A study on personal information system using movable media for effective welfare services]

A data system which enables utilization of individual patient data by public health nurses, physicians and home helpers, is required both for the continuous and comprehensive monitoring of the various needs of the aged receiving care services at home in the local district and for facilitating welfare services. Therefore, an experimental and comprehensive system for public health, medical services and welfare was put into practice for district public health services for the aging society. The results of this trial system shows that this system is useful indeed for the welfare services, though it also has several problems.     

Further study of nebulisation chemotherapy, a new chemotherapeutic method in the treatment of lung carcinomas: fundamental and clinical.

Nebulisation chemotherapy, a chemotherapeutic method for the treatment of lung cancer that involves the administration of anticancer agents through the inhalation of nebulised aerosols, has been found to be highly effective (Tatsumura et al., 1983a,b). We confirmed that 5-FU administered by this method accumulates in the trachea, bronchi and regional lymph nodes of patients treated before surgery, along with 5-FU metabolites, FUR and FUdR, indicating that 5-FU is directly incorporated and metabolised in the respiratory tract. Parallel result were obtained using mongrel dogs. The 5-FU levels in other organs, such as the heart and liver, were found to be extremely low. Only a trace of 5-FU was found in the serum of both the patients and the dogs. We further investigated the anti-tumour effect of this therapy in ten selected patients and observed a satisfactory anti-tumour response of 60.0%. These results, along with our previous finding that the retention time of isotope tracers inhaled as aerosol is considerably longer in tumour tissues than in normal parts (Tatsumura et al., 1983a) explain the high antitumour action of this therapy and the absence of adverse effects of administered 5-FU.     

Influence factors on the development of obesity in 3-year-old children based on the Toyama study

BACKGROUND: Obesity in childhood increases the risk of obesity in adulthood. Obesity in adulthood is a risk factor for chronic diseases such as hypertension and atherosclerosis. Therefore, it is important to eliminate factors influencing the development of obesity in children from the viewpoint of preventive medicine. The purpose of this study is to elucidate the relationship between obesity and lifestyle in 3-year-old children in a case-control study. METHODS: Subjects were selected from the Toyama study at health checkups for 3-year-old children which are done routinely by local governments in Japan on all children of that age. A special questionnaire consisting of items on lifestyle and environmental factors of the children and past histories of parents was distributed to the Toyama study participants beforehand and was collected at the checkup. Matched-pair comparisons were performed between obese children whose body mass index was 18 or more (N = 427) and control children (N = 854) matched by sex and birth month. Multivariate stepwise conditional logistic regression analysis was also applied to assess the influence of confounding factors. RESULTS: The following six factors significantly influenced the development of obese 3-year-old children using the Mantel-Haenszel method: the mother's job, limited playtime outdoors (1 hour or less), snacking irregularity, an overweight father (body mass index >/= 24), an overweight mother (body mass index >/= 24), and overweight at birth (birth weight >/= 3,500 g). An overweight mother or father, limited playtime outdoors, overweight at birth, and snacking irregularity were significantly related to obesity in 3-year-old children after adjusting for confounding factors by multivariate stepwise conditional logistic regression analysis. CONCLUSIONS: We have suggested several factors influencing the development of obesity in 3-year-old Japanese children: parental overweight and overweight at birth as host factors, physical inactivity and snacking irregularity as behavioral factors, the mother's job as an environmental factor.     

Physio-social activities and active life expectancy, life expectancy in Japanese elderly]

PURPOSE: Incidence of loss of activity and death in elderly people living at home were investigated to attempt to determine their relationship to physio-social activities in elderly. METHOD: This longitudinal study of life expectancy and active life expectancies is a thirty-six months follow up study. Loss of activities were classified as follows: Long term (over six months) treatment at home, long term (over six months) admission to hospital or intermediate institute for the elderly, admission to nursing home, and death. Subjects were persons living at home in Ogi, Saga prefecture, aged 70 years or older not requiring help in active daily living (ambulating, bathing, dressing, discharging, eating). RESULTS: 6,274 (male = 2,383, female = 3,891) subjects were followed for thirty six months, and 178 people experienced long term treatment at home, 310 people had long term admission to a hospital or intermediate institute for elderly, 28 people were admitted to a nursing home and 449 people experienced death. The main results were as follows: (1) From the Cox proportional hazards model using the likelihood-ratio method of survival and active life loss, significant hazard ratios for reduction active life expectancy for male were found for age, disability score for ADL, speech disorder, inconvenient bathroom design, with attention to health, and daily activity were associated with extension of active life expectancy. Age, disability score for ADL, speech disorder, inconvenient bathroom design were associated with reduced life expecting, while, attention to health, choosing to undergo regular health examinations, and daily were associated with increased activity in life expectancy. (2) Hazard ratios for reduction active life expectancy for females were age, disability score for ADL, defect of memory deficits, inconvenient design for hallway and stairs. Participating in health examinations, Purpose in life were associated with life expectancy increase. For females were age, disability score for ADL, speech disorder, inconvenient design of bathroom were associated with decrease in life expectancy, while having a person in life was associated with increase in life expectancy. DISCUSSION: Relationship between physio-social activities in elderly is a significant factor in many studies on elderly health. This study suggests that age, disability score for ADL, inconvenient for housing design, active health behavior, daily activities, and Losing a sense of worth in living, affect active life expectancy and life expectancy.     

