Journal of Epidemiology
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Volume 19 , Issue 1
Showing 1-7 articles out of 7 articles from the selected issue
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Young Investigator Award Winner's Special Article
  • Kenji Wakai
    Volume 19 (2009) Issue 1 Pages 1-11
    Released: January 30, 2009
    [Advance publication] Released: January 22, 2009
    JOURNALS FREE ACCESS
    Background: The food frequency questionnaire (FFQ) has been used throughout the world for epidemiological purposes. Because dietary habits vary greatly, the FFQ must be tailored for use with specific populations. The usefulness of FFQs in Japan was assessed by reviewing questionnaires developed and validated in that country.
    Methods: A literature search was conducted to identify articles on the development and/or validation of FFQs for Japanese populations. For each FFQ identified, validation studies were used to abstract its characteristics and information. The correlation coefficients between diet records (DRs) and FFQ estimates and those between the same FFQs completed twice were used to evaluate validity and reproducibility, respectively, of the questionnaires.
    Results: Twenty-one eligible FFQs were identified. They were found to be reasonably valid and reproducible. The median of correlation coefficients between DRs and FFQs ranged from 0.31 to 0.56 for target nutrients, and that between the same FFQs completed twice within a period of 9 months to 1 year ranged from 0.50 to 0.72. Relatively poor validity was found for FFQ estimates on consumption of potatoes, seaweed, sodium, niacin, and polyunsaturated fatty acids. For the purpose of analysis, FFQs were divided into long FFQs (97 or more food items) and short FFQs (<70 items); the former had slightly higher validity.
    Conclusion: FFQs are useful for assessing dietary intake in Japan, although careful consideration is required for the food groups and nutrients for which FFQs had low validity.
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Original Article
  • Hiroshi Shiraishi, Hiroshi Une
    Volume 19 (2009) Issue 1 Pages 12-16
    Released: January 30, 2009
    [Advance publication] Released: January 22, 2009
    JOURNALS FREE ACCESS
    Background: Obesity and drinking are acknowledged risk factors for hyperuricemia. However, the effect of the interaction between obesity and drinking on hyperuricemia is not well understood.
    Methods: The cases comprised 3028 male office workers with hyperuricemia (serum uric acid level ≥7.0 mg/dL); the controls were 5348 men with a serum uric acid level less than 6.0 mg/dL. Logistic regression analysis was used to assess risk factors for hyperuricemia and the interaction between obesity and drinking in hyperuricemia. Participants were divided into 2 groups according to their BMI: individuals with a BMI of 25 or higher were classified as obese and those with a BMI less than 25 were classified as non-obese. In addition, participants were divided into 5 groups based upon their ethanol consumption. The 2 variables were then combined to create 10 groups.
    Results: With non-obese non-drinkers as the reference category, the odds ratio for hyperuricemia was 1.80 for non-obese drinkers of less than 25 mL/day of ethanol, 2.15 for non-obese drinkers of 25–49 mL/day, 2.60 for non-obese drinkers of 50–74 mL/day, 2.56 for non-obese drinkers of 75+ mL/day, 4.40 for obese non-drinkers, 5.74 for obese drinkers of less than 25 mL/day, 6.57 for obese drinkers of 25–49 mL/day, 5.55 for obese drinkers of 50–74 mL/day, and 7.77 for obese drinkers of 75+ mL/day. The interaction between obesity and drinking in hyperuricemia was statistically significant.
    Conclusion: Our results suggest that although combining the effects of obesity and drinking did not result in a multiplicative increase in the risk for hyperuricemia, the combined risk was greater than the sum of the effects of obesity and drinking.
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  • Hsiao-Yu Yang, Jung-Der Wang, Tsai-Chang Lo, Pau-Chung Chen
    Volume 19 (2009) Issue 1 Pages 17-23
    Released: January 30, 2009
    [Advance publication] Released: January 22, 2009
    JOURNALS FREE ACCESS
    Background: A national survey in Taiwan has shown that Chinese herbal therapy increases the risk of chronic kidney disease. However, it is unknown whether herbal therapy will increase the risk of urological cancers. The purpose of this study was to determine whether Chinese herbalists are at higher risk for urological cancers.
