Evaluating measles surveillance: comparison of sentinel surveillance, mandatory notification, and data from health insurance claims.

Inadequate notification is a recognized problem of measles surveillance systems in many countries, and it should be monitored using multiple data sources. We compared data from three different surveillance sources in 2007: (1) the sentinel surveillance system mandated by the Act on Prevention of Infectious Diseases and Medical Care for Patients Suffering Infectious Diseases, (2) the mandatory notification system run by the Aichi prefectural government, and (3) health insurance claims (HICs) submitted to corporate health insurance societies. For each dataset, we examined the number of measles cases by month, within multiple age groups, and in two categories of diagnostic test groups. We found that the sentinel surveillance system underestimated the number of adult measles cases. We also found that HIC data, rather than mandatory notification data, were more likely to come from individuals who had undergone laboratory tests to confirm their measles diagnosis. Thus, HIC data may provide a supplementary and readily available measles surveillance data source.

Coffee consumption but not green tea consumption is associated with adiponectin levels in Japanese males.

PURPOSE: Coffee is among the most widely consumed beverages in the world. Numerous epidemiological studies have reported a significant inverse association between coffee consumption and risk of type 2 diabetes mellitus, but the underlying mechanisms are still not fully understood. Therefore, we conducted an epidemiological study to clarify the relationship between coffee consumption and adiponectin levels in Japanese males. We also evaluated whether green tea consumption affected adiponectin levels. METHODS: We carried out a cross-sectional study. The subjects were 665 male employees in Japan. Coffee consumption was assessed, using a self-administered questionnaire, as the number of times per week and cups per day respondents drank, and subjects were grouped into four levels (non, 1-5 times/week, 1-2 cups/day and ≥3 cups/day). RESULTS: The means of adiponectin levels were positively associated with coffee consumption. A dose-response relationship was found between coffee consumption and circulating adiponectin levels. The relationship remained significant after adjustment for potential confounding factors (P for trend <0.05). However, green tea consumption was not significantly associated with adiponectin levels (P for trend = 0.90). CONCLUSIONS: We not only revealed that habitual coffee consumption is associated with higher adiponectin levels in Japanese males but also found a dose-dependent association between coffee consumption and adiponectin levels. Therefore, our study suggested that coffee components might play an important role in the elevation of adiponectin level.

Is heat shock protein 60 associated with type 2 diabetes mellitus?

AIMS: HSP60 plays a protective role against heat, oxidative injury and ultraviolet. Recently, animal and clinical studies have suggested that HSP60 plays a role in various diseases. However, few epidemiological studies have demonstrated an association between HSP60 levels and type 2 diabetes mellitus. Therefore, an epidemiological study was conducted to examine the association of HSP60 with type 2 diabetes mellitus. METHODS: This study included 83 type 2 diabetes mellitus patients and 161 controls that were recruited from male employees who received annual health check-ups between 2005 and 2007. The serum HSP60 levels were measured using the ELISA method. RESULTS: Because the HSP60 levels were not detectable (<3.125 ng/mL) in 48.0% of the study subjects, HSP60 levels were divided into two categories (detectable or undetectable). A logistic regression analysis showed that the subjects in the undetectable had a 2.03 times higher risk of diabetes mellitus than those in the detectable after adjustment for age, BMI and rate of hypertension medication. CONCLUSIONS: This study was the first epidemiological study to demonstrate an association between type 2 diabetes mellitus and HSP60, thus suggesting that HSP60 may play an important role in the type 2 diabetes mellitus pathology.

Infectious waste management in Japan: a revised regulation and a management process in medical institutions.

In Japan, the waste management practice is carried out in accordance with the Waste Disposal Law of 1970. The first rule of infectious waste management was regulated in 1992, and infectious wastes are defined as the waste materials generated in medical institutions as a result of medical care or research which contain pathogens that have the potential to transmit infectious diseases. Revised criteria for infectious waste management were promulgated by the Ministry of Environment in 2004. Infectious waste materials are divided into three categories: the form of waste; the place of waste generation; the kind of infectious diseases. A reduction of infectious waste is expected. We introduce a summary of the revised regulation of infectious waste management in this article.

