Background: Recently a new direct assay for measurement oflow-density lipoprotein cholesterol has been developed. The purpose of this study was to evaluate the new method and elucidate the association of lifestyle factors with the serum levels of lowdensity lipoprotein cholesterol determined by the direct assay (LDLC/d) among healthy adults in a rural district. At the same time the levels of low-density lipoprotein cholesterol were worked out using the Friedewald formula (LDLC/f) and a comparison was made between LDLC/d and LDLC/f.
Method: Data obtained during the medical checkups in 1998 were used. LDLC/d was estimated by use of the direct assay, Cholestest (Daiichi Pure Chemicals, Japan). The subjects consisted of 678 middle-aged men and women ranging from 40-65 years of age. Co-variance analysis was performed to examine the association of lifestyle factors with lipid and lipoprotein levels.
Results: An inverse relationship was observed between LDLC/d and alcohol drinking among both male and female subjects. The body mass index (BMI) was positively related with LDLC/d among female subjects. Eating between meals was positively related with LDLC/d among males. The association of LDLC/d with these lifestyle factors was stronger than that of LDLC/f. The levels of LDLC/d weresignificantly higher than LDLC/f, suggesting that a different classification of hypercholesterolemia could be formulated by those two levels.
Conclusion: These results indicated that LDLC/d has an advantage over LDLC/f. Further research should focus on the standardization of themethod using LDLC/d to categorize the type of hypercholesterolemia.

View full abstract

To clarify characteristics of home care in rural areas in Japan, we investigated the actual status of home care in a rural area (Asuke town, Asahi town, Inabu town, northern part of Toyota city and Shimoyama village) in Aichi prefecture. The subjects were 149 patients who were under medical care and nursing supervision at home for the last 2 years and a half. Age, sex, ADL, prognosis, principal care-givers of the patients and distance from patients' houses to our hospital were compared with the average data of all the nurse stations in Japan (1996). The percentage of patients over 90 years old was 23.4% in this area as against 13.5% of the national average. Sex and ADL levels were similar to the average. The proportion of females as principal care-givers of patients was 80%, which is about average. However, the proportion ofdaughters-in-law was 51.7%, double of the national average. In 48 cases (32%), the time required to get to the hospital by car was over 31 min. This ratio was 3 times higher than that of the average data, and it took 50 min from farthest patient's house (35km). In prognosis, 66 patients died-44 cases (67%) in hospital and 22 cases (23%) at home.
Our questionnaire survey regarding patients' and care-givers' wishes was responded to by 38 of 47 principal care-givers who utilized our home care and nursing survice program. One half of care-givers were over 60 yearsold and had taken care of a patient for over 5 years. Mental stress, feeding and toileting were major problems most principal care-givers cited. However, they required services at a day-care institution for elderly patients and recovery of used paper diapers. Death at home was wished by 23 (61%) patients and care-givers, if they received enough medial care and welfare services.
These findings revealed that elderly people take care of elderly patients, their houses are far from the hospital and they wish to die at home. More collaboration among all providers of medical care and health and welfare services, and the establishment of an information network are necessary to improve these problems, resulting in safe, acceptable and satisfied home care for patients and care-givers.

View full abstract

A significant delay in identifying pre-ESRD patients is not infrequent in the U.S.A. because an early examination for proteinuria is not common, and renal disease is infrequently documented even when proteinuria and/or an elevated serum creatinine level have existed. Although there are accepted strategies for slowing the progression of renal disease such as the use of an angiotensin converting enzyme (ACE) inhibitor in diabetic patients or suboptimal blood pressure control in hypertensive patients, these strategies are seldom employed. It is also particularly alarming that the patients are often low in the overall health status, hypoalbumic, or anemic at dialysis initiation, and begin dialysis without permanent vascular access or without any education regarding dialysis therapy in many instances.

View full abstract