Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Background: In Japan, cervical cancer (CC) deaths among women aged <50 years have doubled over the last three decades. Obtaining age-specific CC mortality rates among young women is important for taking measures against CC. Age-adjusted CC mortality rates for all ages are inadequate because of the classification of 'uterine cancer, not otherwise specified' (NOS uterine cancer) and CC mortality rates among elderly women. The aim of the present study was to calculate exact age-specific CC mortality rates in women aged <50 years in Kanagawa, taking into account the impact of NOS uterine cancer.
Methods: Using the Kanagawa Cancer Registry, CC deaths (1975-2012) were analyzed and CC mortality rates (age-adjusted, 20-29, 30-49, and >= 50 years) were calculated. In addition, hospitals were surveyed to reclassify cases of NOS uterine cancer. After reclassification, chronological trends were also analyzed.
Results: Age-specific CC mortality rates in Kanagawa and Japan overall showed increasing trends for ages 20-29 (P for trend < 0.001) and 30-49 (P for trend < 0.001). Rates of NOS uterine cancer death were significantly lower in Kanagawa than in Japan overall (P < 0.05), except for patients aged <50 years in 2005-2009 (P = 0.159).
Conclusions: The present study revealed concern for CC among Japanese women younger than 50 years. Well-organized CC screening and HPV vaccination should be provided to reduce CC mortality rates for these young women. (C) 2015 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.canep.2015.08.001

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Language：Japanese   Publisher：(一社)日本循環器病予防学会  

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Language：Japanese   Publisher：(一社)日本循環器病予防学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

Serum, plasma and dietary magnesium (Mg) have been reported to be inversely associated with cardiovascular disease risk factors. We examined the associations between the 24-h urinary Mg/creatinine (Cre) ratio and cardiovascular disease risk factors, such as body mass index (BMI), blood pressure (BP), serum total cholesterol (TC) and prevalence of obesity, hypertension and hypercholesterolemia. A cross-sectional analysis was conducted among 4211 participants (49.7% women) aged 48-56 years in 50 population samples from 22 countries in the World Health Organization-coordinated Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study (1985-1994). In linear regression analyses, Mg/Cre ratio was inversely associated with BMI, systolic BP (SBP), diastolic BP (DBP) and TC (P for linear trend <0.001 for each). These associations were not markedly altered by adjustment for traditional risk factors, urinary markers or cohort effects. Multivariate-adjusted mean values for the subjects in the highest Mg/Cre ratio quintile were 6.3, 3.4, 5.3 and 4.6% lower than those for the subjects in the lowest quintile for BMI, SBP, DBP and TC (P<0.001, respectively). The prevalence of obesity, hypertension and hypercholesterolemia was 2.10 (95% confidence interval: 1.50, 2.95), 1.55 (1.25, 1.92) and 2.06 (1.63, 2.62) times higher (P<0.001, respectively) among the subjects in the lowest Mg/Cre ratio quintile than in the subjects in the highest quintile. These associations were not appreciably altered by adjustment for potential confounding variables. In conclusion, higher 24-h urinary Mg/Cre ratio was associated with lower cardiovascular disease risk factors, including BMI, BP, TC, obesity, hypertension and hypercholesterolemia.

DOI： 10.1038/hr.2014.158

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER-VERLAG BERLIN  

DOI： 10.1007/978-3-319-15126-7_50

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN ATHEROSCLEROSIS SOC  

Aim: The prevalence of overweight and a change in atherosclerotic lipid profiles may be linked to region-specific differences in atherosclerotic diseases. We evaluated whether the lipid phenotype could be linked to region-and sex-specific differences in the degree of atherosclerosis.
Methods: Non-diabetic subjects included Okinawa (n=1674) and Nagano (n=1392) residents aged 30-75 years who underwent carotid ultrasonography for the measurement of maximum intima-media thickness (max IMT).
Results: Average max IMT was higher in Okinawa men and women, and the increase in max IMT with age was enhanced in men. Multiple regression analysis showed that in addition to age and systolic blood pressure, low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol were IMT determinants only in men for both Okinawa and Nagano. Meanwhile, HDL-cholesterol was a determinant for Okinawa men and women, but not for Nagano men and women.
Conclusions: This is the first report to show region-and sex-specific differences in the determinants for max IMT in a Japanese population. The evaluation of the relationship between lipid profile patterns and region-and sex-specific differences in carotid atherosclerosis burden may be required.

DOI： 10.5551/jat.26674

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ PUBLISHING GROUP  

Background The Fukushima Daiichi nuclear power plant accident (FDNPPA) was the world's second largest nuclear power plant accident. At the time that it occurred, internet usage prevalence in Japan was as high as 80%.
Objectives To compare health knowledge on radiation and preventive behaviour between internet users and non-users among adults employed in industries in Fukushima after the nuclear disaster.
Methods We conducted a cross-sectional questionnaire study among adults employed in industries in Fukushima 3-5 months after the FDNPPA. Targets were 1394 regular workers who took part in health seminars provided by the Fukushima Occupational Health Promotion Center. After applying the selection criteria, there were 1119 eligible participants. The questionnaire asked for personal characteristics and main sources of information about the FDNPPA, as well as health knowledge on radiation and preventive behaviours following the nuclear accident. We assessed the contribution of each variable using logistic regression analysis.
Results Among the eligible respondents, 637 workers (56.9%) were internet users and 482 (43.1%) were non-users. Internet users had more health knowledge than non-users (average 4.6 radiation-related health conditions in internet users vs 3.6 conditions in non-users) and more preventive behaviours (average 2.6 behaviours in internet users vs 1.9 in non-users). According to logistic regression analyses, internet usage was positively associated with greater health knowledge on radiation (OR 1.13; 95% CI 1.08 to 1.20) and more preventive behaviours (OR 1.14; 95% CI 1.07 to 1.23).
Conclusions Internet usage was significantly and positively associated with greater health knowledge and more preventive behaviours. The internet is a useful method of distributing information to the general public in emergency situations such as a nuclear disaster.

DOI： 10.1136/emermed-2013-202955

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

AimThis study investigated the status of cervical cancer screening among women in a university hospital-based community who received catch-up human papillomavirus (HPV) vaccinations as a basic element of our community-based cervical cancer prevention advocacy.
MethodsSelf-administered questionnaires were distributed to 173 women working or studying in the community at their first HPV vaccination in 2010, at the third vaccination, and 2 years later. Their demographics and attitudes toward the Pap test were analyzed.
ResultsThe median age of the participants was 27.5 years and 88.2% were sexually active. Before the first vaccination, 38.5% (57/148) of the screening targets had never had a Pap test. Among the women who completed the third vaccination, Pap test experiences within the recent 2 years increased from 45.3% (63/139) at the first vaccination to 71.2% (99/137) at the third vaccination, and 67.5% (54/80) 2 years later. In 45.3% of the screening targets who had never had a Pap test at the time of their first HPV vaccination, their first Pap test was followed by their vaccination.
ConclusionsHaving biennial Pap tests in accordance with the Japanese national cancer screening guideline was shown to be difficult even for the women in the medical community; however, education about the Pap test and the efficacy of HPV vaccination in providing opportunistic screening encouraged them to have their first or suspended Pap test. Our interim data suggest the need for urgently changing the cervical cancer prevention strategy for young adult women who are excluded from the national HPV vaccine program.

DOI： 10.1111/jog.12288

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS INC  

We investigated the relationship among 24-h blood pressure (BP), pulse rate (PR) and core temperature by using an ambulatory BP monitoring, a new wristwatch-type pulsimeter with accelerometer (WPA) and an ear thermometer simultaneously. Our results suggest that the ear temperature which reflects the core body temperature was lowest at base PR during sleep and 75% of normotensives and 54% of subjects without hypertensive medication had a significant correlation between BP and PR. Diabetic subjects showed a significantly higher PR during sleep than non-diabetic subjects. Three types of equipments, especially a new WPA, are expected to be useful for daily lifestyle monitoring to evaluate risk of complications of hypertension and diabetes.

DOI： 10.3109/10641963.2014.892120

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Language：English   Publisher：4  

DOI： 10.1017/dmp.2013.73

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DOI： 10.2196/ijmr.2541

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Language：Japanese   Publisher：(公大)横浜市立大学医学部看護学科  

ブラジル日系永住高齢者の食に対する思いや価値観、役割などをあきらかにし、生活習慣病予防における保健指導の基礎資料とすることを目的に、リオグランデ州の日系集団移住地イボチ、およびサンタカタリーナ州ラーモスの65歳以上の日系永住高齢者5名(女性。65歳〜77歳)を対象に半構成的面接を行った。内容分析の結果、日系高齢者にとっての食の意味として、【家族の健康を守る】【働くという生きがいをもたらす】【かけがいのない家族との絆を深める】【仲間との結びつきをつくり出す】【日本人としてのアイデンティティを保つ】の5つのカテゴリーが抽出された。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ASIAN PACIFIC ORGANIZATION CANCER PREVENTION  

Background: During and after the Fukushima nuclear disaster (FND), many parents were concerned about the effects of radiation on the health of their children. Purpose: To clarify the factors that influenced general workers living with children and the effect of child age groups in implementing preventive behaviorsagainst radiation following the FND. Materials and Methods: A descriptive study of preventive behaviors among general workers was carried out 3-5 months after the nuclear disaster. The subjects were 1,394 regular workers, who took part in radiation seminars run by the Fukushima Occupational Health Promotion Center between July and September, 2011. In total, 1,217 responses were submitted, of which 1,110 were eligible for the present study. This anonymous questionnaire survey inquired about the presence and age of children in the household and about radiation preventive behavior implemented after the FND. The contribution of each variable was assessed by logistic regression analysis. Results: General workers in Fukushima who lived with younger children performed more preventive behavior against radiation during and after the FND. In particular, both location-related and daily routines were practiced significantly more frequently (p<0.01) by workers living with a child in the age ranges of 0-6 (8 of 10 items) and 7-12 (5 of 10 items). Conclusions: This is the first study to assess the positive association between living with children by age group and increased preventive behavior against radiation implemented by general workers after the FND.

