We conducted a cohort study to investigate the effects of coffee and green tea consumption on all-cause mortality in a rural Japanese population.Data were obtained from 2, 855 men and women aged 40-79 years in 1989, and during the subsequent 9.9 years of follow-up.Using the Cox regression model to adjust for potential confounding factors, we calculated the multivariate hazard ratios of death from all causes separately for men and women.The multivariate hazard ratio of mortality for men who consumed two or more cups of coffee per day, compared with those who consumed less than half a cup per day, was 0.43(95% confidence interval, 0.30-0.63), and the ratio for those who consumed half to one cup of coffee per day was 0.70(95% confidence interval, 0.52-0.94).Exclusion of subjects with less than 5 years of follow-up did not substantially change the findings.No other statistically significant associations were identified between consumption of the two beverages and all-cause mortality.For men, multivariate hazard ratios of death from apoplexy showed a significant inverse association with increasing coffee consumption.The effects of habitual coffee consumption and its related factors on health in Japan need to be studied in greater detail.J Epidemiol, 2002;12:191-198
A cross-sectional survey of the entire membership of the Fukuoka Prefecture Medical Association was conducted in 1933 using a self-administered questionnaire. In this investigation the actual prevalence of smoking among physicians and the relationship between their smoking habits and living habits were studied. The study subjects were divided into two groups: those who smoked (1, 737 men and 17 women), and those who did not currently smoke (2, 267 men and 169 women). It was realized that there were many who were currently non-smokers among women, subjects with a high body mass index, those with heart disease, those without peptic ulcers, those who underwent health check-ups regularly, those accustomed to an early bedtime, those who were not aware of mental stress, those who took regular exercise, those who consumed plenty of fresh vegetables, yellow and green vegetables and fruit, those who did not consume Japanese pickles, coffee or green tea, and those who drank alcohol only occasionally and only in small amounts. The results of this study suggested the possibility that physicians who were smokers were a group who smoked little and could easily stop smoking. Moreover, non-smoking physicians were found to have a healthier lifestyle than those who smoked. It was considered that, in developing a smoking cessation program for physicians, it is important for them to establish more health-conscious lifestyles. J Epidemiol, 2002 ;12 :199-207
Two cross-sectional surveys of the entire membership of the Fukuoka Prefecture Medical Association were conducted in 1983 and 1990 using a self-administered questionnaire, and respondents were registered as the study cohort. In this investigation the trend of the actual prevalence of smoking among physicians and the relationship between their smoking cessation and living habits were studied. A decline in the actual prevalence of smoking was demonstrated among the 2, 050 subjects who responded to both surveys (2, 543 men and 113 women). To examine any relationship between lifestyle variables and smoking cessation after 1983, those who were smokers in 1983 (1, 099 men and 7 women, total 1, 100) were divided into two groups, according to whether or not they still smoked in 1990. Subjects who quit smoking accounted for a larger proportion of those physicians with any of the following life-style variables: earlier bedtimes, unawareness of mental stress, greater consumption of fresh vegetables and fruit, and less coffee consumption. Further observation of the relationship between smoking cessation and changes in lifestyle variables showed that there were more who quit smoking among those who became employed physicians, had an increase of the body mass index (BMI) and began to be aware of mental stress. These results suggested that, for physicians who smoked, it is a possibility that smoking was an important way of coping with stress, and thus pointed to the need to take mental-health measures to help physicians to stop smoking. J Epidemiol, 2002 ; 1 2 : 208-216
Purpose: To determine whether the increased prevalence of asthma in Japan has influenced its mortality. Materials and Methods: A descriptive study was conducted by the data obtained from Patient Survey and Vital Statistics of Japan between 1984 and 1996. Asthma fatalities were expressed as the number of deaths from asthma per 100, 000 asthmatic patients receiving medical treatment on the day when the survey was conducted. Results: Mortality, prevalence and asthma fatalities showed different changing patterns among several age groups. Asthma mortality for the 10-24 and 25-44 year-old groups increased during the study period, while for other age groups, it decreased. The prevalence increased for all groups classified by age and sex. Asthma fatalities peaked in 1987 among the 10-24, 25-44 and 45-64 year-old groups, and decreased for others throughout the study period. Conclusions: There is a possibility that an age- specific phenomenon is at work here because asthma mortality increased only in the 10-24 and 25-44 year-old groups, although the prevalence of asthma increased in all groups, whether classified by age or sex. The asthma fatality of the1 0-24, 25-44 and 45-64 year-old groups peaked in 1981: it is conceivable that this was influenced by the particular drug therapy used. The increase in asthma mortality in the 10-24 and 25-44 year-olds might be influenced by the increased prevalence. JEpialemiol, 2002 ;12 : 217-222
