Masked hypertension in elderly managerial employees and retirees.

Masked hypertension is reported to have the same level of hazard risk of cardiovascular mortality and stroke morbidity as sustained hypertension. The number of managerial employees suffering from cardiovascular disease and stroke is known to be greater than other employee. The aim of this study was to compare the 24-h blood pressure (BP) recordings between elderly male managerial employees and retirees and to propose a strategy for identifying masked hypertension. A total of 38 males (16 managerial employees aged 50-69 years and 22 retirees aged 60-65 years) who were not taking any antihypertensive medications participated in this study. Their 24-h BP was measured by an ambulatory BP monitoring device. Daytime (9:00-17:00 h) BPs of the employees (mean, 139/92 mm Hg) were significantly higher than in the retirees (mean 124/80 mm Hg), while there was no difference in BP before and during sleep. In all, 5 of 16 employees (31%) who were diagnosed as normotensive (<140/90 mm Hg) at a periodic health check had hypertension (>135/85 mm Hg) in the morning measured by ambulatory BP monitoring, while 6 (38%) had a similar level of hypertension during the daytime (9:00-17:00 h). These individuals were diagnosed as having masked hypertension. Multiple regression analyses showed that the job was the only factor that contributed to the difference in BP in the subjects during the daytime. This finding suggested that job stress seemed to be one of the main causes of masked hypertension. We argue that more frequent measurements of BP at the work place are necessary to identify subjects with masked hypertension.

Are overnight urinary indicators associated with morning blood pressure in the elderly?

Recent reports suggest that high blood pressure (BP) during the night is associated with hypertensive organ damage, and that increased BP in the morning is closely related to the incidence of stroke and ischemic heart disease. The aim of this study was to investigate the relationships between overnight urinary indicators and 24-hour (24-h) BP, especially in the morning and during sleep in the elderly. A total of 85 volunteers (males 43, females 42), aged between 51 and 76 years and not taking any antihypertensive medications, participated in this study. Their 24-h BP was measured by ambulatory BP monitoring every 30-minute using a TERUMO ES-H531 system. Overnight urine samples were collected using a proportional urine-sampling device, Urine mate P. Overnight sodium (UNa(n)) and potassium (UKn) excretions were measured by an ion electrode method. Simple linear regression analyses showed that systolic blood pressure (SBP) in the morning and diastolic blood pressure (DBP) during sleep were negatively related with overnight urinary weight standardized for body weight (UW(n)/BW). Multiple regression analyses showed that SBP during the morning and during sleep was positively related to UNa(n) and negatively related to UW(n)/BW. We also found a negative relationship between SBP during sleep and UK(n). The study suggested that urine weight adjusted for BW was negatively related with 24-h BP, especially morning BP. Sodium excretion combined with a large volume of urine proportional to body weight may prevent increases in BP, especially in the morning.

[Utilization of emergency ambulances in Yokohoma City, Japan].

OBJECTIVE: In recent years, the annual number of emergency ambulance (EA) calls has increased in Yokohama city, Japan. A questionnaire study was carried out to describe behavioral features of the users in Yokohama city, and to investigate their relationship with the increase in EA utilization. METHODS: We randomly recruited 2,910 citizens, aged 15 years or older, for the questionnaire study and a total of 2,294 (78.8%) replied. The questionnaire included questions about their demographic characteristics, history of EA use, existence of family doctors, and knowledge of emergency medical services and emergency medical information centers. Additionally, respondents who had used EA previously were asked about their reasons for this. RESULTS: A total of 513 (22.4%) respondents answered that they had used EA previously. A slightly higher rate of EA use was shown among elderly people, 65 years old or over (a rate of 26.2%). The major reason for requesting EA use was the urgency of the disease or the injury (61.8%). 182 respondents answered that they requested EA as a means of transportation. However, most of them also mentioned that the urgency of the disease or the injury was one of the reasons for their request. This survey showed no evidence that the citizens of Yokohama have used EA improperly. Elderly people, among whom the annual number of EA uses has increased rapidly over the years, tended to employ EA in a way more in line with regulations than other generations. CONCLUSION: This study suggested that the basic reason for the increase of EA utilization in Yokohama city was not due to inappropriate demand but to the aging of the population.

