Circadian rhythms in plasma concentration of 11-hydroxycorticosteroids in men working on night shift and in permanent night workers

Conroy, R. T. W. L., Elliott, Ann L., and Mills, J. N. (1970).Brit. J. industr. Med.,27, 170-174. Circadian rhythms in plasma concentration of 11-hydroxycorticosteroids in men working on night shift and in permanent night workers. Blood samples have been collected for estimation of plasma 11-hydroxycorticosteroids from three groups of workers - day and night shift workers in a light engineering factory, and night workers in a newspaper printing works. Up to five samples were collected over 24 hr, or two samples per 24 hr were collected for three days. In conformity with the observations of others, day workers showed maximal concentrations in the morning around the time when they started work. In the newspaper workers maximal concentrations were found when they awoke around 14·00 hr. Night shift workers in the engineering works showed a greater variety of pattern, some showing the pattern usual in a day worker, some showing a maximum concentration about midnight and a minimum around 06·00 hr and a large proportion showing no clear circadian rhythm.

In the newspaper workers the rhythm was thus well adapted to their pattern of nocturnal work, whereas relatively few of the night shift workers in the engineering works showed such adaptation. It appears that the adrenal cortical rhythm can be adapted to night work in a community in which this is universal, accepted and lifelong, but that such adjustment is unusual in men on night shift work for limited periods, and whose associates are mainly following a usual nycthemeral existence.

     

Variations of physiological functions and psychological measures and their relationships on delayed shift of sleeping time

The variations of sublingual temperature, pulse rate, flicker fusion frequency (CFF), subjective fatigue feelings (SFF) and 8 selected reaction times and the relationships between them were examined in six university students under the condition of successive 6-h delayed shift with 8 sleeping h and 22 waking h for 6 d. SFF was measured by the scales proposed by the Japanese Society for Industrial Fatigue Research. On the 2nd d when the shifting was started after the subjects had slept from 00:00 to 08:00 and on the 3rd d after sleeping h of 06:00 to 14:00, the variations of sublingual temperature, pulse rate and CFF showed a pattern of circadian rhythm. However, on the 4th-5th d the rhythms of sublingual temperature and pulse rate were flattened. On the other hand, CFF demonstrated a variation of having a nearly constant tendency till 08:00, followed by a gradual decrease during the daytime. The variation of SFF (the scale of "sleepiness and dullness") was similar to that of CFF, although the change of the score was in the opposite direction. On the 3rd-4th d, the 4th-5th d and the 6th d, significantly high rank correlations were observed between sublingual temperature and pulse rate and between CFF and SFF. However, between sublingual temperature and CFF, a high correlation which was observed on the 1st and the 2nd d was not seen on the 4th-5th and 6th d. Eight selected reaction times were shortened during the experimental days, but there was no consistent pattern of variation within these days. The results of the experiment showed that the relationship between CFF and SFF exists during the daytime when the arousal level is low.     

Daily rhythm and heat shock protein expression in obese ob/ob mice

Abstract

Objectives

This study examined heat shock protein (HSP) 70 expression and rhythms of drinking behavior and locomotor activity in obesity, in order to clarify the involvement of HSPs in obesity-induced disturbance of circadian rhythms.

Methods

C57BL/6J ob/ob mice were used as a murine model of severe obesity. Drinking behavior and locomotor activity of male C57BL/6J (control) mice and ob/ob mice were recorded with the behavioral analyzing system. HSP70 concentration in the homogenized supernatant of each tissue, including the brain, liver, and kidney, was measured by an enzyme-linked immunosorbent assay.

Results

We observed an attenuated locomotor activity rhythm in the ob/ob mice compared with the control mice at 13 weeks of age and especially at 27 weeks of age. The drinking rhythm was little affected by obesity. HSP70 protein expression was reduced in the brain and kidney of the ob/ob mice compared with the control mice. However, HSP70 expression in the liver was not altered.

