non-Asian Origin Research Articles

Osilodrostat treatment in patients with Cushing's disease of Asian or non-Asian origin: a pooled analysis of two Phase III randomized trials (LINC 3 and LINC 4).

Cushing's disease is associated with increased morbidity and mortality. Osilodrostat, a potent oral 11β-hydroxylase inhibitor, provided rapid, sustained mean urinary free cortisol (mUFC) normalization in Cushing's disease patients in two Phase III studies (LINC 3, NCT02180217; LINC 4, NCT02697734). Here, we evaluate the efficacy and safety of osilodrostat in Cushing's disease in patients of Asian origin compared with patients of non-Asian origin. Pooled data from LINC 3 and LINC 4 were analyzed. Outcomes were evaluated separately for Asian and non-Asian patients. For the analysis, 210 patients were included; 56 (27%) were of Asian origin. Median (minimum-maximum) osilodrostat dose was 3.8 (1-25) and 7.3 (1-47) mg/day in Asian and non-Asian patients, respectively. mUFC control was achieved at weeks 48 and 72 in 64.3% and 68.1% of Asian and 68.2% and 75.8% of non-Asian patients. Improvements in cardiovascular and metabolic-related parameters, physical manifestations of hypercortisolism, and quality of life were similar in both groups. Most common adverse events (AEs) were adrenal insufficiency (44.6%) in Asian and nausea (45.5%) in non-Asian patients. AEs related to hypocortisolism and pituitary tumor enlargement occurred in more Asian (58.9% and 21.4%) than non-Asian patients (40.3% and 9.1%). Of Asian and non-Asian patients, 23.2% and 13.6%, respectively, discontinued because of AEs. Asian patients with Cushing's disease generally required numerically lower osilodrostat doses than non-Asian patients to achieve beneficial effects. Hypocortisolism-related AEs were reported in more Asian than non-Asian patients. Together, these findings suggest that Asian patients are more sensitive to osilodrostat than non-Asian patients.

THU032 Osilodrostat Is Effective And Well Tolerated In Patients Of Asian And Non-Asian Origin With Cushing's Disease: A Pooled Analysis From LINC 3 And LINC 4