Japanese alcoholic beverage and all cause mortality in Japanese adult men.

This article examines whether an association is found between quantity of alcohol consumed and all cause mortality, and a relation is detected between types of alcoholic beverage and all cause mortality in Japanese male adults. A cohort study was performed in three towns located in two former coal mine areas and a rural area in Fukuoka. A mail survey was carried out between 1988 and 1990, and was extended in a follow-up period to 1995 (two towns) and 1999 (one town). 6,652 Japanese men aged from 40 to 69 years responded to a questionnaire that included alcohol consumption and smoking habit. The data were analysed with Cox's proportional hazards model. As regards an association between all cause mortality and quantity of alcohol consumed, statistically significant relations were recognized in occasional drinkers and drinkers with less than 25g ethanol per day (hazard ratio= 0.71, 95% CI: 0.50-0.99; hazard ratio= 0.51, 95% CI: 0.29-0.88, respectively). With respect to drinkers with 25-50g/day and > or =50g/day, no significant relation was observed in the risk for all cause mortality. Comparing all cause mortality for daily drinkers and nondrinkers with respect to the beverage types, a risk was lower for daily drinkers than for nondrinkers with every type of beverage studied. In particular, there was a statistically significant adverse association for all cause mortality among subjects who reported drinking Japanese sake compared with nondrinkers (hazard ratio= 0.45, 95% CI: 0.30-0.68). Alcohol consumption (particularly Japanese sake) is likely to be associated with a reduced hazardous ratio of all cause mortality.

Nootropic and anxiolytic activity of saponins of Albizzia lebbeck leaves.

The effect of saponin containing, n-butanolic fraction (BF), extracted from dried leaves of Albizzia lebbeck, was studied on cognitive behavior and anxiety in albino mice. The elevated plus maze was used for assessment of both nootropic and anxiolytic activity. The nootropic activity was evaluated by recording the effect of BF (0, 10, 25, and 50 mg/kg) on the transfer latency, whereas anxiolytic activity was assessed by studying its effect on the duration of occupancy in the closed arm. Results showed significant improvement in the retention ability of the normal and amnesic mice as compared to their respective controls. Animals treated with BF (25 mg/kg) spent more time in the open arm in a dose-dependent manner. The BF was without any significant effect on motor coordination. However, it significantly inhibited passivity and hypothermia induced by baclofen (10 mg/kg), a GABA(B) agonist. The data emanated in the present study suggests involvement of gamma-aminobutyric acid (GABA) in the nootropic and anxiolytic activity of saponins obtained from A. lebbeck.

Green tea consumption and chronic atrophic gastritis: a cross-sectional study in a green tea production village.

Chronic atrophic gastritis (CAG) is well known as a precancerous lesion of the stomach, and Helicobacter pylori (H. pylori) infection increases the risk of CAG. While recent studies have reported that green tea consumption decreases the risk of gastric cancer, there has been no study analyzing the relationship between green tea consumption and the both risks H. pylori infection and CAG. We conducted a cross-sectional study on 636 subjects living in a farming village in Japan to examine the relationship among green tea consumption, H. pylori infection, and CAG. Smoking, alcohol drinking, consumption of four beverages, including green tea, and of five foods were investigated as lifestyle factors that may affect H. pylori infection and CAG. The measurement of H. pylori-IgG antibodies was used to define H. pylori infection, and serum pepsinogens were used to define of CAG. The unconditional logistic regression model was used for analyzing each odds ratio (OR). H. pylori infection was positively associated with the risk of CAG (OR = 3.73; 95% confidence interval [CI], 2.59-5.36). High green tea consumption (more than 10 cups per day) was negatively associated with the risk of CAG, even after adjustment for H. pylori infection and lifestyle factors associated with green tea consumption (OR = 0.63; 95% CI, 0.43-0.93). These results support the hypothesis that high green tea consumption prevents CAG.