Behavioural and serological human immunodeficiency virus risk factors among female commercial sex workers in Cambodia.

BACKGROUND: The spread of human immunodeficiency virus (HIV) in Cambodia is mainly caused by sexual transmission and the high-risk group in this country are female commercial sex workers (CSW). There are two types of CSW, direct CSW (DCSW) and indirect CSW (IDCSW), who are different from each other in sexual activities. This study was conducted in order to describe the risk factors on HIV for each type of CSW, and to establish effective preventive strategies against the HIV epidemic among CSW. METHODS: The participants, 143 DCSW and 94 IDCSW, were interviewed using a questionnaire to determine their demographic characteristics and behaviour. Blood samples were taken for serological tests on HIV, Chlamydia trachomatis and syphilis. The association between their behavioural pattern and their serological results was analysed. RESULTS: The questionnaire study showed that IDCSW had a riskier behavioural pattern than DCSW. The HIV seroprevalence rates of the DCSW and the IDCSW were 52.4% and 22.3%, respectively. Univariate logistic analyses showed a significant association between HIV antibody (HIV-Ab) and current age, age at commencement of commercial sex work, duration of commercial sex work, and the seropositivity of Chlamydia trachomatis-IgG antibody (CT-IgG-Ab) among the DCSW. The analyses also showed a significant relationship between HIV-Ab and CT-IgG-Ab among the IDCSW. CONCLUSIONS: Improving condom use rate is very important in order to prevent an HIV epidemic among the two types of CSW. This study also suggests it is important to prevent sexually transmitted disease (STD) such as Chlamydia trachomatis infection. The STD control programme could be efficient for HIV prevention, especially among DCSW.

Cross-sectional study on risk factors of HIV among female commercial sex workers in Cambodia.

To describe epidemiological features on HIV prevalence among female commercial sex workers (CSWs), a cross-sectional study on sexual behaviour and serological prevalence was carried out in Cambodia. The CSWs were interviewed on their demographic characters and behaviour and their blood samples were taken for testing on sexually transmitted diseases, including HIV, Chlamydia trachomatis, syphilis, and hepatitis B. Associations between risk factors and HIV seropositivity were analysed. High seroprevalence of HIV and Chlamydia trachomatis IgG antibody (CT-IgG-Ab) was shown among the CSWs (54 and 81.7%, respectively). Univariate logistic regression analyses showed an association between HIV seropositivity and age, duration of prostitution, the number of clients per day and CT-IgG-Ab. Especially, high-titre chlamydial seropositivity showed a strong significant association with HIV prevalence. In multiple logistic regression analyses, CT-IgG-Ab with higher titre was significantly independently related to HIV infection. These suggest that existence of Chlamydia trachomatis is highly related to HIV prevalence.

Sexual behaviour of commercial sex workers and their clients in Cambodia. Japan-Cambodia Collaborating Research Group.

OBJECTIVE: This study surveyed the sexual behaviour of commercial sex workers and their clients in an attempt to identify factors of transmission of STDs (including HIV/AIDS) and to control their epidemics in Cambodia and South-East Asia. DESIGN: Cross-sectional study. SETTING: Trained questioners asked items of the questionnaires to each objective subject in December 1996. Data were analysed to show the descriptive status by risk group of each person. PARTICIPANTS: 200 direct commercial sex workers, 220 indirect commercial sex workers, and 211 clients in Phnom Penh. RESULTS: Prostitution was widely accepted by both young males and females, and this was an easy way for young girls to obtain money. Although commercial sex workers and clients were knowledgeable about prevention methods against STDs, they seldom used condoms. Some commercial sex workers had been infected with STDs many times, and many of them incompletely treated the diseases by themselves. Social support from governmental and non-governmental organisation was poor. CONCLUSIONS: It is very important to support both commercial sex workers in practicing preventive methods against STDs and also visiting physicians when they notice symptoms of STDs. It is strongly recommended that not only governmental but also non-governmental organisations should be more active in this area.