DOI： 10.7314/APJCP.2013.14.11.6893

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Language：Japanese   Publisher：(一社)日本循環器病予防学会  

【目的】特定健診・保健指導開始2年後までの保健指導実施の有無と、生活習慣病関連指標および服薬治療開始状況への影響について、某企業の健診データ等を用いて検討した。【方法】某鉄道会社における2008年の定期健康診断(以下健診)受診者(N=4780、男性4530人、女性250人)より、特定保健指導積極的支援対象となり、2008-2009年に1度以上保健指導を実施した者(保健指導実施群、465名)と一度も実施していない者(保健指導非実施群、125名)で2010年健診時の健康指標の推移と服薬治療開始者の割合を比較した。さらに、2010年健診受診時の服薬治療開始に影響する因子を検証するため、服薬治療開始を従属変数としベースライン属性、保健指導実施有無を独立変数としてロジスティック回帰分析を行なった。健診データは社員番号により連結可能匿名化した上で、3年分の突合データセットを構築し解析を行なった。【結果】保健指導実施群では、体重、BMI、腹囲、収縮期血圧、拡張期血圧、中性脂肪、HDL-C、空腹時血糖、HbA1cのすべての項目で有意に改善していた。2010年健診時点までの新規服薬治療開始者の割合は、保健指導実施群で5.2%、非実施群で29.6%であった。服薬治療開始を従属変数としたロジスティック回帰分析の結果、ベースライン時の血糖受診勧奨判定(OR 5.582、95%CI:1.802-17.289)、血圧受診勧奨判定(OR 5.671、95%CI:2.524-12.740)、保健指導実施(OR 0.121、95%CI:0.063-0.234)が服薬治療開始に独立に関連していた。【結論】特定保健健診・保健指導を軸とした保健指導介入により、メタボリックシンドローム関連指標の改善および新規服薬治療開始の抑制がみられた。保健指導参加者に対する必要時の適切な受診勧奨と、非参加者に対する生活習慣改善の働きかけを引き続き実施することに加えて、保健指導の長期的な効果について、服薬治療開始後の適切な疾病管理、すなわち生活習慣病の重症化・合併症予防への寄与を検証していくことも重要な課題である。(著者抄録)

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Language：Japanese   Publisher：(公大)横浜市立大学医学部看護学科  

本研究の目的は、ブラジル日系永住者の地域における健康づくりの担い手としての資質と役割を明らかにするとともに、今後の日系コロニアにおける健康に関する支援のあり方について実践への示唆を得ることである。コロニアのリーダー7名を対象に半構成的面接を実施し、エスノグラフィーを用いて質的帰納的に分析した。その結果、5つのカテゴリー【移住の歴史とともに自ら移住地で生活し続ける意志】【多様な文化に柔軟に対応する志向性】【ブラジル社会における個人の健康づくりへの取り組み】【コロニアの共同体意識と将来に向けた展望】【多文化の下での人とのつながりや関係性の広がり】を見いだし、リーダーとして日本文化を継承していく人づくりのために、リーダーシップやエンパワメント等の重要性を示唆した。今後はコミュニティを基盤とした健康に関する人材育成を含めたシステムのあり方や支援方法を検討することが課題である。(著者抄録)

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Language：Japanese   Publisher：(公大)横浜市立大学医学部看護学科  

ブラジル連邦共和国南リオグランデ州イボチ市内の日系人コロニア(日系人の入植地および社会)における地域看護診断について報告した。コロニアに居住する日系1世12名(女性10名、男性2名)を対象に家庭訪問によるインタビューを行うとともに、コロニア出身の日系2世のコミュニティリーダー2名と看護師1名、イボチ市ポスト(行政保健局)看護師へのインタビューを行った。その結果、対象の日系1世は言語的、物理的なバリアによる保健医療へのアクセシビリティの低さから、健康障害の発見や対処が遅れるおそれがあることなどが分かった。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INFORMA HEALTHCARE  

Recent guidelines recommend combination antihypertensive therapy to achieve the target blood pressure (BP) and to suppress target organ damage. This study aimed to examine the beneficial effects of combination therapy with candesartan and amlodipine on BP control and markers of target organ function in Japanese essential hypertensive patients (N = 20) who did not achieve the target BP level during the monotherapy period with either candesartan or amlodipine. After the monotherapy period, for patients already being treated with amlodipine, a once-daily 8 mg dose of candesartan was added on during the combination therapy period (angiotensin II receptor blocker [ARB] add-on group, N = 10), and a once-daily 5 mg dose of amlodipine was added on for those already being treated with candesartan (calcium channel blocker [CCB] add-on group, N = 10). Combination therapy with candesartan and amlodipine for 12 weeks significantly decreased clinic and home systolic blood pressure (SBP) and diastolic blood pressure (DBP). In addition, the combination therapy was able to significantly reduce urine albumin excretion without decrease in estimated glomerular filtration ratio and resulted in significant improvements in brachial-ankle pulse wave velocity, central SBP, and insulin sensitivity. Furthermore, the CCB add-on group showed a significantly greater decrease in clinic and home DBP than the ARB add-on group. The calcium channel blocker add-on group also exhibited better improvements in vascular functional parameters than the ARB add-on group. These results suggest that combination therapy with candesartan and amlodipine is an efficient therapeutic strategy for hypertension with pleiotropic benefits.

DOI： 10.3109/10641963.2012.681081

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INFORMA HEALTHCARE  

Strict blood pressure (BP) control is reportedly important for the management of hypertensive patients with chronic kidney disease (CKD). The purpose of this cross-sectional study was to examine whether the variables of ambulatory BP and the heart rate (HR) profile, central hemodynamics, and arterial stiffness were closely related to the renal function parameters (urine albumin excretion rate [UACR] and estimated glomerular filtration rate [eGFR]) observed in 25 consecutive hospitalized hypertensive patients with CKD. There were significant positive relationships between UACR and 24-hour, daytime, and nighttime ambulatory systolic BP. In addition, there were significant negative relationships between UACR and 24-hour and daytime HR variability. The circulating B-type natriuretic peptide level and hemoglobin A1c were also positively related to UACR. With respect to eGFR, although the 24-hour and nighttime HR variability were positively associated with eGFR, the circulating pentosidine and nighttime HR had a negative relationship with eGFR. On the other hand, central hemodynamics and arterial stiffness did not exhibit any significant association with renal function parameters. These results indicate that ambulatory BP and the HR profile are closely modulated by renal function deterioration. Further studies are needed to investigate the causal relationship between ambulatory BP and the HR profile and renal function parameters in hypertensive patients with CKD.

DOI： 10.3109/10641963.2012.681082

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN EPIDEMIOLOGICAL ASSOC  

Background: Observation of early changes in fasting plasma glucose level induced by post-smoking cessation weight gain is useful in predicting the risks of diabetes mellitus (DM) and impaired fasting glucose (IFG). We investigated the effect of post-smoking cessation weight gain on early changes in the risk of a high fasting plasma glucose (IFG) level (>= 100 mg/dL).
Methods: In 946 subjects who underwent repeated health examinations after smoking cessation, changes in body mass index (BMI) and the odds ratio (OR) for IFG risk (adjusted for sex, age, BMI, fasting plasma glucose at year 1, and alcohol consumption) were calculated every year for 3 years after smoking cessation.
Results: After smoking cessation, the rate of BMI increase significantly increased in quitters: 2.36% at year 2 (never smokers: 0.22%, current smokers: 0.39%) and 0.46% at year 3 (never smokers: 0.14%, current smokers: 0.32%). However, it decreased by 0.15% at year 4 (never smokers: 0.12%, current smokers: 0.26%). The ORs for quitters did not significantly increase at any time during the follow-up period. However, among quitters who had smoked at least 20 cigarettes per day, it was significantly higher (OR 1.51, 95% confidence interval 1.1-2.01 at year I and 1.71, 1.23-2.38 at year 2).
Conclusions: The time course of the risk of IFG after smoking cessation was similar to that for the rate of BMI increase. In contrast to the findings of previous reports, the increase in IFG risk after smoking cessation was brief and disappeared in the absence of a significant increase in BMI.

DOI： 10.2188/jea.JE20110010

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Language：Japanese   Publisher：(公社)日本栄養・食糧学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INFORMA HEALTHCARE  

Accumulating evidence has shown that diabetic patients are increasing in number, and renal and cardiovascular complications are the most common cause of death in diabetic patients. Thus, it would be of considerable value to identify the mechanisms involved in the progression of renal impairment and cardiovascular injury associated with diabetes. Recent evidence also indicated that multifactorial intervention is able to reduce the risk of cardiovascular disease and death among patients with diabetes and microalbuninuria. In this pilot study, we examined the effects of intensified multifactorial intervention, with tight glucose regulation and the use of valsartan and fluvastatin on ambulatory blood pressure (BP) profile, estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio (UACR), in 20 hypertensive patients (16 male and 4 female) with type 2 diabetes mellitus and overt nephropathy. After 12 months of intensified treatment, office BP, fasting plasma glucose (FPG), and low-density lipoprotein cholesterol (LDLC) were significantly decreased compared to baseline (systolic blood pressure (SBP), 130 +/- 2 vs. 150 +/- 1 mmHg; diastolic blood pressure (DBP), 76 +/- 1 vs. 86 +/- 1 mmHg; FPG, 117 +/- 5 vs. 153 +/- 7 mg/dl; LDLC, 116 +/- 8 vs. 162 +/- 5 mg/dl, P < 0.0001). Also, compared to the baseline values, the daytime and nighttime ambulatory BP and short-term BP variability were significantly decreased after 12 months. Furthermore, while eGFR was not altered (44.3 +/- 5.1 vs. 44.3 +/- 6.5 ml/min/1.73 m(2), not significant (NS)), UACR showed a significant reduction after 12 months of intensified treatment (1228 +/- 355 vs. 2340 +/- 381 mg/g-cr, P < 0.05). These results suggest that the intensified multifactorial intervention is able to improve ambulatory BP profile, preserve renal function, and reduce urinary albumin excretion in type 2 diabetic hypertensive patients with overt nephropathy.

DOI： 10.3109/10641963.2011.583971

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INFORMA HEALTHCARE  

We investigated the effectiveness of a workplace intervention program that utilized self-monitoring of daily salt excretion by an electronic salt sensor and sent personalized e-mail advice via cellular phone. Forty-one hypertensive male workers were assigned to intervention and control groups, then counseled together. Intervention group members were asked to measure daily salt excretion and received e-mail advice. After 4 weeks, a greater decrease of blood pressure ( BP) was observed in the intervention group, with significant reductions to daily salt excretion and home BP. The new intervention program is considered useful for BP control among hypertensive workers.