Comparison of mortality between respondents and non-respondents in a mail survey.

We conducted a population-based mail survey and prospectively compared mortality between respondents and non-respondents. Age-adjusted mortality rates for all causes were higher among non-respondents than among respondents in both sexes. Age-adjusted rate ratios were 1.50 for males and 1.33 for females. Non-respondents also had, in both sexes, higher mortality for three leading causes of death, namely, cancer, heart diseases and stroke than respondents. In particular, the difference between the two groups was much greater for cardiovascular disease than for cancer. Our results suggested that prospective studies using data from respondents to mail surveys in Japan would have underestimated the mortality for cardiovascular disease.

Helicobacter pylori infection: relationship between seroprevalence and dietary preference in a rural area.

In order to evaluate the relationship between Helicobacter pylori (H. pylori) infection and dietary preference, a cross-sectional study was performed among 626 residents in a rural area of Japan. Seropositive rates were 88.7% in males and 71.4% in females, and these increased with age for both sexes [male P < 0.05 and female P < 0.01]. The relationship between H. pylori-seropositivities and salted-food intake, after adjustment for age, demonstrated a significant result in the "almost every day" group in males with an odds ratio (OR) of 8.39 and with 95% confidence intervals (CI) of 1.02-69.30. As regards an association between seropositivities of H. pylori and levels of serum pepsinogens for the screening of chronic atrophic gastritis (low pepsinogen values used were a pepsinogen I level below 70 ng/ml and a pepsinogen I/pepsinogen II ratio below 3.0), the ORs of H. pylori-seropositivities for low pepsinogen cases were 6.32 [95% CI: 1.42-28.03] in males and 12.72 [95% CI: 4.57-35.46] in females. With regard to the relationship between low pepsinogen cases and light-colored vegetables intake, a significant low OR for the low pepsinogen cases was obtained in the "almost every meal" group in females after adjustment for age and seropositivities of H. pylori with an OR of 0.37 and with 95% CI of 0.15-0.92.

[Serum leptin level among non-obese students: relationship to body fat, blood pressure, serum lipids, physical activity, and eating habits].

Leptin, a product of the ob gene, is thought to play a key role in the regulation of adiposity. However, it is unclear in humans as to whether or not leptin influences the blood pressure, serum lipids, physical activity level, or eating behavior in relation to obesity. Recent reports have indicated both gender-based differences in the leptin levels and a correlation of the percentage of body fat with leptin levels has been observed among obese subjects. As far as we know, these relationships among non-obese young adults have yet to be studied. Therefore, the serum leptin concentrations among 107 non-obese students (72 males and 35 females) were measured by a radioimmunoassay(RIA). Fasting leptin levels ranging between 1.2 and 23.4 ng/mL were observed in all subjects, and the levels among females were 2.6 times higher than in males (7.64 vs 2.95 ng/mL; p < 0.001). A close correlation was observed regarding the log-transformed leptin levels with the percentage of body fat as determined by the bioelectrical impedance analysis method(r = 0.734, p < 0.001 in males and r = 0.579, p < 0.001 in females). In conclusion, these data thus suggest the serum leptin levels among non-obese students show significant gender-based differences while, in addition, the leptin levels also correlate positively with the percentage of body fat. However, it remains unclear as to whether or not the leptin levels are independently related to the blood pressure, serum lipids, physical activity level (sports activity and leisure-time activity), and eating behavior (eating breakfast, mid-day snacking and nighttime snacking).

Serum leptin levels and their association with several factors related to arteriosclerosis among medical students in Japan.