[Epidemiological study on HIV/AIDS in Cambodia seroprevalence of HIV/STD among commercial sex workers].

OBJECTIVE: To describe epidemiological features of HIV prevalence among female commercial sex workers (CSWs) in Cambodia, a cross-sectional study using a questionnaire study and serological tests was carried out from December 1997 to January 1998. We report the main results of the analyses of serological tests in this article. METHODS: Two hundred ninety six CSWs working in Sisophon and Poi Pet, located in northwest Cambodia, Bantey Mean Chey province, were recruited for interview based on a questionnaire on sexual behavior, and serological tests. The blood samples were examined for HIV antibody, Chlamydia trachomatis IgG antibody, TPHA, Hepatitis B surface antigen, and Hepatitis B surface antibody. The relationship between HIV and the other STD's was analyzed by using logistic regression analysis. RESULTS: The HIV seroprevalence rate was 43.9% (130 out of 296). The seropositive rate of Chlamydia trachomatis IgG antibody (C.T.-IgG-Ab) was 73.3% (217 out of 296). Logistic regression analysis showed a significant association between C.T.-IgG-Ab positive and HIV prevalence. (Odds Ratio: 5.33; 95% Confidence Interval, 2.82-10.07). CONCLUSIONS: This study suggests that the existence of Chlamydia trachomatis is closely related with HIV prevalence among CSWs in Cambodia. Other STDs may also increase susceptibility to male-to-female sexual transmission of HIV. This suggests that appropriate prevention against STDs will be needed for the control of HIV prevalence in Cambodia.

[The HIV/AIDS Epidemic in Cambodia].

In December 1995 and March 1996, we visited institutes which were conducting epidemiological studied of HIV/AIDS in Cambodia, and obtained data for further collaborative study between Japan and Cambodia. Data included information on AIDS patients and HIV infected persons, and behavioral epidemiology of CSWs (Commercial Sex Workers). The cumulative reported number of AIDS patients and HIV infected persons in Cambodia was 86 and 2,536 cases respectively in 1995. The cause of infection was mostly heterosexual contact with very few cases from injecting drug use (IDU) and other causes. The seroprevalence rate of HIV antibody among donated blood rapidly increased from 0.08% in 1991 to 4.47% in 1995, and those among CSWs and pregnant women were 37.9% and 2.6%, respectively, in 1995. The average rate of condom use among CSWs was 66%, but the rate of usual usage was only 14%. These results indicate that the HIV/AIDS epidemic had spread rapidly through CSWs, that it had been spread among peoples in communities, and that usage of condoms among CSWs was insufficient in Cambodia. Without strong countermeasures against HIV/AIDS in this country, HIV/AIDS epidemic may spread significantly to not only peoples in this country but also those in neighbouring countries in the future.

Right ventricular aneurysm due to myocardial fatty infiltration: report of a case.

A case of right ventricular aneurysm due to myocardial fatty infiltration was reported. A 39-year-old man was admitted to our hospital for evaluation of several episodes of syncopal attack presumably induced by malignant arrhythmia. There were frequent observations of ventricular premature beats, which occurred occasionally in couples. Cardiac catheterization disclosed the aneurysm situated at the outflow tract of the right ventricle. Aneurysmectomy was performed and the ventricular premature beats and syncopal attacks were effectively abolished. Etiology of the aneurysm was proved to be a fatty infiltration in the myocardium. To the best of our knowledge, there has been no case report of right ventricular aneurysm due to fatty infiltration in the myocardium.