Trends of stomach cancer mortality in Eastern Asia in 1950-2004: comparative study of Japan, Hong Kong and Singapore using age, period and cohort analysis.

To characterize the temporal trends of stomach cancer mortality in Eastern Asia and to better interpret the causes of the trends, we performed age, period and cohort analysis (APC analysis) on the mortality rates in Japan, Hong Kong and Singapore during 1950-2004, as well as the rates in the US as a control population. For the APC analysis, Holford's approach was used to avoid the identification problem. Age-standardized mortality rates (ASMR) decreased consistently in all four areas during the observation period in both males and females. Japan had the highest ASMR in both sexes, followed by Singapore, Hong Kong and the US, but the differences in ASMR among the four areas diminished with time. The results of APC analysis suggested that the decreasing mortality rates in Eastern Asia were caused by the combination of decreasing cohort effect since the end of the 1800s and decreasing period effect from the 1950s. The US showed similar results, but its decreases in the period and cohort effect preceded those of Eastern Asia. Possible causes for the decrease in the cohort effect include improvement in the socioeconomic conditions during childhood and a decrease in the prevalence of H. pylori infection, while possible causes for the decrease in the period effect include a decrease in dietary salt intake and improvements in cancer detection and treatment. These findings may help us to predict future changes in the mortality rates of stomach cancer.

Legionella pneumophila in rainwater on roads.

During rain, transient puddles form on roads, and this water is splashed into the air by moving vehicles. To determine whether this water contains Legionella pneumophila, we collected samples from roads. We found that L. pneumophila are abundant in these puddles, especially during warm weather.

A patient with Legionnaires' disease transferred after a traffic accident.

Legionnaires' disease (LD) ranks among the three most common causes of severe pneumonia, but is often not specifically diagnosed. Among patients with LD, 40% to 50% of the patients develop neuromuscular signs and symptoms. A patient with LD transferred to our department after a traffic accident. When the patient arrived at our hospital, his respiratory rate was 27 breaths per min. His pulse was 148 beats per min and blood pressure was 116/57 mm Hg. Temperature was 39.6°C. He had copious watery diarrhoea and had been diagnosed as having acute gastroenteritis. The patient had urinary incontinence, gait disturbance, mild headache, fatigue and excessive decrease in spontaneous speech. A urinary antigen test for Legionella pneumophila turned out to be positive. LD commonly involves the neuromuscular system. Although this may be an atypical case of LD, it implies the need for awareness of LD.

Three Year Work Plan (2007--10) of the IUHPE Northern Part of the Western Pacific Region.

The article presents the work plan of the Vice President for the Northern Part of the Western Pacific Region of the IUHPE. The highlights of the plan include, firstly, the organization of the First Asia-Pacific Conference on Health Promotion and Health Education, which will take place in July 2009. Secondly, the plan proposes the establishment of a liaison office and an Internet journal to facilitate collaboration among individuals, groups and organizations working in health promotion and education in this culturally and linguistically diverse region.

Direct observation of conformational folding coupled with disulphide rearrangement by using a water-soluble selenoxide reagent--a case of oxidative regeneration of ribonuclease A under weakly basic conditions.

Oxidative regeneration pathways of bovine pancreatic ribonuclease A (RNase A), which has four SS linkages, were studied at 25 degrees C and pH 8.0 by using trans-3,4-dihydroxy-1-selenolane oxide (DHS(ox)), a new selenoxide reagent with strong oxidation power. The short-term folding study using a quench-flow instrument ( approximately 1 min) revealed that early intermediates (1S, 2S, 3S and 4S) are formed stochastically and irreversibly from the reduced protein (R) and do not have any stable structures. In the long-term folding study ( approximately 300 min), on the other hand, slow generation of the key intermediates (des[65-72] and des[40-95]) through SS rearrangement from the 3S intermediate ensemble was observed, followed by slight formation of native RNase A (N). The parallel UV and CD measurements demonstrated that formation of the key intermediates is accompanied with the formation of the native-like structures. Thus, DHS(ox) allowed facile identification of the conformational folding steps coupled with SS rearrangement on the major oxidative folding pathways.

[An introduction of the concept of social capital into health promotion activities].

