Alcohol consumption and risk for hypertension in middle-aged Japanese men.

OBJECTIVE: To investigate the association of alcohol intake with development of hypertension. DESIGN: Longitudinal study (followed from 1990 to 1999). SETTING: Work site in Osaka, Japan. PARTICIPANTS: Japanese male office workers (n = 1,310) hypertension-free, with systolic blood pressure (SBP) less than 140 mmHg, diastolic blood pressure (DBP) less than 90 mmHg, no medication for hypertension, and no past history of hypertension, 30 to 59 years of age at study entry. MAIN OUTCOME MEASURE: Incidence of hypertension. RESULTS: After controlling for potential predictors of hypertension, the relative risk for hypertension (SBP 140 mmHg or greater and/or DBP 90 mmHg or greater or receipt of antihypertensive medication) compared with non-drinkers was 1.52 [95% confidence interval (CI), 1.05 to 2.19] for persons who drank 0.1 to 22.9 g/day of ethanol, 1.81 (95% CI, 1.29 to 2.54) for those who drank 23.0 to 45.9 g/day of ethanol, 2.12 (95% CI, 1.53 to 2.94) for those who drank 46.0 to 68.9 g/day of ethanol, and 2.48 (95% CI, 1.75 to 3.52) for those who drank > or = 69.0 g/day of ethanol (for trend, P < 0.001). The relative risk for hypertension in current drinkers versus non-drinkers was stronger among men with a body mass index (BMI) less than 24.2 kg/m2 than among men with a BMI 24.2 kg/m2 or more, although the absolute risk was greater in more obese men. CONCLUSIONS: The risk for hypertension increased in a dose-dependent manner as alcohol intake increased in middle-aged Japanese men. The increased relative risk for hypertension associated with alcohol was more pronounced in leaner men.

Risk factors for the development of hypertension: a 6-year longitudinal study of middle-aged Japanese men.

OBJECTIVE: To identify the factors related to the development of hypertension on the basis of annual health examinations at the workplace. SETTING: A cohort of Japanese male office workers who were reexamined for six successive years after their initial examinations in 1990. SUBJECTS: The study cohort comprised 1089 hypertension-free subjects aged 30-54 years. Six-year follow-ups were completed for 934 subjects (85.8%) RESULTS: An analysis using the Kaplan-Meier method showed that the incidence of hypertension above the borderline level increased significantly with increasing age, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol level, uric acid level, total protein level, hematocrit level, and alcohol intake. This increase was significant for systolic blood pressure, diastolic blood pressure, and hematocrit level. The highest cumulative incidences both of hypertension above the borderline level and of definite hypertension were observed among those with 85-89 mmHg diastolic blood pressure, and the second highest among those with 130-139 mmHg systolic blood pressure. Multivariate analysis using the Cox proportional hazards model indicated that age, systolic blood pressure, diastolic blood pressure, and alcohol intake were independent factors associated with the incidence of hypertension above the borderline level. Systolic blood pressure, diastolic blood pressure, and hematocrit level proved to be independently predictive of hypertension, and alcohol intake was of borderline significance as a risk factor for hypertension. CONCLUSION: High normal blood pressure is the strongest predictor for the development of hypertension among middle-aged Japanese men. In addition, high alcohol intake and high hematocrit level may be contributory factors.

Serologic, virologic, and histologic characteristics of chronic phase hepatitis C virus disease in children infected by transfusion.

OBJECTIVE: We studied the time course of hepatic dysfunction, seropositivity to hepatitis C virus (HCV) antibodies, viremia, and histologic evidence of hepatic injury to evaluate the course of HCV infection in children infected by blood transfusion. PATIENTS AND METHODS: Twenty-nine patients (ages 4 to 18 years) who underwent open-heart surgeries for congenital heart disease were grouped into three categories based on alterations in serum alanine aminotransferase (ALT) levels: Group A, acute infection; Group B, subacute infection; and Group C, chronic infection. RESULTS: In Group C, all 13 patients had detectable HCV RNA in serum. In contrast, all patients in Group A had no detectable HCV RNA: In Group B, one of nine patients had detectable HCV RNA and two of four patients examined had persistent chronic hepatitis by histologic criteria. Antibodies directed against C100-3 antigen or core-antigen were more useful than second-generation HCV antibody assays in determining the relationship between viremia and immunologic response. Infection with HCV genotype II and the presence of higher HCV RNA copy numbers were associated with histologic evidence of hepatic damage. CONCLUSION: An abnormal ALT value is frequently associated with viremia, and biochemically resolved acute infection reflects clearance of HCV. However, a normal ALT does not always reflect an absence of hepatocyte damage and HCV replication in patients with subacute disease. The measures outlined in this study are useful indicators of disease activity during the chronic

Scintigraphic monitoring of coronary artery occlusion due to Kawasaki disease.