Discussion

This study suggests that the obesity-induced reduction of HSP70 expression in the brain and kidney can be directly or indirectly associated with disturbance of rhythms of the master clock and peripheral clocks. The study provides a link between circadian rhythm and HSP expression in obesity; the disturbance of these factors may lead to the progression of metabolic disorders.     

Temporal binding at gamma frequencies in the brain: paving the way to epilepsy?

Fast (beta-gamma band 20-100 Hz) rhythms of electrical activity of the brain have been suggested to play an important role in perception, cognition and consciousness providing temporal binding of neural activities and allowing the formation of mental representations. The recent advances in the concept of temporal binding and their relation to the theory of neural networks (connectionism) are reviewed here as well as some experimental results concerning the intensified gamma rhythms and epilepsy. The hippocampal-neocortical gamma rhythms are extremely intense and hypersynchronous at onset of the epileptiform discharges induced by systemic kainic acid in the rat. Those gamma rhythms are followed by a slow rhythm of epileptiform spikes/sharp waves or spike-wave complexes ('spike-wave' activity). During spike-wave activity, gamma synchronisation is significantly decreased. A novel unifying concept is proposed which relates the associative principle of neural networks to the mechanism of temporal binding at high frequencies. It suggests that for each memory stored in an associative network there is a corresponding quasi-stable state of synchronous oscillation at some frequency within the gamma band. It also suggests that excessive temporal binding ("over-binding") occurs at seizure onset when abnormally intensified and globally synchronous fast activity is often observed. "Over-binding" may cause the undesirable formation of false associations due to inadequate synaptic modifications. To prevent this process, spike-wave discharge develops as an extreme activation of the mechanism capable to desynchronise and eventually suppress fast activity and erase the spurious modes of activity associated with hypersynchronous gamma rhythms. Thus, spike-wave activity is suggested to be the "anti-binding" mechanism. This mechanism is also related to the spikes/sharp waves normally occurring in the brain mostly in sleep. It is qualitatively similar to the "unlearning" mechanism of Crick and Mitchison presumably associated with the PGO spikes of the REM sleep.     

Circadian changes in serum and liver metabolites and liver lipogenic enzymes in ad libitum- and meal-fed, lean and obese Zucker rats

Circadian rhythms were studied in ad libitum- and meal-fed Zucker rats. Lean and obese female rats were fed ad libitum or in a single meal from 1400-1800 for 12 d. Both groups of ad libitum-fed rats exhibited a nocturnal feeding pattern; obese rats ate more than the lean rats during the light and dark parts of the cycle. After 12 d, groups of rats were killed at 4-h intervals over a 24-h period, inclusively, and the presence of circadian rhythms was evaluated for the serum metabolites, liver constituents and the liver lipogenic enzymes. The obese ad libitum-fed rats demonstrated rhythms for serum triglycerides, serum cholesterol, liver protein and glycogen, and the activities of fatty acid synthetase, citrate cleavage enzyme (EC 4.1.3.8), and glucose-6-P dehydrogenase (EC 1.1.1.49). Meal feeding the obese rats modified the rhythms for serum cholesterol, liver glycogen and the activities of glucose-6-P dehydrogenase, and citrate cleavage enzyme and a rhythm was established for serum glucose. The feeding schedule did not cue a rhythm for serum triglycerides and phosphogluconate dehydrogenase (EC 1.1.1.44) or modify the rhythm for liver protein. The lean ad libitum-fed rats displayed rhythms for all the measured parameters except serum glucose. Feeding-cued rhythms for all metabolites except serum cholesterol were observed when the lean rats were meal-fed. These data suggest that the rhythms of the ad libitum-fed obese rats may not be similar to those observed in the lean rat. Yet, changing the feeding schedule may be important in establishing rhythm patterns that will alter the anabolic profile characteristic of the Zucker obese rat.     

