Purpose The aim of this study was to assess the relationship between change in body mass index (BMI) and blood pressure in urban residents.
Methods The data for this study were obtained at health checkups carried out between 1984 and 1998 in city A in Osaka Prefecture. The subjects comprised 4,760 men and 9,318 women aged 40-69. Individuals who had taken anti-hypertensives as medical treatment were not included. Hypertension was defined as a systolic blood pressure (SBP)≧140 mmHg or as a diastolic blood pressure (DBP)≧90 mmHg.
 We divided the 15 year period into three of five-years each and divided the subjects with reference to their BMI (Body Mass Index: kg/m²). We calculated the averages of systolic blood pressure and those of diastolic blood pressure in every group and the regression equations of BMI to blood pressure by means of single regression analyses.
 Hypertension incidences were determined in every ten years.
 Among the subjects who had taken health checkups between 1984 and 1988, we analyzed the relationship between change in BMI and blood pressure.
Results 1. In all three-period groups, the averages for SBP and DBP in the highest BMI group were significantly larger than in the lowest group.
 2. Linear regression coefficients for the relation of BMI to blood pressure were significantly positive in all age groups for both men and women.
 3. The incidence of hypertension displayed a tendency to depend on BMI values positively. Especially, rising BMI values in women were significantly associated with increase of the incidence of hypertension.
 4. In each of the years (1984-1988), in the group with decreasing BMI the average values for blood pressure were smaller than those in the increasing group. In some years, the statistical significance was attained.
Conclusion According to the present analyses of health checkup data for urban residents, both blood pressure and the incidence of hypertension positively depend on BMI. This study of transitions showed decrease of BMI to exert a beneficial influence on blood pressure.

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Purpose This study was aimed at predicting the demand for medical services of people with-mild symptoms of common cold. Three alternatives to cope with this condition were presented in questionnaires, which were: consulting physicians, taking OTC (over-the-counter) medicine, and doing nothing. Our prediction of employees' choices with these alternatives will contribute to cost-containment policies of health insurers.
Method We mailed questionnaires to 12,000 selected randomly employees, insured by “A” health insurance company. The questionnaires were designed a hypothetical question method, utilizing several criteria, including number of OTC medicines on hand, and socioeconomic status. A multinomial probit model was used for our estimation and analysis, with alternatives set as dependent variables.
Results There were 3139 respondents, and the response rate was 26.2%. Gender, age, number of family members, and income level did not have any significant effect on the choice of any of the three alternaives. On the other hand, having a family doctor and a number of OTC medicines on hand had significant consequences. In males with a family doctor and without OTC medicine, the probabilities of choose to consult with a physicians, take on OTC medication, or doing nothing, were predicted to be 0.46, 0.32, and 0.22, respectively. People with three or more kinds of OTC medicine are more likely to choose OTC medication than physicians.
Conclusion The study suggests that more kinds of OTC medicine on hand of for individual with mild symptoms of common cold, the leaves the demand for medical services. To reduce medical expenses through consulting medical services, it might be effective for health insurers to provide insured employees with incentives to keep more OTC medicines on hand.

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Purpose This 2-year prospective study was conducted to determine prognosis of two different types of homeboundness among community-living older adults and explore whether those types of homeboundness exert independent effects even after controlling for potential confounders.
Methods Out of all residents aged 65 years and over who lived in Yoita, Niigata, Japan (n=1,673), 1,544 persons participated in the baseline survey which was conducted in November, 2000 (response rate, 92.2%). They were followed for the subsequent 2 years in terms of mortality, institutionalization and functional status (mobility, IADL, BADL, and cognition). Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into types 1 or 2, based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). Type 1 homebound persons included those who could not get out into the neighborhood without assistance (i.e., levels 3 or over). Type 2 included those who were homebound though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We compared two-year prognosis between the type 2 homebound cases and controls (the non-homebound individuals in levels 1 or 2), or the type 1 homebound and controls (the non-homebound in levels 3 or over). Multiple regression analysis or multiple logistic regression models were used to analyze independent effects of the homebound status on the prognosis, controlling for potential confounders such as age, gender, chronic conditions, functional status, and psychosocial variables at baseline.
Results At baseline there were 1,322 non-homebound in levels 1 or 2 (87.0%), 81 type 2 homebound (5.3%), 39 non-homebound in levels 3 or over (2.6%), and 78 type 1 homebound older persons (5.1%). As compared to controls, type 2 homebound elderly showed increased risks of functional decline even after controlling for potential confounders. Relative risks of type 2 homeboundness for developing mobility loss, IADL and ADL disability, and cognitive impairment (MMSE<20) were 3.20(95% CI, 1.60-6.38), 2.85(1.20-6.82), 1.52(0.61-3.75), and 3.05(1.06-8.78) in the partially adjusted model, and 2.49(1.20-5.17), 2.25(0.90-5.63), 1.46(0.54-3.94) and 2.41(0.71-8.17) in the fully adjusted model. Type 1 homebound elderly showed an increased risk for mortality (33.3% vs. 5.1%), but a lower risk for institutionalization (9.0% vs. 25.6%). The independent effect of type 1 was not significant when mortality and institutionalization were combined (relative risk, 2.05 [0.54-7.75] in the fully adjusted model).
Conclusions Type 2 homeboundness is an independent risk factor for functional decline among competent older persons, while the prognosis of older persons with a low functional state is poor, regardless of type 1 homeboundness or not.

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[in Japanese]

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[in Japanese]

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