Noninvasive monitoring of the process of coronary occlusion will probably aid in determining the timing of therapeutic interventions for Kawasaki disease. A pair study of coronary angiography and thallium scintigraphy after dipyridamole infusion-single-photon emission computed tomography with dipyridamole infusion (Dp-SPECT) was repeated at least twice at intervals of several years in 29 patients, and these findings were compared and analyzed in a chronologic manner. The current study demonstrated that angiographic stenosis was more severe, with an increase in the severity of the perfusion defect. Positive rates determined by Dp-SPECT increased with increasing severity of stenosis on angiography. Angiographic findings from the first to the second serial study that showed worsening, no change and improvement were correctly diagnosed from scintigraphic changes in 94% of coronary arterial lesions. About half of the arteries with progression in stenotic severity could be found before complete occlusion by scintigraphic monitoring. It is concluded that Dp-SPECT can be used as a noninvasive monitor of the occurrence and progression of coronary stenoses due to Kawasaki disease.

Relationships of site of infarction and history of previous infarction with short- and long-term prognosis after acute myocardial infarction in Japan.

We studied the outcome in 308 patients with acute myocardial infarction (MI) admitted to the coronary care unit of Kobe General Hospital. Short-term outcome (within 28 days after MI) and long-term outcome (more than 28 days) were examined with survival curves to find any relationship with a history of previous MI and with the site of the MI. In the short term, 38 of the 308 patients died of cardiac causes. The group with anterior MI tended to have higher mortality than the group of patients with inferior MI, and among patients without a previous MI, patients with anterior MI had significantly higher mortality (p = 0.01). In multivariate analysis by the logistic regression model, the site of the MI was found to be independently associated with the short-term outcome. In the long term, with a mean follow-up of 3.4 years, 23 of the 308 patients died of cardiac causes. Different sites of the MI did not result in different outcomes in patients with or without a previous MI. Of patients with anterior or inferior MI, those with a previous MI tended to have higher mortality, and of patients with an inferior MI, the difference was significant (p = 0.001). In multivariate analysis by the proportional hazards model, a history of MI was more predictive than the site of the MI. In conclusion, the site of the MI was associated more with the short-term outcome than with the long-term outcome, and a history of MI was associated more closely with the long-term outcome.

Risk factors for the incidence of hyperuricaemia: a 6-year longitudinal study of middle-aged Japanese men.

BACKGROUND: Few longitudinal studies on the determinants of increase in serum uric acid (SUA) have been completed. METHODS: In all, 1445 hyperuricaemia-free (<7.5 mg/dl SUA, no medication for and no past history of hyperuricaemia) male office workers aged 30-54 years of T Corporation in Osaka, Japan were re-examined for six successive years. Subjects who were found to be hyperuricaemic or had started medication for hyperuricaemia during repeat surveys were defined as incident cases. RESULTS: Among the subjects (n = 1365) not receiving medication for hypertension, diabetes mellitus or renal disease, multivariate analysis using the Cox proportional hazards model indicated that the incidence of hyperuricaemia had significant relationships with body mass index (adjusted hazard ratio [HR] = 1.13 for a 2 kg/m2 increase; 95% CI: 1.02-1.26), mean blood pressure (HR = 1.07 for a 5 mmHg increase; 95% CI: 1.00-1.13), log triglyceride level (HR = 2.21 for a 10 mg/dl increase; 95% CI: 1.12-4.37), alcohol intake (HR = 2.33 for drinking 46.0 g of ethanol per day or more relative to non-drinking; 95% CI: 1.55-3.50) and smoking (HR = 0.65 for current-smoking relative to non-smoking; 95% CI: 0.46-0.92). Age (HR = 0.89 for a 5-year increase; 95% CI: 0.78-1.00) and haemoglobin A1c (HbA1c) (HR = 0.89 for a 0.5% increase; 95% CI: 0.78-1.00) achieved marginal significance. CONCLUSIONS: Obesity, high blood pressure, high triglyceride level, and alcohol intake are contributory factors for the development of hyperuricaemia among middle-aged Japanese men. High HbA1c level and smoking may be negative factors for the incidence of hyperuricaemia.