DOI： 10.3109/10641963.2011.583966

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ PUBLISHING GROUP  

Objective: To determine the ideal conditions for use of the 23-valent pneumococcal polysaccharide vaccine (PPV23) in older outpatients with chronic pulmonary diseases.
Design: Prospective cohort study.
Participants: 1378 outpatients with chronic pulmonary diseases >= 60 years of age.
Intervention: Participants were educated about PPV23, and those who responded affirmatively were vaccinated between August and November 2002. The participants who chose no intervention served as controls. The prevaccine period was defined as August 2001 to August 2002. Participants were followed for 2 years from December 2002 or until death.
Main outcome measures: Events of interest included the first episode of bacterial (including pneumococcal) pulmonary infection (primary endpoint) and death of any cause (secondary endpoint).
Results: Frequent episodes of pulmonary infection during the prevaccine period significantly decreased event-free survival during the 2-year observation period (p<0.001). Chronic respiratory failure was associated with a decreased event-free survival only when the pulmonary infection episode did not occur in the prevaccine period (p<0.001). No significant differences in event-free survival were observed between the vaccinated and unvaccinated group during analysis of the entire cohort. In the Cox proportional hazards regression model, event-free survival decreased significantly when pulmonary infection occurred in the prevaccine period. In the subgroup analysis, the first episode of bacterial pulmonary infection (but not death of any cause) was reduced significantly by PPV23 only in patients with chronic respiratory failure who had no episodes of pulmonary infection during the prevaccine period (p=0.019).
Conclusion: The efficacy of PPV23 against pulmonary infection and death of any cause might be unachievable if pulmonary infection occurs during the prevaccine period. PPV23 needs to be given to older patients with chronic pulmonary disease at an earlier time in which infectious complications in the lung have not yet occurred.

DOI： 10.1136/bmjopen-2011-000105

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Language：English   Publisher：ELSEVIER IRELAND LTD  

DOI： 10.1016/j.ijcard.2009.04.032

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：(一社)日本循環器病予防学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS INC  

It is well known that the sour milk containing lactotripeptides has a blood pressure lowering effect The aim of this study was to evaluate the blood pressure (BP) lowering effect of lactotripeptides by monitoring home blood pressure, 24-h ambulatory measurements (ABPM), and daily urinary salt excretion.
A total of 30 volunteers were given 200 ml of sour milk twice a day for 8 weeks after a 1-week run-in period. This preparation contained the lactotripeptides valine-proline-proline 2.66 mg and isoleucine-proline-proline 1.38 mg. The study participants had daily measurements of urinary salt excretion determined by an electric salt sensor and home blood pressure for each week during the run-in period, before the 4- and 8-week time points. 24-h ABPM was measured at the end of each week. Mean systolic blood pressure (SBP) during night sleep including base BP at 4 and 8 weeks were significantly lower than baseline values. Mean SBP and diastolic blood pressure (DBP) during night sleep of the 22 participants who belonged to the criteria of hypertension by 24-h ABPM was significantly decreased at 4 and 8 weeks. The change in 24-h mean SBP significantly correlated with mean urinary salt excretion over the three measurement periods. The 22 hypertensive subjects without taking lactotripeptides did not show significant change of blood pressure during 24 hours at 4 and 8 weeks. Our study confirmed the BP lowering effect of lactotripeptides during night-time sleep and showed that a lower intake of salt may increase the BP lowering effect of lactotripeptides through 24 hours in hypertensive subjects.

DOI： 10.3109/10641963.2010.491885

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

The initial observation that taurine (T) prevented stroke in stroke-prone spontaneously hypertensive rats (SHRSP) led us to study the effects of T on cardiovascular diseases (CVD), as well as the epidemiological association of T and mortality rates, by using the data from WHO-coordinated Cardiovascular Disease and Alimentary Comparison Study, which covered 61 populations in 25 countries. In this study, 24 hour urine (24-U) samples were examined along with biomarkers of CVD risk. The mortality rate from ischemic heart disease (IHD), which was lowest among the Japanese compared to the populations of other developed countries, was positively related to total serum cholesterol (TC) and inversely related to 24-U taurine excretion (24-UT), as well as the n-3 fatty acid to total phospholipids ratio of the plasma membrane, both biomarkers of seafood intake. Analysis of 5 diet-related factors revealed that TC and BMI were positively associated with IHD mortality in both genders while Mg and T were negatively associated with IHD mortality. TC and sodium (Na) were negatively and positively associated with stroke mortality, respectively. 24-UT was negatively associated with stroke mortality. These five diet-related factors explained 61 and 49% of IHD and stroke variances in male, 63 and 36% of IHD and stroke variances in female, respectively.

DOI： 10.1007/978-0-387-75681-3_2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

BACKGROUND: Between 2003 and 2004, when the new postgraduate medical education program was introduced in Japan, the number of university residents decreased from 5,923 to 3,264 (-31%), whereas the number of non-university residents increased from 2,243 to 4,110 (+45%).
OBJECTIVE:To identify potential reasons for the shift of residents from university to non-university hospitals.
DESIGN:Cross-sectional mailed survey.
PARTICIPANTS:The subjects were 1,794 2nd-year residents at 91 university hospitals and 2,010 2nd-year residents at 659 non-university hospitals.
MEASUREMENTS:Data on hospital demographics, resident demographics, and resident satisfaction with training were collected in 2006 and were compared between university and non-university hospitals.
RESULTS:Compared to non-university hospitals, university hospitals were more likely to have >700 beds (55% vs. 10%, p<0.001) and to have more teaching resources and free access to international medical journals (84% vs. 62%, p<0.001). Nevertheless, one-half (47%) of the university residents reported that they were not satisfied with the residency system and clinical skills training and attributed their dissatisfaction to "daily chores," "low salary," and "poor clinical opportunities." Logistic regression analyses indicated that the proportions of residents who were satisfied with income (OR: 0.32, 95% CI: 0.26-0.40) and the residency system (OR: 0.52, 95% CI: 0.40-0.68) and clinical skills training (OR: 0.77, 95% CI: 0.60-0.99) were significantly lower for university residents than for non-university residents.
CONCLUSIONS:Hospital size and teaching resources do not overcome the other characteristics of university hospitals that lead to residents' dissatisfaction.

DOI： 10.1007/s11606-008-0644-7

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Language：Japanese  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Objectives: In Japan, the demand for pediatric emergency medicine has been increasing, especially in the evening. The purpose of this study was to identify the reasons for overcrowding of pediatric emergency facilities in the evening.
Methods: A population-based survey was conducted in Yokohama City, Japan, that targeted parents of children 1 or 3 years of age. These children participate in regular health checkups. Questionnaires about their child's illnesses and the pediatric emergency system were mailed to 30,000 parents of a child expected to undergo a health checkup between May 2004 and January 2005.
Results: Data obtained from the completed questionnaires indicated that many parents noticed their child's illness or injury most frequently during the evening, when most medical facilities are closed. The peak period when parents noticed their child's illness was the evening (4:00 PM-12 midnight, 54.4%), followed by the daytime (8:00 AM-4:00 PM, 30.3%) and then the nighttime (12 midnight-8:00 AM, 15.3%). During all 3 periods, parents felt it difficult to judge their child's condition and thus many used emergency facilities unnecessarily.
Conclusions: The overcrowding of pediatric emergency facilities in the evening is likely due mainly to a mismatch between the peak time of children's illnesses and the office hours of pediatric clinics. Parents' difficulties in assessing their child's condition and anxiety over their child's illness and injuries seem to be other factors that contribute to this imbalance.

DOI： 10.1097/PEC.0b013e3180328cab

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Objective To examine associations between various dietary markers and mortality from ischemic heart disease (IHD) and stroke.
Design and setting A multi-center cross-sectional study, involved 25 co-operative study centers in 16 countries.
Method In the report, data for males (n = 2462), aged 48-56 years, from 25 centers were included. Various dietary markers were measured from individual's blood and 24-h urine samples. Age-standardized male mortality rates for IHD and stroke were collected for the region encompassing each study center. Ecological cross-center associations between dietary markers and the mortality were analyzed using univariate and multivariate analysis techniques.
Results Bivariate correlation analyses showed that IHD mortality was associated positively with body mass index (BMI), serum total cholesterol (TC), urinary potassium (K) and serum phospholipid palmitic acid, and negatively with urinary taurine, sodium (Na) and Na/K (potassium) ratio, n-3 polyunsaturated (n-3PU) fatty acids and polyunsaturated-to-saturated (P/S) fatty acid ratio. Stroke mortality was associated positively with Na and Na/K ratio and phospholipid arachidonic acid (AA), and negatively with TC and K. Stepwise linear regression analyses indicated that 59% of the variance in IHD mortality could be explained by the variance in taurine and P/S ratio and that 57% of stroke mortality could be explained by Na/K ratio and phospholipid AA.
Conclusion Although ecological associations do not necessarily imply causality, and the present findings are limited to male samples only, the study extends our understanding of dietary markers in relation to worldwide IHD and stroke mortality rates, and indicates useful avenues for further study on IHD and stroke prevention.

DOI： 10.1097/01.hjh.0000239284.12691.2e

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Language：Japanese   Publisher：Japan Society for Medical Education  

Since the publication of To <I>Err is Human</I> in 1999, medical schools around the worldhave been discussing ways to teach medical students about patient safety. To deepen the understanding of patient-safety curriculums used in the United States, Dr. Matthew Weinger, director of the San Diego Center for Patient Safety and a professor at the University of California, San Diego, School of Medicine (UCSD), was invited to participate in around-table discussion on "Patient Safety Curriculum for Medical Students" held at Yokohama City University. Althoughthere have been active discussions in journals and within medical school faculties, no discernable consensus has emerged in the United States, other than that patient safety should become part of the educational system. The patient-safety curriculum used at UCSD and the curriculums promoted by the Department of Veterans' Affairs National Center for Patient Safety are introduced.

DOI： 10.11307/mededjapan1970.37.153

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Language：Japanese   Publisher：The Japan Society of Veterinary Epidemiology  

DOI： 10.2743/jve.9.1

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Other Link： https://jlc.jst.go.jp/DN/JALC/00255076669?from=CiNii

Language：English   Publishing type：Research paper (scientific journal)  

The aim of the present study was to investigate the trend of the prevalence of obesity in China and its association with hypertension and hypercholesterolemia. A multicentre cross-sectional study was conducted in Chinese men and women aged 48-56 years between 1985 and 2000. In the report, three study periods were classified as survey 1 (1985), survey 2 (1988-1989) and survey 3 (1997-2000) in order to describe the long-term trend. The results show that: (i) mean body mass index (BMI), prevalence of obesity (BMI ≥28 kg/m2) and overweight (BMI ≥25 and &lt
28 kg/m2) increased significantly from 1985 to 2000 in both sexes (P &lt
0.001)
(ii) similar to the trend for BMI, the prevalence of hypertension and hypercholesterolaemia (total cholesterol (TC) ≥220 mg/dL) also increased significantly from 1985 to 2000 (P &lt
0.001)
(iii) partial correlation and multiple linear regression analyses indicated that increased BMI was significantly positively correlated with blood pressure and TC and negatively correlated with serum high-density lipoprotein- cholesterol (P &lt
0.01 or P &lt
0.001)
and (iv) multiple logistics regression analysis models indicated that obese subjects had a 3.9-fold higher risk of being hypertensive (relative risk (RR) 4.9
95% confidence interval (CI) 3.4-7.3) compared with those subjects who had a BMI less than 25 kg/m2. The corresponding RR (95% CI) of obesity for hypercholesterolaemia was 2.63 (1.57-4.40). In conclusion, the results highlight the epidemic of obesity, an emerging risk in China. Great efforts must be made to alter this unwelcome trend.

