u;g 'aulocu!-,r ol pege6rel Algec;gcads eneq surerbord ;o.r1uoc 6ug4or.us tBqt Altuacar uaaq Aluo spq U leql pazlleal aq Fnul U 'Ja^a,t oH 'oHBpluljot alnb aq ol steadde asaulqC atll ouroue 0u14ours ou;cnpeuo lsq aql 'saeAopua lueJnelsal Duou.rB lsaluoc AqM* p pue '1sal u/v\oleulqC aql uarpflqc por{cs Aq acueuuoyad uollecnpa "0u14otug UnO laalls lp tl1eoq p 'J!el qilpoq Alunururoc e 'acep IJo/v\ orjl ur sego;od oa:falours qqgepa sasssau;snq dpq o1 uOledutec e 'uarpill.lc por4cs Ououre Faluoc:elsod e 's;epeleu lplnllnclq 'pn6u1;;q p luautdopnap aql apnpu! reaA Dulurocdn aql ro; peuueld sal1^llcv '0661' 'qcleyl ug 'u0geduec qpau fi1q1s;n -q6tq e q1^i uolpunluoc u; 'uDledurec prluoc Du;4ou:s s1 uebaq urelbo.rd qllpa6 st q1paH oql '.s,0661 aql u! sanssl queaH uelsv pluro{pC, pagua '[1unog Eporuey u! qlleoq uplsv uo sbupeaq c;pnd rena lsJll aql 'sanllpluosaJdar pcol Aq perosuods-oc pue Aqyegcyl oa'] roula^og lupuona!'l BluJolllsC rll!,r pa:osuods (eneq 1pn) CHIdV atll 'HdV ul 'qllpaq uplsv rol Apo;.rd dot ar.lt se ssacce a0enOuel poglluop! uol1leoC aql 'q1paq uplsv uo surccuoc ssnoslp ol reqtaOol aupc sol1unuuloc asaupulaln pue uelloe1 'uPotoy 'aseuedeJ. 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Alan ro ou ppr{ sossaulsnq poyl 'asreds ere Dugouls uo sacJnosal prn1nclq 'len6ug1;q 1eq1 paleclpul fuoluenu! aql p s1nso.r [.reu;ru;prd eq1 'u6gedurpc plluoc buqous lnpsoccns e Ougpeurapul rc;d;qsuollept Ou;ryoll6uorp p pllnq ot dlaq llm suolleauB6ro Ailunrruroc qlll lceluoc lplllu! sltll 1eql sadoq uBrbord stll 'pol rlceolno pue lpuollpcnpa up sE paruos osle spq 'Alunuruoc asaulqC aql u! uollBssac pup uolpanad Ouplorus uo spaau pue sacrnosar 6ug1s6a oql passasse rlclr.ln 'Lropenu; slLll 'suollplcossp qilpaq fueunpn pup suollpzlueOro acgruas plcos 'sluprnplsar 'sassaulsnq u/nolpulqC pueqpo aql $6uoure papnpuoc sBm fuoluenul acJnosa.r Alunuuroc B 'Aaruns aql ol uol1ppe ul 'lsol Jeaurs de4 e peq le^ou peq AeW teqt polpclpul spapuodsa.r oleural;o luacrad as.tqt-AUoJ 'arnssard poolq q0!q peq Aaql lpl.ll lolro/n qllpaq rc rolcop e rtq ppl erem sapual ,o %?Z pue sopur to %Ze'ualpl arnssard poog Jlaql ppq JaAa ppq oqn sluapuodsar asoql 1g 'tlluotrt lsq aql ul pqocp luerp pan alruolu! sapul oql lo uacrcd Auol 'Apelnbar palorus lllls %09 'asoql p pue oullslllrlaql u! sagaleQc OOt 1spal lB palotus ppq %99 'pa/na!ruolu! sapur asaulqC aql to 1etll oleclpul sunsar &eu;u;pr6 'qilpaq a4panald pup uolsuauadAq 'asn pqoclp '6uqou.rs sp r.lcns sJopel IsU qllBoq noqe polse srai suapuodsag 'ploqasnoq osaulqg puocas fuane uror; silnpB palcaps A1ueq ol pasn sp/v\ poqlaur 6u;;dr.ues uopueJ cllBuuatsAs e0Bls-oa4 V 'suaplsar u,v\oleulqC puBDlpO qllrn sAaruns uosrad-ug ZBZ papnpuoc sJoi alNap; ouryeads-asauoup3 'Apnls AuuntuuJoc slql ul 'saspaslp cluorqc rol lsp q6lq te are leql uo;legndod aql p tuaubas aql6u;fupep; pue uollepndod asau;qg pupplpg aq1;o agpord e 6u;gnord u! ueuodnr! Alppadse uaaq seq 'aben6ue; fueupd pue ''S'n aql ugAels p tlfual 'rfi6p1eu sB qcns suolpenb uollprnllnccp 6ug1sy'uogplndod uqsy cyceds e uo '6ugcq Apnqnard se/n leql 'elpp pop!^ord seq /leruns Alunurr.uoc asaulllC aql 'UauJnJlsu! pue Aboppoqlaur Aeruns ap!.rdorddB-A1p.rn11nc e 6u;sn Aq qcreasar enl1sues-r{lunuuoc rol paau aq1 pazlseqdua seq uBr6o.rd rng 'Aeruns rclcpl IsU prnollpqaq oulpseq e qbnorql Ailunuuoc asaurq3 puppleg aql lo Uaurssossp spoau e Dullcnpuoc lo palspuoc ruBl0old aqt lo a6ets 1srg aql 'Ayunuruoc asaulqC oql u! srolcel lsg r{Ueaq Jaqlo pue Duulours acnpor ol Ouqloarr uaoq spq 'qlpa6 puB qlleaH pallsc 'sac!ruas qllpoH uelsv aql lp ure:6o.rd uoglou,rold rl1poq a4suaqedtuoc pue anllplouug 'anblun fuan B '686! 