Objective: Japan introduced a new metabolic syndrome (MetS) screening and intervention program. However, the specific benefits of the program have not yet been identified. The aim of our study was to highlight the role of the program in reducing risks related to MetS in a Japanese rural area.
Methods: We used data from a prospective observational cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The subjects of the present study were all users aged 40-74 years who participated in the MetS program between January and September 2010. We ultimately analyzed a total of 413 subjects followed up 12 months after enrolment. The subjects were divided into two groups based on the need for educational support: support and non-support. In each group, we compared the subjects’ MetS conditions at baseline and 12 months later.
Results: Thus, 88 subjects out of 413 were assigned to the support group. Among the support group subjects, there were no significant changes in glycemic metabolism, lipid metabolism, blood pressure and accumulation of visceral fat between the baseline and follow-up checkups. Among the non-support group subjects, there were no significant changes in glycemic metabolism, lipid metabolism and blood pressure between the baseline and follow-up checkups, but there were significant changes for the worse in accumulation of visceral fat with time.
Conclusion: Unfortunately, the metabolic conditions of the rural subjects who participated in a new MetS screening and intervention program did not improve with time. Our findings underscore the importance of developing educational intervention programs to encourage the general population to modify their lifestyle and acquire healthier habits.

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Objective: The purpose of this study was to investigate regional differences in the standard mortality ratio (SMR) and risk factors (including dietary habits) for stroke across the three regions of Ehime Prefecture - Toyo (east), Chuyo (central), and Nanyo (south).
Participants and methods: We obtained medical records derived from 956,979 medical examinations carried out at JA Ehime Kouseiren Medical Examination Centers between April 1994 and March 2006. We analyzed data from 132,090 subjects (Toyo - 47,654, Chuyo - 38,435, Nanyo - 46,001) who underwent their first medical examination during this period. To analyze differences between the three regions, we first calculated the SMR for stroke based on data from the Basic Residential Registers and Health Statistics Bureau. Secondly, we calculated significant differences in body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (Glu), and total cholesterol (T-CHO). Thirdly, we used the Chi-square test to calculate significant differences in the percentage of subjects who consumed the following foods on a daily basis: rice, bread, eggs, fish, meat, vegetables, dairy products, and fruit juice.
Results: Despite the fact that regional differences in the SMR for stroke have been decreasing, in both men and women in Nanyo, the mean values for SBP and DBP were significantly higher and the mean value for T-CHO was significantly lower than in Toyo and Chuyo. In Nanyo, the percentage of subjects who consumed rice and fish (men and women), meat (men), and juice (women) on a daily basis was higher than in Toyo and Chuyo.
Conclusion: In Nanyo, higher SMR for stroke may be related to high SBP and DBP and low T-CHO. As background to these results, it is also thought that regional differences in dietary habits may have an influence.

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Objective: The purpose of this study was to examine the relationship between the emotional intelligence quotient and health-related quality of life using structural equation modeling.
Methods: A self-administered questionnaire survey was conducted among 1,911 mothers who visited the Health Center for an infant medical examination. A hypothetical model was constructed using variables of the emotional intelligence quotient, social support, coping, parenting stress, and perceived health competence.
Result: There were a total of 1,104 valid responses (57.8%). Significant standardized estimates were obtained, confirming the goodness of fit issues with the model. The emotional intelligence quotient had a strong impact on physical and psychological quality of life, and showed the greatest association with coping. This study differed from previous studies in that, due to the inclusion of social support and explanatory variables in coping, an increase in coping strategies was more highly associated with emotional intelligence quotient levels than with social support.
Conclusion: An enhanced emotional intelligence quotient should be considered a primary objective to promote the health of mothers with infant children.

