Psychological factors have been suspected to be associated with the development of systemic lupus erythematosus(SLE)and patients health status.However, psychological profiles among Japanese patients with SLE have been poorly understood.We started a prospective study of female patients with SLE in 1995.Using the baseline data from 279 patients in this prospective study, we cross-sectionally analyzed the relations of clinical factors and social factors to psychological factors, and the association between psychological factors and mental and physical health status.We used the Japanese notion ikigal as an indicator of mental health, and ambulatory activity as an indicator of their physical health, respectively.To measure psychological factors, the short-form of the Eysenck Personality Questionnaire-Revised(short EPQ-R)and the Multidimensional Health Locus of Control(HLOC)scale were used.Active phase of the disease was significantly related to the neuroticism score in the short EPQ-R.Educational level was inversely related to the scores of powerful others and chance HLOC belief.As for health status, the internal HLOC belief was significantly associated with /k/gal and the chance HLOC belief was inversely associated with ambulatory activity.The scores on the short EPQ-R (Extraversion/lntroversion and Neuroticism)were exclusively related to ikigai.This study suggests that psychological factors may have effects on both the development of SLE and patients health status.JEpidemiol, 2002;12:55-63

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This study sought to investigate the effects of walking on serum lipids among the middle-aged and elderly.The subject group included 3312 adult Japanese who underwent a routine health examination at Yukuhashi city, Fukuoka Prefecture, in 1998.The amount of walking in which the subjects engaged and other lifestyle characteristics were examined by a self-reported questionnaire.Analyses of variance were performed to calculate adjusted means of total cholesterol, HDL cholesterol, triglyceride, and LDL cholesterol using walking time as the level of a factor.Multiple logistic regression analyses were also performed to estimate odds ratios and 95% confidence intervals for unfavorable lipid profiles.For both sexes, the adjusted mean for total and LDL cholesterol was higher in individuals who walked than in those who did not walk, and also individuals who walked had higher odds ratios for higher total cholesterol levels than those who did not walk.For men, the adjusted mean for HDL cholesterol was higher in individuals who walked than in those who did not walk.No significant difference was observed in triglyceride or the ratio of total cholesterol to HDL cholesterol between individuals who walked and those who did not walk.This suggests that walking exercise may not achieve the beneficial effect on lipids profiles among middle-aged/older Japanese.JEpidemiol, 2002;12:64-69

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Background:Epidemiologic studies have shown the association between alcohol consumption and colorectal cancer, especially for rectal cancer.The alcohol related enzyme encoding gene ALDH2 has polymorphism Glu487Lys, and 487Lys allele is closely linked with phenotypic loss of enzyme activity.Materials and Methods:A hospital-based case-control study was conducted with 72 colon and 70 rectal cancer cases and 241 non-cancer controls to evaluate the alcohol consumption and ALDH2 Glu487Lys polymorphism.The logistic regression model was applied to estimate the odds ratios(ORs).Result:The crude ORs for Glu/Lys and Lys/Lys genotype relative to Glu/Glu for colon and rectal cancer were not statistically significant.However, with the rectal cancer analysis, the ORs for high alcohol consumption were greater with 487GIu/Lys genotype compared with Glu/Glu, albeit not.Conclusions:These observations suggested rectal cancer risk might be influenced by ALDH2 gene polymorphism.The prevention effect by alcohol reduction might differ by ALDH2 genotype.J Epidemiol, 2002;12:70-76

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We examined allele frequencies for the common cholesteryl ester transfer protein(CETP)TaqI polymorphisms and the associations of CETP-Taql polymorphisms with serum lipid and lipoprotein levels taking into account for selected lifestyle factors in a well-characterized random sample of 527 healthy subjects living a rural community in Japan(256 men and 271 women aged 40-69 years).B2 allele frequency was 0.39 in men and 0.41 in women, and its presence was significantly associated with increased levels of HDL cholesterol(HDL-C)in men(P=0.003 for linear trend).A similar tendency in women was observed, although P value for trend did not reach 0.05.There were not significant interactions between TaqlB genotype and smoking and alcohol drinking or daily physical activity in HDL-C.There were no statistically significant differences among TaqlA genotype in lipid and lipoprotein levels.Multiple linear regression analysis showed that B1 B2 and B2b2 explained 1.7% and 2.2%, and 0.6% and 1.0% of variation in men and in women in HDL-C, respectively.We conclude that the CETP-TaglB polymorphism has a quantitative influence, but appears to be stronger one in men, on HDL-C levels even after adjustment for important lifestyle factors(smoking, alcohol drinking, and daily physical activity).
J Epidemiol, 2002;12:77-84

