The relationship between serum carotenoid levels and cancer death in rural Japanese residents, aged more than 39 years, was examined epidemiologically. The follow-up subjects participated in the comprehensive health examinations, every August from 1986 to 1989, were 929 males and 1424 females, living in a rural area of Hokkaido, Japan. During 2-8 years to December 1994, the ninety-eight deaths were observed among the cohort; that is, deaths from all causes were 67 males and 31 females, and cancer deaths were 34 males and 10 females. Serum samples at fasting were collected at the entry of the cohort and serum levels of β-carotene, αcarotene and lycopene were measured by the HPLC method. The relation between the mortality rates and serum carotenoid levels was estimated statistically using the Cox's proportional hazard model. The results were as follows; the hazard ratio with the overall on high serum β-carotene levels to those of lower was 0.46 (95% C.l.:0.27-0.78) for all causes and 0.33 (95% C.l.:0.14-0.75) for cancer deaths. This result suggested that high levels of serum β-carotene may play some roles on preventing cancer death. J Epidemiol, 1997 ; 7 : 1-8.
A cohort study consisting of 4, 291 residents of a Japanese community has been conducted since 1987. The associations between stressful feelings measured by Stress Arousal Checklist (SACL) and mortality of all causes and cancer were examined. The relative risks (RRs) for mortality for 7 years for high stressful state (SACL score:7-17) and moderate stressful state (3-6) subjects compared with low stressful state subjects (0-2) were 1.1 (95% CI=0.69-1.68), 1.3 (95% CI=0.85-2.00) for all causes and 1.5 (95% CI=0.80-2.99), 1.3 (95% CI=0.67-2.61) for cancer respectively, after being adjusted for sex, age, smoking, drinking, exercise and medical care use. When each item of the SACL was examined independently, six out of 17 items of SACL which were “not comfortable”, “not contented”, “not cheerful”, “dejected”, “nervous”, “not pleasant” showed elevated RRs for all causes of mortality with statistical significance (RRs: 1.4, 1.4, 1.7, 1.7, 1.5, 1.5, respectively), after being adjusted for the possible confounding factors stated above. Especially, the adjusted RRs of “not cheerful” and “dejected” for all causes was 1.7 (95% CI=1.20-2.33), 1.7 (95% CI=1.17-2.46), respectively. The results suggested that stressful feelings of “not cheerful” and “dejected” might increase mortality. J Epidemiol, 1997; 7 : 9-16.
In order to survey patients' views on reference to clinical data for research purposes, an anonymous self-administered questionnaire was distributed to Aichi Cancer Center Hospital patients in 1995. All eligible first-visit outpatients (97 persons), randomly selected revisit outpatients (99 persons), and all eligible inpatients in a good condition at discharge except six cases (97 persons), responded to the questionnaire. Out of 293 patients (115 males, 174 females and 4 unspecified), 85.3% (standard error 2.1 %) considered that hospitals should make active efforts to improve their health care and treatment skills. And 88.1 % (standard error 1.9%) answered that reference to their own clinical data to improve health care and treatment skills was “preferable” or “don't mind”. J Epidemiol, 1997 ; 7 : 17-19.
We discuss problems of conventional methods to evaluate family histories as risk factors in epidemiologic studies, and propose a new one. In the proposal, incidence rates of the disease interested among family members are treated as exposure levels. Besides, we show the quantitative difference between the results obtained by the conventional methods and the new one using models. Because of not so much information required for the new method, we recommend it even though the difference was not so large. J Epidemiol, 1997 ; 7 : 21-25.
In order to evaluate the relationship between the patient-identified regions of abdominal pain and the disease diagnosis, a prospective study was conducted at General Medicine Outpatient Clinic, Saga Medical School Hospital. Four hundred eighty-nine outpatients complaining of abdominal pain at the first visit were classified into 10 groups according to the pain region complained of, i.e., whole abdominal, epigastric, right subcostal, left subcostal, right flank, left flank, periumbilical, right-lower, mid-lower, and left-lower; the clinic physicians and authors in joint-participation assigned the groups through studying the medical records. Comparisons were made in order to calculate sensitivity, specificity, and the positive and negative likelihood ratios between the pain regions and disease diagnoses. In general, the sensitivity of history-taking and physical examination is low, but specificity is high in relation to epigastric pain and gastroduodenal diseases, right subcostal pain and hepatobiliary diseases, and mid lower pain and gynecological diseases (above 0.5). Comparative analysis between the pain regions complained of by the patient in the initial clinic visit and the medical diagnoses yielded clinically useful information as to the efficacy of medical history-taking and physical examination in the identification of abdominal diseases. J Epidemiol, 1997 ; 7 : 27-32.
Simplified methods to estimate long term nutrient intakes would be needed for not only nutritional epidemiologic studies but also other ones. Based on data of diet history questionnaires (DHQ) which ask frequency and portion size for 169 items from 2, 371 participants randomly selected from our cohort study in a rural city of Japan, we simplified the DHQ by eliminating some items using stepwise regression method. To examine the validity of the simplified DHQ (SDHQ), we obtained the SDHQs from 31 volunteers who had finished to complete one-day records once a month during the previous year, we calculated Pearson's correlation coefficient and calorie-adjusted correlation coefficient between the SDHQ and twelve one-day records for each nutrient intake value. Thirty one items were selected for our SDHQ. The mean values of most nutrient intakes from the SDHQ were more than those from twelve one-day records. The correlation coefficients between the SDHQ and twelve one-day records were more than 0.30 except for fat and monounsaturated fat. Calorie adjustment increased in the correlation coefficients for some nutrients. Our results suggest that the SDHQ is a validated and easy-to-use method for assessing long term 17 selected nutrient intakes. J Epidemiol, 1997; 7 : 33-41.
Cigarette advertising plays a crucial role in adolescent smoking. A survey with a selfadministered questionnaire was conducted to 198 female nursing students in Kitakyushu City in 1996 to provide primary data on the young women's contact with cigarette advertising in various media in Japan. The proportions of respondents who had seen cigarette advertising on TV and that on billboards were both over 95% of the effective respondents, the highest among all the media, followed by magazines, newspapers and the radio. The proportion of respondents who “frequently” had contacts was the highest by TV, followed by billboards, newspapers, magazines and radio. Over 50% of students who had past/current smoking experience felt that they were “frequently” exposed to cigarette advertising, and, on the other hand, approximately 50% of those who had never smoked felt that they “occasionally” saw cigarette advertising, on both TV and billboards. In Japan, young women seem to be heavily exposed to cigarette advertising through various media. This study implies that TV and billboards are the most frequently contacted media of cigarette advertising and perhaps the most influential to smoking among young people. J Epidemiol, 1997 ; 7 : 43-47.