Abstract Disclosure: P.J. Snyder: Consulting Fee; Self; Teva Pharmaceutical Industries Ltd. B.M. Biller: Consulting Fee; Self; HRA Pharmaceuticals, Recordati, Sparrow, Xeris Pharmaceuticals (Strongbridge). M. Fleseriu: Consulting Fee; Self; Recordati, Sparrow, Xeris Pharmaceuticals (Strongbridge), HRA Pharmaceuticals. Grant Recipient; Self; Recordati, Sparrow, Xeris Pharmaceuticals (Strongbridge). R. Pivonello: Consulting Fee; Self; Novartis Pharmaceuticals, Recordati, Corcept Therapeutics, Pfizer, Inc., Bresmed Health Solutions, Damor Farmaceutici, S&R Farmaceutici, Organon Italia, Siunergos Pharma, Biohealth Italia. Research Investigator; Self; Novartis Pharmaceuticals, Recordati, Xeris Pharmaceuticals (Strongbridge), Corcept Therapeutics, Takeda, Neurocrine Biosciences, Camurus AB, Pfizer, Inc., Merck Serono, IBSA. E.J. Lee: None. R. Leelawattana: None. J.H. Kim: None. R. Walia: None. Y. Yu: None. Z. Liao: None. A. Piacentini: Employee; Self; Recordati. A.M. Pedroncelli: Employee; Self; Recordati. A. Shimatsu: Consulting Fee; Self; Recordati. Speaker; Self; Recordati. Introduction: Osilodrostat, a potent oral 11β-hydroxylase inhibitor, has demonstrated rapid and sustained normalization of cortisol in two Phase III studies (LINC 3, NCT02180217; LINC 4, NCT02697734) in patients (pts) with Cushing’s disease (CD). Relative osilodrostat bioavailability is estimated to be 20% higher in pts of Asian origin than other ethnicities, and body weight is not a major determinant of this difference. This analysis of the LINC 3 and LINC 4 studies evaluated the efficacy and safety of osilodrostat in pts of Asian and non-Asian origin with CD. Methods: Data were pooled from the LINC 3 and LINC 4 Phase III studies. LINC 3 comprised a 48-week (W) core phase, including an 8W randomized withdrawal for eligible pts. LINC 4 included a 12W, double-blind, placebo-controlled period and 36W of open-label osilodrostat. Both studies had an optional extension. Efficacy and safety outcomes were evaluated separately in pts of Asian and non-Asian origin. Periods where pts received placebo were excluded. Results: In total, 56/210 (27%) pts were of Asian origin, enrolled in China (n=16), South Korea (n=14), Japan (n=9), Thailand (n=9), India (n=7) and USA (n=1). Most non-Asian pts were Caucasian (n=138/154, 90%). Median (min−max) osilodrostat dose was 3.8 (1−25) and 7.3 mg/day (1−47) in pts of Asian and non-Asian origin, respectively. mUFC control was achieved at W48 and W72 in 64.3% and 68.1% of Asian pts and in 68.2% and 75.8% of non-Asian pts, respectively. Improvements from baseline in most cardiovascular and metabolic-related parameters and in physical manifestations of hypercortisolism were similar across both groups during osilodrostat treatment. Osilodrostat was well tolerated; the most common investigator-reported adverse events (AEs) in Asian pts were adrenal insufficiency (44.6%), nausea (33.9%) and decreased appetite (26.8%), and in non-Asian pts, nausea (45.5%), fatigue (40.9%) and headache (39.0%). The most common serious AE in Asian and non-Asian pts was adrenal insufficiency (5.4% and 5.2%, respectively). Hypocortisolism-related AEs occurred in 58.9% of Asian pts and 40.3% of non-Asian pts, most commonly reported by the investigator as adrenal insufficiency (44.6% and 22.1%). AEs related to pituitary tumor enlargement occurred in 21.4% of Asian and 9.1% of non-Asian pts. AEs related to arrhythmogenic potential and QT prolongation were infrequent in all pts. Conclusions: Osilodrostat demonstrated similar beneficial effects in Asian and non-Asian pts in terms of mUFC control and improvements in cardiovascular and metabolic-related parameters and physical manifestations of hypercortisolism. The mean dose to achieve beneficial effects was lower in pts of Asian than non-Asian origin. Osilodrostat was generally well tolerated in Asian and non-Asian pts; AEs related to hypocortisolism and pituitary enlargement were reported more frequently in Asian than non-Asian pts. Presentation: Thursday, June 15, 2023

In the Phase III studies LINC 3 and LINC 4, osilodrostat was effective and well tolerated in patients of Asian and non-Asian origin with Cushing's disease

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Moyamoya disease – a rare disease that a clinician should know about

Ischemic stroke in young patients is an actual problem of modern angioneurology. You should know that in addition to the common causes of stroke (blood vessels, heart and circulatory system pathology, diabetes mellitus), one of the important ones is moyamoya disease. It has become more frequently registered among patients, including those of non-Asian origin in recent times. The disease often manifests itself as a stroke or transient ischemic attacks, and may initially be accompanied by various neurological manifestations for a long time. Late diagnosis of moyamoya disease due to the lack of knowledge of outpatient practitioners about this pathology may result in a stroke for the patient. It is a multifactorial disease with a genetic predisposition and is manifested by vascular remodeling in the system of internal and external carotid arteries (luminal occlusion) with the development of a collateral network resembling “cigarette smoke” during angiography. This defi nition is a literal translation of “moyamoya” from Japanese. The article gives a comprehensive, all-around view of the disease, the tactics of its detection and treatment, with an emphasis on modern methods of surgical revascularization. A clinical case from practice is of interest to internist clinicians as it is connected with atypical manifestation of the disease in an 18-year-old patient. The doctors focused on arterial hypertension as the main cause of the patient’s complaints, and moved away from the algorithm for detecting cerebral vascular pathology.

Abstract WP167: Is There a Distinct Phenotype for Non-Asian Moyamoya Patients?