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Objective:To study daily, weekly, seasonal, within and between-individual variance in intake of selected nutrients and minimal days necessary for assessing true intake with a specified degree of error based on four season consecutive 7 day weighed diet records (WDRs).Subjects and Methods:We evaluated consumption of energy and 30 nutrients based on four season consecutive 7 day WDRs from 80 Japanese female dietitians in 1996-1997.We examined daily, weekly, seasonal, within- and between-individual variation in nutrient intake, relative contributions of their variances to total variance, and minimal days required to estimate a person's nutrient intake within 10% and 20% of their true mean with 95% confidence intervals.Results:The relative contributions of variation for all nutrients by person were larger than those by day, week and season.Within-individual variances were greater than the between-individual variances.The ratios of within- vs.between-individual variances thus ranged from 1.3 - 26.9.Minimal days necessary for estimating nutrient consumption per person within 10% (20%) of the true mean with 95% confidence intervals ranged from 10-35 (3-9) days for energy and major nutrients and 15-640 (4-160) days for micro-nutrients.Conclusions:The relative contributions of variability by person were largest for all nutrients, followed by those due to sequence of days, season and day of week.Within-individual variation was greater than between-individual variation.Minimal days necessary for ascertaining major nutrients were in general fewer than micro-nutrients.
J Epidemiol, 2002;12:85-92

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To examine rural-urban differences in the relationships of sociodemographic, social network, and lifestyle factors to mortality in middle-aged men, we used the data from a community based prospective cohort study, the Komo-Ise study.The subjects were all men aged 40-69 years living in Komochi Village, the rural group (n=2, 295), or the downtown district of Isesaki City, the urban group (n=3, 334), as of 1993.They completed a self-administered questionnaire in 1993 and were followed for all-cause deaths until 2000.The Cox proportional hazards model was used to compute relative risks (RRs) with 95% confidence intervals (CIs).Low educated men and men without a spouse in the rural group had an increased risk of mortality (RR=4.4;95%Cl:1.1- 18.2, RR=2.4;95%Cl:1.2-4.5).Men who did not enjoy good fellowship with their neighbors in the rural group had a decreased risk of mortality (RR=0.58;95%Cl:0.35-0.97).Mortality risks were significantly higher in urban men not participating in hobbies, club activities or community groups (RR=1.6;95%Cl:1.1-2.4).These variables remained significant risk factors, even after controlling for all sociodemographic, social network, lifestyle, and health status variables. Educational level, marital status and relation to neighborhoods showed significant rural-urban differences.J Epidemiol, 2002;12:93-104

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To examine the mutual association of risk factors for both Helicobacter pylori (H.pylon) infection and chronic atrophic gastritis (CAG), a cross-sectional study on 954 residents of a rural town in Japan was conducted.Using an unconditional logistic model, we calculated the odds ratios (ORs) for H.pylori infection according to each lifestyle, as well as the ORs for GAG according to each lifestyle and H.pylori infection.A significant positive association was observed between H.pylori infection and the risk of CAG (OR = 6.29).On the other hand, a significant negative association was observed between high consumption of light-colored vegetables and the risk of CAG (OR = 0.68).We also used a path analysis to examine the direct relations of gender, age, and lifestyle variables to CAG, as well as the indirect relations of these variables to GAG through H.pylori infection.Aging had a significantly direct positive association with GAG. Although aging also had an indirect positive association with GAG through H.pylori infection, aging had no association with the consumption of light-colored vegetables.The high consumption of light-colored vegetables showed no association with H.pylori infection but had a significantly direct negative association with CAG.The results of this study suggest a possibility that high light-colored vegetables consumption contributes to the prevention of CAG.
J Epidemiol, 2002;12:105-111

