Predictors of smoking cessation during pregnancy among the women of Yamato and Ayase municipalities in Japan.

Cigarette smoking during pregnancy affects the unborn fetus. This study aimed to investigate: (1) the smoking status of pregnant women before, during and after pregnancy in the Yamato and Ayase municipalities, Kanagawa, Japan; (2) the characteristics that differentiate successful spontaneous smoking quitters from continuous smokers during pregnancy; and (3) the awareness of risks of smoking that may influence smoking cessation during pregnancy. A community-based, cross-sectional survey of 420 postpartum women, who delivered their babies from July 2002 to October 2002, was performed. Out of 420 respondents, 275 (65.4%) did not smoke before and during pregnancy. Of the 145 women who smoked before pregnancy, 101 (69.3%) quit successfully while pregnant. Smoking prevalence during pregnancy was 10.4%. Out of 101 successful quitters during pregnancy, 22 (21.8%) women resumed smoking after childbirth. A multiple regression analysis showed that the independent predictors of smoking cessation during pregnancy were primiparous women and women living with non-smokers in the household. Although maternal age predicted smoking cessation in a simple regression analysis, this predictive value was lost in the multiple analysis. A simple analysis showed no significant association between the awareness of smoking risks and smoking cessation during pregnancy. It is suggested that Japanese smokers are more likely to quit while pregnant than women in other countries. In the future, smoking cessation programmes should be designed to help multiparous women and women living with smokers to give up smoking.

Allograft glomerulitis: histologic characteristics to detect chronic humoral rejection.

The aim of this study was to clarify the histopathologic significance of allograft glomerulitis in chronic allograft nephropathy (CAN). Review of our renal allograft biopsy files revealed 140 specimens with CAN among 115 selected patients. They were classified into two groups: one had CAN with glomerulitis (group G), and the other was free of this finding (group NG). We evaluated the clinicopathologic parameters as follows: levels of serum creatinine and proteinuria in the biopsy; presence of circulating anti-donor antibodies; allograft failure rate; history of biopsy-proven acute cellular rejection (ACR) and acute humoral rejection (AHR); complications of ACR and chronic rejection (CR); and results of immunofluorescence studies for C4d and HLA-DR. The glomerulitis group showed a significantly greater incidence of CR complications, the presence of circulating anti-donor antibodies, and C4d deposition in peritubular and glomerular capillaries. This group also showed higher levels of serum creatinine and proteinuria, higher graft loss rate, and increased AHR incidence, although the differences were not significant. There was also no statistical significance in the HLA-DR expression on tubular epithelial cells. The present results strongly suggest that humoral factors may play an important role in the progression of glomerulitis in CAN. Therefore, we suspect that glomerulitis in CAN is one of the main histologic markers for CR. The presence of glomerulitis may represent humoral factor-dependent inflammation. It should be considered an important diagnostic criterion for CR in addition to double-contour formation and elastica disruptions with or without subendothelial inflammation (Banff '97).

Measuring and analyzing activities of daily living and quality of life in community elderly residents [abstract]

The rapid growth of the elderly population as well as the ongoing change in family structure is of public health concern in Japan. Before one can attempt to solve the problem of providing support to the elderly community residents, some assessment of their health status must be undertaken. We measured the activities of daily living (ADL), quality of life (QOL) and SF-36 score of about 716 elderly residents aged 65 years and over by interviewing them at home. The items of our survey included ADL, QOL (PGC), SF-36 scores, the elderly health-awareness, attitude, daily activities and other related subjects. Comparisons were then conducted in regard to the scores on the individual subscales of the SF-36 of residents with each of the diseases and the national-norm scores for Japan. ADL of the people who responded, "go out very often", was 99.9, followed by 98.6 for "occasionally", 87.4 for "seldom". ADL of the people who responded, "able to do shopping for daily necessities", was 99.7 while for "unable" it was 81.1. QOL of the people who resonded that their health status was "excellent" was 98.6, followed by 12.7 for "very good", 11.4 for "good", 8.3 for "not very good" and 7.1 for "not good". About the differences in SF-36 scores standardized with the national-normscores for Japan, only "role limitations due to physical problems" was -0.17 in males; "role limitations due to physical problems" was-0.19, "pain" was -0.10, and "mental health" was -0.01 in females. The survey revealed the prevalence of poor health among those ADL (QOL) showing 8090 (78). From this it may be concluded that ADL, QOL and SF-36 scores are very useful indices for us to rate the elderly patients' health status level, thus enabling us to consider what support is required by them. (AU)

Characteristic lifestyles in 6-year-old children with obese parents: Results of the toyama birth cohort study.

