We conducted a population-based mail survey and prospectively compared mortality between respondents and non-respondents. Age-adjusted mortality rates for all causes were higher among non-respondents than among respondents in both sexes. Age-adjusted rate ratios were 1.50 for males and 1.33 for females. Non-respondents also had, in both sexes, higher mortality for three leading causes of death, namely, cancer, heart diseases and stroke than respondents. In particular, the difference between the two groups was much greater for cardiovascular disease than for cancer. Our results suggested that prospective studies using data from respondents to mail surveys in Japan would have underestimated the mortality for cardiovascular disease. J Epidemiol, 2000 ; 10 : 136-139
The purpose of this study was to examine the relationships between risk factors and smoking status among high school students in Okinawa, Japan. We also examined if there is a doseresponse relation between the number of risk factors and smoking status. Self-reported questionnaires including smoking status and potential risk factors were conducted using a sample of 1, 029 students of a public senior high school in Okinawa. The percentage of smokers was 40.0% for males and 10.6% for females, and it was significantly higher for males than females. As a result of multivariate analysis, we identified four significant risk factors; peer smoking, attitude of peer toward subject smoking, intention to smoke at the age 20, and alcohol drinking. The number of these risk factors was linearly associated with increased percentage of smokers, and a linear trend was significant for both gender students. Additionally, magnitude of risk for smoking among females became considerably great compared with those of males as the number of risk factors increased. In conclusion, this study was the first study in Japan to indicate a significant dose-response relationship between the number of risk factors and smoking status among high school students. We also found that females with many risk factors had extremely increased vulnerability to smoking compared to male counterpart. These findings may be useful to identify high-risk students who need more intensive smoking prevention programs and to develop the content of effective interventions. J Epidemiol, 2000 ; 10 : 140-148
Past studies in Europe and the USA have found that people with higher education levels have better health practices. The aim of this study was to examine the association between health practices and education level among people in a rural Japanese community. Data were derived from the Ohsaki National Health Insurance Cohort Study, which has been following 52, 029 NHI beneficiaries, aged 40 to 79 years, in Miyagi Prefecture, Japan. The relationship between education level and seven health indices (smoking, drinking, body mass index, sleeping, exercise, breakfast, and snacks) was analyzed. Higher education was associated with shorter sleeping hours for both men and women, and lower BMI for women. In age groups younger than 70 years, people with higher education tended to exercise more. Smoking for women, alcohol consumption, and a Health Practices Index were not related to education levels. These results are different from those from Europe and the USA. This study suggest that the relationship between health practices and education level is weaker in Japan than in Europe and the USA. J Epidemiol, 2000 ; 10 : 149-156
We conducted a survey on smoking among all members of the medical association in Fukui Prefecture, using a questionnaire to be filled in by the subjects. The survey was conducted from December of 1996 to February of 1997, and the return rate was 90.8%. The main results of this survey were as follows: the prevalence of current smoking among medical doctors was 26.0% (male: 27.8%, female: 5.2%), which was lower than that of adults in the general population. The prevalence of past smoking among doctors 20 to 34 years old by age cohort was highest and that among doctors 35 years old and higher declines as age cohort increased. Doctors' participation in activities for the prevention of smoking in the general society was also found to be at a low level. J Epidemiol, 2000 ; 10 : 157-162
We examined apolipoprotein E (Apo E) polymorphism and methylenetetrahydrofolate reductase (MTHFR) 677 C to T mutation by using the polymerase chain reaction (PCR) method in 100 elderly Japanese aged 60 or more, and assessed whether these genetic factors are associated with an increased risk for the clinical phenotypes of senile dementia, Alzheimer's disease (AD) and vascular dementia (VD) by cross-sectional survey. It was found that the Apo E * 4 allele were associated with an increased prevalence of AD as previously reported. Although, it was not strongly related to the severity of senile dementia, a weak associaton between the ApoE genotype and the severity of dementia was suggested. The proportion of patients with senile dementia was higher in the group of carriers of MTHFR mutation than in the group of noncarriers. Furthermore, the proportion of male patients with senile dementia was higher in the group of homozygous for the mutation (+/+) than the group without the mutation (-/-). Notably in VD patients, 5 of 7 males had the +/+ genotype. The results suggest that the ApoE ε 4 genotype and the MTHFR mutation are associated with the clinical phenotype and the clinical onset of senile dementia. J Epidemiol, 2000 ; 10 : 163-172
Background: In Japan, mortality from suicide has peaked around 50 years old among men, with increasing trend after 65 years old, and this peak became more apparent in recent years. Beside this, “psychological autopsy” has revealed depression as one of the most important risk factors for suicide. There is, however, no cohort study which examined the relationship between depressive mood measured by simple method and suicide in middle-aged general population. Methods: In 1989, baseline information was collected by a self-administered questionnaire, and 18, 450 workers were followed up to March 31, 1995. All deaths observed during active service were identified, and when retired, its date was recorded. Among 5, 352 male workers aged between 40 to 54, 11 committed suicide during follow-up period of 5 years. Analysis were carried out by Cox's proportional hazard model, controlling for age. Results: Those who slept 9 hours or more per night demonstrated 12.14-fold risk of suicide compared with those who slept less than 9 hours. Smokers were more likely to commit suicide than non-smokers. Those who answered affirmatively to more than 7 out of 12 questions, which were derived from Zung self-rating depression scale, experienced an increased risk of suicide (RR 9.95; 95%Cl: 1.89-52.44), even after adjusting for other confounding factors. Conclusion: We found an association between depressive mood and subsequent suicide in a middle-aged workers. Detailed observation and follow-up of those with depressive mood should be systematically organized with due attention and caution. J Epidemiol, 2000 ; 10 : 173-178