    Methods: We studied all Chinese herbalists in Taiwan that were registered in the Chinese Herbalist Labor Union between 1985 and 2000. We retrospectively followed their survival status and causes of death using the National Mortality Registry Database from 1985 to 2004. Standardized mortality ratios (SMRs) for urological cancers in herbalists were calculated and compared with those of the general population of Taiwan.
    Results: A total of 6548 Chinese herbalists were enrolled and 88,289 person-years were accrued during the observation period. After adjustment for age and sex, the SMR for urological cancers was significantly higher for Chinese herbalists than for the general population (SMR = 3.10; 95% CI: 1.41–5.87). When further stratified by location, the SMR for kidney cancer and other urinary organ cancers (SMR = 3.81; 95% CI: 1.39–8.28) except bladder cancer (SMR = 2.26; 95% CI: 0.47–6.59) were significantly higher for the Chinese herbalists. The SMR for chronic and unspecified nephritis, renal failure, and renal sclerosis were also significantly higher for herbalists (SMR = 2.40; 95% CI: 1.40–3.84).
    Conclusions: Chinese herbalists have a significantly higher risk for urological cancers. This increased risk among herbalists highlights the urgent need for safety assessments of Chinese herbs.
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  • Shinya Hayasaka, Yosuke Shibata, Shizukiyo Ishikawa, Kazunori Kayaba, ...
    Volume 19 (2009) Issue 1 Pages 24-27
    Released: January 30, 2009
    [Advance publication] Released: January 22, 2009
    JOURNALS FREE ACCESS
    Background: In April 2008, a new health check-up and health guidance system was introduced by the Japanese Government to promote increased physical activity. However, few studies have documented the health benefits of physical activity in Asian populations. We examined the association between all-cause mortality and level of physical activity in a Japanese multicommunity population-based study.
    Methods: The Jichi Medical School Cohort Study is a multicommunity, population-based study based in 12 districts in Japan. Baseline data from 4222 men and 6609 women (mean age, 54.8 and 55.0 years, respectively) were collected between April 1992 and July 1995. The participants were followed for a mean duration of 11.9 years. To determine the association between all-cause mortality and level of physical activity, crude mortality rates per 1000 person-years and hazard ratios (HRs) with 95% confidence intervals (CI) were determined using the Cox proportional hazards model. Physical activity was categorized by using physical activity index (PAI) quartiles. The lowest (first) PAI quartile was defined as the HR reference.
    Results: In men, the lowest mortality rate was observed in the third quartile, with 95 deaths and a crude mortality rate of 7.6; the age- and area-adjusted HR was 0.59 (95% CI, 0.45–0.76), and the mortality curve had a reverse J shape. In women, the lowest mortality rate was observed in the highest PAI quartile, with 69 deaths and a crude mortality rate of 3.5; the HR was 0.81 (95% CI, 0.58–1.12).
    Conclusion: Our results suggest that increased physical activity lowers the risk for all-cause death in Japanese.
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  • Tetsuya Kamei, Shuji Hashimoto, Miyuki Kawado, Rumi Seko, Takatoshi Uj ...
    Volume 19 (2009) Issue 1 Pages 28-33
    Released: January 30, 2009
    [Advance publication] Released: January 22, 2009
    JOURNALS FREE ACCESS
    Background: Patients with subacute myelo-optico-neuropathy (SMON) suffer from a number of serious neurological symptoms that adversely affect their activities of daily living (ADL). However, the effects of these neurological symptoms on functional capacity and life satisfaction have not been reported.
    Methods: We analyzed data from 1,300 SMON patients aged 55–94 years that was obtained at medical check-ups carried out by the SMON Research Committee in 2004–2006 in Japan. The neurological symptoms investigated were visual impairment, dysbasia, symptoms of the lower extremities, and sensory symptoms. Neurological symptoms were classified by severity. The Barthel Index, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and the participant’s response to the question “Are you satisfied with life?” were used to evaluate ADL, functional capacity, and life satisfaction, respectively. Data were analyzed using a proportional odds model with the scores for these items as ordinal dependent variables.