OBJECTIVE: The aim of this study was to identify characteristic lifestyles in children with obese parents. METHODS: 8,030 children (4,072 males and 3,958 females) aged 6 to 7 years were investigated. A questionnaire relating to the lifestyles of children was distributed through elementary schools for completion by parents. The heights and weights of parents were self-reported. A parent with a body mass index (weight in kilograms divided by the square of height in meters) greater than the 90th percentile for gender (26.7 kg/m(2) for fathers and 24.3 kg/m(2) for mothers) was defined as an obese parent. A chi-square test for each trend was applied to evaluate an increasing trend in the frequency or level of each lifestyle in children with obese parents. RESULTS: Children with obese parents were significantly associated with increasing trends in the proportions categorized by irregular intake of breakfast, faster eating, longer TV watching, and shorter sleeping hours. CONCLUSIONS: These lifestyles are considered to be possible risk factors for the development of obesity. These characteristic lifestyles observed in children with obese parents could strengthen the relationship between child and parental body compositions, in addition to the genetic predisposition to obesity in children with obese parents. These findings indicate that education with lifestyle modification for obese parents will be required to prevent further weight gain in children with obese parents.

Relation between smoking prevalence and various social factors in Japan.

Although the smoking prevalence among women is significantly low compared to that among men in Japan, the prevalence in young Japanese women has been steadily increasing recently. The relationship between the prevalence of smoking among the general population and various social factors was investigated with a special emphasis regarding the influence of household size on the smoking prevalence of young Japanese women. Thirty-one thousand and six hundreds twenty-seven subjects of 20 years and older were randomly selected from the general population of Japan. The Ministry of Health and Welfare, Japan planned and conducted the survey. Subjects were divided into male and female, and smoking prevalence was investigated in terms of age, place of residence, occupation and household size factors. Statistical analyses were performed using chi-square test and multiple logistic regression. Multiple logistic regression analyses suggested that for men there was a strong relationship between becoming a smoker and living in a municipality with a smaller population, and that for women who were living in a municipality with a larger population. For women, as the size of a household increased from living alone to a two- or three-generation household, the tendency to becoming a smoker decreased, but this tendency was not observed among men. As to reasons for quitting smoking, more women than men living in two- and three-generation households gave "family's advice" as a major reason (p < 0.01). The steady replacement of the traditional three-generation household by smaller households in Japan may lead to an increase in the number of young women who smoke.

Duodenal somatostatinoma: a case report and review of 31 cases with special reference to the relationship between tumor size and metastasis.

Somatostatinomas are rare functioning neoplasms usually arising in the pancreas and duodenum. We report a case of somatostatinoma in a 42-year-old male with neither neurofibromatosis nor somatostatinoma syndrome. A large tumor in the descending duodenum had given rise to multiple lymph node metastases. An additional 31 duodenal somatostatinoma cases were also reviewed. Most originated in the descending part of the duodenum, with the ampulla and peri-ampullary area as the most common sites (60%). Frequent manifestations were abdominal pain (25%), jaundice (25%), or cholelithiasis (19%), the latter two reflecting obstruction of the bile duct by tumors. Only two cases showed a possible somatostatinoma syndrome (6%). The tumors with metastases, lymph nodes (10) and liver (2), were significantly larger than average than those without (2.91 +/- 1.49 cm vs 1.36 +/- 0.71 cm, P < 0.05). With a cut-off point of 2.0 cm, diagnostic accuracy for metastasis was 77.78% with 87.50% specificity and 63.64% sensitivity. The smallest tumor with metastases was 0.8 cm and the largest without metastases was 3.0 cm. These results indicate that duodenal somatostatinomas are malignant by nature and the risk of metastasis significantly increases with tumors larger than 2.0 cm.

[Development of a scale for subjective QOL common to patients with intractable diseases].

OBJECTIVE: We have developed a scale for evaluating subjective quality of life (QOL) common to patients with intractable diseases. SUBJECTS: Two-hundred and forty-seven outpatients of housebound patients from 7 collaborating hospitals or institutions participated in preliminary surveys. The patients were diagnosed with one of 14 diseases targeted by the Ministry of Health and Welfare's Specific Disease Treatment Research Project. Two-hundred and fifty-seven outpatients or housebound patients of 8 collaborating hospitals or institutions participated in a second survey that targeted 15 diseases. METHODS: The concept of subjective QOL was examined, and a favorable subjective QOL score was defied as "a state in which patients accept their current condition and possess a high level of morale with no signs of anxiety, despite the presence of their disease". Sixty-six items were then identified and included in a preliminary survey. Three preliminary surveys and a second survey were then conducted. A final scale for the items was then decided, and the items were assessed for their reliability and validity. RESULTS: Nine items reflecting two factors, "acceptance" and "morale", were selected and assessed for their reliability and validity as follows: 1) The response of subjects who accepted their illness yet possessed a high level of morale showed a good fit with the proposed scale (Adjusted Goodness of Fit Index = 0.925). 2) The confidence coefficient of the re-test method for subjective QOL scale scores was r = 0.78 (95% con idence interval: 0.72-0.83; n = 226) nd the alpha coefficient was 0.822, indicating a high level of reliability. 3) A strong negative correlation (r = -0.76, 95% confidence interval: -0.82 to -0.69; n = 178) was found between the subjective QOL scale scores and self-rating depression scale (SDS) scores, and a moderately positive correlation (r = 0.35, 95% confidence interval: 0.23-0.46; n = 238) was found between the subjective QOL scale scores and activities of daily living (ADL) scores. 4) No statistically significant differences were observed in the distribution of subjective QOL scale scores when analyzed according to sex, age group, disease, or duration of illness. CONCLUSIONS: We have developed a scale consisting of 9 items for determining the subjective QOL of patients with intractable diseases. The scale was confirmed to properly reflect our concept of subjective QOL, which consists of two factors: "acceptance" and "morale" The scale was also confirmed to be stable and highly reliable.

