Breakfast consumption frequency is associated with grip strength in a population of healthy Japanese adults.

BACKGROUND AND AIMS: Several studies have reported that regular consumption of breakfast is associated with health benefits. However, only a few studies have examined the association between frequency of breakfast consumption and muscular function. Therefore, this study aims to investigate the association between frequency of breakfast consumption and muscle strength among apparently healthy Japanese adults. METHODS AND RESULTS: A cross-sectional study design was used. Between 2008 and 2011 in Sendai, Japan, 1415 Japanese adult employees (1069 men and 346 women) aged between 19 and 83 years participated in the study. Grip strength, as measured by a handheld digital dynamometer, was used as an indicator of muscle strength. Frequency of breakfast consumption during the previous month was assessed using a brief self-administered dietary history questionnaire, and the results were divided into three categories for analysis: low (≤2 days week⁻¹), middle (3-5 days week⁻¹) and high (≥6 days week⁻¹). Multivariate analysis was performed using analysis of covariance, with covariates mainly including socio-demographic, lifestyle-related and health-related factors. After adjusting for several potential confounders, grip strength was shown to be positively associated with breakfast consumption frequency (geometric means, 95% confidence interval (CI): low frequency, 36.2 (35.7-36.8) kg; middle frequency, 36.7 (36.0-37.5) kg; high frequency, 37.0 (36.6-37.5) kg; P for trend = 0.03). Grip strength per kilogramme body weight (kg kg⁻¹) was also positively associated with frequency of breakfast consumption (P for trend = 0.01). CONCLUSIONS: This cross-sectional study reveals a positive association between breakfast consumption frequency and muscle strength in apparently healthy adults.

Skin advanced glycation end-product accumulation is negatively associated with calcaneal osteo-sono assessment index among non-diabetic adult Japanese men.

UNLABELLED: This study aims to determine the relationship between advanced glycation end-product (AGE) accumulation in skin tissue and bone strength, assessed by quantitative ultrasound, among healthy adult Japanese men. The results of the study suggest that men with higher AGE accumulation in skin tissue have a lower osteo-sono assessment index. INTRODUCTION: AGE accumulate in bone collagen with age and diabetes and decrease the mechanical properties of bone. Although increased AGE levels are associated with fractures among diabetic patients and elderly women, it is unclear whether a relationship between increased AGE levels and bone strength is present in apparently healthy adult males. The aim of this study was to determine the relationship between AGE accumulation in tissue and the mechanical properties of bone among adult Japanese men, using quantitative ultrasound as a surrogate measure of the latter. METHODS: Skin autofluorescence (AF), which is a noninvasive method for measuring tissue AGEs, and osteo-sono assessment index (OSI), which is determined by quantitative ultrasound, were measured in 193 adult Japanese men (median age 43 years; interquartile range 37.0-55.0 years). RESULTS: Adjusted for age, BMI, calcium intake, physical activity, smoking status, and education level, log-transformed skin AF had a negative association with log-transformed OSI (ß = -0.218, P < 0.01). Adjusted geometric means (95% CI) for OSI across the tertiles of skin AF were 2.81 (2.75-2.87) for the lowest tertile, 2.81 (2.74-2.87) for the middle tertile, and 2.66 (2.61-2.73) for the highest tertile; thus, OSI for the highest skin AF appeared to be 5.0% lower than that for the lowest and middle skin AF tertiles (P < 0.01). CONCLUSION: Among apparently healthy adult Japanese men, those with higher skin AF had a lower OSI, indicating a relationship between AGE accumulation and bone strength. A long-term prospective study is required to clarify the causality.

Quantification of relationship between health status and physical fitness in middle-aged and elderly males and females.