DOI： 10.1111/j.1440-1681.2004.04105.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Background: A double-blind randomized controlled trial was carried out to assess the effect of sour milk, containing two tripeptides (valine-proline-proline and isoleucine-proline-proline), on blood pressure (BP).
Methods: A total of 46 borderline hypertensive men aged 23 to 59 years were recruited at their workplace for this trial. Subjects were randomly allocated into two groups; sour milk drink group (S-group, n = 23) and placebo (acidified milk) drink group (P-group, n = 23) for 4 weeks. Blood pressure was measured twice at each occasion by a physician, at the health center of the company, with a mercury sphygmomanometer at baseline, 2 and 4 weeks. Statistical analysis was performed by SPSS 10.0J.
Results: The S-group and P-group showed no significant difference in baseline systolic BP (mean [SD], S: 147.6 [9.6], P: 145.3 [13.0]) or diastolic BP (S: 95.3 [9.91, P: 91.5 [9.6]). In the S-group, change in systolic BP at 2 and 4 weeks were -4.3 mm Hg (95% confidence interval [CI] -8.3 to -0.4; P =.032) and -5.2 turn Hg (95% Cl -10.1 to -0.3; P =.039), both statistically significant. Diastolic BP showed change from -1.7 mm Hg (95% Cl -5.4 to 2.0) at 2 weeks and -2.0 (95% CI -5.4 to 1.5) at 4 weeks, respectively. In the P-group, change in systolic BP was -0.5 (95% Cl -5.8 to 4.8) at 2 weeks and -3.7 (95% Cl -8.3 to 0.9) at 4 weeks and change in diastolic BP was -0.6 (95% Cl -4.7 to 3.6) at 2 weeks and -0.3 (95% Cl -3.9 to 3.3) at 4 weeks, which were not statistically significant.
Conclusions: This trial demonstrated the beneficial effect of sour milk on BP in borderline hypertensive men who were not taking antihypertensive medication. (C) 2004 American Journal of Hypertension, Ltd.

DOI： 10.1016/j.amjhyper.2004.03.674

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Publisher：2  

DOI： 10.1081/CEH-120028553

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Whether the benefit of a public health program surpasses the cost of providing the program is an important question for public service providers. This study aimed to evaluate one health checkup program provided by a municipal government by measuring the public's willingness to pay (WTP) for maintaining the program. METHODS: A questionnaire-based study of a health checkup program targeting people joining the National Health Insurance system was conducted. The WTP was estimated from a demand curve for the program, which was constructed by a revealed preference method, that is, by the travel cost method. RESULTS: The WTP was calculated as 5410 yen per person, an amount substantially below the cost to the government of providing the service. The aggregate WTP was also estimated to be lower than the current expense of the municipal government. CONCLUSION: The amount users are willing to pay for a health checkup program provided by the municipal government appears to be less than the actual cost of the program. The travel cost method might reflect short-term private benefit produced by the health checkup program but cannot take into account long-term private benefit or overall social benefits which ensues.

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：Japanese Society of Public Health  

Cost-effectiveness analysis is a method used to evaluate the outcomes and costs of treatments or interventions designed to improve health. It has been widely regarded as an important aid to providing health care services efficiently. This paper reviews several measures for controlling medical costs in Japan, where a fee-for-service system is employed to remunerate for medical services provision. From the point of view of cost-effectiveness, the first step in health care reform for controlling medical costs should be minimizing useless medical services because the cost-effectiveness ratio of these tends to infinity. For the purpose of minimizing unserviceable provision in the field of medicine, two approaches must be considered. One is establishing a system so that physicians can act as perfect agencies for their patients. The other is encouraging academic research on the effectiveness of medical services.

DOI： 10.11236/jph.49.7_613

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

There is considerable interest in the association between taurine (2-aminoethanesufonic acid) and risk of ischemic heart disease (IHD), but little information has been made available on the distribution of taurine in populations around the world. The present study aimed to describe the differences in taurine excretion levels and their associations with IHD mortality rates in 24 populations in 16 countries worldwide. This was a multicenter cross-sectional study. In each center, 100 men and 100 women aged 48-56 years were selected randomly from the local populations. Twenty-four hour urinary taurine excretion was measured using an amino acid analyzer (Hitachi 835, lbaragi, Japan). Age-adjusted IHD mortality rates in the relevant populations were calculated using the direct standard method. The results indicated that (a) percentiles 25%, 50% and 75% of the distributions of 24-h taurine excretion showed large variations in the study populations. Median values of taurine ranged from 191.6 mu mol/day (St John, Canada) to 2,180.6 mu mol/day (Beppu, Japan) in males, and from 127.5 mu mol/day (Moscow, Russia) to 1,590.0 mu mol/day (Beppu, Japan) in females. The highest overall median value of taurine was found in the Japanese population samples, followed by the Chinese samples (Shanghai and Taiwan). European, North American and oceanic Caucasians, however, had much lower median values of taurine, except in the cases of the samples from France and Spain. (b) Median values of taurine were significantly associated negatively with age-adjusted IHD mortality rates across the 24 study population samples in men (R(2)=0.42, p&lt;0.01), and in women (R(2)=0.55, p&lt;0.01). These negative associations remained significant after adjustment for serum total cholesterol, body mass index and urinary sodium to potassium ratios. In conclusion, the study provides, for the first time, a cross-sectional database on distribution of 24-h urinary taurine excretion in 24 population samples worldwide. A strong and inverse association between population levels of taurine excretion and IHD mortality was observed.

DOI： 10.1291/hypres.24.453

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Objective Many studies have reported that the resting heart rate (HR) is intimately related to the prognosis of cardiovascular disease. However, HR in the waking state is influenced by psychological and physical activity and has low reproducibility. To measure the base HR (minimum and stable HR during sleep) with ease, we developed a wristwatch-type HR recorder. We then investigated the pathophysiological significance of the base HR.
Subjects and methods The subjects were 158 patients (82 men and 76 women) with essential hypertension (HT) on no medication and 204 normotensive (NT) subjects (105 men and 99 women, matched for age). On the basis of pulse waves from the wristwatch-type photoelectric plethysmograph, using a blue sensor with a wavelength of 450 nm, HR was recorded easily minute by minute during sleep time. In addition, 40 (23 men and 17 women) of the HT patients were hospitalized. Their cardiac index (CI) and stroke volume index (SVI) were measured by means of the cuvette method during waking time and night-time deep sleep when their HR had reached a minimum level.
Results Mean base HR(HR0) in NT subjects was 49 +/- 4 beats per minute (bpm) and tended to rise with increasing age (r = 0.51, P &lt; 0.01). In HT patients, HR0 was significantly higher: 60 +/- 7 bpm (P &lt; 0.01). CI of HT patients, measured during night-time deep sleep, maintained a stable value of 2.45 +/- 0.36 l/min per m(2). SVI in patients whose HR0 was above 60 was significantly lower than that in patients whose HR0 was below 60 (37 +/- 4.5: 45 +/- 4.8 ml/m(2), P &lt; 0.01). Corresponding differences in mean HR and SVI during waking or nighttime, became smaller.
Conclusions These findings suggest that there is a close relation between base HR and cardiac function caused by such conditions as age and hypertension. This relation became indistinct during waking time. Moreover, the wristwatch-type HR recorder appears to be a useful tool for measuring base HR. (C) 2001 Lippincott Williams & Wilkins.

DOI： 10.1097/00004872-200106000-00019

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPANESE SOC HYPERTENSION CENT ACADEMIC SOC, PUBL OFFICE  

Our aim was to examine differences in dietary intake and blood pressure(BP) and their associations in four different ethnic Chinese populations, the Nan, the Uygur, the Kazak and Tibetan subjects. This study used a sub-database of the Chinese sample of the WHO-Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. The WHO-CARDIAC Study was a multicenter cross-sectional study. In each center, 100 men and 100 women aged 48-56 years were selected at random from the local population. Various markers of dietary intake and their relation with BP were studied. The results of the present study indicated the following. 1) There were significant differences in mean BP and prevalence rates of hypertension, with both being higher in the Kazak and Tibetan subjects than in Hen and Uygur subjects. 2) The highest mean body mass index (BMI) was observed in the Kazak subjects, while the highest 24-h urinary sodium (Na) and sodium to potassium (Na/K) ratio excretion were observed in the Tibetan subjects. There were also significant differences in other factors, such as magnesium, 3-methylhistidine (3MH) (a biological marker of animal protein intake) and taurine(a biological marker of seafood intake) excretion levels among the four ethnic: peoples. 3) In general, BMI, Na and/or Na/K ratios were positively, and 3MH/creatinine and taurine/creatinine ratios were negatively associated with BP. 4) After adjustment for age, sex and potassium, subjects with obesity (BMI greater than or equal to 26 kg/m(2)) had significantly higher relative risk of being hypertensive (HT) than those with BMI &lt; 26 kg/m(2) in the Han, Uygur and Kazak populations; and subjects with elevated sodium excretion (Na greater than or equal to 244 mmol/day) had significantly higher relative risk of being HT than those with Na &lt; 244 mmol/day in the Hen, Uygur and Tibetan populations. In conclusion, mean BP and prevalence rates of hypertension were significantly different among the tour ethnic groups. These differences are likely to be due, at least in part, to the differences in several diet-related factors, which in turn are associated with culture and environmental differences, Different health promotion strategies might thus be emphasized in different populations.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Objective Having found no definite relationship between blood pressure (BP) and 24h sodium excretion in women aged 48-56 years (in contrast to the results in men of the same age) in the WHO Cardiovascular Diseases and Alimentary Comparison (WHO-CARDIAC) Study, we analyzed the data to investigate whether the sodium-BP association differed between pre- and post-menopausal women.
Design and methods The WHO-CARDIAC is a multicenter cross-sectional study, involving, as of July 2000, 60 collaborating centers in 25 countries. In each center, 100 men and 100 women aged 48-56 years were selected randomly from the general population of the area. In this report, 2212 women in 21 centers located in 17 countries worldwide, who had data on menopausal status, were studied.
Results After adjustment for age, body mass index (BMI) and 24h urinary potassium excretion, 24h sodium excretion was positively and significantly associated with systolic blood pressure (SBP) [pooled regression coefficient: 0.037 (SE 0.01), P&lt; 0.01] and with diastolic blood pressure (DBP) [0.023 (0.006), P&lt; 0.01] in post-menopausal women. Pooled regression coefficients of sodium-BP association were not significant in premenopausal women (P &lt; 0.05). Cross-center correlation analyses of the 21 centers showed that 24 h sodiumexcretion was positively associated with SEP and DBP in both pre- and post-menopausal women, and this positive association between sodium excretion and SEP was significant in post-menopausal women (R-2 = 0.23, P= 0.029).
Conclusion Different associations between sodium and BP were observed in women with pre- and postmenopausal status. There may be a tendency for salt sensitivity to increase at the menopause. &lt;(c)&gt; 2001 Lippincott Williams & Wilkins.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPANESE SOC HYPERTENSION CENT ACADEMIC SOC, PUBL OFFICE  