Sales of inhaled β2-agonist bronchodilators may be related to the increase in asthma deaths. The aim of this study is to find whether prescribed drug therapy was associated with the increased risk of death from asthma and life-threatening attacks(LTA).The"case"group comprised those under 35 years of age who expired or experienced LTA from January 1994 through December 1996.For each case, an age and sex matchedcontrol was selected from asthma patients.Hospital records were reviewed to obtain information on the prescribed drug therapy and clinical asthma severity for the cases and controls.Bivariate analysis with conditional logistic regression models for matched data sets were used to estimate theseverity-adjusted odds ratios for each asthma medication.Twenty-four fatal cases and 54 LTA cases were observed.The crude odds ratio of clinical severity(OR=9.33, 95%CI:2.84-30.7)was larger than unity and with statistical significance.After adjusting for clinical severity, the odds ratios computed for all β2-agonists delivered by metered dose inhaler(MDI)increased(OR=2.08, 95%CI:0.78-5.50)from that of crude analysis.Among those subjects under 20 years of age, the clinical severity-adjusted odds ratio for the use of all *2-agonists by MDI(OR=3.67, 95%CI:0.77- 17.5)was higher than that of all subjects.The prescription of f32-agonists by MDI increased the risk of asthma death after taking clinical severity into account.Although not statistically significant, our results suggested that l32-agonists administered by a MDI might have increased the risk of asthma death and LTA in Japan because the magnitude of the effect was similar to that reported in other countries.J Epidemiol, 2002;12:223-228
This paper lists the genotype frequencies of 50 polymorphisms of 37 genes(ALDH2, ADRB2, ADRB3, COMT, CD36, CXCR2, CCND1, COX2, CYP2A6, CYP17, CYP19, IGF1, IL-1A, IL-1B, IL1RN, IL-1R1, IL-6, IL-8, IL-10, LEP, Le, L-myc, MPO, MTR, MTHFR, MAO-A, NQO1, OGG1, p53, p73, Se, SRD5A2, TGF-B, TNF-A, TNF-B, XPD, and XRCC1)and 6 sets of combined genotype frequencies for 241 non-cancer Japanese outpatients.Though the genotype frequencies of 25 polymorphisms have already been reported in our previous papers, 15 polymorphisms(CD36 A52C, CXCR2 C785T, CCND1 G870A, IGF1 C/T at intron 2 and G2502T, IL-1A 46-bp VNTR, IL1R1 C-1 16T, IL-6 Ins/Del 17C, IL-8 A-278T and C74T, IL10 T-819C, LEP A-2548G, SRD5A2 2bp VNTR, XPD Lys751GIn, and XRCC1 Arg399Gln)and six sets of combined genotype frequencies(IL-1B C-31T and IL-1A C-889T, IL-1B C-31T and IL-1RN 86-bp VNTR, IL-1B C-31T and IL-1R1 C-1 16T, TNF-A G-308A and TNF-B A252G, SRD5A2 Val89Leu and 2-bp VNTR, and XRCC1 Arg399Gln and XPD Lys751Gln)were reported in this paper for the first time for Japanese.Although microarray technology will produce this kind of information in near future, this is the first document that reports the genotype/allele frequencies among Japanese for an archival purpose.J Epidemiol, 2002;12:229-236
The aim of this study was to evaluate the validity of sleeping hours of young children as reported by their parents. The subjects were 21 healthy children aged 3 to 4 years. They were asked to attach a small instrument for calculating sleeping hours objectively, over 3 consecutive nights. Parents reported the sleeping hours of their children during the study periods. The mean values were used in the analysis. Pearson's correlation coefficients and paired t-tests were used to evaluate the correlations and differences between the reported and objectively measured sleeping hours. The correlation coefficient and difference between the reported and assumed (objective sleeping hours representing the difference between times for falling asleep and waking) sleeping hours were 0.90 (p<0.001) and 0.79 hours (95% confidence interval: 0.59-0, 99), respectively. The correlation coefficient and difference between the reported and actual (the assumed, sleeping hours minus the sum of epochs being scored as awake during the assumed sleep) sleeping hours were 0.90 (p<0.001) and 0.92 hours (0.73-1.10), respectively. Although parents tended to overestimate the sleeping hours of their children, the correlation between the reported and objective sleeping hours is high, which indicates that reported sleeping hours could be used in a survey that requires data on relative differences in sleeping hours amongst a given population. J Epidemioi, 2002 ;12 : 237-242