Background and Purpose: Idiopathic moyamoya syndrome (IMMS) is a progressive narrowing of the anterior circulation arteries resulting in the development of a tenuous collateral blood supply which is prone to rupture or thrombosis. IMMS has mostly been studied in East Asian populations where it was first described, with limited data describing this syndrome in non-Asians. We aimed to describe IMMS patients in New York and identify differences between Asians and non-Asians in this population. Methods: Using the New York State Department of Health Statewide Planning and Research Cooperative System database from 2000-2014 we identified all newly diagnosed cases of IMMS (ICD-9 437.5) in adults aged 18 and older. We excluded patients with down syndrome, neurofibromatosis type 1 and sickle cell disease. We compared patient demographics, comorbidities and extracranial-intracranial revascularization (ECIC) rates for IMMS patients that self-identified with Asian race/ethnicity vs those who did not. Results: All IMMS diagnoses occurred in urban hospitals. There were 554 IMMS patients in total; 89.4% (n=495) were non-Asian while only 10.6% (n=59) were Asian. A smaller proportion of non-Asian IMMS patients were diagnosed in smaller, non-academic hospitals compared to Asians (3.8% vs 10.2%, p=0.03) (Table). Both groups showed comparable rates of characteristics and comorbidities. Stroke risks following IMMS diagnosis were similar for both Asians and non-Asians (13.6% vs 22.4%, p=0.1); strokes occurred later for non-Asian patients with ECIC than in those without (2.1 + 2.8 vs 1.4 + 2.1 years, p=0.04). No subsequent strokes occurred in Asians after ECIC. Conclusion: Individuals of non-Asian origin account for almost 90% of IMMS diagnoses in New York State, but they are infrequently diagnosed in small, non-academic hospitals. Further research is needed to identify a distinctive phenotype and genotypic profile of IMMS in non-Asians.

Elevated liver fibrosis index FIB-4 is not reliable for HCC risk stratification in predominantly non-Asian CHB patients.

We aimed to validate the liver fibrosis index FIB-4 as a model for risk stratification of hepatocellular carcinoma development in predominantly non-Asian patients with chronic hepatitis B infection seen at a tertiary referral center in Germany.We retrospectively analyzed 373 adult patients with chronic hepatitis B infection. Patient demographics, hepatitis B markers, antiviral treatment, laboratory parameters, results from liver imaging and histology were recorded. Patients were divided into 2 groups according to their FIB-4 levels and their hazard ratios for developing hepatocellular carcinoma were analyzed adjusted for age, sex, body mass index, alcohol consumption, and antiviral medication.Median follow-up was 8.7 years (range 1-21.3 years), 93% of patients were of non-Asian origin, and 64% were male. Compared with patients with a low FIB-4 (<1.25) patients with FIB-4 ≥1.25 showed a hazard ratio for incidence of hepatocellular carcinoma of 3.03 (95% confidence interval (CI): 1.24-7.41) and an adjusted hazard ratio of 1.75 (95% CI: 0.64-4.74). Notably, 68% of patients with liver cirrhosis and 68% of those who developed HCC during observation had a low FIB-4 (<1.25).We could not confirm that a FIB-4 value ≥1.25 is a reliable clinical indicator for incidence of hepatocellular carcinoma in predominantly non-Asian patients with chronic hepatitis B. Further studies in geographically and ethnically diverse populations are needed to prove its utility as a predictive tool.

Invasive Klebsiella pneumoniae Liver Abscess with Multiple Septic Metastatic Complications – Case Report and Review of Literature

Klebsiella pneumoniae is a common bacterial pathogen that is known to cause diverse community acquired and nosocomial infections [1,2]. These infections commonly occur in hospitalized individuals with impaired host defenses [3]. However the proportion of community acquired vs nosocomial infection has markedly increased in recent years [4]. A community acquired syndrome of cryptogenic invasive Klebsiella pneumoniae Liver Abscess Syndrome (CIKPLA) has been known to typically affect individuals of Southeast Asian origin, and is complicated by devastating septic spread to other organs [5]. We report a case of community acquired invasive Klebsiella pneumoniae infection with multi organ involvement in an individual of non-Asian origin. The aim of this case report is to alert clinicians about increasing prevalence of CIKPLA syndrome, its different clinical presentations and occurrence in different populations suggesting a need for increased vigilance for early diagnosis and prompt management to prevent disastrous sequelae.