[Excess mortality from influenza epidemics in Japan, 1980-1994].

In 1973, WHO proposed that "excess mortality" be used for comparative assessment of the severity of influenza epidemics between countries. In this study, analysis of the data for deaths in Japan between 1980-1994 revealed excess mortality, which could be a useful indicator in Japan. There were six influenza epidemics, and statistically significant excess mortality rates were calculated in both deaths from acute respiratory diseases and all causes. The total number of excess deaths from acute respiratory diseases during influenza seasons for the 15 years was 13,931. Statistically significant excess mortality rates were also shown for other diseases, including ischemic heart disease, cerebro-vascular disease, diabetes, nephritis, chronic liver disease, malignant neoplasm, and chronic respiratory disease. Therefore, "excess mortality" is clearly present in recent years in Japan. In analyses of age-specific excess mortality rates, the epidemic was found to be most fatal to the aged. Further, the value of % excess (= excess rate divided by expected rate x 100) suggested that the number of deaths from all causes would be a more useful indicator than that from acute respiratory diseases. It was confirmed that excess mortality was applicable to regional surveillance of epidemic influenza.

Estimating adolescent cigarette consumption in Japan.

We estimated the cigarette consumption among Japanese adolescents based on the data which was obtained from a 1990 nationwide school-based questionnaire survey of smoking prevalence among high school students. Cigarette consumption for adolescents was estimated using the data on current smokers' rate and cigarette consumption per day. Participants were 57,189 high school students (aged 13-18 years) including 4666 current smokers. The estimated adolescents' consumption was calculated at 3.5 to 4.3 billion units in 1990. The proportion of adolescents' consumption to the total sales was 1.1% to 1.3%. The corresponding tax amounted to between 21 and 25 billion yen in 1990. The difference between the total sales and the crude cigarette consumption for adults has increased gradually over 20 years. Logically, some part of this increase should be attributed to cigarettes consumed by adolescents. The increase in this difference seemed to keep pace with the increasing number of cigarette vending machines. These results indicate that a considerable amount of cigarettes were consumed by adolescents in 1990.

Proliferation of parathyroid cells negatively correlates with expression of parathyroid hormone-related protein in secondary parathyroid hyperplasia.

BACKGROUND: Parathyroid hormone-related protein (PTHrP) is now suspected to act as an autocrine or paracrine regulator of cell growth or differentiation, although it was originally reported as a hypercalcemic substance in malignancies. This study was performed to assess the relationship between PTHrP expression and cell proliferation in human parathyroid glands. METHODS: The localization of PTH and PTHrP was studied in 42 samples of hyperplastic parathyroid from 14 long-term hemodialysis cases with immunohistochemistry and in situ hybridization. Results were compared with proliferative activity (proliferating cell nuclear antigen index: counts of proliferating cell nuclear antigen-positive cells/100 cells). The localization of the PTH/PTHrP receptor was also examined. Ten normal glands were studied as controls. RESULTS: In hyperplasia, cells positive for PTH, PTHrP, or both were observed immunohistochemically. The areas expressing PTHrP mRNA completely coincided with those positive for PTHrP immunohistochemically. Oxyphilic or transitional oxyphilic cells were consistently positive for PTHrP. PTH/PTHrP receptors were located in the cytoplasmic membrane in most parathyroid cells. Proliferating cell nuclear antigen-positive cells were rare in normal glands with an index of 0. 22 +/- 0.09 (mean +/- sem). They were significantly increased in hyperplastic cases but less for PTHrP-positive than for -negative cells (1.25 +/- 0.16 as compared with 7.80 +/- 0.52; P < 0.0001). CONCLUSION: The observed low level of proliferation of PTHrP-positive cells suggests a functional role for PTHrP as a possible growth suppressor in the human parathyroid.

Comparative Composition of Brown Rice Lipids (Lipid Fractions) of Indica and Japonica Rices.

The brown rice lipids were analyzed from three japonica and two indica rices. They had substantially no difference in the ratio of NL, GL, and PL, the C16/C18 (16:0/the sum of 18:0, 18:1, 18:2, and 18:3) ratio in PL classes, and in the order of unsaturated index in each glycerolipid class among the five varieties. However, the chemical compositions of glyceroglycolipids and cerebroside were different in indica and japonica rices. The contents of 18:3 of MGDG and DGDG were higher in japonica than indica rices, but those of 16:0 were reversed. The ratio of C14-20/C21-26 of the hydroxy fatty acids in cerebroside was 1.18 in japonica and 0.62 in indica rices. Furthermore, the ratio of the trihydroxy sphingoid bases to dihydroxy ones showed a great difference between the subspecies. Unsaturated fatty acid contents in the TG and PL classes were largely different from each other among japonica rices harvested in separate districts.