Schedule of protein ingestion and circadian variations of glycogen phosphorylase, glycogen synthetase and phosphoenolpyruvate carboxykinase in rat liver.

The circadian rhythms of liver glycogen and hepatic activity of glycogen synthetase (GS), glycogen phosphorylase (GP) and phosphoenolpyruvate carboxykinase (PEPCK) were studied in adult male rats. The rats either received a mixed diet ad libitum (10% protein) or a protein meal (1.85 g protein) given at 09:00 or 21:00 hours, with free access to a protein-free diet (separately-fed). When the protein meal was ingested at 09:00 hours it was followed by a drop in liver glycogen and a persistent daylight increase in GP and PEPCK activities, this phenomenon being attenuated when proteins were ingested during darkness (21:00 hours). Moreover in the latter case, the circadian rhythm of liver glycogen was modified (glycogen accumulation occurring later) and the protein meal ingestion was followed after a transient decrease by a high and sustained GS activity during a long period (12 hours). The drop in the hepatic glycogen level and the unusually long daylight period of sustained GP and PEPCK activities in separately-fed rats consuming the protein meal at 09:00 hours suggests that, in this case, part of the ingested nitrogen could have been catabolized and used for gluconeogenesis, thus explaining our previous observation of lower nitrogen retention observed in this group of rats.     

Circadian rhythms of seven heavy metals in plasma, erythrocytes and urine in men: observation in metal workers

To elucidate circadian rhythms (variation within a day) of 7 toxic or essential metals in plasma and erythrocytes in relation to the rhythms in urine in men, 19 male metal foundry workers were examined; they were exposed to lead (Pb), zinc (Zn) and copper (Cu) occupationally but separated from the exposure during the study. Circadian rhythms were found for plasma concentration of Pb, cadmium (Cd), Zn, Cu and chromium (Cr) in the workers. Circadian rhythms were also found for Pb, inorganic mercury (Hg), Zn and Cr in erythrocytes and for all metals except Zn in urine. Both the plasma and urinary levels of Pb, Cd, Cu and Cr together with urinary excretion of Mn and creatinine tended to decrease during night hours; both the erythrocyte and urinary levels of Hg together with both the plasma and erythrocyte levels of Zn tended to increase during morning hours. The results of profile analysis suggested that the circadian rhythm of Pb in urine was affected more strongly by its plasma and erythrocyte rhythms than by the rhythm of creatinine in urine, i.e. the rhythm of glomerular filtration; the urinary rhythms of Cd, Cr, and Mn were affected more by the creatinine rhythm; and the urinary rhythm of Cu was affected by both its plasma and creatinine rhythms. On the other hand, the urinary rhythm of Hg was assumed to be independent of the creatinine rhythm and be affected by its erythrocyte rhythm. The present study suggested that different biological limit values might be needed for different hours of the day especially for shift workers who are exposed to various heavy metals. Instead, further studies should be conducted to find the adjustment methods by which no circadian rhythms are discerned.     

Social strain and cortisol regulation in midlife in the US

Chronic stress has been implicated in a variety of adverse health outcomes, from compromised immunity to cardiovascular disease to cognitive decline. The hypothalamic pituitary adrenal (HPA) axis has been postulated to play the primary biological role in translating chronic stress into ill health. Stressful stimuli activate the HPA-axis and cause an increase in circulating levels of cortisol. Frequent and long-lasting activation of the HPA-axis, as occurs in recurrently stressful environments, can in the long run compromise HPA-axis functioning and ultimately affect health. Negative social interactions with family and friends may be a significant source of stress in daily life, constituting the type of recurrently stressful environment that could lead to compromised HPA functioning and altered diurnal cortisol rhythms. We use data from two waves (1995 and 2004-2005) of the Midlife in the U.S. (MIDUS) study and from the National Study of Daily Experiences (NSDE) and piecewise growth curve models to investigate relationships between histories of social strain and patterns of diurnal cortisol rhythms. We find that reported levels of social strain were significantly associated with their diurnal cortisol rhythm. These effects were more pronounced for individuals with a history of greater reported strain across a ten-year period.     

