To examine the relationship between lifestyle and sociodemographic risk factors and mortality, a population-based prospective cohort study was conducted in two areas of Gunma Prefecture, Japan, and a cohort consisting of 11, 565 subjects aged 40-69 at baseline in 1993 was followed. During the five-year follow-up period, 201 men and 103 women died. The relative risks (RRs) of risk factors were estimated by the Cox proportional-hazards model. Significant RRs with multivariate adjustment for all-cause mortality was observed for body mass index (BMI). The curve for the relationship between BMI and all-cause mortality was L-shaped in men and Ushaped in women, with the lowest RRs at a BMI of 22-25 in both men and women. Other significant RRs for all-cause mortality were observed for obesity in the subjects' 30's in both men and women (RR: 2.42 and RR: 2.75), poor perceived health status in men (RR: 4.55), and having had a health examination in the past three years in both men and women (RR: 0.49 and RR: 0.46). These results suggested that increased risk of death was independently associated with a lower BMI, obesity in the subjects' 30's, and not undergoing health examinations, among both men and women, and poor perceived health status among men. J Epidemiol, 2001 ; 11 : 51-60
To investigate the magnitude of the 'regression to the mean' effect for the changes in serum total cholesterol (TC), triglycerides (TG), and high density lipoprotein cholesterol (HDLC) levels during one-year interval between annual health check-ups in occupational settings, the relationships between the baseline level and subsequent one-year change in TC, TG or HDLC were analyzed using paired health check-up data in 1998 and 1999 of 547 Japanese male clerical workers. After adjustment for age, body mass index (BMI), yearly change in BMI, drinking score and smoking score by the multivariate analyses, the yearly changes in each serum lipid (ATC, A Ln(TG) or A HDLC) were clearly inversely associated with the lipid levels in 1998. For example, in the multiple linear regression analyses setting A value in each serum lipid as a dependen-aut-name=Mamoru Ishikawa ent variable, the partial regression coefficients for the baseline lipid levels (f3, ) were - 0.21 (p<0.001) for the TC, - 0.39 (p<0.001) for the Ln(TG) and - 0.15 (p<0.001) for the HDLC, respectively. These results suggest that the observed yearly change in each serum lipid level may largely reflect the 'regression to the mean' effect in addition to the real yearly biological change. J Epidemiol, 2001 ; 11:61-69
Objective: To examine response bias by neuroblastoma screening participation status in apopulation-based postal survey of parents in Ishikawa Prefecture, Japan Methods: The eligibility criteria for the study were: 1) parents whose infants were born in Ishikawa Prefecture between March 1997 and February 1998, and 2) of those parents who resided in the Prefecture in March 1999. Four-page questionnaires were mailed to one-third of screening participants (n= 2, 886) and all the nonparticipants (n= 1, 401). Questionnaires were anonymous, with no identifiers on the questionnaire. Colored papers were used for printing questionnaires to differentiate screening participation status. Response rates were calculated using demographic information on the infant registry as the denominator and demographic characteristics data from the returned questionnaire as the numerator. Results: The response rate was 63% for participants and 33% for nonparticipants. The following factors were associated with lower response rates regardless of screening participation status: older maternal age (≥035 years), higher parity (≥04), nuclear family status, and mother having a full-time occupation. Approximately 20% of screening nonparticipants reported having participated in the screening. Place of residence, maternal age, and parity were associated with the percentage of incorrect reporting. Conclusion: Screening participation status was a major factor associated with low response rate, although some demographic characteristics were also predictive of low response rates. Incorrect reporting of screening participation among nonparticipants indicates a strong social desirability bias in this official survey in Japan. J Epidemiol, 2001 ; 11 : 70-73
In many of the least developed countries, working people are significantly exposed to a number of occupational problems that may result in a deterioration of their health, safety and well being. These work-related problems are untenable, not only because of the occupational problems itself but also because of the simultaneous exposure to heat, dusts, noise, organo-chemicals, and biological and environmental pollution. This situation has existed for a long time due to various socio economic, geographical, cultural and local factors. The deteriorating situation of health and safety in the workplace may perhaps exist due to the inadequate resource facilities, economic constraints and lack of opportunity to conduct research and studies on the assessment of exposure-diseases associations. Officials, who are employed by the state, are not able to implement work regulations and labour legislation easily. Generally, they are not professionally trained and expert in the occupational health, industrial hygiene and/or safety fields, and thus, successful application and implementation of control measures are lacking. Steps to control work exposure limits have been ineffective, since national policies have been rare, owing to the multiple obstacles in preventing occupational problems. However, the major focus is on practical solutions to differing workers' needs, consideration of which is very important, depending on the what the industrial entrepreneurs could reasonably to be expected to afford. Why there is a lack of motivation and effort regarding the development of health and safety-this paper explores some important issues, aiming to focus public attention on the legacy of national and international efforts. Examples are likewise given to show the real situation of health and safety in the least developed countries. J Epidemiol, 2001 ; 11 : 74-80
Sudden deafness sometimes has an identifiable cause, but in most cases the cause is unknown (idiopathic sudden deafness). Vascular impairment has been proposed as an aetiological mechanism for this condition, but it is unclear whether traditional cardiovascular risk factors, such as smoking or alcohol intake, are associated with this condition. We accordingly investigated associations of idiopathic sudden deafness with smoking, alcohol intake and sleep duration in a case-control study. Cases were consecutive patients diagnosed with idiopathic sudden deafness between October 1996 and August 1998 at collaborating hospitals in Japan. Controls were obtained from a nationwide database of pooled controls, with matching for age, gender and residential district. Exposure variables were assessed from a self-administered questionnaire. Subgroup analyses were performed using audiometric subtypes of sudden deafness. Data were obtained for 164 cases and 20, 313 controls. Increased risks of idiopathic sudden deafness were observed among participants who consumed two or more units of alcohol per day (OR=1.90, 95% CI=1.12-3.21), and among participants who slept less than seven hours per night (OR=1.61, 95% CI=1.09-2.37). The direct association with alcohol intake was particularly strong for the participants with profound hearing loss. There was little evidence of an association with smoking. This study suggests that alcohol intake and short sleep duration might be risk factors for idiopathic sudden deafness. J Epidemiol, 2001 ; 11 : 81-86
Many epidemiologic studies on the relationship between smoking and Parkinson's disease (PD) have been conducted. Morens et al. reviewed many articles in the study field and concluded that smoking is inversely associated with the risk of PD. In the present study, the object is to obtain summarized risk estimates of the relationship from the published articles using meta-analysis. Summarized risk estimates on the relationship between smoking and PD were found to be about 0.5 with statistical significance in meta-analysis. Therefore, the result that smoking is inversely associated with the risk of PD is appropriate. J Epidemiol, 2001 ; 11 : 87-94
The HIV/AIDS pandemic has challenged the resourcefulness of epidemiology and epidemiologists. In response to the challenge, epidemiologists have used existing epidemiologic strategies, expanded existing strategies, and developed new strategies to answer key questions about the transmission of HIV, the natural history of HIV at the molecular, host, and community levels, for evaluation of treatment effectiveness and intervention strategies, and to inform public health policy. In responding to the challenge of the pandemic, epidemiologists have also increasingly collaborated with scientists from other disciplines, particularly immunology, virology, and the behavioral sciences. Examples of the application of these epidemiologic strategies are presented. J Epidemiol, 2001 ; 11 : 95-102
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