To investigate the factors influencing the visual acuity of primary school pupils, an epidemiological study of 480 pupils in the 6th grade (11-12 years of age) was conducted in 8 primary schools in Sapporo City, Japan. Questionnaires were used to inquire into their current and past visual acuity and related factors. Dividing the subjects into those whose visual acuity of both eyes was 0.7 or more and those whose visual acuity of at least one eye was less than 0.7, odds ratios of various factors were calculated. Lifestyle and dietary factors showed no significant odds ratios. Parental myopia and age of parents at the birth of subjects showed significant odds ratios. Visual acuity of the pupils whose parents were myopic or older than 30 years when they were born tended to have worse visual acuity as they got older. Till the ages 11 or 12, hereditary factors seem much more contributory to visual acuity than environmental ones. J Epidemiol, 2000 ; 10 : 179-182
Japan has no legal restrictions on cigarette advertising and vending machines. This lack of smoking control measures is a possible contributor to smoking initiation by adolescents. This study was conducted to provide primary data on environmental factors related to smoking, such as cigarette advertising and candy cigarettes, that influence elementary school children in Japan. A cross-sectional survey was conducted with a self-administered questionnaire at two elementary schools in Kitakyushu City, Japan in 1995. Questionnaire sheets were anonymously filled out by 282 elementary school children at school. The effective response rate was 91.5% (128 boys and 130 girls). Over 90% of respondents had seen cigarette advertising on TV, candy cigarettes and cigarette vending machines. Over 75% had at least one smoker in their family. Fewer female children expressed an intent to smoke in the future despite the fact that there were no significant sex differences in smoking-related experiences. Children were highly exposed to cigarette advertising on TV, candy cigarettes, vending machines and family members' smoking. Control of such smoking-related factors in the environment would be crucial to keeping children from initiating smoking behavior. J Epidemiol, 2000 ; 10 : 183-187
This study aimed to explore the changes in medical student's knowledge and attitudes regarding clinical epidemiology and biostatistics (CEB) after community medicine (CM) taught courses. All the 3rd (before CM-taught courses) and 4th year (after CM-taught courses) undergraduate students of Dhaka Medical College, Bangladesh, were given a questionnaire concerning some introductory level problems on CEB and attitudes towards them. Mean knowledge scores were not statistically different between these two groups: 3.70 and 3.85 (out of 9) on clinical epidemiology; 0.20 and 0.18 (out of 4) on biostatistics ; and 3.91 and 4.04 as a total (out of 13) among them, respectively. Most of the 3rd and 4th year students agreed that CEB is essential for smooth understanding of clinical medicine and journals, and asserted to include it in CM-taught courses. Since the current CM-curriculum does not offer any improvement of knowledge among them, well-planned taught courses on it should be included as a component of CM. J Epidemiol, 2000 ; 10 : 188-190
Background: The personality of healthy individuals has not been well studied in relation to health consciousness, dietary habits and actual food intake, simultaneously. Objective: Our objective was to study the association between personality and dietary habits. Design: Information on dietary habits, including taste preferences and the frequency of food consumption, was collected through a questionnaire from 76 male and 394 female students. The personality of students was determined by a modified NEO-FFI test. Health status, height, body weight, body fat percentage and blood pressure were measured by physical examination. Main outcome measures were personality scores as indicators of a healthy dietary pattern. Results: Food intake was influenced by neuroticism (N), extraversion (E), openness (0) and agreeableness (A) of personality. Taste preferences and receptivity to dietary advice were also influenced by personality: the odds ratios (ORs) between the high and low tertiary points of the NEO-FFI scores for salty and sweet taste preferences were significantly higher in the group that scored high for neuroticism (N) (salty taste preference: OR=2.25, NS in males and OR=2.39, 95%CI=1.16-4.93 in females; sweet taste preference: OR=21.00, 95%CI=2.40-183.99 in males and OR=3.33, 95%CI=1.61-6.91 in females). On the other hand, the groups with high scorer for 0 and A did not like salty tastes. The groups with high scores for A and C were receptive to dietary advice. High scores of each N, E, 0, A, and C factor were characterized by distinguishable, dietary habits and lifestyle. For nutritional or health education, group classes are sufficient for high A and O. High C scorer displayed discrepancies between health consciousness and dietary habits, so intervention or a close follow-up by medical professionals would be necessary to improve the health of individuals in this group. High E scorer possessed a confident attitude towards their health, but they were not interested in developing healthy habits. High N scorer was adverse to receiving health information and learning healthy dietary habits. Conclusion: Personality determined by NEO-FFI test was related to dietary habits and health attitude. Effective health education methods must take the personality of the targeted individuals into consideration. J Epidemiol, 2000 ; 10 : 191-198
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