    Results: For most neurological symptoms, scores for ADL, functional capacity, and life satisfaction were significantly lower in participants with severe or moderate neurological symptoms than in those with nearly normal results upon examination. The odds ratio for life satisfaction due to superior functional capacity was significant after adjustment for sex, age, and ADL score.
    Conclusion: The presence of neurological symptoms in SMON patients was associated with low functional capacity, life satisfaction, and ADL. Our results suggest that the life satisfaction of SMON patients can be increased by improving their functional capacity.
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  • Shizuha Arai, Naoki Nakaya, Masako Kakizaki, Kaori Ohmori-Matsuda, Tai ...
    Volume 19 (2009) Issue 1 Pages 34-40
    Released: January 30, 2009
    [Advance publication] Released: January 22, 2009
    JOURNALS FREE ACCESS
    Objective: To determine the associations between personality subscales and attendance at gastric cancer screenings in Japan.
    Methods: A total of 21,911 residents in rural Japan who completed a short form of the Eysenck Personality Questionnaire-Revised (EPQ-R) and a questionnaire on various health habits including the number of gastric cancer screenings attended were included in the primary analysis. We defined gastric cancer screening compliance as attendance at gastric cancer screening every year for the previous 5 years; all other patterns of attendance were defined as non-compliance. We defined gastric cancer screening visiting as attendance at 1 or more screenings during the previous 5 years; lack of attendance was defined as non-visiting. We used logistic regression to estimate the odds ratios (ORs) of gastric cancer screening compliance and visiting according to 4 score levels that corresponded to the 4 EPQ-R subscales (extraversion, neuroticism, psychoticism, and lie).
    Result: Extraversion had a significant linear, positive association with both compliance and visiting (trend, P < 0.001 for both). Neuroticism had a significant linear, inverse association with compliance (trend, P = 0.047), but not with visiting (trend, P = 0.21). Psychoticism had a significant linear, inverse association with both compliance and visiting (trend, P < 0.001 for both). Lie had no association with either compliance or visiting.
    Conclusion: The personality traits of extraversion, neuroticism, and psychoticism were significantly associated with gastric cancer screening attendance. A better understanding of the association between personality and attendance could lead to the establishment of effective campaigns to motivate people to attend cancer screenings.
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  • Nan-Ping Yang, Yi-Hui Lee, Ching-Heng Lin, Yuan-Chang Chung, Wen-Jone ...
    Volume 19 (2009) Issue 1 Pages 41-48
    Released: January 30, 2009
    [Advance publication] Released: January 22, 2009
    JOURNALS FREE ACCESS
    Background: We surveyed the emergency medical system (EMS) in Taiwan to provide information to policymakers responsible for decisions regarding the redistribution of national medical resources.
    Methods: A systematic sampling method was used to randomly sample a representative database from the National Health Insurance (NHI) database in Taiwan, during the period from 2000 to 2004.
    Results: We identified 10,124, 10,408, 11,209, 10,686, and 11,914 emergency room visits in 2000, 2001, 2002, 2003, and 2004, respectively. There were more males than females, and the majority of adults were younger than 50 years. Diagnose of injury/poisoning was the most frequently noted diagnostic category in emergency departments (EDs) in Taiwan. There were 13,196 (24.3%) and 2,952 (5.4%) patients with 2 and 3 concomitant diagnoses, respectively. There was a significant association between advanced age and the existence of multiple diagnoses (P < 0.001). With the exception of the ill-defined symptoms/signs/conditions, the two most frequent diagnoses were diseases of the circulatory system and diseases of the respiratory system in patients aged 65 years or older. On average, treatment-associated expenditure and drug-associated expenditure in Taiwan EDs averaged NT$1,155 ($35.0) and NT$190 ($5.8), respectively, which was equal to 64.5% and 10.6% of the total ED-associated cost. General ED medical expenditure increased with patient age; the increased cost ratio due to age was estimated at 8% per year (P < 0.001).
    Conclusions: The frequency of major health problems diagnosed at ED visits varied by age: more complicated complaints and multiple diagnoses were more frequent in older patients. In Taiwan, the ED system remains overloaded, possibly because of the low cost of an ED visit.
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