The Second British Epidemiology and Public Health Course was held from 19 to 25 August 1996 in Osaka as a satellite meeting for the 14th International Scientific Meeting of the International Epidemiological Association. Thirty-three researchers from 10 countries participated in the course. Professor Walter W Holland gave a special lecture about Snow on cholera during the course, and the lecture revealed that Henry Whitehead who was a junior priest at that time contributed to Snow's work to prevent the cholera outbreak in Golden Square in 1854. What John Snow did in his life are reviewed in detail in this paper. J Epidemiol, 1998 ; 8 : 185-194.
To examine the factors associated with cause-specific mortality, a cohort of 1, 405 randomly selected elderly people aged 65 years and over living in Settsu, Osaka Prefecture, was followed up for 54 months. Multivariate analysis using Cox proportional hazards model identified male sex, age, disability, medical treatment, and no participation in social activities as independent factors for overall mortality. Use of health checks and daily health enhancing practices showed an independent negative association with overall mortality. As for cause-specific mortality, male sex was a constant factor for the three major causes of death: cancer, heart disease and stroke. Advanced age and no participation in social activities showed a close association with heart disease mortality, while disability and medical treatment were independent factors for death caused by stroke and cancer, respectively. Use of health checks and daily health enhancing practices exhibited a strong negative association with all three major causes of death. The same tendencies were seen after those who reported undergoing medical treatment for the index diseases of heart disease and stroke at entry were excluded. These results suggest that predictive factors for mortality vary for specific causes of death, but that health promoting measures contribute to a reduction in mortality related to three major causes of death, thus resulting in a decrease in overall mortality among the elderly. J Epidemiol, 1998 ; 8 : 195-202.
A self-administered diet history questionnaire has been developed for the use in health education in Japan. The relative validity of the test-version was examined using 3-day diet record (DR) as a reference method. Subjects were mildly hypercholesterolemic 47 women aged 38-69 years living in Hikone, Japan. The questionnaire provided close estimation of nutrients compared to the DR (mean of the 3-days), 1-25 % differences between the two methods were observed for total energy and 17 nutrients examined. The differences were in general smaller for macronutrients, 1-3 %, than for micronutrients, 1-25 %. Pearson correlation coefficients between the questionnaire and the DR (mean of the 3-days) ranged from 0.16 for niacin to 0.60 for saturated fatty acid (mean = 0.41). The energy-adjustment using regression analysis and the correction of attenuation due to error from a limited number of days of DR slightly improved the results. The correlations ranged from 0.19 for niacin to 0.75 for saturated fatty acid (mean = 0.48). Average 37 and 6 % subjects were classified into same quartile and opposite quartile respectively between the two methods. This questionnaire may be useful to assess individual nutrient intake level at least for the subjects examined. J Epidemiol, 1998 ; 8 : 203-215.
To clarify how and why blood pressure differs between occupations, the proportions of hypertensives, and the measures of blood pressure, body mass index (BMI) and alcohol consumption among the individuals not taking antihypertensive drugs were compared between the eight occupational categories using the data from a health check-up for 589 middle-aged Japanese males, mostly randomly selected from five areas in Japan. After adjusting for age, the relationships of occupation to the proportion of hypertensives and the mean systolic and diastolic blood pressure substantially differed among the five areas. However, after further adjustment for residence, these blood pressure levels (the proportion of hypertensives, and the mean systolic and diastolic blood pressure) were found to be higher for the "Personnel in transport and communications", the "Clerical personnel", the "Managerial and civil personnel" and the "Professional and technical personnel", whereas these values were consistently lowest in the "Service personnel". Age and residence-adjusted mean BMI was also higher for the four occupational categories with the increased blood pressure levels. According to a weighted multiple regression analysis across the eight occupations, the age and residence-adjusted mean BMI was a significant predictor of the age and residence-adjusted mean systolic and diastolic blood pressure (p=0.068 and 0.018, respectively). These results suggest that the occupation-related changes in BMI may largely contribute to the occupation- related changes in blood pressure. J Epidemiol, 1998 ; 8 : 216-226.
We investigated the relationship of cigarette smoking, alcohol use, recreational exercise and obesity with serum lipid atherogenicity because of paucity of epidemiological studies. The subjects were 2, 228 male officials of the Self-Defense Forces in Japan, who were aged 49-55 years and received a preretirement health examination in the period from 1991 to 1992. A self- administered questionnaire was used to ascertain cigarette smoking, alcohol use and recreational exercise. Serum total cholesterol (TC) and low-density-lipoprotein cholesterol (LDL-C) were increased with increasing levels of body mass index (BMI) and waist-to-hip ratio (WHR), and decreased with increasing levels of cigarette smoking and alcohol use. Serum high-density- lipoprotein cholesterol (HDL-C) was positively associated with alcohol use and recreational exercise, and negatively associated with cigarette smoking, BMI and WHR. BMI and alcohol use were most strongly associated with both LDL-C/HDL-C and TC/HDL-C ratios with BMI in an atherogenic direction and alcohol use in an antiatherogenic direction. Recreational exercise was weakly associated with less atherogenic lipid profile. BMI was the strongest determinant of serum lipid atherogenicity whereas alcohol use was most antiatherogenic. WHR was less important than BMI in the determination of serum lipid atherogenicity in Japanese men. J Epidemiol, 1998 ; 8 : 227-234.