Drowsiness detection during different times of day using multiple features

Driver drowsiness has been one of the major causes of road accidents that lead to severe trauma, such as physical injury, death, and economic loss, which highlights the need to develop a system that can alert drivers of their drowsy state prior to accidents. Researchers have therefore attempted to develop systems that can determine driver drowsiness using the following four measures: (1) subjective ratings from drivers, (2) vehicle-based measures, (3) behavioral measures and (4) physiological measures. In this study, we analyzed the various factors that contribute towards drowsiness. A total of 15 male subjects were asked to drive for 2 h at three different times of the day (00:00–02:00, 03:00–05:00 and 15:00–17:00 h) when the circadian rhythm is low. The less intrusive physiological signal measurements, ECG and EMG, are analyzed during this driving task. Statistically significant differences in the features of ECG and sEMG signals were observed between the alert and drowsy states of the drivers during different times of day. In the future, these physiological measures can be fused with vision-based measures for the development of an efficient drowsiness detection system.     

Influence of meal time on salivary circadian cortisol rhythms and weight loss in obese women

OBJECTIVE: We aimed to determine the influence of meal time on salivary circadian cortisol rhythms and weight loss in obese women. METHODS: Twelve obese subjects (body mass index >40 kg/m(2)) were hospitalized for 64 d and then randomly assigned to one of three 18-d stages with a 5-d interval between stages. In stage 1, the subjects received a hypocaloric diet (1000 kcal/d) portioned into five meals per day. In stage 2, the subjects received the same diet between 0900 and 1100 h. In stage 3, they received the same diet between 1800 and 2000 h. Between admissions, the subjects were discharged from the hospital and consumed their usual diet at home. Salivary cortisol rhythm (in six samples collected over a 24-h period) was determined during each stage, and anthropometric, bioimpedance, indirect calorimetric, and urinary nitrogen excretion variables were measured. RESULTS: Salivary cortisol circadian rhythms were similar during all stages when measured on day 1 or 18 of treatment. Despite significant reductions in all anthropometric measurements except waist/hip ratio, no significant changes were observed in salivary cortisol rhythm after alteration of the eating hours. Starting on day 4 of treatment, nitrogen ingestion and excretion levels decreased significantly; on day 10, nitrogen balance was negative in all study stages. CONCLUSION: Administration of a hypocaloric diet led to changes in weight, body composition, resting metabolic rate, and nitrogen balance but did not significantly alter salivary circadian cortisol rhythms.     

Circadian excretory rhythms in night workers

Conroy, R. T. W. L., Elliott, A. L., and Mills, J. N. (1970).Brit. J. industr. Med.,27, 356-363. Circadian excretory rhythms in night workers. Urine samples have been collected from day and night shift workers in a light engineering factory over periods of 24 or 48 hours during which blood was also collected for determination of plasma 11-hydroxycorticosteroids (11-OHCS). Different subjects divided their 24-hour output into as few as 4 or as many as 14 portions. Where possible, the timing of the excretory rhythms was assessed objectively by fitting a sine curve. The potassium excretory rhythm was, in most subjects, well adapted to night work in that they excreted least during their hours of sleep; no relationship could be discerned between potassium excretory and plasma 11-OHCS rhythms. The sodium excretory rhythm was less regular than that of potassium in both night and day workers, and in night workers both sodium excretion and urine flow were often high during the hours of sleep, so that the subjects were sometimes awakened by the need to micturate. There was, however, sufficient association between the behaviour of sodium and potassium to suggest that their excretory rhythms have a common cause, and that this is not the secretion of 11-OHCS. Phosphate excretion fell sometimes on rising, even though plasma 11-OHCS concentration was not high, and sometimes after a high level of plasma 11-OHCS, at a time other than on rising. This suggests that these are two independent contributory causes of the usual morning fall in phosphate excretion.     