Trabecular Bone Score (TBS) Predicts Vertebral Fractures in Japanese Women Over 10 Years Independently of Bone Density and Prevalent Vertebral Deformity: The Japanese Population‐Based Osteoporosis (JPOS) Cohort Study

Bone strength is predominantly determined by bone density, but bone microarchitecture also plays an important role. We examined whether trabecular bone score (TBS) predicts the risk of vertebral fractures in a Japanese female cohort. Of 1950 randomly selected women aged 15 to 79 years, we analyzed data from 665 women aged 50 years and older, who completed the baseline study and at least one follow‐up survey over 10 years, and who had no conditions affecting bone metabolism. Each survey included spinal imaging by dual‐energy X‐ray absorptiometry (DXA) for vertebral fracture assessment and spine areal bone mineral density (aBMD) measurement. TBS was obtained from spine DXA scans archived in the baseline study. Incident vertebral fracture was determined when vertebral height was reduced by 20% or more and satisfied McCloskey‐Kanis criteria or Genant's grade 2 fracture at follow‐up. Among eligible women (mean age 64.1 ± 8.1 years), 92 suffered incident vertebral fractures (16.7/10³ person‐years). These women were older with lower aBMD and TBS values relative to those without fractures. The unadjusted odds ratio of vertebral fractures for one standard deviation decrease in TBS was 1.98 (95% confidence interval [CI] 1.56, 2.51) and remained significant (1.64, 95% CI 1.25, 2.15) after adjusting for aBMD. The area under the receiver operating characteristic curve of TBS and aBMD combined was 0.700 for vertebral fracture prediction and was not significantly greater than that of aBMD alone (0.673). However, reclassification improvement measures indicated that TBS and aBMD combined significantly improved risk prediction accuracy compared with aBMD alone. Further inclusion of age and prevalent vertebral deformity in the model improved vertebral fracture prediction, and TBS remained significant in the model. Thus, lower TBS was associated with higher risk of vertebral fracture over 10 years independently of aBMD and clinical risk factors including prevalent vertebral deformity. TBS could effectively improve fracture risk assessment in clinical settings. © 2014 American Society for Bone and Mineral Research.     

Trends in stroke incidence and acute case fatality in a Japanese rural area : the Oyabe study

BACKGROUND AND PURPOSE: Stroke mortality in Japan has significantly declined during recent decades. To determine the cause of this decrease, we studied the trends in stroke incidence and case fatality within 28 days after stroke in a rural area in Japan. METHODS: We used a population-based registry during 1977-1991 in Oyabe, a rural area in the central part of Japan. The average population aged 25 years and older numbered 32 859 persons. Changes in age-standardized stroke incidence rate were calculated and compared between the 3 periods 1977-1981, 1982-1986, and 1987-1991. The 28-day case fatality rate was evaluated and also compared between the 3 periods by onset year. RESULTS: The total number of strokes was 2068. The age-standardized incidence rate of all strokes decreased during the 15-year period, from 605 to 417 per 100 000 in men and from 476 to 329 per 100 000 in women. A marked decline was found during 1977-1986 but was not apparent during 1987-1991. Moreover, there was an increase in the group aged 75 years and older. The 28-day case fatality rates for all strokes improved from 18.0% to 14.2% in men and from 26.8% to 19.1% in women during the observation period. CONCLUSIONS: These data indicate that declines in the stroke incidence and the 28- day case fatality have been associated with a marked decrease in stroke-related mortality in Japan.     

A meta-analysis of epidemiological studies on the relationship between occupational electromagnetic field exposure and the risk of adult leukemia

Since the first paper by Milham et al. suggested that occupational exposure to an electromagnetic field (EMF) could increase the risk of adult leukemia, many epidemiological studies on this problem have been published. In this report the method of meta-analysis was used to summarize the results from these papers quantitatively. The combined relative risk of all leukemia (RR=1.11), as well as acute lymphocytic leukemia (RR=1.38), acute myeloid leukemia (RR=1.07) and chronic lymphocytic leukemia (RR=1.14) increased but not significantly. So far, it is difficult to make a consistent conclusion about the relationship of the occupational exposure to EMF and adult leukemia. Further carefully designed case-control and cohort studies using the more valid means of exposure assessment are required.