Primary Health Care (PHC) and Health Promotion (HP) have been adopted as core health strategies for socio-political interventions. Although the two have a lot of similarities in terms of concepts, they, nevertheless, have their differences. The first difference lies in the population and diseases perspectives that PHC and HP are literally defined as just “health care” and “promotion of health”, respectively. The second difference, from a social and political point of view, is that PHC can be expressed as social and political efforts to make health knowledge, health care skills and the entire health service delivery system respond to the people's needs and situations, while HP is a process in which individuals and their environment are geared toward the pursuit of healthy lifestyles. These differences strengthen the unique values of each strategy. HP, which is a form of social mobilization for health, is about catering to the needs of developing countries. On the other hand, the principle of PHC, which is beneficiary-oriented, is universally applicable for both developed and developing countries.

View full abstract

Purpose To prevent coronary heart disease and type 2 diabetes mellitus, we need to focus on “the deadly quartet” (coexistence of upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertention), and the multiple risk factor syndrome related to insulin resistance. As few urban community-based population studies have evaluated the correlation between glycated hemoglobin A1c (HbA1c) levels and risks of life-style related disease, we investigated this parameter and its correlation with atherosclerotic risk factors in participants of health check ups in two communities in Kanagawa prefecture. We also examined whether these correlations were affected by difference between the two groups.
Methods The study populations comprised male and female residents aged 40-79 in two communities (A and B cities) in 1998.
Age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), HDL-cholesterol (HDL-C), triglycerides (TG), GOT, GPT, Uric acid (UA), and γGTP were considered as atherosclerotic risk factors. Firstly we calculated correlation coefficients with HbA1c level. Secondly, logistic regression analyses were performed with HbA1c as the dependent variable, and risk factors correlated with HbA1c significantly and variable for each community as independent variables. To assess whether community differences affect associations between HbA1c levels and risk factors, we added interaction terms as independent variables in the logistic regression analysis.
Results 1. There were no significant interaction terms while significant positive associations were observed between HbA1c and age, BMI, and levels of TC and γGTP for men in both communities. A significant negative association was observed between HbA1c and UA..
 2. Age, BMI, and the levels of SBP, TG, GPT, and γGTP were positively associated, and GOT was negatively associated with the HbA1c levels in women in both communities. Each community had its own association between TC and HbA1c.
Conclusions The findings that TC is associated with HbA1c in men, and that BMI and the level of TC are linked with HbA1c in women are consistent with previous results for Japanese. The association between HbA1c and TG in women was newly observed for Japanese. Furthermore, the levels of γGTP in both sexes and also GPT in women are associated with HbA1c. From these results, investigating linkage between HbA1c level and atherosclerotic risk factors was thought to be appropriate for estimating accumulation of multiple risk factors in the community.

View full abstract

Introduction As intensive health care users, the elderly contribute significantly to rising health care cost in Japan. This research sought to elucidate the decision making processes elderly use when seeking medical care and their expectations of medical facilities and physicians.
Methods We conducted qualitative individual interviews with rural elderly, over 65 years old, who had access to private physician offices, community, regional, and university hospitals. Interview questions elicited participants' experiences in seeking medical care; their most memorable experiences in hospitals; and their expectations for medical services. After the individual interviews, we surveyed the participants to verify the results.
Results A total of 19 individuals participated in these interviews. These 19 individuals and an additional five individuals who met eligibility criteria were surveyed by mail after the interviews and verified the results. The participants indentified “a feeling of intimacy” and “receriving kindhearted treatment” as the most important attributes of medical facilities. Other important factors included: accommodating patients' preferences; being close to home; earning the patient trust; and having a well organized infrastructure. Comparatively important element were: “technology and skill”, “opinion and reputation of third person”, “length in the latency”, “continued medical treatment by the same doctor”, “actual feeling of improvement”, “introduction to a higher order medical facility”, “multiple medical departments”, and “medical judgement by multiple doctors”. These factors fall into three categories: emotional expectations; expectations of the health system; and convenience in daily life. The survey data confirmed these findings.
Discussion These results suggested that elderly expect “supportive” and “accommodating” health care services in which the medical activity does not cause problems for daily life. However, these vague expectations for the medical system need translated into practical steps. Still, it is important for health care providers to consider these expectations and the relationships among them. These findings corroborate the results of a previous investigation that used focus group interviews.