To estimate the usefulness of data mining algorithms for extracting risk predictors of diabetic vascular complications in proper order in the future, we tried applying the Classification and Regression Trees (CART) method to the prevalence data of 155 type 2 diabetic outpatients and already known risk factors. Among the 6 categorical and 15 continuous risk factors, age (cutoff: 65.4) was the best predictor for classifying patients into groups with and without macroangiopathy (p=0.000). Body weight (cutoff: 53.9) was the best predictor (p=0.006) in the older group (age>05.4), whereas systolic blood pressure (cutoff: 144.5) was the best predictor in the remaining group (p=0.002). Age (cutoff: 04.8) was also the best predictor for categorizing them into groups with and without microangiopathy (p=0.000). In the older group (age>64.8), BMI (cutoff: 21.5) was the best predictor (p=Q.001), whereas morbidity term (cutoff: 15.5) was the best predictor in the other group (p=0.010). Because the orders and values of all risk factors and cutoff points mined were reasonable clinically, this method may have the potential to highlight predictors in order of importance to apply tailor-made prevention of diabetic vascular complications. J Epidemiol, 2002 ; 12 : 243-248
To assess the familial aggregation of uterine myomas in Japanese women with myomas, one hundred forty four women requiring surgery for myomas and 288 age-matched healthy controls were studied in Hokkaido, Japan. The incidence of positive first-degree family history of myomas among women aged 45-54 years with myomas was greater than that among controls (31.5% versus 15.2%, respectively, p < 0.01). Analyses categorized by the status of parity and familiality among subjects showed that the risk for myomas was the greatest in women who had both fewer births (parity = 0 or 1 ) and the positive family history of myomas as compared with those who had both more births (parity 2) and the negative familiality of myomas (odds ratio = 5.8, 05% confidence interval = 2.3 --14 8). The results of this study suggest that Japanese middle-aged women with myomas have the familial predisposition of uterine myomas. Furthermore, nulliparous women with the familial aggregation of myomas may be at increased risk of the disease. J Epidemiol, 2002 ; 12 : 240-253
In order to describe the relationship between mortality rate and extreme heat during the summer of 1999 in Hokkaido, we calculated the monthly age-adjusted death rates, average monthly mean temperature and average monthly high temperature for the years 1995 to 1999 in Hokkaido.The materials were derived from Statistics and Information Department, Minister's Secretariat, Ministry of Health, Labour and Welfare of Japan, Statistical Bureau Management and Coordination Agency Government of Japan and the Japan Meteorological Agency.Trends in the monthly age-adjusted death rates and temperature changes in the same period were analyzed. The highest average monthly high temperature for August and September (28.8°C and 23.8°C, respectively) occurred in 1999;the similar trend was observed in the highest average monthly mean temperature.In August 1999, there were 14 days with highest temperatures of 30°C and over.The age-adjusted rate in August 1999 was significantly higher compared with those for the years 1995 to 1998 (p<0.01).We concluded that an unusually hot spell in 1999 was followed by a high mortality rate in Hokkaido.J Epidemiol, 2002;12:254-257
The 8-oxoguanine DNA glycosylase (OGG1) repairs DNA by removing 8-hydroxyguanine, a highly mutagenic oxidative DNA adduct.Recently, the gene for OGG1 was cloned and several polymorphisms have been reported.Because environmental carcinogens produce 8hydroxyguanine residues that potentially cause oncogenic mutations by mismatching to this modified base, the capacity to repair these lesions can be involved in cancer susceptibility.This study investigated the association between OGG1 Ser326Cys polymorphism and risk of the lung adenocarcinoma for Japanese by a prevalent case-control study in Japan.The subjects comprised 138 cases and 241 non-cancer outpatients as controls.OGG1 gene polymorphism was genotyped by a PCR-CTPP (polymerase chain reaction with confronting two-pair primers) method.The distribution of OGG1 Ser326Cys genotype among controls (Ser/Ser, 28.3%; Ser/Cys, 49.2%;and Cys/Cys, 22.5%) was not different from that among cases (Ser/Ser, 29.0%; Ser/Cys, 51.4%;and Cys/Cys, 24.0%).The sex-age adjusted odds ratio (OR) was 1.06 with 95% confidence interval (CI) 0.64-1.76 for Ser/Cys genotype and 0.81 with 0.44-1.52 for Cys/Cys genotype.The ORs according to the interval between diagnosis and study enrollment were also examined because the polymorphism was a potential prognostic factor of lung cancer.The ORs of Ser/Cys and Cys/Cys genotypes in the cases less than 3 years after diagnosis were higher than overall ORs;1.86 (95%Cl, 0.91-3.77), and 1.46 (0.64-3.35), respectively.The OR for smoking was not statistically different among genotype, though the sample size was too small to detect even a moderate interaction.This study supported the first study by Sugimura et al (Cancer Epidemiol Biomarkers Prev, 1999;8:669-674), that the association of OGG1 Ser326Cys polymorphism was limited for the risk of lung adenocarcinoma. J Epidemiol, 2002;12:258-265