AIM: The purpose of this study was to quantify the degree of the relationship between health status and physical fitness level in middle-aged and elderly people using multiple discriminant analysis. METHODS: The participants were 3114 males and females aged 30 to 69 years. Ten physical fitness tests and medical checkups were performed. The participants were divided into 2 groups according to health status; the healthy group and the unhealthy group. Multiple discriminant analysis was applied to the multivariate data. RESULTS: Correct discriminant probabilities of multiple discriminant functions to discriminate the healthy group and unhealthy group were 72.3% for males and 71.7% for females. For all age groups, a gender difference was not found (P>0.05). For aging, as a result of the test of proportion, it was found that the correct discriminant probabilities decreased with age for both genders (P<0.05). CONCLUSIONS: These results suggest that there is a relatively strong relationship between health status and the level of physical fitness in both males and females. These findings support daily physical activities and exercise to maintain or improve physical fitness could be useful for the health status of middle-aged and elderly people. From the result that the correct discriminant probability decreased with age, the changes in probability for males and females were calculated and described with correct discriminant probabilities by moving averages with 5 point smoothing.

Assessment of myocardial viability using coronary zero flow pressure after successful angioplasty in patients with acute anterior myocardial infarction.

OBJECTIVES: To investigate the relation between coronary flow reserve (CFR), coronary zero flow pressure (Pzf), and residual myocardial viability in patients with acute myocardial infarction. DESIGNS: Prospective study. SETTING: Primary care hospital. PATIENTS: 27 consecutive patients with acute anterior myocardial infarction. MAIN OUTCOME MEASURES: F-fluorodeoxyglucose (FDG) positron emission tomography (PET) was used in 27 patients who underwent successful intervention within 12 hours of onset of a first acute anterior myocardial infarction. Within three days before discharge they had < 25% stenosis in the culprit lesion as determined by angiography 24 (3) days after acute myocardial infarction. Pzf and the slope index of the flow-pressure relation (SIFP) were calculated from the simultaneously recorded aortic pressure and coronary flow velocity signals at peak hyperaemia.%FDG was quantified by comparing FDG uptake in the infarct myocardium with FDG uptake in the normal myocardium. RESULTS: There was a correlation between %FDG and CFR, where y = -1.477x + 62.517, r = -0.072 (NS). There was also a correlation between %FDG and SIFP, where y = -0.975x + 60.542, r = -0.045 (NS), and a significant correlation between %FDG and Pzf, where y = -0.98x + 85.108, r = -0.696 (p < 0.001). CONCLUSIONS: CFR does not correlate with FDG-PET at the time of postreperfusion evaluation of residual myocardial viability. The parameter that correlates best with residual myocardial viability is Pzf and this may be a useful index for predicting patient prognosis.

[Cost and effectiveness of exercise therapy for patients with essential hypertension].

PURPOSE: While exercise therapy is established as an appropriate treatment for essential hypertension, its economic profile has not been fully evaluated. The purpose of this study is to evaluate cost and effectiveness in comparison with drug therapy. SUBJECTS AND METHODS: The study subjects were hypertensive patients under treatment at an outpatient clinic. Fifty-seven were selected on a non-randomized manner for exercise therapy and the same number of patients was chosen for drug therapy after matching age, sex, medication and complications. The following data were collected during three months of intervention. 1) Effectiveness: Change of systolic blood pressure before and after the intervention. 2) Cost: equipment, personnel expenses for exercise therapy and fees for health check-ups (exercise therapy); fees for consultation, laboratory examination and medications (drug therapy), 3) Cost-effectiveness: cost per 1 mmHg systolic blood pressure reduction. We evaluated the variance of cost-effectiveness by controlling the number of program participants, personnel expenses, and equipment expenses of exercise therapy. We also simulated how the cost-effectiveness of exercise therapy would improve by modifying the number of exercise participants, personnel and equipment expenses. RESULTS: The cost-effectiveness per 1 mmHg systolic blood pressure reduction was yen 11,268 for exercise therapy and yen 2,441 for drug therapy. Extending program facilities and increasing the number of participants would improve the cost-effectiveness of exercise therapy, but there were limitations to how far this could be achieved in the hospital setting. CONCLUSION: Differences in cost-effectiveness between exercise and drug therapies are attributed to differences in personnel expenses. Although they could be reduced by managerial effort of the hospital to some extent, outsourcing of exercise therapy to community-based facilities should be considered.

Telepsychiatry: assessment of televideo psychiatric interview reliability with present- and next-generation internet infrastructures.