The association between serum leptin levels and several factors related to arteriosclerosis were studied in subjects who were Japanese medical students taking no medications. The group was comprised of 75 males and 35 females. The age distribution in males was 21.4 to 29.8 years (median age, 24.0 years) and in females was 21.3 to 29.9 years (median age, 22.9 years). Statistical analyses were performed using the Wilcoxon rank sum test and Spearman correlation. Median levels of serum leptin were 3.3 ng/ml in males and 7.6 ng/ml in females. The largest correlation observed was widi percent body fat irrespective of sex [males; r=0.775, p<0.001, females; r=0.553, p<0.001]. However, body mass index (BMI) was similarly well correlated with serum leptin [r=0.631, p<0.001] in males but not in females [r=0.305, p=0.075]. A negative correlation was observed between high density lipoprotein cholesterol (HDL-C) and leptin in both sexes [males; r=-0.298, p<0.01, females; r=-0.363, p<0.05] .respectively. Percent body fat, BMI, diastolic blood pressure, apolipoprotein B, and HDL-C were the most significant factors in males. Percentage of body fat and HDL-C were the most important factors in females.

[A prospective study on the relationship between body mass index and mortality in middle-aged and elderly people in Japan].

We conducted a prospective study to clarify the relationship between mortality and body mass index (BMI) in a middle-aged and elderly population in Japan. The subjects included 12,649 people (5,686 males and 6,963 females) aged from 40-69 years, who were identified by a mail survey between 1987 and 1989, and thereafter were followed up from the date of the survey until February 28, 1995. Cox's proportional hazards model was used to adjust for age, smoking status, drinking habit and occupation, and hazard ratios were calculated for total mortality and cancer mortality based on levels of BMI, while using a BMI of 22 to approximately 24 as a reference level. Results showed a U shaped relationship between BMI and total mortality in females. Females demonstrated a minimal total mortality in the reference group, but a significantly high hazard ratio in the lowest group of BMI < 20 (hazard ratio = 1.95, p < 0.01) and the highest group of BMI > or= 26 (hazard ratio = 1.71, p < 0.01). On the other hand, males did not demonstrate such a U shaped relationship, but instead showed an L shaped relationship between BMI and total mortality. Males showed a minimal total mortality at a BMI of 24 of approximately 26 (hazard ratio = 0.92), but a significantly high hazard ratio in the lowest BMI group (hazard ratio = 1.57, p < 0.01). In contrast, an elevated hazard ratio was not observed in the highest BMI group (hazard ratio = 1.05). The relationship between BMI and cancer mortality was found to be similar to the relationship between BMI and total mortality in both males and females. Our findings suggest that moderate overweight may be a sign of good health among both middle-aged and elderly men in Japan.

[Medical expenditure for the elderly and factors related to its geographical variations within Fukuoka Prefecture].

Using national health insurance data in 1992, medical expenditure for the elderly in Fukuoka Prefecture were compared with that in all of Japan, and analyzed for relationships to several socioeconomic factors, medical supply, medical needs, and health care and welfare services using univariate and multivariate analyses to clarify factors related to geographical variations in medical expenditure within Fukuoka Prefecture. The results were as follows: 1) Compared to national average, Fukuoka Prefecture showed 43% higher per capita medical expenditure for inpatients, despite slightly lower inpatient medical expenditure per day. For outpatients, per capita medical expenditure in Fukuoka Prefecture was similar to national average. 2) Of the elderly aged 70 or over, 6.7% had hospitalizations of durations exceeding six months with over half of these being hospitalized for the entire year. Circulatory diseases, particularly stroke, were the most important cause for long-term hospitalization. 3) In both univariate and multivariate analyses of geographical variations, per capita inpatient medical expenditure was correlated positively with the number of hospital beds per 100,000 and negatively with the average number of persons per household. In the multivariate analyses, per capita inpatient medical expenditure was not correlated with all-cause death rates for the elderly aged 70 or over, an index of medical needs. This suggests that factors other than medical needs contribute greatly to the hospitalization of elderly. In both univariate and multivariate analyses, per capita outpatient medical expenditure showed a significantly positive correlation with all-cause death rates for the elderly aged 70 or over and negative with rates of participation in general health checkups.