We aimed to compare the differences in diet-related factors and their associations with blood pressure (BP) between Chinese and Japanese. A total of 1,151 Chinese (MIF: 551/600) and 1,681 Japanese (782/899), aged 48-56 years, were studied using a multi-center cross sectional study design. This work was a constituent part of the World Health Organization(WHO) Cardiovascular Disease and Alimentary Comparison (CARDIAC) Study. Measurements included in the present report were BP, body mass index (BMI), serum total cholesterol (TC), 24-h urinary sodium, potassium, calcium, magnesium, creatinine, 3-Methylhistidine (3MH, a marker of animal protein intake) and taurine (a marker of seafood intake) excretion levels. Results were as follows: (a) Japanese men had a significantly higher prevalence of hypertension than the Chinese (34.4% vs. 20.5%, p&lt;0.01). After adjustment for age, Japanese men had a significantly higher mean systolic and diastolic BP(SBP, DBP), and Japanese women had a significantly higher DBP than the Chinese subjects overall (p&lt;0.01, respectively). (b) Japanese had significantly higher mean BMI, TC and sodium excretion, and lower mean magnesium excretion than Chinese (p&lt;0.01), (c) In the Japanese sample, multiple linear regression analyses (using a stepwise procedure) showed that SEP had a significant positive association with BMI and sodium excretion, and a significant negative association with magnesium excretion, while DBP had a significant positive association with BMI and a significant negative association with the 3MH to creatinine ratio(3MH/Cre), In the Chinese sample, both SEP and DBP showed a significant positive association with BMI and sodium, and a significant negative association with 3MH/Cre. In conclusion, Japanese had significantly higher mean BP than Chinese. The differences in BP may have been partly attributable to differences in various diet-related factors, particularly in BMI, sodium, magnesium-rich foods and animal protein intake, between the two populations.

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Language：Japanese   Publisher：(株)医学書院  

上肢3種類,下肢3種類,下肢・体幹3種類,体幹2種類,計11種類の運動機能障害評価項目からなる評価票を作成し,運動失調を主症状とする50例を対象として運動機能の評価を行った.そのうち,無作為に抽出した26例について,1〜4週後に同一検者による再評価を行い,一致率(κ値)求めた.上肢及び下肢の偏倚試験,踵膝試験でκ≦0.60,即ちmoderate以下の評価項目がみられたが,その他の評価項目については全てκ≧0.61,即ちgood以上であり,今回検討を行った範囲では,作成した評価票は実用に耐えうる信頼性を有しているものと考えられた

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1177/204748730000700106

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER-VERLAG TOKYO  

Recent evidence suggests that an insertion/deletion (IID) polymorphism of the gene encoding angiotensin-converting enzyme (ACE) is associated with myocardial infarction and related cardiovascular diseases. We investigated a possible association of the A CE polymorphism with essential hypertension in a total of 263 cases/controls from among the elderly (age, over 70 years) and middle-aged (age between 30 and 60 years) Japanese population. The frequency of the III homozygote was significantly higher in hypertensive subjects than in controls in the elderly age group (33/57 vs 16/46; P = 0.02), but no association was observed in the middle-aged group (25/75 vs 26/85; P = 0.71). Similarly, having at least one insertion allele was associated with essential hypertension in the elderly age group (83/114 vs 46/92 in controls; P = 0.001), but not in the middle-aged group (78/150 vs 94/170; P = 0.524). These data suggest that genetic variation at the ACE locus may be associated with some determinants for blood pressure in elderly persons, and imply the involvement of the ACE insertion/deletion polymorphism in the etiology of age-related essential hypertension in the Japanese population.

DOI： 10.1007/s100380070019

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Language：English   Publishing type：Research paper (scientific journal)  

Background: The importance of body mass index (BMI) and salt intake as determinants of blood pressure (BP) continues to be disputed. We aimed to investigate associations among BMI, sodium excretion, and BP in Chinese populations, who have a relatively much lower body weight than Caucasians. Methods: A multicenter cross-sectional study was carded out in seven Chinese collaborating centers (Urumiqi, Lhasa, Guiyang, Guangzhou, Taiwan, Shanghai, and Shijiazhuang) between 1985 and 1997, as a part of the WHO-CARDIAC Study. In each center, 100 men and 100 women, aged 48-56 years, were selected randomly from the general population. BMI was calculated as weight(kg)/height(m)2. Twenty-four-hour urinary sodium excretion was analyzed using a flame photometry method. Results: The results showed that, after adjustment for age, sex, smoking, and alcohol consumption, (1) BMI was significantly positively associated with systolic BP (SBP) (pooled regression coefficient [β] = 2.92, P &lt
0.01), and with diastolic BP (DBP) (β = 3.3, P &lt
0.01) within centers
(2) sodium excretion was significantly positively associated with SBP (pooled β = 3.15, P &lt
0.01)
and (3) the age-sex-adjusted pooled β of the association between sodium and DBP was significantly positive (β = 1.17, P &lt
0.05). However, for this within-center pooled analysis, after adjustment (including BMI, smoking, alcohol consumption, and urinary potassium) this association became nonsignificant (β = 0.78, P = 0.22). (4) Increased BMI and sodium levels were significantly associated with a high risk of prevalence of hypertension. Conclusions: The main results suggest that BMI has strong, significant, and independent relationships with SBP, DBP, and prevalence of hypertension, and sodium is positively and significantly associated with SBP and hypertension in middle-aged Chinese populations. The nonsignificant association between sodium and DBP requires further study.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

1. It is generally believed, though difficult to prove, that diet plays a role in the risk of various diseases. Components of difficulties include several issues such as dietary assessment method, regression dilution bias, multicolinearity and interaction among nutrients,
2. The present study focuses on colinearity and interaction between sodium and calcium, which should be cautiously examined in nutritional epidemiological studies in relation to blood pressure and bone mineral density.
3. The World Health Organization&apos;s International Cooperative Cardiovascular Diseases and Alimentary Comparison study showed significant multicolinearity among urinary sodium, calcium and urea nitrogen as well as urinary calcium and magnesium, Urinary sodium and calcium had significant correlation (r = 0.438, P &lt; 0.05, n = 48) by cross-centre analysis,
4. Interaction between sodium and calcium on bone mineral density is studied using the data set from bone mineral density screening for 1658 females, aged 20-40 years, in Yokohama, Japan, Among those who have lower calcium intake (&lt; 600 mg/day), higher calcium intake (%) from small fish, which is likely to be associated with a high salt diet, related to significantly lower mineral bone density.
5. Interaction between sodium and calcium on bone mineral density among young Japanese females is suggested. Moderate sodium restriction is needed for prevention of not only cardiovascular diseases but also osteoporosis.

DOI： 10.1046/j.1440-1681.1999.03083.x

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Language：Japanese   Publisher：The Japanese Society of Nutrition and Dietetics  

DOI： 10.5264/eiyogakuzashi.57.61

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Recently a point mutation of guanine to thymine at nucleotide position 1917 in the endothelial nitric oxide synthase (eNOS) gene has been reported to be associated with coronary artery spasm. In addition, a significant association of the 4a/b polymorphism in intron 4 of the eNOS gene with coronary artery disease has been reported. However, the implications of these polymorphisms with respect to acute myocardial infarction (AMI) remain to be established. We conducted a case-control study of 226 patients with AMI and 357 healthy gender- and age-matched control subjects. In the former group, coronary angiograms were evaluated according to angiographic criteria based on the number of diseased vessels (greater than or equal to 75%) and the number of stenotic lesions (greater than or equal to 50%), Homozygosity for the Glu-Asp298 polymorphism existed in 5 of 226 patients with AMI (2.2%) but not in any of the 357 control subjects (P=.0085). However, when we evaluated the coronary angiograms of 226 case patients, there was no difference in the number of diseased vessels or the number of stenotic lesions between the patients with this homozygote and those without it. By contrast, there was no evidence of a significant increase in the risk of AMI or the severity of coronary atherosclerosis among individuals with the a/a genotype of the eNOS4a/b polymorphism, Our results imply that patients who are homozygous for the Glu-Asp298 polymorphism may be genetically predisposed to AMI; however, this mutation apparently is not related to the severity of coronary atherosclerosis. Further studies are needed to confirm our results and characterize the molecular mechanisms by which eNOS is involved in susceptibility to AMI.

DOI： 10.1161/01.HYP.32.3.521

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER HEART ASSOC  

To clarify the role of genetic factors in atherosclerotic plaque formation in the carotid artery and magnetic resonance imaging abnormalities in the brain, we investigated the association of these abnormalities with the angiotensin-converting enzyme (ACE) genotype. One hundred sixty-nine subjects (age, 59.2 +/- 0.8 years, mean +/- SE) admitted to our hospital for health checkups underwent brain magnetic resonance imaging to evaluate lacunar infarction. B-mode ultrasound examinations of the carotid arteries were performed to detect atherosclerotic plaque. The I/D polymorphism of the ACE gene was determined by the polymerase chain reaction method. Multivariate regression analysis was performed to assess the effects of the following variables on the presence of plaque, mean plaque thickness, and number of plaques: fibrinogen, sex, age, body mass index, mean blood pressure, glycosylated hemoglobin, LDL cholesterol, HDL cholesterol, hematocrit, and the D allele of the ACE gene. The frequency of carotid atherosclerotic plaque was significantly (P = .034) higher in subjects with the D allele than in those without this allele. However, the frequency of lacunar stroke was similar in these groups. A multivariate regression analysis showed that the presence of plaque was independently associated with the D allele (odds ratio = 3.27, P = .016). However, mean plaque thickness and the number of plaques were not associated with the D allele. The D allele of the ACE gene may be involved in the presence of carotid plaque but not in the extent of this plaque or asymptomatic lacunar stroke in Japanese subjects.