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A Meta-analysis on the therapeutic state of hypertensive population in Japan is performed by the three nation-wide governmental surveys focusing on the impact of new diagnostic criteria described in the Guidelines for the Management of Hypertension in Japan 2000.These surveys are the National Survey of Circulatory Disorders, National Nutrition Survey and Patient Survey in 1990.The meta-analysis approach is used to evaluate the validity and reliability of these three national data sets, particularly the National Nutrition Survey.The population with history of hypertensive treatment and without previous diagnosis was calculated using the old and new diagnostic criteria.The results of three national surveys are fairly consistent.National Nutrition survey can be used to monitor the overall therapeutic status of Japanese population if the definition is considered judiciously.The impact of new diagnostic criteria is extensive as demonstrated by the results of the analysis on the National Nutrition Survey of 1999.The hypertensive population doubled and one half of the Japanese population over the age of 30 is now defined as hypertensive.A policy to manage this newly diagnosed hypertensive population is urgently needed to lessen the burden on Japanese health care system. JEpidemioi, 2002;12:112-119

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To assess the reliability of responses to questionnaires regarding previous illness, family history of cancer, and smoking and drinking habits, we repeated questionnaire surveys four times at intervals of 2 weeks and 1 year(short-term), and 4.5 years(long-term)among 440 subjects aged 40-69.The reliability was assessed using kappa statistic.Kappa was calculated both for complete data and data including missing values.The changes of mode of pre-after paired responses were also investigated.Our results from complete data showed both short- and longterm reliabilities of replies regarding smoking or drinking were excellent(mean kappa 0.85-0.99).The reliability of previous illness was excellent except for stroke for short-term intervals(meankappa 0.85 -1.00), but varied depending on the kinds of illness with long-term intervals(meankappa -0.01-0.75).Responses to family history had fair to excellent short-term reliability(meankappa 0.54-0.85).Inclusion of missing value as an independent category reduced reliability remarkably.Subjects stating absence of medical history were more likely to have missing values for this item than subjects with some history.In conclusion, the reliability for information given on previous illness was as good as that on smoking and drinking for a short interval, but was lower for a long-interval probably due to the development of new cases.The reliability of a family history on cancer was slightly poorer than that of individual's previous cancer or other illnesses and that of smoking and drinking even for a short interval.J Epidemiol, 2002;12:120-125

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Mild hyperhomocysteinemia is one of the known strong risk factors for atherosclerotic diseases, and therefore it is important to clarify factors that could determine plasma total homocysteine(tHcy)level.A cross-sectional study with a random sample of 455 Japanese rural residents aged 40-69 years was conducted in 2000 to investigate the associations of plasma tHcy concentration with 5, 10-methylenetetrahydrofolate reductase(MTHFR)gene and selected life-style related factors.The frequency of the mutant allele, Valine(V)allele, was 0.40 and the prevalence of W genotype was 14.3 %.Plasma tHcy concentration in W was significantly higher than those in two other genotypes.There were significant inverse associations of plasma tHcy with serum folate and serum vitamin B12(P<0.001 for trend, respectively);both being stronger in W than in other genotypes.The number of cigarettes smoked per day was positively associated with plasma tHcy concentration.A multivariate regression analysis revealed that serum folate, serum vitamin B12, and MTHFR genotype were independently associated with plasma tHcy.The inter-individual variance of plasma tHcy was more explained by serum folate and vitamin B12 than by MTHFR genotype.Higher intakes of folate, vitamin B12, and non-smoking may be important to prevent mild hyperhomocysteinemia and the eventual atherosclerotic diseases in this Japanese rural population.J Epidemiol, 2002;12:126-135

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In many municipalities, implementation rates of health services mandated by the Health and Medical Service Law for the Elderly have not reached the national goal that was set at the start. This study aimed to evaluate the effects of health services using medical expenses for the National Health Insurance (NHI) and certification rate for long-term care insurance services in 99 municipalities in Gifu Prefecture as indices. Both indices were standardized by the age composition of the population. Among the health services, visit rates for health examinations or implementation rates for health education or health counseling correlated negatively with medical expenses for each insured person. The visit rate for gastric cancer screening correlated negatively with medical expenses for malignant neoplasms of the stomach. Implementation rates of health education or health counseling, or ratios of public health nurses correlated positively with certification rates for long-term support need and care need grade 1, and negatively with those for long-term care need grades 2, 3, and 4. The author concluded that medical expenses are reduced by the implementation of available health services, that early detection and prevention of aggravation of disease is essential for those who need long-term care services, and that health services must be reinforced with primary prevention.
JEpidemiol, 2002; 12:136-142