Urinary and fecal incontinence in a community-residing older population in Japan.

OBJECTIVE: To estimate the prevalence and risk factors of urinary and fecal incontinence among a community-residing older population in Japan. DESIGN: Population-based cross-sectional study. SUBJECTS: A randomly selected sample of 1473 people aged 65 years and older living in the City of Settsu, Osaka, in 1992. MEASURES: Data collected via in-home visits were used to estimate the prevalence of urinary and fecal incontinence and to provide information regarding potential risk factors of urinary and fecal incontinence. RESULTS: Data were obtained from 1405 older adults, a response rate of 95.4%. The prevalence of any degree of urinary incontinence was 98/1000 in both sexes, and 87/ 1000 men and 66/1000 women admitted to some degree of fecal incontinence. Daily, 34/1000 and 20/1000 of the population were incontinent of urine and feces, respectively. There was an increasing prevalence of urinary and fecal incontinence with age in both sexes, but the expected greater prevalence in women was not found. By univariate analyses, age older than 75 years, poor general health as measured by Activities of Daily Living, stroke, dementia, no participation in social activities, and lack of life worth living (Ikigai) were associated significantly with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years, poor general health, and stroke were independent risk factors for any type of incontinence. Diabetes was an independent risk factor for isolated fecal incontinence, and dementia and no participation in social activities were independent risk factors for double incontinence. CONCLUSIONS: Incontinence of urine and feces is a prevalent condition among very old people living in the community in Japan and is associated highly with health and psychosocial conditions.

Relation between intellectual dysfunctioning and mortality in community-residing older people.

OBJECTIVE: To examine the relationship between intellectual dysfunctioning and mortality in a community-residing older population. DESIGN: Of the 1473 randomly selected people aged 65 years and older living in Settsu, Osaka Prefecture, in October 1992, 1405 were contacted. Data for assessment of intellectual dysfunctioning were obtained from 1383 people (98.4%), who constituted the study cohort. Follow-up for 42 months was completed for 1300 subjects (94.0%; 1117 living, 183 deceased). MEASURES: Data on general health status, history of health management, psychosocial conditions, and intellectual dysfunctioning were collected by means of interviews during home visits at the time of enrollment. Intellectual dysfunctioning was determined with the assessment instrument developed by the Social Survey Division of the Office of Population Censuses (OPCS) in Great Britain. RESULTS: The Kaplan-Meier analysis indicated that the estimated survival rates for men and women decreased with a decline in intellectual function in two age groups: 65 to 74 and 75 years and older. For both sexes, the log rank test showed that the curves among the four groups based on intellectual dysfunctioning (intact, mild, moderate, and severe) achieved statistical significance for the age group of 75 years and older. For both age groups and each of the levels of intellectual dysfunctioning, the estimated survival rate for men was lower than that for women. Application of the Cox proportional hazards model resulted in unadjusted hazard ratios of mild, moderate, and severe intellectual dysfunctioning for mortality of 1.68, 2.44, and 5.37, respectively. Multivariate analysis on the other hand, yielded adjusted hazard ratios of mild, moderate, and severe intellectual dysfunctioning of 1.19, 1.12, and 1.74, respectively, leaving severe dysfunctioning as the only statistically significant factor associated with mortality. Other factors such as sex, age, general health status, history of management, and psychosocial conditions were controlled. CONCLUSION: Intellectual dysfunctioning, as measured by an assessment instrument developed by OPCS, represents an increased risk factor for mortality among community-residing older people.

Predictors for development of hyperuricemia: an 8-year longitudinal study in middle-aged Japanese men.