Clinical articles published in Japanese journals are said to be characterized by poor study design, less sophisticated statistics, and producing few high-grade clinical evidences.Two American and two Japanese medical journals, published in 1990, 1993, 1996, and 1999 were compared to find out the differences regarding study design, statistical methods, and level of clinical evidence of original articles and synthetic studies.There were 1689 original articles in American and 308 in Japanese journals.Regarding study design, American articles contributed much more to randomized controlled trials/controlled trials/clinical trials (27.9% vs.14.3%, p=0.001), cohort studies (21.6% vs.6.2%, p=0.001), and case-control studies (6.5% vs.0.3 %, p=0.000).Among original articles in American and Japanese journals, mean number of statistical methods used were 2.4 and 1.7 per article (p=0.000), respectively.Articles providing high grade clinical evidence (grade la, lb & lla) were much greater in proportion in American journals than Japanese journals (31.1% vs.12.7%, p=0.001).The overall picture of Japanese medical articles seems to be improving recently, at least in terms of statistical methods toward more diversified and sophisticated way of use, compared to the previous data. J Epidemiol, 2002;12:266-270
An inverse association between blood cholesterol level and excess mortality in low cholesterol level subjects has been reported, but there has been no reasonable explanation widely accepted. To evaluate the associations between unfavorable factors and low blood cholesterol in non- Western populations, we performed a cross-sectional study in a rural Japanese population.A self-administered questionnaire concerning health characteristics and a nutritional survey, using a continuous 48-hour dietary record, was conducted on 461 males and 571 females aged 20-79 years old.The serum total cholesterol (TC) of less than 160 mg/dl was defined as low cholesterol, which accounted for 18% of the subjects.The multivariate odds ratio of having low cholesterol adjusted for age and selected variables were 0.70 (95% Cl:0.52-0.94) for 1 SD increment of Key's lipid factor, 0.71 (0.51-0.97) for 1SD increment of vitamin A intake, 2.23 (1.01-4.91) for heavy drinking, 2.80 (1.21-6.46) for being underweight and 2.59 (1.01-6.61) for blood transfusion in males, and 1.04 (1.00-1.08) for 10 cigarette-year increase in smoking in females.Even when further adjusted for body mass index, these associations were still significant except for those who were underweight and had undergone blood transfusion in males.These findings may partly explain the excess mortality of the Japanese males with low serum TC. J Epidemiol, 2002;12:271-279
To describe changes in activities of daily living (ADL) of community-dwelling Beijing elderly people, observed for 8 years, and to identify the demographic characteristics that predict the functional change.Four sets of interview data from1992 to 2000 were used to evaluate changes among Beijing elderly aged 55 years and over.Results revealed that prevalence of disability increased from 3.9% to 7.1 % during the 8 years of follow-up with the average increasing rate of disability was 0.41 % per year.Meanwhile an increasing likelihood of recovery from disability is observed with age and time.Women, aged 75 or more, experienced higher disability than men though it was in the opposite for younger ages.In addition, certain demographic subgroups (such as women, unmarried, illiterate and living in non urban area) appeared to be at higher risk for ADL impaired.The patterns of ADL change is in both the direction of improvement and declination. Demographic variables emerged as a significant predictor in estimating functional outcomes. Furthermore, it is recommended that the demarcation factor for the evaluation of ADL should be 75 years of age.J Epidemiol, 2002;12:280-286
Improving an unhealthy lifestyle decreases risk of incidence and death of lifestyle-related diseases.Consultation about a healthy lifestyle to recipients of health checkups conducted by public health nurses is one method for such improvement.The objective in the present study was to investigate the difference between consciousness of intervention by (1) the public health nurses who conducted consultations with recipients of health checkups and (2) the recipients who were consulted by the public health nurses.Data on 1370 male white collar workers who underwent health checks were analyzed.When public health nurses determined that recipients required health consultation regarding lifestyle from the health checkup, they consulted with the recipients regarding improvement of lifestyle.The consultation regarding lifestyle included abstinence from smoking, drinking in moderation, exercise, and eating.The results of the analysis regarding difference in consciousness of the intervention by the public health nurses and the recipients show that (1) most drinkers did not think they were being discouraged to drink despite intervention by the public health nurses and (2) the smokers and the subjects with no habitual physical exercise tend to think that they were being consulted even though the public health nurses did not intervene regarding smoking and exercise. J Epidemiol, 2002;12:287-294
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