Social factors, such as networks, institutions, trust, and social norms, are currently known as "Social Capital", the concept of which seeks to provide a basis for visualization and measurement of phenomena stemming from such factors. As a considerable amount of research has demonstrated that collective actions may be established with a greater degree of ease in communities with well-accumulated social factors, we can promote collective actions of Health Promotion activities through the concept of Social Capital and thereby establish more effective intervention. It is to be expected that theoretical research and operational experience using Social Capital may contribute to enhancing the effectiveness of Health Promotion activities, improving various health determinants through collective action.

[Changes in community health and welfare services with introduction of the long-term care insurance system in Japan].

OBJECTIVE: In Japan, a long-term care insurance system for elderly people was introduced in April, 2000. We have conducted a survey using a questionnaire in order to explore consequent changes in community health and welfare services. METHODS: We sent questionnaires to all municipal governments (671 cities, 1,991 towns, 567 villages and 23 wards) in Japan in November, 2001, and obtained replies from 441 cities (response rate: 65.7%), 800 towns (40.2%), 197 villages (34.9%), and 16 wards (69.6%). The questionnaire included questions concerning the budget and manpower for community health and welfare services, the state of the long term care insurance system, and the activities of public health nurses. RESULTS: A total of 57% of all municipal governments was found to be carrying out the long term care insurance program in collaboration with other governments. In order to clarify the changes in welfare services for elderly people from the budgetary viewpoint, we calculated the ratios of the 2000 and 2001 fiscal budgets applied for welfare services for elderly people, in comparison with the 1999 fiscal year. The budgets for elderly people declined to about 40% in 2000 and 2001 compared with 1999, since the budget for care services was transferred to the account of the long term care insurance system. The activities of public health nurses employed by municipal governments were not affected by the introduction of long term care insurance system. About 80% of all municipal governments suggested that both the amounts of care services received by each elderly people and the number of elderly people who received care services were increasing, and about 70% indicated that the quality of care services was improved with introduction of the long term care insurance system. DISCUSSION: Most municipal governments consider that introduction of the long term care insurance system has had a good influence on community health and welfare services. Moreover, our results suggest that the long term care insurance has a beneficial impact on care services themselves.

[Differences between primary health care and health promotion from the aspects of population, diseases, and social-political structures].

Primary Health Care (PHC) and Health Promotion (HP) have been adopted as core health strategies for socio-political interventions. Although the two have a lot of similarities in terms of concepts, they, nevertheless, have their differences. The first difference lies in the population and diseases perspectives that PHC and HP are literally defined as just "health care" and "promotion of health", respectively. The second difference, from a social and political point of view, is that PHC can be expressed as social and political efforts to make health knowledge, health care skills and the entire health service delivery system respond to the people's needs and situations, while HP is a process in which individuals and their environment are geared toward the pursuit of healthy lifestyles. These differences strengthen the unique values of each strategy. HP, which is a form of social mobilization for health, is about catering to the needs of developing countries. On the other hand, the principle of PHC, which is beneficiary-oriented, is universally applicable for both developed and developing countries.

[Utility of the public health approach for the world population strategy].

OBJECTIVE: The populations of developing countries have so dramatically increased over the past two centuries that it has tended to undermine sustained economic growth and development. The population growth rate in the Philippines, in particular, remains at 2.0%, one of the highest in the other southeastern Asian countries. This has exacerbated problems of economic disparity and deterioration in development so that the Philippine Government has declared it a political priority to address the population problem and for this purpose has asked the Japan International Cooperation Agency (JICA) for assistance. METHOD: Based on past experience with the world population issue, the International Conference on Population and Development in Cairo (ICPD) declared that the population strategy should be merged into socio-economic development strategies that aim to achieve basic human needs, such as, education, public health and gender equality. JICA assistance to improve maternal and child health status and promote community health initiatives in the Philippines is based on this new paradigm; the ICPD plan. OUTPUT AND CONCLUSION: JICA has supported a diverse range of public health activities, such as the establishment of a comprehensive maternal and child health care system, advocacy of reproductive health, performance of adolescence health education and assistance for participatory community action. The efforts were generally geared towards sustainable implementation of health activities in the community. The JICA project employed the public health approach that gained a global consensus at Cairo to challenge the problem of a continuously high rate of population growth.