View full abstract

Purpose Estimation of nutritional intake from photographs of served meals has been proposed. We examined the inter-observer agreement and validity of this method for assessment of the daily diet.
Methods Twenty-five family members (13 men and 12 women, mean age ±SD: 47.3±5.6 years) of students in a dietetic course performed both meal photography and traditional weighed dietary records for four days. For the photo method, two observers independently identified foods and estimated their portion sizes from the potographs, converting them into energy and nutrient intake with a food composition table. The inter-observer agreement with the photo method was assessed in terms of inter-observer ratios, correlations, and coefficients of variation (CV), and the method was validated using the weighed dietary records as the reference. Its running cost was also calculated.
Results The inter-observer ratios for estimation of mean daily nutritional intake ranged from 0.89 (magnesium) to 1.14 (retinol) with a median of 1.03. The correlation coefficients between observers varied from 0.65 (saturated fatty acids [SFA]) to 0.92 (vitamin C) on a daily basis (median, 0.79), and from 0.65 (SFA) to 0.96 (vitamin C) on an individual basis (median, 0.78). The CVs ranged from 7.9% (energy) to 23.8% (carotene) (median, 13.3%), and from 5.2% (energy and magnesium) to 17.8% (carotene) (median, 8.8%) for daily and individual intake, respectively. Regarding validity, the ratios between methods (the photo method/weighed dietary records) ranged from 0.96 (potassium and SFA) to 1.11 (retinol and salt) with a median of 1.00. Correlations between the two methods were distributed from 0.40 (salt) to 0.82 (vitamin C and retinol) on a daily basis (median, 0.67), and from 0.47 (salt) to 0.90 (vitamin C) on an individual basis (median, 0.74). The CVs ranged from 10.5% (energy) to 39.6% (carotene) (median, 16.9%), and from 6.1% (protein) to 20.6% (carotene) (median, 11.2%), respectively. It was calculated to cost 105 Japanese yen per meal when using a lens-attached film for 25 shots.
Conclusions Inter-observer agreement and validity of the photo method, though varying with the nutrient, were generally acceptable. Although some modifications are needed for diners-out, the method appears to be useful as a dietary recording tool.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

Objective In order to clarify epidemiologic features of selected intractable diseases, an investigation of the fourth nationwide survey, in 1998, was performed.
Methods We asked 47 prefectural governments to provide data concerning every patient receiving financial aid for treatment of 39 selected intractable diseases from April 1997 to March 1998. The items for each patient required were the beginning year of the financial aid, the disease code, sex, date of birth, residence, type of insurance, whether an in-patient or outpatient, medical institution and the clinical division where the patient was treated. We performed a detailed analysis regarding the age distribution, the prefecture, in-patient or outpatient, the clinical division, the insurance, and the disease, for both males and females.
Results 1. The total number of patients who received financial aid for treatment was 399, 719 with a sex ratio of 0.66 (males 158, 766, or female 240, 953), 60.7% being between 45 and 74 years of age. Of 214, 173 patients whose status could be confirmed regarding outpatient or inpatient. 14.7% were the latter. Of 129, 685 cases, 56, 471 (43.6%) were treated in departments of internal medicine. Of 396, 187 patients, 65, 841 (16.6%) were covered by the health and medical services law for the aged. The greatest number of patients resided in Tokyo, and the least was in Yamanashi Prefecture.
 2. With regard to specific intractable diseases, the largest number of patinets receiving aid for treatment were suffering from ulcerative colitis at 52, 261, while the least number was for primary pulmonary hypertension at 96. The numbers for each group had increased within the 13 years from 1984 to 1997, except for SMON. As the patients' age increased, the percentage of those receiving treatment also increased and the numbers of aged individuals were especially elevated.
 3. The proportion of in-patients for the Creutzfelde-Jakob disease was 76.4 percent, which was remarkably higher than for other diseases.
Conclusion By the present analysis of the nationwide survey in fiscal year 1997, we could clarify changes in epidemiologic features of patients receiving financial aid for treatment. This kind of analysis should be continued to obtain important information on the epidemiology of intractable diseases.

View full abstract

Purpose We encountered a tuberculosis patient with the BCG strain in his sputum. Based on this experience, we investigated ideal surveillance and quality assurance for bacterilological examination as well as cooperation between medical organizations and public administrative organizations such as public health centers for prompt and appropriate measures against tuberculosis.
Methods Acid-fast bacilli isolated in the laboratory of a hospital were analyzed by restriction fragment length polymorphism (RFLP) and molecular epidemiological data for pathogen were provided to the public health center in charge.
Results DNA of acid-fast bacilli isolated from sputum of a tuberculosis patient showed a BCG like pattern on RFLP analysis using two IS6110 and PGRS (polymorphic GC-rich sequence) probes. Additional investigation revealed that the patient had been treated with BCG immuno-therapy against bladder cancer. Accordingly, it was suggested that this was the origin of the BCG strain in the sputum. Therefore, the patient was re-examined clinically, and further contact tracing by the public health center was stopped.
Conclusions This study indicates that adequate surveillance and quality assurance in bacteriological examination as well as effective exchange of information between medical organization and public health centers are very important for prompt and appropriate measures against tuberculosis. Further, it provided strong support for identification of pathogens of the molecular level by RFLP analysis.

View full abstract

[in Japanese]

View full abstract