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：LIPPINCOTT-RAVEN PUBL  

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Background: Studies of immigrant populations are useful for analysis of the effects of environmental factors on cardiovascular disease. We have examined the association between dietary habit of fish intake and cardiovascular risk. Methods: Population-based samples of 433 middle-aged Japanese men and women in Japan (Shimane (group JS) and Okinawa (group JO)) and 269 Japanese immigrants in Brazil (Sao Paulo (group BS) and Campo Grande (group BC)), who had originally moved to Brazil mainly from Shimane and Okinawa, were recruited to the study. They underwent blood pressure measurement, 24-h urine collection, blood tests and electrocardiographic examination, and completed a dietary questionnaire. Results: There was a significant gradient through the groups, from JS to JO, BS and BC with respect to the prevalence of obesity, hypertension, increased glycohaemoglobin concentrations and ST-T segment change on the electrocardiogram (prevalences for men and women combined: group JS 2.0%, group JO 3.8%, group BS 3.9% and group BC 9.0%
P &lt
0.025). The prevalence of hypercholesterolaemia was noted more frequently in groups BS and BC. Twenty- four-hour urinary taurine excretion in both sexes and n-3 polyunsaturated fatty acids (n-3 PUFA) in plasma phospholipids in men were significantly higher in groups JS and JO than in groups BS and BC. A striking negative gradient in the frequency of fish intake per week was found from group JS (men/women, 4.7/4.8) to groups JO (3.8/3.6), BS (1.9/1.6) and BC (0.5/0.5). Conclusions: This study suggests a possible association between fish intake and reduced cardiovascular risk, through the beneficial effects of taurine and n-3 PUFA and a habitual low intake of calories and fat.

DOI： 10.1097/00043798-199706000-00006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-LISS  

The present study compares 75 Japanese men and women living in Okinawa (age adjusted mortality rate for IHD: men 26.41; women 14.48) with 164 Japanese immigrants in Brazil (MD: men 89.45; women 62.62). In each population, leucocyte copper levels were the same in men and women, but plasma copper was 15% lower in men than women (P &lt; 0.05). Leucocyte copper was 33% higher (P &lt; 0.01) in Okinawa in both men and women, but plasma copper was the same. There were no differences in plasma zinc and leucocyte zinc between men and women in each population. However, the leucocyte zinc and plasma zinc was higher in Brazilian immigrants (19% and 116%, respectively). The leucocyte Zn/Cu ratio in Brazilian immigrants was 60% higher than in Okinawa (P &lt; 0.001). In each population, men had the same total serum cholesterol as women, and there was no difference between these two populations. HDL cholesterol was 20% higher in women than men (P &lt; 0.05) in both populations and 20% higher in Okinawa than in Brazil (P &lt; 0.05). Okinawa has a high dietary intake of copper, mostly from shellfish and seaweed, whereas Brazil has a high intake of zinc, especially from meat. It is concluded that leucocyte copper and zinc are good indexes of intracellular trace elements status. Japanese immigrants in Brazil have a lower copper status and higher zinc status than those living in Okinawa where there is less IHD mortality. A low intake of copper and high intake of zinc may be associated with increased IHD. (C) 1997 Wiley-Liss, Inc.

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：PLENUM PRESS DIV PLENUM PUBLISHING CORP  

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：PLENUM PRESS DIV PLENUM PUBLISHING CORP  

Objectives
To assess effects of oral taurine supplementation on lipids and sympathetic nerve tone in healthy young men on experimental high fat and cholesterol diets.
Methods
Twenty-two healthy male volunteers, aged 18-29 years, were recruited for this randomized control trial after informed concent according to the Ethical Comittee of Shimane Medical University. Volunteers were randomly allocated into 2 study groups and given experimental diet of identical regimen [total calorie 2500 kcal, cholesterol 1000 mg, polyunsaturated fat/saturated fat (PIS) ratio 0.52, fat 40% of total energy intake (%E), protein 14%E, carbohydrate 46%E] to raise serum cholesterol (CHO) level for 3 weeks. Alcohol intake, smoking and strenuous physical activities were prohibited. Taurine powder (6 g/day) was supplied to one group (T-group, N=11) and placebo capsules to the other (C-group, N=11), by a single-blind approach. Blood samples and 24 h urine specimens were obtained once every week. Two men in the C-group dropped out due to upper respiratory infection. There were no difference in age, body mass index (BMI) or blood pressure (BP) between the groups. Statistical analysis was performed by analysis of variance (ANOVA, repeated measurement) and Student&apos;s t-test.
Results
There were no changes in BMI and BP in either group during the period. Significant increases in total CHO (25.4 +/- 17.5 mg/dl, mean +/- SD), LDL-CHO (17.1 +/- 14.5) and LDL (43.9 +/- 37.6) were observed in C-group but were attenuated in the T-group. The T-group showed significant increases in VLDL-CHO, VLDL and TG. The T-group had significantly lower urinary norepinephrine excretion than the C-group in the last week.
Conclusion Oral taurine supplementation attenuated increases in T-CHO, LDL-CHO and LDL in healthy men on high fat cholesterol diets but induced significant increases in VLDL-CHO, VLDL and TG, which could be explained by a possible effect of taurine on lipoprotein lipase. Significantly lower urinary norepinephrine excretion observed by the taurine administration implies the suppression of the sympathetic nervous system.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

1. An association between Na and blood pressure (BP) was studied in the Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study, an international cross-sectional epidemiological study, involving 55 populations from 25 nations.
2. The partial regression coefficient of BP against 24 h urinary Na was calculated in a multiple linear regression model, by adjusting other confounding factors. This demonstrated different distribution in each of several groups stratified according to their ethnicity and geographical location.
3. The relationship of urinary K to BP regression against urinary Na excretion was investigated to clarify its role in the association of Na with BP.
4. Urinary Na/K ratio showed a significant inverse linear relationship with the regression coefficient of BP on urinary Na excretion among seven Japanese populations.
5. The effect of K was to increase urinary Na excretion, as the ratio of Na/K might modify the association between Na acid BP.

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OBJECTIVE: To assess the relationship of biological markers of dietary factors with blood pressure (BP) (Core Study) and with age-adjusted mortality rates of stroke and ischemic heart disease (Complete Study) in the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study, a multicentre epidemiological study in 55 centres of 24 countries as of 1993. DESIGN AND METHODS: From each population, 100 men and 100 women aged 48 to 56 years were randomly selected for BP measurement, 24-hour urine collection, blood tests, etc. Various biological dietary markers from the urine and blood were analysed centrally. Age-adjusted mortality rates from stroke and ischemic heart disease were obtained from 19 centres in 14 countries. RESULTS: Core Study: Cross-centre analyses, using simple linear regression, showed a positive relationship of body mass index to systolic BP and diastolic BP in men (p &lt
0.001) and women (p &lt
0.05). There were also strong positive correlations between 24-hour sodium excretion rates and both systolic and diastolic BP (both p &lt
0.01) in men. An inverse relationship was found between the 24-hour magnesium/creatinine excretion ratio and diastolic BP (p &lt
0.05) in men. Complete Study: Stroke mortality was significantly positively related to the 24-hour sodium excretion rate in men (p &lt
0.01) and to the sodium/potassium ratio in both sexes (p &lt
0.05). It showed an inverse relationship of serum phospholipid with serum total cholesterol (p &lt
0.05) and a positive relationship with arachidonic acid. A strong positive relationship between serum cholesterol level and ischemic heart disease (p &lt
0.001) was observed in men. The serum phospholipid n-3 polyunsaturated fatty acid (PUFA) level and the PUFA to saturated fatty acid (SFA) ratio were significantly inversely correlated with ischemic heart disease. The 24-hour taurine excretion rate, a biological marker of seafood protein intake, showed a significant inverse correlation with ischemic heart disease in both sexes (p &lt
0.01). CONCLUSION: The Core Study revealed a consistent adverse effect of high body mass index and excess salt intake on BP and a beneficial effect of magnesium on BP. The Complete Study demonstrated an adverse effect of high sodium, low potassium intake and hypercholesterolemia on stroke
and an adverse effect of cholesterolemia as well as beneficial effects of serum phospholipid n-3 PUFA, PUFA/SFA and the taurine excretion rate on death from ischemic heart disease.

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：PULSUS GROUP INC  

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：PULSUS GROUP INC  

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：INSERM / JOHN LIBBEY EUROTEXT  

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1. To investigate the epidemiological relationship of dietary factors to blood pressure (BP) and major cardiovascular diseases, we carried out the international cooperative Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study, which so far involves 48 centers in 20 countries as of August 1991. From each population, 100 men and 100 women aged 50-54 years were randomly selected for BP measurement, 24-h urine collection, blood tests, and medical interview. Various biological markers of diets from urine and blood were analyzed centrally in the Izumo CARDIAC center. 2. Cross center analysis using simple linear regression revealed strong significant correlations of body mass index (BMI) to systolic BP (SBP
p &lt
0.01) and diastolic BP (DBP
p &lt
0.001) in men. 24-h urinary sodium (Na) excretion in men also showed significant correlations with SBP (p &lt
0.05) and DBP p &lt
0.05) even after controlling for the effect of BMI (SBP
p &lt
0.05, DBP
p &lt
0.05). 3. Within center analysis using multiple linear regression implied that BMI and Na strongly adversely affect BP, whereas magnesium may have beneficial influence on BP. 4. Multicolinearities among 24h urinary sodium, calcium, and urea nitrogen were noted in men.