Live birth distribution by time and place from 1981 to 1998 in Japan

OBJECTIVES: To investigate the diurnal rhythm of live births labored spontaneously, and the effects of obstetric intervention on birth time distributions. METHODS: The data of live births tabulated by time (one-hour intervals), date and birthplace throughout Japan between 1981 and 1998 were obtained with permission from the former Ministry of Health and Welfare. Together with an investigation of hourly birth numbers by place in each year, an annual transition of hourly birth rates in medical institutions and the diurnal rhythm of birth numbers in maternity homes and at home were analyzed using regression analysis. RESULTS: In every calendar year studied the hourly live birth numbers at hospitals showed a single-peak distribution pattern with maximum values at 13:00-15:00. The annual transition of hourly birth rates showed a 10% (birth numbers base) decrease in the 11:00-13:00 period in 1998 as compared with that in 1981, while there was a corresponding increase of 8% in the 13:00-15:00 period. Hourly birth numbers at clinics showed a double-peak distribution pattern with maximum values during the 11:00-12:00 and 14:00-15:00 periods in early 1980, while a single-peak distribution with a maximum value during the 13:00-15:00 period appeared in 1989 and has remained thereafter. Hourly birth rates (birth numbers base) increased by over 6% in the 13:00-15:00 and 17:00-20:00 periods over the past 18 years, while they decreased by 10% in the 9:00-13:00 period. The results at maternity homes were clearly different from those at hospitals and clinics. The live birth numbers totaled for the 18 years showed a double-phase distribution with a maximum value in the 6:00-7:00 period and a minimum value in the 19:00-20:00 period. The best-fit regression model for the obtained data was a sine curve with a maximum value at 6:00 (coefficient of determination 0.97). Hourly distributions of live births at home also fitted best to a since curve with the maximum value again at 6:00 (coefficient of determination 0.95). CONCLUSIONS: The results suggested that the timing of spontaneous live births follows a circadian rhythm and that obstetric intervention affects time distributions of live births by shifting over 10% of births during the night and early morning to a working day service time (9:00-17:00).     

Circadian rhythms in the urinary excretion of heavy metals and organic substances in metal workers in relation to renal excretory mechanism: profile analysis

Summary Circadian rhythms in the urinary excretion of eleven heavy metals and organic substances were examined under free, water-restrictive and water-loading conditions for 6 d (2 d for each of the three conditions) in twenty metal workers exposed to lead, zinc and copper. Circadian rhythms were found for all heavy metals and organic substances as well as for urinary flow (UF) rate, creatinine (Cn) and total urinary solutes (TUS). The Cn rhythm was significantly unparallel to the OF rhythm under the water-loading condition, indicating that the two rhythms were essentially different from each other. Circadian rhythms of the eleven urinary substances were then related to the Cn and OF rhythms, using profile analysis. The results indicated that the rhythms in the manganese, chromium, copper and beta-2-microglobulin excretion depend on the Cn rhythm, i.e. the rhythm of glomerular filtration; the rhythms in the hippuric acid, delta-aminolevulinic acid and TUS excretion are on the OF rhythm, i.e. the rhythm of reabsorption by the distal tubule and collecting duct. On the other hand, the rhythms in the lead, inorganic mercury, cadmium, zinc and coproporphyrin excretion were considered as reflecting complex renal excretory mechanisms.     