To identify the factors responsible for increases in serum uric acid (SUA), a cohort of 1,312 hyperuricemia-free (SUA < 7.5 mg/dL and no medication for hyperuricemia or hypertension) male office workers aged 30 to 52 years were examined annually for 8 successive years. Subjects who were found to have become hyperuricemic (SUA > or = 7.5 mg/dL) or who started medication for hyperuricemia during repeat surveys were defined as incidence cases. The SUA trend was also examined in 1,062 subjects for whom 9 consecutive SUA values were available and who did not start medication for hyperuricemia or hypertension during the observation period. Multivariate analyses, excluding the baseline SUA level as a factor in the Cox proportional-hazards model, indicated that age (negative), body mass index (BMI), log triglyceride level, hemoglobin A(1c) (HbA(1c)) level (negative), white blood cell count, and alcohol intake at study entry were significantly associated with the incidence of hyperuricemia. In the model including the baseline SUA level, baseline SUA level was the strongest factor for the incidence of hyperuricemia, and BMI, white blood cell count, and alcohol intake at study entry remained as independent factors. From stepwise linear regression analyses for SUA slope, excluding the baseline SUA level as a factor, significant correlates with SUA slope were, in order of their relative importance, slopes of BMI, HbA(1c) (negative), blood urea nitrogen, log triglyceride level, total protein, and baseline levels of hematocrit (negative), white blood cells, and HbA(1c) (negative). In stepwise linear regression analyses, including the baseline SUA level as a factor, SUA level (negative) and alcohol intake at study entry emerged as significant factors for SUA slope. The cumulative percentage of variation for SUA slope was 25.6%. In conclusion, obesity, alcohol intake, and multimetabolic disorders were determined to be independent predictors for the development of hyperuricemia. In addition, the white blood cell level may be a contributory factor.

Paradoxical weight loss with extra energy expenditure at brown adipose tissue in adolescent patients with Duchenne muscular dystrophy.

We examined the energy expenditure in patients with Duchenne muscular dystrophy(DMD) to evaluate the cause of the paradoxical weight loss observed in large numbers of adolescent patients before any obvious impairment of their swallowing function. In the morning, resting energy expenditure (REE)/m(2) was almost the same as that in normal controls despite a reduction in fat-free mass (FFM); thus, REE/m(2)/FFM was significantly increased in patients (median, 21.2 kcal/m(2)/FFM kg; range, 17.7 to 44.2, P =.012). A thermographic examination in the morning showed an obvious elevation of the body surface temperature on the back. This phenomenon was consistent with a paradoxical fall in the low frequency (LF)/high frequency (HF) ratio at night analyzed using the inter-RR spectrum by 24-hour electrocardiogram, which indicated relative activation of the sympathetic nervous system. The urinary secretion of norepinephrine at night was also significantly greater in patients (median, 0.119 microg/kg/h; range, 0.061 to 0.219, P =.011). These results suggest that paradoxical activation of the sympathetic nervous system may accelerate the production of heat in brown adipose tissue (BAT) and increase the level of energy consumption in patients, and that adolescent DMD patients may require greater caloric intake than expected to maintain body weight, which is important to improve the prognosis of their respiratory function.

Altered kinetic properties of a mutant adenine phosphoribosyltransferase.

Three siblings in a Japanese family experienced recurrent 2,8-dihydroxyadenine urolithiasis despite the presence of adenine phosphoribosyltransferase (APRT) activities in the hemolysates (19.9% to 28.2% of normal value). However, studies on viable T cells from these patients indicated that APRT was not functional in viable cells. Further analysis of the partially purified enzymes from hemolysates disclosed that patient's APRT had a reduced affinity to 5-phosphoribosyl-1-pyrophosphate (PRPP). Seven healthy members of this family whose APRT functioned normally in viable T cells had the erythrocyte enzyme levels between the patients and normal individuals (38.2% to 65.6%), suggesting that they are carriers of the defective gene. These results indicate that the defective gene code a unique mutant APRT with a reduced affinity to PRPP, and the patients are homozygotes. The mutant enzyme was also shown to be more heat-stable than normal enzyme. However, since mutant enzyme, unlike normal enzyme, was insensitive to the stabilization effect of PRPP, the latter became more heat-stable than the former when the heat treatment was performed in the presence of PRPP. This type of defect with alterations in the kinetic and physical properties of APRT as described here is likely to be a common type of APRT deficiency in Japan.

Severe impairment in adenine metabolism with a partial deficiency of adenine phosphoribosyltransferase.

Among three unrelated patients with recurrent 2,8-dihydroxyadenine urolithiasis, two completely lacked adenine phosphoribosyltransferase (APRT) in both erythrocytes and proliferative T cells. The third patient possessed significant enzyme activities in both hemolysates and T-cell extracts at levels comparable to heterozygotes for complete APRT deficiency. Despite significant APRT activities in cell extracts, cultured T cells from the third patient were at least 100-fold more resistant than normal T cells to an adenine analog, 6-methylpurine, whose cytotoxicity is dependent on APRT. These data indicate that APRT activity in T cells from the third patient is positive in cell extracts, but apparently not operating in viable cells. Although the cells from the patients with complete APRT deficiency were as resistant to 6-methylpurine as the cells from the third patient, the cells from the heterozygotes for complete APRT deficiency were almost as sensitive as normal T cells. Therefore, adenine metabolism in the third patient but not in the heterozygotes seems to be as severely impaired as in the patients with complete APRT deficiency, which is quite consistent with the clinical manifestations in these individuals.