DOI： 10.1177/026010609200800303

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To investigate the relationship of dietary factors to cardiovascular diseases, we conducted a study of 234 middle-aged Japanese men and women in Okinawa (JJ), and 160 Japanese immigrants of similar age, originally from Okinawa, in Brazil (JB). JB showed double the prevalence (%) of ST-T changes in the electrocardiogram (ECG) (JJ: M3.4, F4.4, JB: M8.3, F10.1) and of hypertension (HT) (JJ: M15.9, F18.4
JB: M32.8, F36.4, p&lt
0.05) when this was assessed on BP ≥ 160/95 and/or the taking of antihypertensive medication
however the mean level of blood pressure did not differ. A gradient in the rate of HT in men and of ECG ST-T changes in both sexes was observed from JJ to JB of first-generation and to JB of second-generation. JB had much higher body mass index (kg/m2) (JJ: M24.8 ± 0.3, F24.8 ± 0.4
JB:M26.2±0.4, F26.5 ± 0.4, p&lt
0.01) in both sexes, and an 8-fold higher rate of oral contraceptive usage (p &lt
0.001). Total cholesterol level showed no significant difference between JJ and JB. 24-hour urinary taurine excretion in both sexes and plasma phospholipid n-3 fatty acid level in men were significantly higher in JJ than in JB. The dietary pattern in Japanese immigrants in Brazil, characterized by low fish and large meat intake, is possibly responsible for the higher risk of HT and ECG ST-T changes, indicating the importance of dietary rather than genetic factors. © 1992, The Japanese Society of Hypertension. All rights reserved.

DOI： 10.1291/hypres.15.45

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Genetic rat models of hypertension, such as spontaneously hypertensive rats (SHR) and in particular, stroke-prone SHR (SHRSP) are useful models for research on the genetic pathogenesis, gene-environment interaction and control of environmental factors for the prevention of hypertension and related cardiovascular diseases (CVD). Since recent genetic analysis of hypertension in SHRSP indicated that one of the hypertensive genes related to salt-induced blood pressure (BP) rise was linked with the gene of the angiotensin-converting enzyme, gene-environment interaction is important in the humoral, neural, vascular and nutritional mechanisms of hypertension and CVD. Extensive experimental studies in SHRSP by the authors have demonstrated nutritional factors counteracting directly or indirectly against the adverse effect of excess salt intake, such as K, Mg, Ca, dietary fibres, protein, some amino acids and fatty acids, etc.
they are therefore effective in preventing stroke, the typical complication of hypertension. Experimental atherosclerotic models were established in SHRSP, which indicated also a gene-environment interaction in the pathogenesis of atherosclerosis at the cellular level of vascular smooth muscle cells. Excess salt intake accelerated cholesterol absorption from the intestine to induce arterial fat deposition as well as to active platelet aggregation by the mechanism of increased intracellular Ca2+ mobilization. Based on such experimental findings on the hypertension and related CVD prevention, a cross-sectional multicentre epidemiological 'CVD and Alimentary Comparison' Study (WHO-CARDIAC Study) was designed to assess the relationship of biological markers of dietary factors with BP ('core' study) and major CVD mortalities ('complete' study) and has been successfully undertaken for the past 8 years in co-operation with 54 centres in 23 countries. The results of 'core' study so far obtained by cross-centre simple linear regression analysis demonstrated adverse effects of body mass index and salt intake on BP in men and possible beneficial effects of Mg by within-centre multiple linear regression analysis. Preliminary cross-centre simple linear regression analysis of the 'complete' study indicated a positive correlation of serum cholesterol levels and negative correlation of serum phospholipid polyunsaturated to unsaturated fatty acid ratios and 24 h urinary taurine excretion with coronary heart diseases mortality
a positive correlation of 24 h urinary Na and Na/K ratios and a negative correlation of serum cholesterol levels with stroke mortalities was indicated. These epidemiological data confirmed mostly the applicability of experimental findings to the nutritional prevention of hypertension and CVD prevention. Thus, gene-environmental interaction is the basis for the predictive-preventive medicine of CVD, which could replace current diagnostic therapeutic medicine in the 21st century.

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DOI： 10.1536/ihj.32.568

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MARCEL DEKKER INC  

Stroke-prone spontaneously hypertensive rats (SHRSP) and normotensive Wistar-Kyoto rats (WKY) were maintained in isolation or in group to analyze the effect of isolation, one type of emotional stress, on the development of hypertension and its complications. SHRSP kept isolated during the whole or a half of the experimental period developed severer hypertension within a shorter period than those kept together with other animals throughout the experiment, and showed significantly higher incidences of cerebral stroke (40 or 33%) than the latter (8.3%).
Histological and pathophysiological studies revealed pituitary-adrenal and cardiac hypertrophy accompanying more accelerated urinary epinephrine (E) excretion which indicated emotional stress caused by isolation might aggravate pathological lesions in hypertension. Neither WKY in isolation nor in groups developed hypertension, although isolated WKY had significantly heavier pituitary and adrenal glands accompanied with more accelerated urinary E and calcium excretions than WKY kept in groups.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Informa Healthcare  

Stroke-prone spontaneously hypertensive rats (SHRSP) and normotensive Wistar-Kyoto rats (WKY) were maintained in isolation or in group to analyze the effect of isolation, one type of emotional stress, on the development of hypertension and its complications. SHRSP kept isolated during the whole or a half of the experimental period developed severer hypertension within a shorter period than those kept together with other animals throughout the experiment, and showed significantly higher incidences of cerebral stroke (40 or 33% than the latter (8.3% Histological and pathophysiological studies revealed pituitaiv-adrenal and cardiac hypertrophy accompanying more accelerated urinary epinephrine (E) excretion which indicated emotional stress caused by isolation might aggravate pathological lesions in hypertension. Neither WKY in isolation nor in groups developed hypertension, although isolated WKY had significantly heavier pituitary and adrenal glands accompanied with more accelerated urinary E and calcium excretions than WKY kept in groups. © 1991 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

DOI： 10.3109/10641969109042090

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT-RAVEN PUBL  

As a part of the international cooperative Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study, we carried out surveys for the relationship of dietary factors to blood pressure (BP) in 10 areas in China, (Altai, Beijing, Guangzhou, Guiyang, Hetian, Lhasa, Shanghai, Shijiazhuang, Tulufan, and Urumqi). Systolic BP and diastolic BP were significantly positively associated with salt excretion and body mass index. However, 3-methylhistidine divided by creatinine, and taurine divided by urea nitrogen in 24-h urine were significantly negatively associated with both BPs. These results suggest that meat protein intake may beneficially influence BP, whereas salt may adversely affect BP.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT-RAVEN PUBL  

The relationship between alcohol consumption and blood pressure (BP) was studied in 29 centers in 12 countries as part of the International Cooperative Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. From each population, 100 men and 100 women aged 50-54 were randomly selected for BP measurement by automated system and for a standardized interview to complete the questionnaire relating to alcohol consumption. In cross-center simple linear regression analysis, mean alcohol consumption calculated from a previous week's drinking did not show a linear association to BP. In within-center multiple linear regression analysis, relationships between high alcohol intake (greater-than-or-equal-to 300 g/week) and BP were assessed among 26 centers with high alcohol drinkers after being adjusted for other confounding variables. Positive associations of high alcohol intake with systolic BP (SBP) and diastolic BP (DBP) were noted in 17 and 16 centers, respectively. Thus, high alcohol intake was positively and independently associated with BP in individual subjects.

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Blood pressure (BP) examinations and urine analyses for the assessment of dietary Na, K, and protein intakes were carried out according to the standardized methods for the World Health Organization Cardiovascular Diseases and alimentary Comparison Study in aged people with or without a longlasting nutritional intervention. Nutritional intervention to reduce salt intake and increase K and protein intakes was effective for BP reduction even in aged people over 65 years.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT-RAVEN PUBL  

The automatic blood pressure (BP) measurement device (A) developed for the World Health Organization (WHO) Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study was compared in Spain with the standard auscultatory-mercury manometer (M) in 440 randomly selected subjects, 50-54 years old (50% men and 50% women). BPs were recorded simultaneously in the same arm. Systolic BP (SBP), analyzed in 1,440 readings, was 127.5 +/- 18.9 mm Hg by A system and 127.6 +/- 18.6 mm Hg by M system (NS). Diastolic BP (DBP) was 71.3 +/- 11.7 mm Hg by A and 79.3 +/- 11 mm Hg by M (p &lt; 0.001). We confirmed good correlations in SBP and DBP measured by both methods (r = 0.95 and r = 0.88, respectively; both p &lt; 0.001). Nearly complete consistency was noted between SBP readings by both methods but not between DBP readings; the readings by M were significantly higher those by A. Since A's consistency with SPB and DBP readings obtained by the intra-arterial method (the most commonly used method) previously had been proven to be satisfactory, DBP obtained by clinical practice is possibly overestimated in adults.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT-RAVEN PUBL  

To investigate the epidemiological relationship of dietary factors to blood pressure (BP) and major cardiovascular diseases, we carried out the International Cooperative Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study, which so far involves 45 centers in 20 countries. From each population, 100 men and 100 women aged 50-54 years were randomly selected for BP measurement, 24-h urine collection, and blood test. Various biological markers of diets from urine and blood were analyzed centrally in the Izumo CARDIAC center. In within-center multiple regression analyses, body mass index (BMI) was strongly positively and independently associated with BP. Urine magnesium (Mg) excretion was negatively and independently associated with BP. In cross-center simple regression analyses, systolic and diastolic BP showed significant correlations with BMI (p &lt; 0.01) and 24-h urinary sodium (Na) excretion (p &lt; 0.005) in men and significant inverse correlations with urinary 3-methylhistidine (3-MH) divided by creatinine (p &lt; 0.01 and p &lt; 0.005, respectively) in men, and were inversely correlated with urinary Mg in women (p &lt; 0.05). Therefore, Na and BMI adversely affect BP, whereas animal protein and Mg intakes may have beneficial influence on BP.