ELF-test less accurately identifies liver cirrhosis diagnosed by liver stiffness measurement in non-Asian women with chronic hepatitis B

BackgroundThe enhanced liver fibrosis test (ELF-test) has been validated for several hepatic diseases. However, its performance in chronic hepatitis B virus (CHB) infected patients is uncertain. ObjectiveThis study investigates the diagnostic value of the ELF test for cirrhosis identified by liver stiffness measurement (LSM) in non-Asian women with CHB. Study designWomen of non-Asian origin with perinatally acquired CHB infection, detected during pregnancy in the period 1990–2003, returned to our center between September 2011 and May 2012 for LSM and blood sampling to perform an ELF test and to calculate, APRI and FIB-4 scores. Fibrosis stages were classified by the METAVIR system. ResultsA total of 119 women were included in this study with a median age of 43 years, all ALT levels being <2× ULN and all being HBeAg negative. The overall median LSM (IQR) stiffness and ELF test were 5.5kPa (4.0–6.8) and 8.4 (7.8–9.2) respectively. LSM and ELF test classified 14 (12%) and 19 (16%) patients with severe fibrosis to cirrhosis (≥F3, i.e. liver stiffness >8.1kPa), however in only 4 (3%) patients there was an agreement between LSM and ELF test. With LSM as reference, the area under receiver operating characteristic curve (AUROC) for detection of ≥F3 fibrosis was for ELF 0.65 (95% CI 0.51–0.80; p=0.06), APRI 0.66 (0.50–0.82; p=0.07) and FIB-4 0.66 (0.49–0.82; p=0.07). ConclusionThe ELF test less accurately discriminates severe fibrosis or cirrhosis when compared to LSM in our cohort of non-Asian women with CHB.

P-20 * PRELIMINARY RESULTS OF PATTERN OF ALCOHOL METABOLISM AMONG DRIVING UNDER THE INFLUENCE OF ALCOHOL OFFENDERS: ASSOCIATION BETWEEN ALCOHOL METABOLISM, ALCOHOL USE BEHAVIOUR AND OTHER PSYCHOSOCIAL VARIABLES

This study reports on the potential utility of a saliva test to identify different patterns of driving under the influence of alcohol (DUI) offenders' alcohol metabolism. The pattern of alcohol metabolism, i.e., biogenetic disposition pertinent to alcohol intake is a significant issue, because only about half of Japanese people metabolise alcohol as people of non-Asian origin do. The remaining Japanese people exhibit different biochemical reactions after consuming alcohol, ranging from complete or partial alcohol intolerance to enhanced/prolonged alcohol intoxication. A sample of convicted DUI offenders was interviewed (N = 64). Together with results from a saliva test that classifies the participants' alcohol metabolism into five types, we collected information on alcohol intake, screening for alcohol use disorder, alcohol biomarkers, and psychosocial variables. RESULTS showed that (1) a significantly higher proportion of offenders was classified as being biogenetically susceptible to alcohol dependence as compared to the general Japanese population, and that (2) no significant associations were observed between alcohol metabolism typology and alcohol intake, alcohol use disorders and psychosocial variables, except for one biomarker and the past frequency of DUI. Although alcohol metabolism is only a part of various determinants leading to DUI behaviour, remedial intervention that utilises the saliva test may help DUI offenders to set forth a personalised, concrete coping strategy to stay away from the negative consequences of alcohol use including DUI. Language: en

Genetic variation in LINGO-1 (rs9652490) and risk of Parkinson's disease: Twelve studies and a meta-analysis

Studies of the relationship between Parkinson's disease (PD) and rs9652490 SNP in LINGO1 gene have reported inconsistent results. To assess the association between the variant and PD risk, a meta-analysis from 12 case–control studies was performed. A total of 6053 PD cases and 5997 controls in 4 studies among Asians and 8 studies among non-Asians were included. The overall and geographic subgroups analysis was conducted, and odds ratios (OR) and 95% confidence intervals (95%CI) were calculated in the fixed-effects or random-effects model. The combined results of overall analysis showed a lack of association of rs9652490 and PD (fixed-effects model, OR 1.00, 95%CI 0.94–1.06), no matter what genetic model of rs9652490. The separate analysis in patients of Asian origin or non-Asian origin also failed to show any ethnic-dependent association. In conclusion, the present meta-analysis does not support the notion that LINGO1 rs9652490 SNP is a major genetic risk factor for PD.