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We investigated the geographical patterns of mortality from eight(males)/ten(females)sites of malignant neoplasm, using cluster analysis with Standardized Mortality Ratios(SMRs), and examined the relationship between the mortality structure and urbanization.To explore the geographical tendencies is important for the prevention of cancers;such as noticing risk factors associated with regional variance.The death rates, by site, gender and age from 1990 to 1994 in Japan, were obtained from Vital Statistics.The deaths and population in municipalities were obtained from"Population of Ibaraki Prefecture".These were represented as averaged values in five-year periods.As an indicator of urbanization and mortality structure, the population density of municipalities and the overall rank scores of SMRs were used, respectively.Cluster analysis formed some distinctive structures.For males, Cluster 1 included four municipalities and three of these were located in the mountainous area in northwest Ibaraki, characterized by high SMRs from bone marrow.Cluster 5 consisted of the mid-south areas, characterized by high SMRs from stomach cancer.For females, the clusters seemed to be characterized by SMRs from esophagus cancer.An association between mortality structure and urbanization was found for females, 0.364(p<0.01), but not for males, 0.162(p=0.14).J Epidemiol, 2002;12:143-152

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Objective:To investigate whether changes at computed tomography(CT)imaging in the ageing brain are associated with future risks for functional dependence.Subjects:160 residents aged 69 years and older at the cranial CT and were independently living in a rural community in Hokkaido, Japan.Methods:Cranial CT was performed between 1991 and 1993, graded for ventricular enlargement, sulcal enlargement, white matter change, and small infarction.Functional status was reassessed in 1998 in each participant.Multiple logistic regression analysis was performed to estimate the association of CT changes in the ageing brain with development of functional dependence over six years.Results:Functional dependence was found in 19 residents at the second survey.After adjusting for age, sex, medical conditions, and cognitive functioning, small infarction and ventricular enlargement were significantly associated with development of functional dependence(adjusted odds ratio = 9.27 and 4.62).Conclusions:After controlling for age, the age-related changes on cranial CT have significant association on development of functional dependence.J Epidemiol, 2002;12:153-159

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Utility is a simple expression of health-related quality of life in individuals with different states of health. A number of studies on utility measurements were conducted and published in the past. We retrieved 164 English-language articles which appeared in 1966 through 1999 for a systematic review.The number of reports has been increasing at an accelerating pace, especially during the past decade. The most widely used method of utility measurement was time trade-off, TTO (40%), followed by rating scale, RS (31%) and standard gamble, SG (29%).The utility of chronic health status was more frequently reported as compared with acute health status (907 vs 86). Accordingly, frequently explored clinical categories were cardiology, neurology, nephrology, and gastroenterology. Specifically, coronary heart disease (52 utilities), physical disability due to neurological diseases (45 utilities), chronic renal failure (74 utilities), and colorectal cancer (29 utilities) were subject to utility measurement. Mental or social dysfunctioning accounted for only a small proportion (48 utilities). There is a strong tendency for RS to yield the lowest and SG to yield the highest values.We compiled an extensive list of the results of studies on utility as a reference for health care professionals in this field. J Epidemioi, 2002 ; 12 :160-178

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As cancer mortality data is not available, a study regarding the real problem of cancer mortality is timely and urgent in Viet Nam.Therefore the aim of the present study was to calculate cancer mortality in the city of Hanoi and Ho Chi Minh.The correlation between cancer mortality to incidence ratios and relative survival probabilities for 23 cancer sites was estimated according to SEER(1973-97), then cancer mortality was calculated from the cancer incidence and cancer survival for 25 cancer sites in each city.Cancer mortality rate for all cancer sites except skin(ASR per 100, 000)was 103.9 for males and 52.4 for females in Hanoi, and 93.7 for males and 60.7 for females in Ho Chi Minh.For males, the five most common cancer deaths were cancers of the lung, liver, stomach, colon/rectum, and nasopharynx in both Hanoi and Ho Chi Minh.For females, cancer death in the cervix was uncommon in Hanoi but the most common site in Ho Chi Minh(ASR 2.2 VS.14.2 per 100, 000).The present findings are the first results of cancer mortality from Viet Nam and should be useful for further cancer control programs there.
J Epidemiol, 2002;12:179-187

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