Mortality of frail elderly people living at home in relation to housing conditions.

STUDY OBJECTIVE: The study was undertaken to identify any relationship between the mortality of frail elderly people living at home and their housing conditions. DESIGN AND SETTING: A cohort of frail elderly people living in Yao City, Osaka Prefecture, Japan was followed for six years. Data on demographic variables, activities of daily living, the disease that was the main cause of the disability, medical treatment, the feasibility of continuing family care, and some housing conditions were collected in December 1983 by interview during home visits. Deaths were checked for each year for five years. SUBJECTS: Altogether 423 people aged 65 years or more living at home in Yao City who were disabled and housebound for at least three months were studied. MEASUREMENTS AND MAIN RESULTS: Life table analysis and multivariate logistic regression analysis were done. The cumulative survival rates of old people with good housing conditions were higher than those with poor housing conditions in each group stratified by age, sex, or the activities of daily living level. The odds ratio for poor housing conditions compared with good housing conditions for five year mortality remained highly significant after adjustment for potential confounding factors including age, sex, and the activities of daily living level by logistic regression analysis. CONCLUSIONS: The mortality of frail elderly people living at home is affected by housing conditions. Programmes to improve housing conditions of the disabled are important for home care of the elderly.

Effects of preventive health services on survival of the elderly living in a community in Osaka, Japan.

STUDY OBJECTIVE: To examine the relationships between the use of preventive health services--such as health checks, basic health examination/cancer screening, and daily preventive health practices--and survival of elderly people living in the community. DESIGN AND SETTING: A cohort of elderly people aged 65 years and over living in Settsu City, Osaka was followed for 38 months. Data on the history of health management, disability scores, and psychosocial conditions were collected in October 1992 by interview during home visits. SUBJECTS: Of the 1491 people randomly selected from the computerised sex-age register at enrollment, 1473 were contacted and responses were obtained from 1405 (95.4%). They constituted the study cohort. Follow up was completed for 1325 (94.3%) (154 decreased and 1171 alive). MEASUREMENTS AND MAIN RESULTS: From the analysis using the Kaplan-Meier method and the log-rank test, female sex, younger age group (65-74 years), use of health checks, use of basic health examination and/or cancer screening, use of daily preventive health practices, less disability, taking part in social activity, and finding life worth living were univariately statistically significantly related to survival. The estimated survival rates were highest in those with regular health checks or daily preventive health practices before 59 years of age or both basic health examination and cancer screening. From the Cox proportional hazards model, use of health checks and use of daily preventive health practices remained as statistically significant factors associated with survival, controlling for other factors such as sex, age group, medical treatment, disability scores, and psycho-social conditions, and these hazard ratios (not used v starting at 59 years) were 0.41 (95% CI, 0.25, 0.66) and 0.52 (95% CI, 0.30, 0.88), respectively. CONCLUSIONS: Health management efforts such as health checks and daily preventive health practices may increase survival in the elderly.

Long working hours and risk for hypertension in Japanese male white collar workers.

STUDY OBJECTIVE: To evaluate the association of long working hours with the risk for hypertension. DESIGN: A five year prospective cohort study. SETTING: Work site in Osaka, Japan. PARTICIPANTS: 941 hypertension free Japanese male white collar workers aged 35-54 years were prospectively examined by serial annual health examinations. Men in whom borderline hypertension and hypertension were found during repeated surveys were defined as incidental cases of borderline hypertension and hypertension. MAIN RESULTS: 336 and 88 men developed hypertension above the borderline level and definite hypertension during the 3940 and 4531 person years, respectively. After controlling for potential predictors of hypertension, the relative risk for hypertension above the borderline level, compared with those who worked < 8.0 hours per day, was 0.63 (95% confidence intervals (CI): 0.43, 0.91) for those who worked 10.0-10.9 hours per day and 0.48 (95% CI: 0.31, 0.74) for those who worked > or = 11.0 hours per day. The relative risk for definite hypertension, compared with those who worked < 8.0 hours per day, was 0.33 (95% CI: 0.11, 0.95) for those who worked > or = 11.0 hours per day. The multivariate adjusted slopes of diastolic blood pressure (DBP) and mean arterial blood pressure (MABP) during five years of follow up decreased as working hours per day increased. From the multiple regression analyses, working hours per day remained as an independent negative factor for the slopes of systolic blood pressure, DBP, and MABP. CONCLUSIONS: These results indicate that long working hours are negatively associated with the risk for hypertension in Japanese male white collar workers.