OBJECTIVE: We assessed the reliability of remote video psychiatric interviews conducted via the internet using narrow and broad bandwidths. METHOD: Televideo psychiatric interviews conducted with 42 in-patients with chronic schizophrenia using two bandwidths (narrow, 128 kilobits/s; broad, 2 megabits/s) were assessed in terms of agreement with face-to-face interviews in a test-retest fashion. As a control, agreement was assessed between face-to-face interviews. Psychiatric symptoms were rated using the Oxford version of the Brief Psychiatric Rating Scale (BPRS), and agreement between interviews was estimated as the intraclass correlation coefficient (ICC). RESULTS: The ICC was significantly lower in the narrow bandwidth than in the broad bandwidth and the control for both positive symptoms score and total score. CONCLUSION: While reliability of televideo psychiatric interviews is insufficient using the present narrow-band internet infrastructure, the next generation of infrastructure (broad-band) may permit reliable diagnostic interviews.

Issues of intervention aimed at preventing prospective surplus of physicians in Japan.

OBJECTIVES: In Japan, regulatory intervention aimed at preventing a prospective surplus of physicians is an important medical issue. The study committees organized by the Ministry of Health and Welfare (MHW) in 1986, 1993 and 1998, concluded that the number of physicians would exceed demand for their services in the future. As a result, the government planned to reduce the number of medical students. However, MHW has not been successful in the intervention so far, as shown by the fact that their initial plan for a 10% reduction in the number of students enrolled in medical school has not been attained. In this paper, we examine why the MHW policy failed. METHODS: We reviewed those forecasts performed by past MHW study committees and examined whether the government policy of controlling physician training was appropriate. Additionally, we did a preliminary projection of specialty-specific demand for physician services as a reference for future physician manpower policies in Japan. RESULTS: We found that both conflicts among various interest groups and a lack of precise projections of physician services hampered the proper formation and implementation of a physician manpower policy in Japan. CONCLUSIONS: It might be necessary to examine the appropriateness of the MHW policy in reducing the overall number of students enrolled in medical schools. As a first step in formulating and implementing a physician manpower policy, we should begin to consolidate the necessary data to conduct precise and proper projections of future physician demand.

Ventricular arrhythmias with left bundle branch block pattern and inferior axis: assessment of their mechanisms on the basis of response to ATP, nicorandil and verapamil.

The present study investigated the mechanism of ventricular arrhythmias showing left bundle branch block (LBBB) pattern with an inferior axis. The effects of 3 drugs, adenosine triphosphate (ATP), nicorandil and verapamil, were evaluated in 17 patients. ATP suppressed the arrhythmias in 14 patients and nicorandil suppressed them in 8 of those 14. Verapamil suppressed 5 of the 6 ATP-nicorandil-sensitive arrhythmias. Four patients with ATP- or nicorandil-sensitive arrhythmias were not sensitive to verapamil. On the other hand, 3 of the ATP-insensitive arrhythmias were sensitive to neither nicorandil nor verapamil. The QT intervals and QTc were shortened by nicorandil in 5 of the 6 patients who were sensitive to all 3 drugs. One mechanism of suppression by nicorandil could be related to less Ca++ entering the myocardium, which would decrease the duration of the action potential as indicated by the shortened QT intervals. The results suggest that the mechanism of some ventricular arrhythmias is related to triggered activity. Arrhythmias that are sensitive to ATP or nicorandil, but not to verapamil, may be caused by abnormal automaticity. On the other hand, arrhythmias that are insensitive to all 3 drugs might be related to reentry. The features of ventricular arrhythmias with LBBB pattern and inferior axis differ and therefore the causative mechanisms are not the same.

Functional transitions in instrumental activities of daily living among older Japanese.