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Objective: The aim of this study was to assess the economic burden of disability of school-aged children and to evaluate the association between disabilities and household socioeconomic status, as well as the economic burden of disability and household socioeconomic status in Vietnam.
Materials and Methods: Nationally representative data for 9,882 children aged 6 to 17 years from the Vietnam Household Living Standard Survey 2006 were used. Disabilities were measured in six basic functional domains, including vision, hearing, remembering or concentrating, mobility, self-care, and communication. We evaluated the association between area, household income, educational attainment, or occupation of household head, and each difficulty. The ratio of health-care expenditure to per capita household income was compared by presence of a disability as well as household socioeconomic status.
Results: The prevalence of difficulty was 1.9% for vision and 2.3% for at least one of the other five domains. Difficulty in vision was more prevalent in the richer households (p=0.001), whereas difficulty in the other five domains was more prevalent in the poorer households (p=0.002). The ratio of health-care expenditure to per capita household income was greater than 0.05 in 4.6% of children. The adjusted odds ratio of children with difficulty in vision having a health-care expenditure share greater than 0.05 compared with children without difficulty was 4.78 (95% CI: 2.95, 7.73; p<0.001), and that for difficulty in the other five domains was 3.13 (95% CI: 2.04, 4.80; p<0.001). Among children with difficulty in at least one of the five domains other than vision, the proportion of children with a health-care expenditure share greater than 0.05 was higher among children from the poorer households (p=0.033).
Conclusions: Children with a disability spent more on health care relative to their income than those without. Visual disability was more prevalent among children from the richer households, whereas other disabilities were more prevalent among children from the poorer households.

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Objective: Multiple studies worldwide have supported the predictive validity of self-rated health (SRH) with regard to disability and mortality among elderly people. Although SRH is an important study topic providing clues to enhance a person’s quality of life, there is currently insufficient data on age- and gender-specific differences among factors associated with SRH in Japan, particularly in rural areas. The present study examined the factors associated with SRH of a segment of Japan’s rural population by age- and gender-specific analysis.
Methods: We used data from a cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The study subjects were 155 male and 169 female users from June 2009 to August 2010 who agreed to participate in this study. We divided the study subjects into 4 categories as follows: men aged less than 65, women aged less than 65, men aged 65 and over, and women aged 65 and over. The subjects who responded positively to the SRH-related questions were defined as the high SRH group, and those who responded negatively were defined as the low SRH group. We then compared the data between the high and the low groups in each category.
Results: In all four categories, there were statistically significant differences in regular hospital or clinic attendance between the high and low SRH groups. In all four categories, there were no significant differences in eating or exercise habits between the two SRH groups.
Conclusion: Because regular hospital or clinic attendance by a subject is indicative of the presence of chronic health problems, it is natural for the subject’s perception of their own health to be negative. However, rural physicians should provide patients with emotional and psychological support to deal with any health-related concerns positively.

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Objective: Paraquat poisoning occurs worldwide, and both the fatality rate and the number of deaths are out of the ordinary. Japan is one of the few countries in the world that have replaced 24% products with 5% products. This report is an attempt to introduce information about paraquat poisoning in Japan.
Methods: The Japanese Association of Rural Medicine has carried out extensive surveys on clinical cases of pesticide poisoning at its 122 member installations since 2007. Of all the findings, we have picked out and evaluated those concerned with paraquat poisoning.
Findings: Twenty-two out of 28 persons who attempted to commit suicide with paraquat died in 2007-2011. The rate of deaths from suicide attempts with paraquat stands at somewhere near 80% or so even with 5% products, so it appears that the attempts to reduce the death rate did not have the intended effect even with products having a lower concentration.
Conclusion: The “outcome prediction line” propounded in 1979 still stands today, while a wide variety of therapies have been studied. It seems that paraquat should at least be classified into Class Ib (highly hazardous) given that the mortality remains high and efficacious therapies remain elusive.

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Objective: The aim of this report was to discuss validity of pacemaker surgery for elderly individuals over 90 years old.
Patient: We operated on 12 individuals over 90 years old who had syncope or congestive heart failure in association with bradycardia, between January 2005 and November 2012.
Methods: All 12 patients were referred to us by the cardiology department of our hospital for pacemaker surgery. We applied our routine technique: cutdown of the cephalic vein, creation of a subpectoral pocket, use of screw-in leads, and use of generators with an automatic output control system.
Results: All of the patients received a dual chamber system with atrial and ventricular leads and recovered uneventfully. The follow-up period was between 1 month and 7 years.
Conclusion: An advanced age over 90 years old is not a contraindication for pacemaker surgery.

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