'Areruqal aculg 'puBlIBo ''S'W 'o) rlD uaalqlsx ''O'UI 'uaqC 'W JnqUV'geq1ea1 ''H'd'ltl 'rna'l pou qilsaH Alunuurog ururolBulrlC puepleg aql u! uollourord :WVUgOud "HI-lVf/t Sl l{I'lVAH" AHI CONFERENCE FACULTY ASIAN HEALTH SERVICES, OAKLAND, Rod MARION WU LEE, Ph.D., Research Associate, Lew, M.P.H., Vea Thai, Arthur M. Chen, M.D., Department of Family, Community and Kathleen Kim Ko, M.S. Preventive Medicine, Stanford University School ALTCE CHAN-Y|P, M.D., C.M., F.R.C.P.(C), of Medicine, Palo Alto, California. F.A.A.P., Associate Professor, Department of PETER LEE, M.D., F.R.C.P.(C), Fifth Conference Paediatrics, McGill University, Montreal. Scientific Programme Chairman; Associate PANG L|NG CHAN, M.D., F.R.C.S.(C), Professor of Medicine, University of Toronto, F.R.C.O.G., Head, Obstetrics and Gynaecology, Toronto. Sunnybrook Medical Center, University of FAI LlU, M.D., F.R.C.P.(C), F.A.G.S., President Toronto, Toronto. Mon Sheong Foundation and Mon Sheong PETER P. CHANG, M.8., 8.S., D.P.M., D.Psch., Home for the Aged, Toronto. F.R.C.P.(C), Honorary Lecturer, University of TED H.T. LO, M.8., B.S., M.R.C.Psych., Toronto, Toronto. F.R.C.P.(C), Lecturer, University of Toronto, JULIA CHING, 8.A., M.A., Ph.D., Professor, Toronto. Department of Religious Studies and East Asian WINNIE NG, 8.A., T.E.S.L., Coordinator, Equity Studies, University of Toronto, Toronto. Programmes, Labour Council of Metropolitan JOHN H.C. CH|U, M.D., F.R.C.P.(C), D.A.B.R., Toronto and York Region, Toronto. Fifth Conference Chairman, Chairman APOSTOLOS PAPAGEORGIOU, M.D., Continuing Medical Education, North York F.R.C.P.(C), Chief and Professor of Pediatrics, Branson Hospital, Toronto. Obstetrics and Gynecology, McGill University; STELI-A GHIU, B.Sc., R.P.Dt., Professional Pediatrician and Neonatologist in Chief, Jewish Dietician, Mississauga Hospital, Toronto. General Hospital, Montreal. EI-AINE S.K. CHOI, M.B.B.S., Assistant COLLIN P. QUOCK, M.D., Clinical Professor of Professor of Medicine, Community Health and Medicine, School of Medicine, University of Pediatrics, Tufts University, Boston. California. San Francisco. BRENDA GALLIE, M.D., Senior Scientist, MORRIS SHERMAN, M.B., B.Ch., Ph.D., Research Institute, The Hospital for Sick F.C.P.(S.A.), F.R.C.P.(C), Assistant Professor, Children; and Professor, Department of Medical Department of Medicine, University of Toronto, Genetics, University of Toronto, Toronto. Toronto. GREGORY FUNG, M.D., Gastroenterologist, JOSEPH SO, 8.A., M.A., Ph.D., Professor, The Chinese Hospital, San Francisco. Anthropology Department, Trent University; BARRY J. GOLDLIST, M.D., F.R.C.P.(C), Peterborough. F.A.C.P., Interim Director, Interdepartmental TORONTO CHINESE HEALTH EDUCATION Division of Geriatrics, University of Toronto, COMMITTEE, Bosco Tang, Lisa Loong. Toronto. sru wA TANG, M.8., B.S., F.R.C.P.(C), Ph.D., FRANCIS HO, M.D., C.C.F.P., F.C.F.P., Associate Professor, Department of Psychiatry Chairman, Mount Saint Joseph Hospital and Human Behavior, University of California, Foundation, Vancouver; Clinical Associate lrvine. Professor, Depafiment of Family Practice, LAP-CHEE TSUI, B.Sc., M.Phil., Ph.D., Senior Faculty of Medicine, University of British Scientist, Research Institute, Hospital for Sick Columbia. Children; Associate Professor, Department of THOMAS HUM, M.D., Chief of Obstetrics and Medical Genetics and Medical Biophysics, Gynaecology, the Chinese Hospital, San University of Toronto, Toronto. Francisco. RONALD G. WORTON, B.Sc., M.Sc., Ph.D., YUET WAI KAN, M.D., F.R.S., Louis K. Diamond Geneticist in Chief, Hospital for Sick Children, Professor of Haematology, University of Toronto. California, San Francisco. WEN-HSIEN WU, M.D., M.S., Professor and MARIA LEE, M.S.W., C.S.W., Supervisor, Health Chairman, Department of Anaesthesiology, Promotion and Advocacy Section, Department UMDNJ- New Jersey Medical School, Newark. of Public Health, Toronto. ROSE T.T. YOUNG, M.D., F.R.C.P. (London, Edinburgh and Glasgow), F.R.A.C.P., Senior Pro-Vice-Chancellor and Professor of Medicine. University of Hong Kong, Hong Kong. 96