PTU-017 IgG4 +ve autoimmune hepatitis is not observed among patients of non-Asian origin

IntroductionIgG4 mediated autoimmune disease has recently been described in relation to pancreatitis and sclerosing cholangitis. Furthermore recent reports, mainly from Japan, have also identified cases of autoimmune hepatitis (AIH) in...

Architektoniczny eksperyment u podnóża Chińskiego Muru

Architektoniczny eksperyment u podnóża Chińskiego Muru

Trust, discrimination and acculturation: Experimental evidence on Asian international and Australian domestic university students

Migrations have intensified with the advent of globalisation. Societies once solidly monocultural are becoming increasingly multicultural. It is, however, not clear how social capital would travel across cultural boundaries. A multicultural environment might result on agents preferring to interact with those of their own culture, discriminating against others. We study trust, an aspect of social capital, between domestic Australian students of non-Asian origin and international students of Asian origin. To measure the degree of trust and patterns of discrimination between these groups, the Berg et al. (1995) trust game and a series of control games were used in framework where each participant played each game against several partners knowing their domestic or international status. Controlling for individual heterogeneity, domestic students significantly discriminated against international students in the trust game, and individual discrimination was taste-based rather than based on beliefs towards international students’ trustworthiness. Moreover, the average amount that international students sent in the trust game was negatively related with the number of semesters studied at university in Australia, which may partly reflect cultural adjustment but also institutional disadvantages faced specifically by international students. The study furthers understanding of the patterns of discrimination between domestic and international university students and the nature of this discrimination.

Migrants referring to the Bologna Transcultural Psychiatric Team: Reasons for drop-out

Recent immigrants face various difficulties in adjusting to western countries and show a high prevalence of mental disorders. Access to a culturally appropriate community mental health centre (CMHC) is crucial for immigrants (Bhui et al., 2007). The Bologna West Transcultural Psychiatric Team (BoTPT, Tarricone et al., 2009) is one of the first projects in Italy that prioritizes cultural competence care. This paper aims to evaluate the effectiveness of this service and to describe what characteristics of patient and psychiatric intervention are related to 'drop-out'. All migrants who consecutively attended the BoTPT between 1 July 1999 and 30 June 2008 were included and evaluated at first contact and again six months later. After six months we followed up 162 patients; 32 (17.9%) of these had interrupted treatment. Non-Asian origin, a recent history of migration and not receiving social intervention were the strongest predictors of drop-out cases. Psychiatric consultation services to migrants could be made more effective by enhancing: (a) cultural competence, through cultural mediator involvement; and (b) social support from the first psychiatric contact. These two characteristics of psychiatric consultation could be developed from resources ordinarily present in the context of a CMHC and could then become a cost-effective strategy for addressing mental health needs among first-generation immigrants.

Assessing Asian Scholarly Research in Library and Information Science: A Quantitative View As Reflected in Web of Knowledge

This paper highlights the quantitative performance of scholarly LIS research in Asian countries based on articles published during 2001–2007 in journals indexed by the Social Science Citation Index of Web of Knowledge. The quantitative performance of Asian countries has been judged and compared on the basis of various quantitative indicators: (a) size of scientific activity measured by volume of production in various types of publications during the period of study, (b) authorship pattern and collaboration of scientific activity measured by co-authorship and the amount of national and international collaboration, (c) the pattern of citations measured by counting the cited and citing references of published articles, and (d) a newly developed metrics-research performance.The results show that during the last seven years, the publication rate has increased twofold and, among the Asian countries, the authors of the People's Republic of China contributed the greatest number of articles, followed by Taiwan and South Korea. There is also an increasing trend toward collaborative research among Asian authors, with most of the collaboration occurring either among authors from the same country or with authors of non-Asian origin. The research performance analysis indicates that articles written by authors from South Korea received the highest number of citations, followed by Taiwan. Although the quantity of articles published by authors of Taiwan and South Korea is higher than Singapore and Israel, the articles contributed by authors from these latter two blocks appear in higher-impact journals.These findings show the increasing contribution made by Asian scholars to the international LIS literature, and the quality of that research.