We observed functional transitions in instrumental activities of daily living (IADL) over one year among older Japanese and examined factors influencing the deterioration of each IADL. The sources of the study were the first and second panel studies of the Saku Longitudinal Study on Aging, which were done in 1988 and 1989. The study subjects were those participants aged 70 or older. Five IADL items--using public transportation, shopping for daily necessities, preparing meals, paying bills, and managing deposits--were measured in each survey. Deterioration of each IADL item was examined in relation to demographic characteristics such as age, sex, occupational status, living arrangements, and educational status. Of the effective baseline cohort (n = 5,559), 4,892 responded in the second survey (response rate 88%). Over 80% of the respondents who were initially independent in each IADL item remained independent in the second survey. Multiple logistic regression analyses revealed that greater age, having no occupation, and living with children at the baseline were associated with deterioration in each item of IADL. Lower educational status was associated with deterioration in each item of IADL except preparing meals. This study indicates that being engaged in work, living separately from children, and having higher educational status are strongly correlated with remaining independent in IADL for older people aged 70 or older.

ELISA for urinary trehalase with monoclonal antibodies: a technique for assessment of renal tubular damage.

BACKGROUND: alpha,alpha-Trehalase, located on renal proximal tubules, is a glycoprotein that hydrolyses alpha,alpha-trehalose to two glucose molecules. Urinary trehalase reflects damage to renal proximal tubules, but its activity has not been measured routinely because measurement of catalytic activity is rather complicated and because conventional assays for enzyme activity might not reflect all of the trehalase protein because of enzyme inactivation in urinary samples. METHODS: We established novel monoclonal antibodies for human trehalase and a sandwich ELISA for quantification of urinary trehalase. We determined the urinary trehalase protein concentration with this ELISA and trehalase catalytic activity, and the results of these two methods were compared. RESULTS: The ELISA system was more sensitive than the detection of enzyme activity and could detect a subtle difference in the amount of trehalase present in renal diseases. The within- and between-assay CVs in the ELISA were 6.7-7.6% and 6.2-8.2%, respectively. Highly significant increases in both the quantity and activity were seen in patients with nephrotic syndrome (acute phase), Lowe syndrome, and Dent disease. The quantities were 70- to 200-fold greater, whereas enzyme activities were, at most, 10-fold higher than those of control subjects. In the detection of small amounts of trehalase in patients with chronic glomerulonephritis and renal anomalies, quantities were better than enzyme activities. CONCLUSIONS: We have established an ELISA system for quantification of urinary trehalase that uses novel monoclonal antibodies. Our ELISA system is simpler and more sensitive than a conventional activity assay and reflects trehalase protein. This ELISA can be a useful as a common tool for clinical assessment of renal proximal tubular damage.

Cost analysis between stent and conventional balloon angioplasty.

The present study evaluated the cost of coronary stenting compared with conventional balloon angioplasty in Japan. Procedural cost was estimated as the sum of the procedural fee and the cost of devices such as angioplasty balloon and stent. The data such as the number of balloon catheters and stents used, and the rate of crossovers that was shown by the Stent Restenosis Study (STRESS) were applied to calculate the costs of stenting and conventional balloon angioplasty. For the estimation of hospital room and nursing costs, the length of the in-hospital stay was estimated at 7 days. The costs of procedures such as laboratory and radiological tests were determined based on routine coronary intervention at Chiba University Hospital. The rates of target lesion revascularization in the STRESS trial (conventional balloon angioplasty: 21%, stenting: 15%) were used to calculate the cost during follow up. The in-hospital costs of conventional balloon angioplasty and stenting were estimated to be Yens 982,300 and Yens 1,416,893, respectively. The overall costs, including follow-up cost, of conventional balloon angioplasty and stenting were estimated to be Yens 1,188,583 and Yens 1,564,238, respectively. The in-hospital cost of stenting is higher compared with conventional balloon angioplasty because of greater balloon use and direct stent cost. Lower target lesion revascularization reduces the cost difference between conventional balloon angioplasty and stenting, but the higher initial cost of stenting is not fully offset.

Effects of adenosine triphosphate on ventriculoatrial conduction--usefulness and problems in assessment of catheter ablation of accessory pathways.