A prospective study on mortality among Japanese coal miners.

We conducted a prospective study to clarify mortality patterns among Japanese coal miners in a former coal mining area. Subjects included 1,796 coal miners and 4,022 non-coal-miners, who were identified by a mail survey between 1987 and 1989, and then followed up from the date of the survey to April 30th, 1994. We applied Cox's proportional hazards model to compare the mortalities between coal miners and non-coal-miners. Among the coal miners, significantly high risk ratios were observed in all causes of death (risk ratio = 1.4, p < 0.05) and all malignant neoplasms (risk ratio = 1.5, p < 0.05). Risk ratios for all causes of death and all malignant neoplasms also rose with the length of experience in coal mining. Analysis of the results for sites of cancer showed that coal miners had high risk ratios for stomach cancer (risk ratio = 1.6), liver cancer (risk ratio = 1.4) and lung cancer (risk ratio = 1.6), though these ratios were not statistically significant. When the risk ratio for lung cancer was analyzed according to the length of experience in coal mining, coal miners with at least 15 years' experience had a significantly high risk ratio (risk ratio = 2.4, p < 0.05), though coal miners with less than 15 years' experience had almost the same risk as non-coal-miners.

Hepatitis B surface antigen, hepatitis C virus antibody, body mass index, and alcohol drinking among workers with elevated serum alanine aminotransferase.

METHODS: We conducted a case-control study on liver diseases among Japanese workers to examine associations between elevated serum alanine aminotransferase (alanine aminotransferase value > or = 50 IU/liter) and selected factors such as hepatitis B surface antigen positive, hepatitis C virus antibody positive, body mass index, and alcohol drinking. Out of 3,738 workers (1,477 males and 2,261 females) in a supermarket chain, 91 workers with an elevated serum alanine aminotransferase value (> or = 50 IU/liter) were classified as cases and 182 workers with normal serum alanine aminotransferase value and without an episode of blood transfusion were randomly selected as controls. RESULTS: Prevalence rates of hepatitis B surface antigen positive and hepatitis C virus antibody positive were 4.4 and 23.1% among the overall cases, 2.9 and 11.8% among the cases with 100 > alanine aminotransferase value > or = 50, and 8.7 and 56.5% among the cases with alanine aminotransferase value > or = 100. A logistic regression analysis was conducted. Odds ratios were 4.94 for hepatitis B surface antigen positive (P < 0.05) and 77.19 for hepatitis C virus antibody positive (P < 0.001). Odds ratios for body mass index increased with increasing body mass index values; 3.32 for 26 > body mass index > or = 24 (P < 0.01) and 5.03 for body mass index > or = 26 (P < 0.001). No increased risk was observed among regular drinkers of less than 27 g/day of ethanol (odds ratio is 0.23) or of 27-53 g/day of ethanol (odds ratio is 0.47). A slightly increased odds ratio of 1.35 was observed among regular drinkers of 54-81 g/day of ethanol, but this was not statistically significant. CONCLUSIONS: Our results suggest that hepatitis C virus and high body mass index are predominant factors in elevated serum alanine aminotransferase levels among Japanese workers, while alcohol drinking is a minor factor.

[An epidemiological study of tuberculosis in the former coal mining area of Chikuho. II. A case-control study on the relationship between socioeconomic factors and tuberculosis].

The authors conducted a case-control study on the relationship between socioeconomic factors and tuberculosis in the former coalmining area of Chikuho where tuberculosis incidence was high. The cases were 292 newly registered tuberculosis patients in Iizuka Health Center District, in the former coalmining area of Chikuho. Controls were randomly selected from resident cards, matched for sex, age, and place of residence. The results of comparing the cases with the controls were as follows: 1) Significantly more of the male cases had had long-term employment in coalmining. Exposure to dust is likely to be associated with the high tuberculosis incidence in males aged 50 or over. 2) The cases showed significantly higher unemployment levels and lower educational levels. Among females, more of the cases were unmarried or divorced, and a significantly higher proportion were receiving welfare benefits. The high incidence of tuberculosis is probably related to a low socioeconomic level resulting from closure of coalmines. 3) No difference was observed in working hours, night shifts, smoking rate, and drinking habits. These factors are unlikely to be singly related to the onset of tuberculosis.