Circadian rhythms in the urinary excretion of metals and organic substances in "healthy" men

Circadian rhythms in the urinary excretion of metals and organic substances were examined in ten "healthy" men under conditions of water loading and restriction. Four characteristic rhythms were observed: (1) decreased excretion during the night for lead and urinary flow rate; (2) decreased excretion of hippuric acid, delta-aminolevulinic acid, coproporphyrin, creatinine, and total urinary solutes during the night and morning hours; (3) increased excretion of mercury and zinc during the morning hours; and (4) no significant variation for copper. Excretion of lead, hippuric acid, delta-aminolevulinic acid, and total urinary solutes was significantly correlated with urinary flow rate and creatinine excretion, which suggested that their circadian rhythms were the consequence of reduced glomerular filtration and increased reabsorption by the distal tubule and collecting duct during the night and morning hours. Similarly, it was suggested that the mercury and zinc rhythms resulted partly from increased reabsorption during the night hours; the coproporphyrin rhythm reflected reduced glomerular filtration of coproporphyrinogen during the night and morning hours.     

Relationship between utilization of health notebooks and the elderly population rate among Japanese municipal governments

OBJECTIVE: Health conditions are changing rapidly in aging societies and an essential health service by municipal governments is to promote the utilization of health notebooks in support of the health of individuals. The objective of this study was to clarify the relationship between utilization of health notebooks and rates for elderly among Japanese municipal governments. SUBJECTS AND METHODS: Questionnaires on the utilization of health notebooks were mailed to all 3,255 municipal governments in Japan. The 2,445 that filled in all items on the questionnaire were enrolled in this study. Questions concerned opportunities for utilizing health notebooks when residents received health education/guidance, health examinations, home visits, or welfare service. If they answered "Frequent use" for these opportunities, one point was given. Furthermore, if they answered that they filled in the results of residents' health examination into health notebooks, one point was given. If a municipal government got 4 points or more, this municipality was classified as "health notebooks frequently used". RESULTS: The percentage of municipalities defined as "health notebooks frequently used" was higher among municipal governments with a high rate of elderly residents than with a lower rate. The odds ratio for being classified as "health notebooks frequently used" was higher among municipal government with high rates for the elderly and public health nurses per elderly person than with low rates. CONCLUSION: With increase in the percentage of elderly residents, municipal governments need to promote their health services in support of residents' health. To improve the utilization of health notebooks, municipalities should increase the number of public health nurses.     

Nutrient intake as a time signal for circadian rhythm.

In considering nutrition and circadian rhythms, time-of-eating behavior is an inherited, genetically controlled pattern that can be phase-shifted by conditioning or training. In addition, there are metabolic responses to meal eating, such as entrainment of a number of enzyme levels, hormone concentrations and other metabolic and physiologic activities. To separate truly inherent rhythms from entrained responses, it is necessary to determine which oscillations continue their circadian rhythms under completely free-running conditions of no zeitgeber, such as darkness vs. light or meal eating vs. fasting. Where meal eating provides a time signal to a biological clock experiment, healthy animals-not starving but constantly receiving nutrition to avoid an eating time signal-should be used. The ability to determine which daily rhythms are not genetically inherent, but rather are responses to a particular time signal, requires the elimination of all but this time signal. By using free-running conditions that are totally without time-giving signals, entrainment by (response to) meal feeding is readily separated from inherited endogenous circadian rhythm. Both types of daily rhythm exist and both involve the biological clock mechanisms . A method by which to identify each is proposed.     

Factors affecting attitudes toward care of elderly mothers

OBJECTIVE: In this study, we aimed to examine the factors that affect people's attitudes toward parental care. Previous qualitative studies present several factors that affect the decision of adult children of whether to take care of elderly parents or send them to a nursing home when they become fragile and need daily help. In the present study, we included affection, filial obligation, sekentei (i.e., wanting to keep an appearance of taking care), and other factors presented in previous studies. METHODS: In May 2001, we mailed a questionnaire to females in their 30s who live in an agricultural area of K. City, Saitama Prefecture in Japan. We asked the respondents whether they would take care of their mothers or mothers-in-law, or send the mothers to a nursing home when the mothers need 24-hour care in the near future. RESULTS: Logistic regression analysis revealed that filial obligation and sekentei affected attitude toward care in the case of a mother while affection did in the case of a mother-in-law. DISCUSSION: These results suggest that women who do not have intimate feelings towards their mothers-in-law may choose not be a caregiver. On the other hand, women may take care of their mothers, whatever feelings they have because of the blood-relation. Also it may be that in such a small agricultural area, sekentei affects people's conduct, even if it is a private matter, such as caring an elderly mother.     