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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J-GLOBAL

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：(一社)日本循環器病予防学会  

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Language：Japanese   Publisher：神奈川県公衆衛生協会  

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J-GLOBAL

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J-GLOBAL

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Other Link： http://search.jamas.or.jp/link/ui/2012174837

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本高血圧学会  

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Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：(一社)日本循環器病予防学会  

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Other Link： http://id.nii.ac.jp/1246/00000673/

Language：English   Publisher：JAPANESE CIRCULATION SOC  

Background: Although lifestyle modification is the key treatment of metabolic syndrome (MetS), clinical data on the dynamical relationship between metabolic state and MetS has been limited. This study investigated the mutual correlations between demographic and biochemical variables, and the metabolic state based on the plasma amino acid (AA) concentrations, during a lifestyle modification for MetS.
Methods and Results: Japanese subjects, consisting of 54 patients with MetS [MetS(+)] and 35 persons without MetS [MetS(-)] were included in the study. Before a lifestyle modification program, the levels of glutamate metabolism-related AA (Glu-mAA), aromatic AA metabolism-related AA (Aromatic-mAA) and alanine metabolism-related AA (Ala-mAA) were significantly higher, while those of glycine-serine-threonine metabolism-related AA (Gly-Ser-Thr-mAA) were significantly lower compared to those in MetS(-). After a lifestyle modification, significant reductions (P&lt;0.05) in the BMI (-1.4 kg/m(2)), mean blood pressure (-7.9 mmHg), hemoglobin A(1c) (-0.4%), and triglycerides (-30.6 mg/dl) were observed, and significant differences in the plasma AA levels between MetS(+) and MetS(-) were resolved. In addition, the diagnostic items of MetS were positively correlated with the levels of Glu-mAA, Ala-mAA, branched chain AA (BCAA)-mAA, Aromatic-mAA, and negatively correlated with the levels of Gly-Ser-Thr-mAA.
Conclusions: As MetS subsided, the abnormality of mean plasma AA levels of the MetS(+) group returned to similar values as those in the MetS() group, suggesting a novel viewpoint regarding the metabolic mechanism of lifestyle modification. (Circ J 2010; 74: 2434-2440)

DOI： 10.1253/circj.CJ-10-0150

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Language：Japanese   Publisher：横浜市立大学医学会  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：横浜市立大学医学会  

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Language：English   Publisher：TAYLOR & FRANCIS INC  

It is well known that the sour milk containing lactotripeptides has a blood pressure lowering effect The aim of this study was to evaluate the blood pressure (BP) lowering effect of lactotripeptides by monitoring home blood pressure, 24-h ambulatory measurements (ABPM), and daily urinary salt excretion.
A total of 30 volunteers were given 200 ml of sour milk twice a day for 8 weeks after a 1-week run-in period. This preparation contained the lactotripeptides valine-proline-proline 2.66 mg and isoleucine-proline-proline 1.38 mg. The study participants had daily measurements of urinary salt excretion determined by an electric salt sensor and home blood pressure for each week during the run-in period, before the 4- and 8-week time points. 24-h ABPM was measured at the end of each week. Mean systolic blood pressure (SBP) during night sleep including base BP at 4 and 8 weeks were significantly lower than baseline values. Mean SBP and diastolic blood pressure (DBP) during night sleep of the 22 participants who belonged to the criteria of hypertension by 24-h ABPM was significantly decreased at 4 and 8 weeks. The change in 24-h mean SBP significantly correlated with mean urinary salt excretion over the three measurement periods. The 22 hypertensive subjects without taking lactotripeptides did not show significant change of blood pressure during 24 hours at 4 and 8 weeks. Our study confirmed the BP lowering effect of lactotripeptides during night-time sleep and showed that a lower intake of salt may increase the BP lowering effect of lactotripeptides through 24 hours in hypertensive subjects.

DOI： 10.3109/10641963.2010.491885

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Other Link： http://search.jamas.or.jp/link/ui/2010038542

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Background: Utilizing a computer algorithm, information from calls to an ambulance service was used to calculate the risk of patients being in a life-threatening condition (life threat risk), at the time of the call. If the estimated life threat risk was higher than 10%, the probability that a patient faced a risk of dying was recognized as very high and categorized as category A+. The present study aimed to review the accuracy of the algorithm. Methods: Data collected for six months from the Yokohama new emergency system was used. In the system, emergency call workers interviewed ambulance callers to obtain information necessary to assess triage, which included consciousness level, breathing status, walking ability, position, and complexion. An emergency patient's life threat risk was then estimated by a computer algorithm applying logistic models. This study compared the estimated life threat risk occurring at the time of the emergency call to the patients' state or severity of condition, i.e. death confirmed at the scene by ambulance crews, resulted in death at emergency departments, life-threatening condition with occurrence of cardiac and/or pulmonary arrest (CPA), life-threatening condition without CPA, serious but not life-threatening condition, moderate condition, and mild condition. The sensitivity, specificity, predictive values, and likelihood ratios of the algorithm for categorizing A+ were calculated. Results: The number of emergency dispatches over the six months was 73,992. Triage assessment was conducted for 68,692 of these calls. The study targets account for 88.8% of patients who were involved in triage calls. There were 2,349 cases where the patient had died or had suffered CPA. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the algorithm at predicting cases that would result in a death or CPA were 80.2% (95% confidence interval: 78.6% - 81.8%), 96.0% (95.8% - 96.1%), 42.6% (41.1% - 44.0%), 99.2% (99.2% - 99.3%), 19.9 (18.8 - 21.1), and 0.21 (0.19 - 0.22), respectively. Conclusion: A patient's life threat risk was quantitatively assessed at the moment of the emergency call with a moderate level of accuracy. © 2009 Ohshige et al
licensee BioMed Central Ltd.

DOI： 10.1186/1471-227X-9-21

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Language：Japanese   Publisher：先端医学社  

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Other Link： http://search.jamas.or.jp/link/ui/2009058570

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：(株)医学出版  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：English   Publisher：SPRINGER  

BACKGROUND: Between 2003 and 2004, when the new postgraduate medical education program was introduced in Japan, the number of university residents decreased from 5,923 to 3,264 (-31%), whereas the number of non-university residents increased from 2,243 to 4,110 (+45%).
OBJECTIVE:To identify potential reasons for the shift of residents from university to non-university hospitals.
DESIGN:Cross-sectional mailed survey.
PARTICIPANTS:The subjects were 1,794 2nd-year residents at 91 university hospitals and 2,010 2nd-year residents at 659 non-university hospitals.
MEASUREMENTS:Data on hospital demographics, resident demographics, and resident satisfaction with training were collected in 2006 and were compared between university and non-university hospitals.
RESULTS:Compared to non-university hospitals, university hospitals were more likely to have &gt;700 beds (55% vs. 10%, p&lt;0.001) and to have more teaching resources and free access to international medical journals (84% vs. 62%, p&lt;0.001). Nevertheless, one-half (47%) of the university residents reported that they were not satisfied with the residency system and clinical skills training and attributed their dissatisfaction to "daily chores," "low salary," and "poor clinical opportunities." Logistic regression analyses indicated that the proportions of residents who were satisfied with income (OR: 0.32, 95% CI: 0.26-0.40) and the residency system (OR: 0.52, 95% CI: 0.40-0.68) and clinical skills training (OR: 0.77, 95% CI: 0.60-0.99) were significantly lower for university residents than for non-university residents.
CONCLUSIONS:Hospital size and teaching resources do not overcome the other characteristics of university hospitals that lead to residents&apos; dissatisfaction.

DOI： 10.1007/s11606-008-0644-7

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Language：Japanese   Publisher：(一社)日本内科学会  

平成16年度から施行された新医師臨床研修制度第一期生の臨床能力修得状況について、平成18年度3月の2年次研修医を対象にアンケート調査を行い、旧制度下の平成15年度3月の2年次研修医対象のデータと比較した。解析対象は大学病院および臨床研修病院の研修医で、平成15年度2474名、平成18年度1166名とした。1)自己評価でみる限り、新制度へ移行後、調査対象となった幅広い臨床能力の修得状況は全般的に著しく向上し、加えて以前認められていたような大学病院の研修医と研修病院の研修医との差がほとんど認められなくなった。2)調査対象となった82の症状・病態・疾患と4種類の医療記録すべてにおいて、旧制度下の研修医よりも新制度下の研修医は経験症例数・記載件数が有意に多かった。3)新制度下の研修医は、すべての研修医に幅広い臨床能力を修得させるという目的は達成される方向にあると考えられた。

DOI： 10.2169/naika.96.2681

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Other Link： https://jlc.jst.go.jp/DN/JALC/00304871023?from=CiNii

Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：医学書院  

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Other Link： http://search.jamas.or.jp/link/ui/2007202981

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：Japanese   Publisher：国立保健医療科学院  

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Other Link： http://search.jamas.or.jp/link/ui/2007109111

Language：Japanese  

DOI： 10.11307/mededjapan1970.36.365

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本国際保健医療学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：医学書院  

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Language：Japanese   Publisher：日本総合診療医学会  

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Language：Japanese   Publisher：Japan Society for Medical Education  

The purpose of this study was to evaluate the clinical clerkship program at the University of Tokyo Hospital. We report results of course and faculty evaluations by students and of qualitative evaluations, such as students, free comments and group interviews. Methods: Each item of the course and faculty evaluations was related to the overall educational goals developed in advance. Students evaluated the course and faculty immediately after the course ended. Results: Students rated the clerkship program favorably overall, but the scores of thesecond month (3.38) were lower that those of the first month (3.63). Although learning basic clinical procedures is not the main educational goal of the clerkship, students varied widely in their opportunities to perform procedures. Scores of faculty evaluations ranged from 2.93 to 3.87 in the first month and were lower in the second month for all but two items. Interviews revealed that students had fewer learning experiences in the second month because new residents started their rotations at that time. Conclusion: The results suggest that the scheduling of clinical clerkships should be changed. The contents of clerkship need further consideration.

DOI： 10.11307/mededjapan1970.35.369

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Language：Japanese   Publisher：Japan Society for Medical Education  

A clinical clerkship program was introduced at the University of Tokyo in 2002 to help students acquire clinical knowledge, skills, and attitudes by increasing their involvement in clinical activities. We assessed the learning effectiveness of clinical clerkships at the University of Tokyo Hospital by examining evaluations of student&#039;s clinical competence by themselves and by the faculty. Methods: We evaluated each clerkship with reference to overall educational goals developed in advance. We measured students&#039; self-evaluations and evaluatio s by the faculty before and after the clerkship. Results: At the end of the 2-month clerkship, students&#039; self-evaluation scores (3.18) were significantly higher than before the clerkship (2.71). In particular, scores for patient care were markedly higher. Evaluation scores by the faculty were also higher during (3.64) and after (3.57) clerkships than before (3.26) clerkships. Conclusion: We will use this data to make next year&#039;s clerkship programs more effective. We should also develop more-objective strategies for evaluation and establish relevant educational goals.

DOI： 10.11307/mededjapan1970.35.361

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Language：Japanese   Publisher：(一社)日本熱帯医学会  

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Other Link： http://search.jamas.or.jp/link/ui/2004054307

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：ELSEVIER SCI IRELAND LTD  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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CiNii Books

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Language：Japanese   Publisher：南山堂  

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Other Link： http://search.jamas.or.jp/link/ui/2000171062

Language：Japanese   Publishing type：Book review, literature introduction, etc.  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：Japanese   Publishing type：Book review, literature introduction, etc.  

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PubMed

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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CiNii Books

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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CiNii Books

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CiNii Books

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Language：English   Publishing type：Book review, literature introduction, etc.   Publisher：INT LIFE SCIENCES INST  

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Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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