Medical Services at an International Summer Camp Event Under Hot and Humid Conditions: Experiences From the 23rd World Scout Jamboree, Japan.

INTRODUCTION: The 23rd World Scout Jamboree (WSJ) was a 10-day summer camp held in Japan in 2015 under hot and humid conditions. The attendees comprised 33,628 people from 155 countries and territories. The aim of this study was to examine the provision of medical services under such conditions and to identify preventive factors for major diseases among long-term campers. METHODS: Data were obtained from WSJ medical center records and examined to clarify the effects of age, sex, and period on visit frequencies and rates. RESULTS: Medical records from 3215 patients were examined. Daytime temperatures were 31.5±3.2°C and relative humidity was 61±13% (mean±SD). The initial visit rates among scouts and adults were 72.2 and 77.2 per 1000 persons, respectively. No significant age difference was observed in the initial visit rate; however, it was significantly higher among female patients than male patients. Significant differences were also seen in the adjusted odds ratios by age, sex, and period for disease distributions of initial visit frequencies. In addition, a higher initial visit frequency for heat strain-related diseases was seen among the scouts. Initial visit frequencies for heatstroke and/or dehydration increased just after opening day and persisted until closing day. CONCLUSIONS: Our findings suggest the importance of taking effective countermeasures against heat strain, fatigue, and unsanitary conditions at the WSJ. Medical services staff should take attendees' age, sex, and period into consideration to prevent heat strain-related diseases during such camps under hot and humid conditions.

Relationship between isometric contraction intensity and muscle hardness assessed by ultrasound strain elastography.

INTRODUCTION: Ultrasound elastography is used to assess muscle hardness or stiffness; however, no previous studies have validated muscle hardness measures using ultrasound strain elastography (SE). This study investigated the relationship between plantar flexor isometric contraction intensity and gastrocnemius hardness assessed by SE. We hypothesised that the muscle would become harder linearly with an increase in the contraction intensity of the plantar flexors. METHODS: Fifteen young women (20.1 ± 0.8 years) performed isometric contractions of the ankle plantar flexors at four different intensities (25, 50, 75, 100% of maximal voluntary contraction force: MVC) at 0° plantar flexion. Using SE images, the strain ratio (SR) between the muscle and an acoustic coupler (elastic modulus 22.6 kPa) placed over the skin was calculated (muscle/coupler); pennation angle and muscle thickness were measured for the resting and contracting conditions. RESULTS: SR decreased with increasing contraction intensity from rest (1.28 ± 0.20) to 25% (0.99 ± 0.21), 50% (0.61 ± 0.15), 75% (0.34 ± 0.1) and 100% MVC (0.20 ± 0.05). SR decreased linearly (P < 0.05) with increasing MVC from rest to 75% MVC, but levelled off from 75 and 100% MVC. SR was negatively correlated with pennation angle (r = -0.80, P < 0.01) and muscle thickness ( r= -0.78, P< 0.01). CONCLUSION: SR appears to represent muscle hardness changes in response to contraction intensity changes, in the assumption that the gastrocnemius muscle contraction intensity is proportional to the plantar flexion intensity. We concluded that gastrocnemius muscle hardness changes could be validly assessed by SR, and the force-hardness relationship was not linear.

Relationship between inter-city air pollution levels and physical fitness parameters among sixth-grade Mongolian primary school boys, China, 2013-2016.

Objectives: Adverse health effects due to air pollution have recently been recognized as a serious social problem in China. In this study, we investigated inter-city relationships between air pollution and physical fitness levels among Mongolian elementary school boys in five cities of the Inner Mongolia Autonomous Region (IMAR), China. Study design: Retrospective cross-sectional cohort study. Methods: Physical fitness measurements of 1443 male Mongolian sixth-grade children were obtained from an existing dataset from the year 2013-2016, and correlations were calculated between these measurements and the percentage of good air quality days for five different cities: Hohhot, Baotou, Chifeng, Bayannur, and Xilinhot. Results: Significant differences in the percentage of good air quality days from 2013 to 2016 were observed among the five cities studied. Statistical analysis showed a significantly positive correlation between good days and students' vital capacity, and a significantly negative correlation between good days and 50 â€‹m â€‹× â€‹8 shuttle run time for the students included in this study. Differences in the extent of air pollution among the study cities might account for differences in lung function and cardiovascular endurance levels in these Mongolian children. Conclusions: There is an urgent need for policy intervention to reduce air pollution levels in the IMAR. It is necessary to improve school physical education classes and physical training considering the current air pollution situation. Future research needs to replicate school year survey results from other cities, include longitudinal studies, and clarify the relationship between air pollution, physical exercise, and overall health.

[Predictors of houseboundedness among elderly persons living autonomously in a rural community].

