To evaluate effects of impaired glucose tolerance on aortic stiffness, pulse wave velocity was measured in 1) subjects with impaired glucose tolerance (n=40) or 2) diabetes mellitus (n=58), or 3) in age-and sex-matched controls with normal glucose tolerance (n=40, 57 ± 2 yrs, 17men). After overnight fasting, pulse wave velocity between right brachial artery to bilateral ankle arteries (baPWV) was obtained from simultaneous recordings of pulse wave in four limbs (Form PWV/ABI, Colin AT company, Nagoya, Japan). 1. baPWV were controls (1339 ± 47 m/s) < impaired glucose tolerance (1562 ± 43) < diabetes mellitus (1763 ± 53) (p<0.001). 2. In stepwise multiple regression analysis, age and systolic blood pressure correlated to baPWV in controls (adjusted R²=0.690, p<0.001); age and systolic bool pressure and HOMA-IR (the homeostasis model insulin resistance index) in impaired glucose tolerance (R2=0.566, p<0.001); age, systolic blood pressure, HbAlc and plasma triglyceride in diabetics (R²=0.519, p<0.001). Values not included in the model were total cholesterol, triglyceride, body mass index, and HDL-cholesterol. Data suggested that baPWV could be useful to predict early atherosclerotic changes in subjects with impaired glucose tolerance, and predictors for baPWV could be influenced by glucose tolerance.

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Daily exercise is effective in reduction of blood pressure in hypertension. Although there have been many reports of this effect of exercise under medical intervention, there have been few reports of the association between long-term daily physical activity and blood pressure. Therefore we investigated the relationship between daily exercise and blood pressure over a duration of six years. We investigated 2, 070 Japanese employees of a certain company aged 18-65 years, who undergo a group-physical examination once a year, that have undergone the physical examination both in 1994 and in 2000. Among them we enrolled 754 individuals aged 40-65 years at study entry. We used a questionnaire to survey daily physical activity.
A total of 204 middle-aged mild hypertensive subjects were enrolled. Among them 24.5% of the subjects reported being physically active. However only 8.8% of the subjects reported exercising not only for more than 30 minutes but also more than once or twice a week. In this group both systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly decreased over the duration of six years. However, SBP and DBP in exercise group, who underwent exercise for less than 30 minutes, did not change significantly.
In conclusion, from this study daily exercise of both over 30 minutes and more than once or twice a week results in the reduction of blood pressure for middle-aged mild hypertensive over a long-term observation.

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About half of dietary salt intake comes from salt containing seasoning such as salt, soy sauce and miso (soybean paste) in Japan. We conducted a randomized, placebo-controlled, double-blind cross-over study to examine the effect of low sodium soy sauce and soybean paste on salt intake. The subjects were 1 man and 16 women between 34 and 76 years of age in a district. During a one week period, the intervention group received low sodium soy sauce (25 % lower in sodium compared with common soy sauce) and soybean paste (20 % lower in sodium compared with common soybean paste), and controls received common soy sauce and soybean paste for both table and cooking use. Changes in urinary salt excretion during 24 hours with proportional sampling method were evaluated.
Salt excretion decreased by 2.3 g in the intervention group and increased by 0.6 g in the controls, and the difference between two groups was 2.9 g. No statistically significant difference was found in urine volume and urinary excretions of creatinine, potassium, calcium and magnesium. Taste scores of low sodium soy sauce and soybean paste did not differ much compared with the control soy sauce and soybean paste. Feasibility for long-term use of low sodium soy sauce and soybean paste and their effect on blood pressure should be further investigated for application in community-based intervention trials of salt and blood pressure in Japan.

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We investigated the relationship between insulin resistance and remnant-like particle cholesterol (RLP-C) using 472 subjects (174 men and 298 women) randomly selected from inhabitants of two rural communities in Japan, Tanno and Sobetsu. Fasting immunoreactive insulin (FIRI), fasting blood glucose (FBS), total cholesterol (TC), triglyceride (TG), HDL cholesterol, LDL cholesterol, and RLP-C were measured in each subject. HOMA-R was used as an indicator of insulin resistance. The subjects were divided into two groups according to the value of HOMA-R : an insulin-resistance (IR) group consisting of subjects with HOMA-R≥ 1.73 and a normal (NR) group consisting of subjects with HOMA-R < 1.73. There was a significant positive correlation between HOMA-R and RLP-C. The value of RLP-C was higher in the IR group than in the NR group (5.9 mg/dl vs. 3.6 mg/dl). The frequency of hyper RLP cholesterolemia (RLP-C ≥7.5mg/dl) was higher in the IR group than in the NR group (21.7% vs. 4.8%). The results of multiple regressionanalysis showed that HOMA-R was closely related to RLP-C. The results of this study suggest that RLP-C is closely associated with atherosclerosis in insulin-resistance syndrome.

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Difference in dietary patterns of middle-aged and elderly Japanese determined at the time of medical examinations 10years apart was investigated in a cohort study. Energy intake decreased with age, but protein, fat and calcium intake was preserved or increased. Rice, fats & oils, green & other vegetables, meats, eggs and salt intakes were decreased. Algae, and women's soybean products and milk & daily products intakes were increased. Therefore, change of food choices in the middle-aged and early elderly period related to a historical effect, in addition to an aging effect.

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[in Japanese]

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In 1993, we developed and introduced the standing order system for the management of patient care in the intensive care unit of the 'S' Medical School Hospital. From 1998, critical path methods have been applied for the education of the newly employed nurses. In this study, we analyzed the educational effects of the critical path method on the education of the newly appointed nurses.
We evaluated the effectiveness of critical path by using writer questionnaires regarding the use of critical path. The assessment of the results was performed objectively by the use of a five step scale. The results showed that critical path enabled new nurses to execrate proper nursing care for the different conditions of the diseases, but it developed a tendency for them to depend too much on the critical path and which led to providing care of patients in stereotyped ways. From the results of the preliminary use of the critical path, we added a nursing management sheet to the critical path to promote a thought processes in patient care. This management sheet was effective in helping the new nurses to develop rational daily care of the patients and avoiding stereotyped care. Furthermore, we attached the standard values related to hemodynamics, drug doses, etc. for reference so that the changes of the patient status would not be overlooked.
In conclusion, the critical path method is a highly useful educational tool for newly employed nurses.

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