Overview of Gefitinib in Non-small Cell Lung Cancer: An Asian Perspective

Clinical experience with the EGFR-TKI gefitinib in Asian patients with NSCLC will be reviewed, both in patients who have previously failed chemotherapy and in the first-line setting (gefitinib is currently not licensed for first-line treatment). Tolerability and specific adverse events in patients of Asian origin will be discussed. Differing objective response rates between patients of Asian and non-Asian origin when treated with gefitinib (and standard cytotoxics) will also be discussed along with EGFR mutations and drug resistance. Reports of Phase II/III clinical experience with gefitinib 250 mg/day in Asia were identified by searching in Medline and ASCO databases for publications between 1993 and 2008. Defined search criteria included (gefitinib OR Iressa OR ZD1839) AND NSCLC AND (Asia OR Japan OR China OR Taiwan OR Korea) or 'Clinical trial' type, with additional searches, including AND 'interstitial lung disease (ILD)' or 'EGFR mutation'. Numerous Phase II/III trials including patients of Asian origin with previously treated advanced NSCLC report a consistent clinical benefit of gefitinib. Gefitinib is generally well tolerated by patients with NSCLC although the incidence of ILD in Japanese patients must be noted. Studies analyzing EGFR mutations indicate that these mutations occur at a much higher rate in patients of Asian origin than in non-Asian patients. Data from several studies indicate that EGFR mutation-positive patients of Asian origin have better efficacy outcomes with first-line gefitinib when compared with those who are EGFR mutation-negative. Research is ongoing to evaluate the role of tailoring patients' treatment according to their genetic phenotype.

Use of ACE inhibitors and risk of community-acquired pneumonia: a review

The administration of angiotensin-converting enzyme (ACE) inhibitors has been suggested as an alternative strategy for lowering the risk of community-acquired pneumonia (CAP) in the elderly, especially in patients with neurological and cerebrovascular comorbidity. We critically examined the relevant data from studies regarding the impact of ACE inhibitors in lowering the risk of CAP and/or mortality due to CAP in the elderly. We searched PubMed, Cochrane Database, and references of initially retrieved articles, and http://clinicaltrials.gov for ongoing trials. We identified 285 evaluable studies. Fourteen studies met the inclusion criteria and were evaluated further, of which seven were prospective studies, two randomized controlled trials, and five retrospective studies. Eight of ten studies including patients of Asian origin demonstrated a statistical significance in favor of ACE inhibitors. On the contrary, only one of five studies including patients of non-Asian origin demonstrated results in favor of ACE inhibitors. The available data suggest that ACE inhibitors may contribute to the reduction of the risk of CAP. Nevertheless, clinical data are scarce and mainly comprise studies including patients of Asian origin. As there seem to be differences regarding the genetic polymorphism of ACE among patients of different origins, future studies are needed that incorporate relevant genetics data that may help clarify the role, if any, of ACE inhibitors in preventing CAP.

Is Religion or Culture the Key Feature in Changes in Substance Use after Leaving School? Young Punjabis and a Comparison Group in Glasgow

Aims. To establish levels of use of tobacco, alcohol and illegal drugs among 18–20 year old men and women of Asian (Punjabi) and non-Asian origin compared with levels four years earlier and consider the role of religion and culture in abstinent behaviour. Design. Structured self-complete questionnaire used with 94% of pupils with South Asian names recorded by the Greater Glasgow education department in 1991 and a proportionate random sample of pupils in the same years who did not have South Asian names. Followed up in 1996 in an interviewer-led structured questionnaire in their own homes. Setting. Greater Glasgow, largest city in the west of Scotland. Participants. Eight hundred and twenty-four overwhelmingly British-born 14–15 year olds in 1992, 492 followed up aged 18–20 years in 1996. Measurements. Self-report measures of ever having tried alcohol, tobacco and drugs and the quantities consumed at age 14–15 and 18–20. Indication of reasons for abstinence from substance use at age 18–20. Findings. Asians were much more abstinent from all these substances at both ages (p < 0.001), except for smoking at 18–20. However, religiously specific patterns of abstinence were particularly strong for alcohol (Muslim odds ratio 7- to 9-fold lower at 14–15, 16- to 25-fold lower at 18–20) and smoking (Sikh/Hindu odds ratio 10-fold lower than Muslims, 20-fold than Christians at 18–20), though there is a shared Asian tendency for women to observe these patterns more than men at 18–20. Conclusions. At age 14–15 abstinence was high in the largely British-born generation of Asians mainly for cultural reasons common to religious groups. Four years later culturally determined abstinence has atrophied, and abstinence reflects the specific influence of ascetic religious traditions, though some cultural influence remains in that women are more affected. Intergenerational changes are similar. The erosion of constraints on smoking presents a threat to health.