Do preventive health services reduce eventual demand for medical care?

The aim of this study was to find out whether there is any relation between the use of preventive health services provided for by municipalities under the Japanese Health Services for the Elderly Act and the demands for in-patient and out-patient care by insured residents aged 40 or older who were covered by the National Health Insurance, eligible for preventive health services under the act, in nine cities within the same catchment area in Osaka Prefecture. Main outcome measures were correlation coefficients between the use of in-patient and out-patient care, and (1) the rate of use of health check-ups, and (2) the cost for preventive health services per resident. Hospital admission rate per 1000 insured persons had a strong negative correlation with the rate of use of health check-ups. The rate of long stay, 180 days or more, per 1000 insured persons was also negatively correlated with the rate of use of health check-ups. There were negative correlations between the rate of use of health check-ups and both the in-patient cost per insured person, and the rate of high in-patient cost, 600,000 Yen or more, per 1000 insured persons. On the other hand, out-patient utilization rate per 1000 insured persons had a positive correlation with the rate of use of health check-ups. However, there was a negative relation between the rate of use of health check-ups and the out-patient cost per insured person because of negative associations between the rate of use of health check-ups and the out-patient days, and cost per case. The rate of high out-patient cost, 60,000 Yen or more, was negatively correlated with out-patient utilization rate per 1000 insured persons. Negative relations were also shown between the cost for preventive health services per resident and the in-patient and out-patient cost per case and per insured person, except out-patient utilization rate per 1000 insured persons. The correlation coefficient between the cost for preventive health services per resident and the total medical cost per insured person was r = -0.779 (P = 0.007). Provision of preventive health services under the Health Services for the Elderly Act may possibly improve health management in the early stage of diseases by detecting abnormalities in health, and that investing in prevention might contribute to reducing the subsequent total demand for medical care.

Percentage of elderly and the use of welfare services at city welfare offices in Japan.

Japan's population is aging rapidly. As in other developed countries, the establishment of a system of care for the elderly, especially for those suffering from dementia, has become an urgent issue. As the role of welfare offices, which is to directly serve the people, has become increasingly important, the need to assess their use in terms of demographic factors has risen. With respect to demographic factors, this study analyses the use of the welfare services by the demented elderly at city welfare offices in Japan from 1987 to 1989. In December 1991, questionnaires were mailed to 670 city welfare offices nationwide, excluding those located in designated large cities and special wards in Tokyo. Four-hundred and thirty-seven (65.2%) of the offices responded. Offices located in areas with a relatively high percentage of elderly reported giving fewer counselling sessions and reported fewer people registered for or utilizing domiciliary welfare services than offices in areas with a relatively low percentage of elderly. The differences between the two areas in the total amount of counselling, counselling cases at the welfare office, and respite-care for 1989 and day-care service registration were significant. The Pearson's correlation coefficients for the percentage of elderly and these activities all showed negative values, except for home-help utilization in 1987 and 1989. Welfare offices in which the number of activities increased significantly over the 3 years examined in this study were more common in the areas where a committee for communication between medical and welfare sectors (hereinafter "liaison-committee") existed. Discriminant analysis suggests a correlation between the existence of a liaison-committee and the following variables: the percentage of the elderly living alone, the number of home-helpers per elderly, the capacity of day-care service per elderly and the number of surgeries per elderly. From the results, it is apparent that the welfare offices in areas with a high elderly percentage tended to have less activity. Today, municipalities with a high percentage of elderly in its population are particularly required to draw up plans for their health and welfare. The establishment of a network like a liaison-committee will enable the municipalities to achieve their goals.

Effect of early fosfomycin treatment on prevention of hemolytic uremic syndrome accompanying Escherichia coli O157:H7 infection.