AIM: The housebound state is a risk factor for disability. This prospective study aimed to determine factors predictive of houseboundedness in the elderly, with an ultimate goal of preventing this condition. METHODS: A self-report questionnaire pertaining to mental, physical and social status was administered to 732 community-dwelling elderly persons (313 men, 419 women; age range, 65-85 years) in October 2000. All subjects independently performed both basic and instrumental activities of daily living, went out alone for long distances, and did not use long-term care insurance. They were followed up until March 2003. "Housebound" was defined as leaving the house once a week or less. A stepwise multiple logistic regression model, adjusted for age, was used to identity factors predictive of houseboundedness. Data were analyzed on the basis of gender. RESULTS: By the end of the follow-up period, 14.4% of men and 26.0% of women had become housebound. Stepwise multiple logistic regression analysis showed that predictive factors for men were lack of frequent contact with friends, neighbors and relatives; symptoms of lower limb pain; and self-assessed weight or muscle loss; and predictive factors for women were lack of frequent contact with friends, neighbors and relatives; lower limb pain; and self-assessed deterioration in health. Limited social contact and the presence of lower limb pain were common predictive factors for houseboundedness in both men and women. CONCLUSION: The findings from this study show that, among autonomous elderly persons, those who are socially isolated or who have physical pain are more likely to become housebound.

Acute effects of cigarette smoking on the heart rate variability of taxi drivers during work.

OBJECTIVES: This study attempted to clarify the acute effects of cigarette smoking on autonomic nervous function among taxi drivers under ordinary work conditions. METHODS: Holter electrocardiographic recordings from 20 healthy middle-aged taxi drivers were analyzed for the time from 0800 in the morning to 0159 at night. The amplitudes (milliseconds) of the high-frequency (HF) component and the ratio of the low-frequency component to HF (LF/HF) were calculated as changes in the R-R interval, and time-course changes were investigated by a complex demodulation method. The exact starting time of smoking was identified with the use of a specially designed cigarette lighter. The mean LF/HF and HF for 5 minutes immediately prior to smoking were calculated as the baseline, and the means for every 5 minutes up to 15 minutes were calculated. The average values of these parameters for all of the cigarette smoking within the same time span of 0800-1659 and 1700-0159 were also determined. RESULTS: The LF/HF significantly increased (P<0.05) within 5 minutes from the baseline immediately after smoking. This significant change in LF/HF was observed only at night. Although the interactive effect of the time of day on time course changes was not significant for the LF/HF or HF, the reactivity to increase LF/HF and decrease HF was more prominent at night. CONCLUSIONS: Cigarette smoking significantly increased LF/HF within 5 minutes during ordinary taxi driving. Nighttime smoking seemed to have a more potent acute effect on the cardiac modulation of taxi drivers than in the daytime. The sympathomimetic and parasympatho-withdrawal response of smoking may play an additional role in increasing cardiac risk among taxi drivers.

[Incidence of disability in housebound elderly people living in a rural community].

This study aimed to explore whether being housebound is a risk factor for disabilities and whether low social communication increases incidence of disability in elderly people. A self-reported questionnaire regarding demographic characteristics was administered to 2,046 community-dwelling elderly people (aged 65 and older) in October 2000, and subjects were followed up until March 2003. All subjects were independent in activities of daily living. In this study, being housebound was defined on frequency of going out, with those who left the house once or less per week being classified as housebound. We further classified the housebound into four groups: I, going out alone is difficult but social communication occurs; II going out alone is difficult and no social communication occurs; III, going out alone is possible but not undertaken often, and some social communication occurs; and IV, going out alone is possible but seldom undertaken and no social communication occurs. In this population, overall prevalence of being housebound was 8.5%, and about half of those who were housebound fit the third classification. At the end of the follow-up period, 12.7% of subjects reported disabilities. The incidence of disability was higher in the housebound compared with the non-housebound. The incidence of disability by age was higher in housebound groups than in the non-housebound in elderly individuals aged under 85, but no significant differences were recognized in those aged over 85. In terms of housebound status, all housebound groups had higher levels of disability than the non-housebound. However, the groups without social communication (H and IV) exhibited higher incidence of disability than those with social communication (I and II). From the results obtained, we conclude that being housebound is a risk factor for disability in elderly individuals aged 65 to 85 years who are living independently, and that lower social communication also represents a risk factor for disability. This study appears to indicate that a frequency of going out of once or less a week is a valid guide for determination of housebound status.

Comparison of the status of overweight/obesity among the youth of local Shanghai, young rural-to-urban migrants and immigrant origin areas.