Circadian rhythms and behavior of permanent nightworkers

Summary This paper describes rest/activity rhythms of permanent shift workers: rotary printers. They reported during one week the hours of their sleep onset and of their meals, and their subjective appreciation of tiredness and mood. The average sleep duration (7.84 h) can be compared with that of day workers and is fairly longer than the duration of day sleep of shift workers when they are on nightshift. This long sleep can be accounted for by: (1) the early bedtime (around 05.00 h), (2) an adjustment of biological rhythms to the schedule inversion.Other evidence (naps, meal time) supports the hypothesis of a physiological adjustment. It is pointed out that this adjustment is fragile: the printers must have very rigid life habits and schedules (sleep, meals). Each time they change this strategy (especially during week-end) it is subjectively felt as detrimental.     

Preventable hospitalizations in primary care shortage areas. An analysis of vulnerable Medicare beneficiaries

BACKGROUND: Health care outcomes among vulnerable elderly populations (defined in this study as Medicare beneficiaries who rated their overall general health as "fair" or "poor") are a growing concern. Recent studies suggest that potentially preventable hospitalizations may be useful for identifying poor ambulatory health care outcomes among vulnerable populations. OBJECTIVES: To determine if Medicare beneficiaries in fair or poor health are at increased risk of experiencing a preventable hospitalization if they reside in primary care health professional shortage areas. DESIGN: A survey of Medicare beneficiaries from the 1991 Medicare Current Beneficiary Survey. PATIENTS: Medicare beneficiaries living in the community. RESULTS: Medicare beneficiaries in fair or poor health were 1.82 times more likely to experience a preventable hospitalization if they resided in a primary care shortage area (95% confidence interval, 1.18-2.81). After controlling for educational level, income, and supplemental insurance, Medicare beneficiaries in fair or poor health were 1.70 times more likely to experience a preventable hospitalization if they resided in a primary care shortage area (95% confidence interval, 1.09-2.65). CONCLUSIONS: Medicare beneficiaries in fair or poor health are more likely to experience a potentially preventable hospitalization if they live in a county designated as a primary care shortage area. Provision of Medicare coverage alone may not be enough to prevent poor ambulatory health care outcomes such as preventable hospitalizations. Improving health care outcomes for vulnerable elderly patients may require structural changes to the primary care ambulatory delivery system in the United States, especially in designated shortage areas.     

A survey of subjective symptoms and life-style in junior high school students

PURPOSE: A questionnaire survey was conducted to examine a relationship between indefinite complaints and life styles in junior high school students and to apply the results to life guidance. METHODS: Twenty nine public junior high schools were selected by random sampling of 13 cities and 3 towns in Kanagawa Prefecture. A self-reported questionnaire was supplied to all subjects, containing 100 life-style related items, including a simplified CMI (Cornel Medical Index) questionnaire. RESULTS: The number of students who were evaluated as "point medical examination" based on physical symptoms of CMI and "disorder" based on the mental and physical symptom increased with the grade for both males and females. The students who reported "the life rhythm was always irregular" tended to be in the group evaluated as "disorder" or "point medical examination". The life rhythm was related to bedtime, sleeping hours and eating habits. It was observed that the students whose daily habits were always irregular had late bedtime, short sleeping hours and an irregular eating habit. As a result of the quantification method for the second type of analysis, it was found that sleeping time was the most related factor to the life rhythm. Furthermore 90% and more of students reported they did not consider nutritional balance with regard to their eating habits. CONCLUSION: It was suggested that those students who had irregular life rhythm needed sufficient sleep and nutrition guidance to maintain their health.