The effects of adenosine triphosphate (ATP) on ventriculoatrial (VA) conduction were examined before and after accessory pathway (AP) ablation, with emphasis on assessment of the complication of dual atrioventricular (AV) node pathway. By evaluating the differences in the response to ATP of APs and other pathways, we assessed the usefulness and problems of this method. Of 59 patients who underwent AP ablation, 31 showed pre-excitation and 28 had concealed APs. A dual AV node pathway was found in 9 patients (15.3%) before ablation. After ablation, a dual AV node pathway was newly found in 9 patients. Thus, the total number of patients with a dual AV node pathway was 18 (30.5%). VA conduction over APs was not blocked in 26 of 29 patients, but the remaining 3 APs were blocked transiently by ATP. ATP caused VA block over the AV node in 15 of 16 patients and a dual AV node pathway in all 11 patients. In contrast, VA conduction over the retrograde fast pathway was blocked in 9 of 14 patients with AV node re-entrant tachycardia. ATP has little effect on APs, so observation of the response to ATP provides a more reliable and useful means of evaluating successful ablation. With this method, however, it is important to consider the possibility of the presence of ATP-sensitive APs and ATP-resistant retrograde fast pathways. The influence of ablation-induced injury has not been fully clarified. It is therefore essential to take into account various data, including the comparison between data obtained before and after ablation.

[A drug revolving fund program for rural villages in the Philippines].

In 1994, a community-based drug revolving fund program was introduced in 10 pilot villages in the province of Tarlac, Philippines, as a component of a health project by the provincial health office and Japan International Cooperation Agency (JICA). The purpose of the program was to set up a cooperative drug store in each community in order to regularly provide rural residents with essential drugs at affordable prices. The following are the results and findings during the first two years of operation. 1. Collaboration with a local NGO facilitated implementation and management of the program, when socio-cultural consideration was necessary. Stable and prompt procurement of drugs was secured on a contract with a commercial wholesaler in Manila. 2. Out of the 105 kinds of pharmaceuticals that were sold both in the cooperative and commercial drug stores, 83% were less expensive than the average market price, and 51% were discounted more than 25% of the market price. 3. The levy of premiums was introduced to increase the cooperative fund with the consent of each community. The amount was 0.1-0.2% of the average family income. However, regular collection of premiums was difficult due to various reasons. The practice of the sales on credit was common in all pilot villages. 4. While the knowledge of community health workers, who were in charge drug sales, was improved after training sessions on rational drug use, it was not at a sufficient level yet. 5. When assisting a community-oriented health program, an exterior organization should try to encourage the community to generate its own solutions to operational difficulties, based on the socio-cultural context in the community.

[Preoperative assessment of aortic dissection by three-dimensional CT angiography].

In 21 patients with aortic dissection including 12 patients with acute aortic dissection, aortic lesions were evaluated preoperatively by newly developed three-dimensional CT angiography (3 D-CTA) using helical scan CT. Rapid and safe three-dimensional evaluation of aortic dissection was achieved with no complications. Three-dimensional structure of aortic dissection was well reflected in the image of 3D-CTA. Preoperative three-dimensional evaluation was useful to determine and proceed the operative procedure for the repair of aortic dissection. All patients were alive and results of surgical treatments were excellent. Intimal flaps and entries were visualized by multiple threshold display (MTD) method of 3D-CTA. Multiple threshold display method is an important three-dimensional reconstructive method and 3D-CTA may be a new useful and powerful diagnostic modality for aortic dissection.

Assessment of aortic disease using three-dimensional CT angiography.

The recently developed technique of three-dimensional CT angiography (3D-CTA) was applied to 68 patients with aortic disease. These patients were examined using a unique method of data collection: a helical scanner with continuous tube rotation and continuous table feed. The scanner was used in conjunction with administration of dynamic intravenous contrast material to enhance the vascular image. The group of patients included 35 with aortic dissection, 19 with true thoracic aneurysms, and 14 with abdominal aortic aneurysms. Three-dimensional evaluation was achieved in all patients with no complications. Surgical intervention was used in 45 patients with aortic dissections and aortic aneurysms, and 44 of these patients (98%) survived and were discharged. Preoperative 3D-CTA findings were quite similar to intraoperative findings, and were useful in determining operative procedures. Rapid and accurate assessment of aortic disease was achieved by 3D-CTA. Three-dimensional CT angiography can play an important role in the preoperative assessment of aortic dissections and aortic aneurysms leading to successful surgical treatment.