Purpose A non-randomized controlled trial was conducted to evaluate the effectiveness of three lifestyle modification programs to reduce blood pressure: individual counseling only; counseling using group dynamics; and individual support using mail.
Methods We enrolled men and women ages 20-69 with a systolic blood pressure (SBP) of 130-159 mmHg and/or a diastolic blood pressure of 85-99 mmHg (high-normal or mild hypertension). Participants were assigned to one of 4 groups: individual counseling (n=134); group counseling (n=79); mailing support (n=127); and controls (with usual care) (n=178). The three intervention programs included behavioral support for each person's lifestyle problems once a month for 6 months. Sex and age adjusted net blood pressure change (and 95% confidence intervals [CIs]) compared with the control group was calculated for each of the intervention groups.
Results Net SBP change was the largest for the group counseling group: sex and age adjusted net SBP change was −6.5 mmHg (95%CI: −10.0, −3.0). Net SBP change for the mailing support group was also significant (−4.3 mmHg [95%CI: −7.3, −1.3]). Net SBP change for the individual counseling group was −2.5 mmHg (95%CI: −5.5, 0.5). Looking at the results separately by sex, net SBP reduction was also largest in women of the group counseling group, whereas improvement in men was similar among 3 groups (approximately 4 mmHg). Body weights were reduced by about 1 kg in all 3 groups.
Conclusions Lifestyle modification programs using group dynamics or using individual support by mail, in addition to individual behavioral support, appear to be effective for blood pressure reduction. Group counseling may be more effective in women.

View full abstract

Purpose To provide the strategies, achievement and evaluation of a community health education program for salt reduction with media campaigns.
Methods The intervention community was Kyowa town (A district of Chikusei city, census population in 1985=16,792) where we have systematically conducted a community-based blood pressure control program since 1981, and health education on reduction of salt intake since 1983 for primary prevention of hypertension. The education program was performed through media campaigns including use of banners, signboards, posters, and calendars with health catchphrases. We also used catchphrase-labeled envelopes when sending documents from the municipal health center to individuals. Health festivals were held annually to enhance health consciousnesses and to improve health behavior. Some of the posters and calligraphy were painted or drawn by elementary schoolchildren as part of their education. The program was evaluated by repeated questionnaires and examination of salt concentrations of miso soup and dietary salt intake.
Results Between 1983 and 1988, the prevalence of persons who were aware that health consultation including blood pressure measurements were available at the town office increased from 65% to 84%. The prevalence of those who knew the salt intake goal (10 g or less/day) increased from 47% to 63% and that of those who reported to reduce salt intake also increased from 38% to 58%. As for salt concentrations of miso soup, the proportion with less than 1.1% increased from 47% to 66% between 1985 and 2004. Age-adjusted mean salt intake for persons aged 40-69 years declined from 14 g to 11 g in men and from 12 g to 10 g in women between 1982-1986 and 2000-2004.
Conclusion A long-term systemic education program through media campaigns proved feasible with the cooperation of community leaders, schools and food associations.

View full abstract

Objective To determine the range of excess death associated with influenza in Japan.
Methods The monthly rates for mortality from all causes other than accidents (ICD9: E800-E949, ICD-10: V01-X59) were determined from the Japanese national vital statistics for 1987-2003. By employing a model using the annual mortality rates and the seasonal index, the number of expected deaths and the 95% range of mortality in the absence of influenza-associated deaths (normal range) were obtained. Point estimation of excess mortality during an influenza season was performed by calculation of differences between the number of deaths observed and the number of deaths expected. The range of excess death was defined: the lower limit of the excess death was performed by calculation of difference between the number of deaths observed and the upper limit of the normal range. The upper limit of the excess death, on the contrary, was performed by calculation of difference between the number of deaths observed and the lower limit of the normal range. Based on the results of a survey of tendencies in the occurrence of infectious diseases, months showing a high prevalence of influenza and associated deaths were regarded as “months when the rate of death from influenza was 0.9 deaths/100,000 person-years or higher”.
Results The excess death determined by point estimation was largest in 1999, followed by 1995, 1993, 1997, 2000, and 2003. The point estimation (range of excess death) in 1999 was approximately 49,000 (approximate range, 37,000-60,000). Correspondingly, the excess death in 1995 was approximately 38,000 (approximate range, 27,000-48,000). While values in 1993, 1997, 2000, and 2003 were in the approximate range of 21,000 to 25,000, the range of excess death of each year showed the differences: approximate range from 15,000 to 36,000 in 1993, from 18,000 to 31,000 in 1997, from 18,000 to 28,000 in 2000, and from 11,000 to 34,000 in 2003, respectively. From comparison of the range of excess deaths by year, that in 1995 appeared to be the largest among the examined years.
Conclusion By considering the range of variation in the number of deaths in the years when no influenza epidemics occurred, the increase (the largest number and smallest number of deaths) associated with elevation the prevalence of influenza could be determined. Estimation of the range of excess deaths can be considered a useful method for understanding the influence of influenza on public health.

View full abstract