[An epidemiological study of tuberculosis in the former coal-mining area of Chikuho. I. An analysis of newly registered tuberculosis patients in Iizuka Health Center District].

To clarify risk factors and groups at high risk of tuberculosis, a study on tuberculosis was conducted in the former coalmining area of Chikuho, where the death rate from tuberculosis was high. The authors analysed 701 newly registered tuberculosis patients during the 5 years from 1982 through 1986 in Iizuka Health Center District in the Chikuho area, studied the geographical distribution of tuberculosis incidence in Fukuoka Prefecture, and compared the trends of tuberculosis incidence in Iizuka Health Center District, all Japan and Fukuoka Prefecture. The results were as follows: 1) The incidence of tuberculosis in Iizuka Health Center District was higher than those both in all Japan and in Fukuoka Prefecture. The incidence in Iizuka Health Center District has not decreased since 1981. Therefore, the difference in tuberculosis incidence between Iizuka Health Center District, and all Japan and Fukuoka Prefecture has gradually become greater. The incidence of tuberculosis in 1986 was 81.6 (per 100,000) in Iizuka Health Center District, 58.1 in Fukuoka Prefecture, 46.6 in all Japan. 2) A specific pattern was observed in the geographical distribution of tuberculosis incidence in Fukuoka Prefecture. A high incidence was concentrated in the former coalmining area of Chikuho. 3) The positive rate of tubercle bacilli (38.8%) was the same as that in all Japan. However, the positive rate was higher in age groups 10-49 than that in all Japan. 4) A total of 83.5% of tuberculosis cases were detected when visiting doctors, mainly with complaints of cough, fever and sputum. Only 6.9% of the patients were detected by screening examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Electron transfer process in cytochrome oxidase after pulse radiolysis.

The reduction of bovine heart cytochrome oxidase by the 1-methylnicotinamide (MNA) radical was investigated by the use of pulse radiolysis. With the decay of the MNA radical, the absorption at 445 and 605 nm, a characteristic to ferrous heme a of the oxidase, increased. The kinetic difference spectrum obtained was similar to that of the fully reduced minus the fully oxidized form of the oxidase, and was not different from that obtained in the reaction of the MNA radical with the mixed valence CO complex of the oxidase, where heme a3 is the CO-bound reduced form with heme a oxidized. This suggests that the absorption changes at 445 and 605 nm arise from the reduction of heme a, not heme a3. In order to elucidate the contribution of "visible" copper in this reaction, the absorption of the oxidase in the near-infrared region was measured. A decrease of the 830 nm band due to the reduction of visible copper was detected with a half-life of 5 microseconds. This absorption change obeyed pseudo-first order kinetics and its rate constant increased with the concentration of the oxidase. This suggests that the absorption change at 830 nm is followed by a bimolecular reaction of the MNA radical with visible copper of the oxidase. After the first phase of the reduction, the return of the 830 nm band corresponding to oxidation of the copper was observed with a half-life of 100 microseconds. Concomitantly, the absorption at 605 and 445 nm due to the reduction of heme a increased. The rates of oxidation of the copper were identical to those of the reduction of heme a and independent of the oxidase concentration. This suggests that the MNA radical reacts with visible copper of the oxidase with a second order rate constant of 1.5 X 10(9) m-1 s-1 and subsequently the electron flows to heme a by intramolecular electron migration with a first order rate constant of 1.8 X 10(4) s-1. An activation energy of the intramolecular electron transfer was calculated to be 2.8 kcal/mol in the range 4-33 degrees C.