To clarify mortality risks of oesophageal cancer associated with hot tea, alcohol, tobacco and diet, further analyses on the data from a large prospective cohort study in Japan were conducted. The subjects for analysis were 220, 272 'men and women aged 40 to 69 at the baseline of 1965. There were 440 oesophageal cancer deaths during the period from January 1966 to December 1981. Person-years at risk were 3, 065, 182 in total. Rate ratio and 95% confidence interval adjusted for attained age, prefecture, occupation and sex were (RR (95%Cl)): 1.6 (1.2-2.0) for hot tea (drinking green tea at high temperatures) in comparison with not-hot tea (drinking green tea at moderate temperatures); 2.4 (1.8-3.1) for daily (4 times/week or more) alcohol drinking in comparison with non-drinking; and 2.3 (1.7-3.1) for heavy smoking (15 cigarettes/day or more) in comparison with non-smoking. Dose-response relationships were found in alcohol drinking and smoking among men and women (p for trend; p<0.001). The rate ratios were not significantly associated with the dietary factors except for green-yellow vegetables (1-3 times/month or less in comparison with daily; RR=2.0, 95%Cl: 1.2 -3.1), where a no dose-response trend was observed (p=0.45). In comparison based on the binary variables, the RR for the subjects with daily alcohol drinking and current smoking was 3.9 with 95%C1 of 2.7 to 5.4, relative to those exposed to neither habit. The joint effect of alcohol drinking (A) and smoking (S) was more than additive (A*S > A+S: 3.9>1+(1.0-1)+(1.6-1)). Further sub-analysis showed that the RR for the subjects with daily alcohol drinking, current smoking and hot tea was 5.7 with 95%Cl of 3.7 to 8.9, when the reference was the subjects with not-daily alcohol drinking, non-smoking and not-hot tea. Similar results were obtained from further adjustment of green- yellow vegetables. It is concluded that mortality risks of oesophageal cancer in the present cohort were substantially associated with thermal effect of hot tea, alcohol drinking, smoking and lower consumption of green-yellow vegetables. This finding suggests that life-style modification for smoking and dietary habits is essential to reduce the risks of oesophageal cancer in Japan. J Epidemiol, 1998; 8 : 235-243.
This study was performed to determine the distribution of hepatitis C virus (HCV) genotypes among asymptomatic carriers (ASC) and patients with chronic hepatitis without cirrhosis (NC- CH), liver cirrhosis (LC), and hepatocellular carcinoma (HCC) in the Osaka area, and to assess whether infection with HCV genotype l b (II) is more likely to develop into hepatocellular carcinoma (HCC) than is that with genotype 2a (III) or genotype 2b (IV). Genotypes of all study subjects were determined by Okamoto's method. HCV genotype 1 b was detected in 100 of the 143 ASC (69.9%), 551 of the 726 NC-CH patients (75.9%), 86 of the 103 patients with LC (83.5%), and 153 of the 179 HCC (85.5%) patients. Using unconditional logistic regression analysis, the age- and sex- adjusted odds ratios contrasting NC-CH with ASC, LC with ASC and HCC with ASC were 1.38 [95% confidence interval (CI) = 0.93-2.05], 2.28 (95% Cl = 1.12-4.63) and 2.27 (95% Cl = 1.02-5.06) respectively. HCV genotype l b is predominant in both healthy carriers and patients with chronic liver diseases in the Osaka area. The findings from the three case-control studies indicate that type l b infection is more closely associated with the development of LC and HCC than type 2a or 2b through its role in the progression of chronic liver inflammation to a cirrhotic stage. J Epidemiol, 1998 ; 8 : 244-249.
The prevalence of hepatitis C virus (HCV) infection and factors relating to the HCV transmission were evaluated in a community without high mortality from chronic liver disease in Niigata prefecture. A total of 2, 231 subjects were examined to detect anti-HCV core antibodies by enzyme-linked immunosorbent assay with synthetic peptides CP14 and CP9. The prevalence was 1.66% (95% CI; 1.17% to 2.29%) and tended to increase with age. The values were lower than those reported from districts with hepatic disease endemic. Histories of blood transfusion (relative risk (RR) 5.51; 95% Cl 2.90 to 10.48) and surgery with hospital admission (RR 4.43; 95% Cl 2.04 to 9.65) were significantly associated with the anti-HCV core antibodies positive. Multiple logistic analysis corroborated independency of these factors. Among 188 subjects who experienced surgery and/or blood transfusion after 1990, only one (0.5%) had HCV infection. By contrast, 8 (3.5%) were positive in subjects who experienced first acupuncture therapy after 1990. The acupuncture therapy in alternative medicine could be still related to the HCV transmission. J Epidemiol, 1998 ; 8 : 250-255.