OBJECTIVE: To clarify the effect of early fosfomycin treatment, an antimicrobial agent in common use in Japan, on children with E. coli O157 with the aim of preventing hemolytic uremic syndrome (HUS). DESIGN: Non-randomized prospective study for development of HUS among inpatients with E. coli O157. SETTING: The hospitals where the 292 inpatients were treated. CASES: A total of 292 inpatients aged six to eleven years with E. coli O157 infection, 36 (12.3%) of whom were HUS cases. RESULTS: Most of the HUS inpatients (91.7%) developed this complication between the sixth and ninth day of illness. We therefore analyzed the effects of antimicrobial therapy, especially that of fosfomycin, on prevention of HUS within the first five days of illness, because fosfomycin was the most frequently used (88.0%). To clarify the effect of fosfomycin alone on prevention of HUS, we carried out an analysis using the data for 130 inpatients who received fosfomycin alone or did not receive any antimicrobial agents, within the first five days of illness. multivariate analysis, controlled for age, gender and presence of fever, showed that all adjusted odds ratios for the development of HUS with the use of fosfomycin within the first three days of illness were less than 1.0, with the use of fosfomycin on the second day of illness achieving statistical significance (adjusted OR, 0.09; 95% CI, 0.01-0.79). Furthermore, inpatients who took fosfomycin within the first two days of illness developed HUS significantly less often than those who did not (adjusted OR, 0.15; 95% CI, 0.03-0.78). On the other hand, fosfomycin therapy on and after the third day of illness was not associated with the prevention of HUS. CONCLUSION: The early use of fosfomycin within the first two days of illness might prevent the development of HUS.

Cigarette smoking and risk for hearing impairment: a longitudinal study in Japanese male office workers.

The association of cigarette smoking with development of hearing impairment (loss of 30 dB at 1000 Hz and 40 dB at 4000 Hz) over a 5-year follow-up was studied in 1554 non-hearing-impaired Japanese male office workers who ranged in age from 30 to 59 years. After controlling for potential predictors of hearing impairment, the relative risk for low-frequency hearing impairment compared with never smokers was 1.12 (95% confidence interval [CI], 0.57 to 2.17) for ever-smokers, 1.21 (95% CI, 0.65 to 2.25) for current smokers of 1 to 20 cigarettes/day, 1.35 (95% CI, 0.70 to 2.61) for current smokers of 21 to 30 cigarettes/day, and 1.82 (95% CI, 0.98 to 3.38) for current smokers of 31 or more cigarettes/day (P for trend = 0.063). The respective multivariate-adjusted relative risks for high-frequency hearing impairment compared with never smokers were 1.70 (95% CI, 0.85 to 3.40), 1.82 (95% CI, 0.92 to 3.59), 2.00 (95% CI, 0.98 to 4.08), and 2.20 (95% CI, 1.09 to 4.42) (P for trend = 0.025). As the number of pack-years of exposure increased, the risk for high-frequency hearing impairment increased in a dose-dependent manner (P for trend = 0.011), but the risk for low-frequency hearing impairment did not (P for trend = 0.172). Our results indicate that cigarette smoking is highly associated with development of high-frequency hearing impairment in Japanese male office workers.

Associations between self-assessed masticatory disability and health of community-residing elderly people.

OBJECTIVE: To examine the relationship between the self-assessed masticatory disability and the health of community-residing older people. METHODS: Of 1473 randomly selected people aged 65 years and older living in Settsu, Osaka Prefecture, in October 1992, data on general health status, history of health management, psychosocial conditions, and dental conditions were obtained from 1405 people by interviews made during home visits. Follow-up for 54 months was completed for 1306 subjects (93.0%; 1072 living, 234 deceased). RESULTS: Being over 75 years of age, having poor general health and poor dental status, not using dental health checks, not using general health checks, not participating in social activities, not feeling that life is worth living (no "ikigai"), and feeling anxious about the future were univariately and significantly associated with self-assessed masticatory disability. Logistic regression analyses indicated that being older than 75 years, having poor general health and poor dental status, not using dental health checks, and not participating in social activities were independently associated with self-assessed masticatory disability. The Cox proportional hazards model showed that being male, over 75 years of age, and in poor general health, as well as not using general health checks, and not participating in social activities were independently associated with mortality. Self-assessed masticatory disability was univariately and significantly related to mortality, but by itself was not a significant risk factor for mortality, because of the potential influence of other variables. CONCLUSIONS: Certain health and psychosocial factors are closely associated with self-assessed masticatory disability among older people. Further investigations are needed to determine whether masticatory disability is a significant risk factor for mortality.