BACKGROUND: Few studies have examined the association of perceived health with socio-economic status, especially income, and social isolation and support in Japan. The purpose of this study is to clarify the associations among perceived health, lifestyle, and socio-economic status, as well as social isolation and support factors, in middle-aged and elderly Japanese. METHODS: Subjects were 9,650 participants aged 47-77 years who completed a self-administered questionnaire in 2000 in the second survey of a population-based cohort (the Komo-Ise study). The questionnaire included items on sociodemographic and socio-economic factors, social isolation and support, lifestyle, past history of chronic disease and perceived health. Perceived health was dichotomized into excellent or good health and fair or poor health. A logistic regression analysis was used to determine the odds ratios of socio-economic status, social characteristics and lifestyle in relation to self-reported fair or poor health. RESULTS: We found that household income, physical activity, sleeping, smoking habit, and BMI had a strong association with self-reported fair or poor health in middle-aged and elderly Japanese men and women. Male subjects tended to report fair or poor health as household income decreased. The results for women differed in that social isolation and low social support had a stronger association for selfreported fair or poor health than low household income. CONCLUSIONS: The results indicated that perceived health was associated with socio-economic and social characteristics among middle-aged and elderly residents in Japan.
BACKGROUND: A community-based survey was conducted to investigate reproductive tract infections (RTIs) among pregnant women in Vietnam, where epidemiologic data on these infections are scarce. METHODS: The focus of the study were: candidiasis, bacterial vaginosis, group B streptococcal infection,trichomoniasis, gonorrhea, syphilis, and hepatitis B. In addition to their prevalence, a generalized estimating equation was used to analyze infection-associated factors and diagnostic test analysis to examine the accuracy of currently performed presumptive clinical diagnoses. RESULTS: Among 505 pregnant women in 10 communes, 182 (36%) had at least one infection with a wide regional variation in prevalence. The most prevalent infection was candidiasis (17%); sexually transmitted infections were rare except hepatitis B (10%); and the prevalence of bacterial vaginosis and group B streptococcal infections was 7% and 4%, respectively. Two factors were associated with the decreased risk of endogenous infections: a higher household assets score (odds ratio [OR] = 0.67) and condom use (OR = 0.15). Not living with a husband (OR = 1.55) was associated with an increased risk. For hepatitis B, three factors were associated with a decreased risk: employment by the government (OR = 0.26), higher education (OR = 0.18), and being older at the time of first sexual intercourse (OR = 0.58). Women's self-reported symptoms and clinical findings had low positive predictive values. Only clinical findings from the vaginal wall showed both a sensitivity and specificity over 50%. CONCLUSIONS: Suggested recommendations are: extensive application of microscopic diagnosis, prevention of hepatitis B transmission, and addressing the issues of regional differences in the prevalence of RTI and of less wealthy people. J Epidemiol 2005; 15: 163-172.
BACKGROUND: There have been comparatively few large-scale cohort studies analyzing all-cause mortality due to cigarette smoking. The goal of this analysis is to investigate the relationship between smoking status and all-cause mortality, and to evaluate the effect of smoking in the Japanese. METHODS: The baseline data were collected between 1992 and 1995. Ultimately, 10,873 Japanese (4,280 males and 6,593 females) aged 19 years or older from 12 rural communities located across Japan participated in the study. This analysis is based on the results, including the information on those who died and moved out of the communities, obtained by December 31, 2001. The Cox's proportional hazards model was used to calculate the hazard ratio (HR) of mortality for smoking with adjustment for age, systolic blood pressure, total cholesterol, body mass index, alcohol drinking habit and education. RESULTS: The mean follow-up period was 8.2 years, during which time, 284 males and 192 females died. The multivariate-adjusted HRs for total mortality among former and current smokers compared with never smokers were 1.09 (95% confidence interval [CI]: 0.73-1.61) and 1.65 (95% CI: 1.16-2.35) in males, and 0.98 (95% CI: 0.40-2.42) and 0.91 (95% CI: 0.42-1.95) in females, respectively. Those for the consumption of 1-14, 15-24, and 25+ cigarettes per day among male smokers were 1.62, 1.57, and 1.89, respectively. In females, there was no great difference in all-cause mortality between smokers and never smokers. CONCLUSIONS: The results of our study confirm an increased risk in males of premature death from all causes among Japanese with a smoking habit. J Epidemiol 2005; 15: 173-179.
BACKGROUND: Many studies have reported that the consumption of alcohol induces the generation of free radicals. Moreover, recent studies suggest that serum gamma-glutamyltransferase (γ-GTP) within its normal range might be an early marker of oxidative stress. In this study, we tested the hypothesis that serum antioxidant carotenoids would be inversely associated with serum γ-GTP in alcohol drinkers within normal liver function. METHODS: A total of 266 Japanese men who had received health examination in 2003 participated in the study. The associations of serum γ-GTP and serum-carotenoid concentrations stratified by alcohol intake levels were evaluated cross-sectionally. The participants were divided into three groups according to their ethanol intake level (non-drinker, less than 1 g/day; light drinker, 1-25 g/day; and moderate and heavy drinkers, 25+ g/day). The multivariate-adjusted geometric means of the serum γ-GTP concentrations in each tertile of the serum-carotenoid concentrations were calculated after adjustment for ethanol intake, age, body mass index, total cholesterol, triacylglycerols, current tobacco use, and habitual exercise. RESULTS: The serum γ-GTP concentrations were significantly high in accordance with the ethanol intake level. In moderate and heavy drinkers, the multivariate-adjusted geometric means of serum γ-GTP concentrations were significantly low in accordance with the tertiles of the serum lycopene, α-carotene, β-carotene, and β-cryptoxanthin concentrations. CONCLUSIONS: The serum antioxidant carotenoids were inversely associated with alcohol-induced increases of serum γ-GTP in moderate and heavy drinkers within normal liver function. J Epidemiol 2005; 15: 180-186.
BACKGROUND: The development of an efficient noninvasive examination to detect coronary atherosclerosis is needed as a strategy to prevent coronary heart disease. To evaluate the usefulness of calcium score measured by multi-detector row computed tomography (MDCT), we compared calcium score derived from MDCT with findings of coronary artery stenosis assessed by coronary angiography (CAG). METHODS: In 108 patients (94 men, 14 women; average age, 65.7 years), we performed unenhanced CT scans and calculated coronary artery calcium score in 259 vessels without previous intervention and severe motion artifact to determine the correlation with the degree of coronary stenosis by CAG. RESULTS: The sensitivity and the specificity of calcification (calcium score 0.1+) for severe stenosis (75+%) were 89% and 43%, respectively. All four vessels with calcium score 1000+ had a severe stenosis. The areas under the receiver operating characteristics curve of calcium score for severe stenosis were 0.80 ± 0.04, indicating the efficacy of this technique. CONCLUSIONS: Coronary artery calcification and calcium score determined by MDCT were associated with coronary arteries with severe stenosis. This technique appears to be useful for the evaluation of coronary atherosclerosis. J Epidemiol 2005; 15: 187-193.