Cognitive arithmetic across cultures.

Canadian university students either of Chinese origin (CC) or non-Asian origin (NAC) and Chinese university students educated in Asia (AC) solved simple-arithmetic problems in the 4 basic operations (e.g., 3 + 4, 7 - 3, 3 X 4, 12 •*• 3) and reported their solution strategies. They also completed a standardized test of more complex multistep arithmetic. For complex arithmetic, ACs outperformed both CCs and NACs. For simple arithmetic, however, ACs and CCs were equal and both performed better than NACs. The superior simple-arithmetic skills of CCs relative to NACs implies that extracurricular culture-specific factors rather than differences in formal education explain the simple-arithmetic advantage for Chinese relative to non-Asian North American adults. NAC's relatively poor simple-arithmetic performance resulted both from less efficient retrieval skills and greater use of procedural strategies. Nonetheless, all 3 groups reported using procedures for the larger simple subtraction and division problems, confirming the importance of procedural knowledge in skilled adults' performance of elementary mathematics. Knowledge of elementary arithmetic (i.e., simple addition, multiplication, subtraction, and division) is a pervasive requirement of everyday modern life, providing the essential means for dealing with a widely diverse variety of numerical-problem-solving situations. Basic arithmetic also provides the foundation for the more advanced mathematical skills that are central to all modern scientific disciplines. Consequently, understanding this fundamental intellectual skill is an important goal for cognitive science (Ashcraft, 1995; Geary, 1994). In this study, Chinese adults educated in the People's Republic of China and Canadian adults educated in Canada, either of Chinese or non-Asian origin, solved simple arithmetic problems involving the four basic operations (e.g., 3 + 4, 7 - 3, 3 X 4, 12 -=- 3). Participants also reported their strategy (i.e., direct memory retrieval vs. procedural strategies) after each problem. The purpose was to address three important questions of current research in cognitive arithmetic. First, when adults solve simple-arithmetic problems, what is the relative balance of direct memory retrieval versus use of procedural strategies such as counting or transformation (e.g., 6 + 7 = 6 + 6+1 = 13)? Recent evidence suggests that even skilled adults make substantial use of procedures (e.g., LeFevre, Sadesky, & Bisanz, 1996), but no study has attempted to assess this for the entire domain of elementary arithmetic. Second, what determines the problem-size effect (PSE) in cognitive arithmetic? The PSE is the virtually ubiquitous phenomenon that the difficulty of simplearithmetic problems increases as problem size increases. The PSE has been recognized and studied systematically for over 75 years (e.g., Clapp, 1924), but our study was the first to estimate the

Cognitive arithmetic across cultures.

Canadian university students either of Chinese origin (CC) or non-Asian origin (NAC) and Chinese university students educated in Asia (AC) solved simple-arithmetic problems in the 4 basic operations (e.g., 3 + 4, 7 - 3, 3 x 4, 12 divided by 3) and reported their solution strategies. They also completed a standardized test of more complex multistep arithmetic. For complex arithmetic, ACs outperformed both CCs and NACs. For simple arithmetic, however, ACs and CCs were equal and both performed better than NACs. The superior simple-arithmetic skills of CCs relative to NACs implies that extracurricular culture-specific factors rather than differences in formal education explain the simple-arithmetic advantage for Chinese relative to non-Asian North American adults. NAC's relatively poor simple-arithmetic performance resulted both from less efficient retrieval skills and greater use of procedural strategies. Nonetheless, all 3 groups reported using procedures for the larger simple subtraction and division problems, confirming the importance of procedural knowledge in skilled adults' performance of elementary mathematics.