BACKGROUND: Obesity in adolescents and children has become a global public health problem and lots of factors influence the status of obesity and overweight. The present study aims to compare the health-related factors which could influence the obesity in Chinese children and adolescents in three different groups which including the local developed city group, rural-to-urban migrants group and immigrants origin areas group. METHODS: We conducted a cross-sectional study consisted of 2457 children and adolescents aged 7-10 years old including 914 rural-to-urban migrants subjects, 795 local Shanghai subjects and 748 from immigrant origin areas. Physique measurements and self-reported information on health-related factors, such as physical activities, dietary habits, socio-economic factors such as family income, sleep habits, etc. were collected by questionnaire. SPSS16.0 was used in the analysis. RESULTS: Mean level of body height, body weight and sitting height were different among the three groups, local youth group was higher in all the indexes than the other two groups. Grip for both hands were higher in local group also, while the heart rate was lowest in rural-to-ruban migrants group. The mean BMI in three groups showed significant difference, highest for local group. Higher SBP level was found in city and rural-to-urban migrants group also. However, no difference of DBP between groups was detected. The distribution of pre-hypertension and hypertension in three groups were significantly different and the distribution of overweight and obesity between genders in all three groups were different. The prevalence of overweight was 19.04% in rural-to-urban migrants group (19.92% for male and 17.64% for female), 28.21% for city group (35.64% for male and 20.72% for female); while no overweight or obesity subjects were found in immigrant origin areas group in this study. When compared the overweight and obesity prevalence between city group and rural-to-urban migrants, we found the overweight was more common in the local youth group. Univariable Logistic regression analysis and multivariable analysis results suggested that the more rice intake, higher family income and SBP higher than 140 mmHg were risk factors to obesity for rural-to-ruban migrants, while good dietary habits (no TV watching during meals) was preventive factor to obesity and SBP higher than 120 mmHg and unsocial factor were associated with obesity for rural-to-urban migrants. CONCLUSIONS: Our study revealed the prevalence of overweight and obesity in developed city children and adolescents and rural-to-urban migrants were relatively high, especially more common in local population and male gender. Lifestyle, dietary and psychological factors offered important contribution in increasing or decreasing the risk of obesity.

Hemodialyzability of ionizable fluoride in hemodialysis session.

The fluoride ion content in serum and in dialysate medium was determined by means of a fluoride ion-selective electrode in 29 patients undergoing hemodialysis treatment. Abnormally high serum fluoride of 65.9 +/- 28.3 microg l(-1) at the beginning and 46.5 +/- 26.7 microg l(-1) at the completion of the hemodialysis session was observed. Results showed that 60.0 +/- 23.9% of the serum fluoride at the beginning of the session was theoretically filterable, and 80.8 +/- 42.4% of this fraction was actually filtered throughout the hemodialysis session. The dialysis procedure is considered to be safe and adequate for serum fluoride removal. The high serum fluoride at the completion of the hemodialysis session was thought to originate from the fraction of unfilterable binding fluoride. To make further progress towards improvements in serum fluoride removal during HD, attention to the binding fraction of serum fluoride is required.

Effects of changing shift schedules from a full-day to a half-day shift before a night shift on physical activities and sleep patterns of single nurses and married nurses with children.

To clarify the effects of changing shift schedules from a full-day to a half-day before a night shift, 12 single nurses and 18 married nurses with children that engaged in night shift work in a Japanese hospital were investigated. Subjects worked 2 different shift patterns consisting of a night shift after a half-day shift (HF-N) and a night shift after a day shift (D-N). Physical activity levels were recorded with a physical activity volume meter to measure sleep/wake time more precisely without restricting subjects' activities. The duration of sleep before a night shift of married nurses was significantly shorter than that of single nurses for both shift schedules. Changing shift from the D-N to the HF-N increased the duration of sleep before a night shift for both groups, and made wake-up time earlier for single nurses only. Repeated ANCOVA of the series of physical activities showed significant differences with shift (p < 0.01) and marriage (p < 0.01) for variances, and age (p < 0.05) for a covariance. The paired t-test to compare the effects of changing shift patterns in each subject group and ANCOVA for examining the hourly activity differences between single and married nurses showed that the effects of a change in shift schedules seemed to have less effect on married nurses than single nurses. These differences might due to the differences of their family/home responsibilities.

[Structural analysis of users' needs from a community pharmacy related to home care in a suburban area].

OBJECTIVES: To clarify the needs of home care service users needs from a community pharmacy and the functions related to home care in a suburban area. METHODS: A questionnaire on pharmacy services and functions was submitted to 472 home care service users in a suburban area. Gender, age, family status, presence of carers, health condition, home care services being used, prescription and pharmacy utilization status, presence of family pharmacy, and recognition of the need for drug management guidance by home visiting pharmacists were surveyed as well as the users' needs from a community pharmacy and its functions. Using these results, principal component analysis was performed. RESULTS: It was found that the users had a great need for the following services and functions: adequate medication instruction, listening attentively to users, and a good attitude from pharmacists and clerks. Meanwhile, the users' need for home care related services was relatively low, i.e. counseling about home care and welfare services, provision of a home visiting service, and provision of home care supplies. Also, principal component analysis indicated that users' needs consisted of five components, viz, medical services, material supply, convenience, readiness of service provision, and consideration of privacy. Regarding home care related services, counseling about home care and welfare services was related to the medical services; provision of home care supplies was related to the material supply; provision of a home visiting service was related to convenience. CONCLUSIONS: It was shown that users did not clearly recognize a service need for home care services as a new function of community pharmacies. Rather, users recognized the need for home care services connected to these already provided by community pharmacies. Therefore, information provision and education are necessary so that users can clearly understand the details and merits of the home care services which community pharmacies provide.

[General practitioner's recognition of service cooperation with community pharmacists related to home care in a suburban area].

OBJECTIVES: To clarify the factors affecting a general practitioner's demands and the recognition of service cooperation with community pharmacists related to home care in a suburban area. METHODS: A questionnaire on pharmacy services and functions was administered to 215 general practitioners in a suburban area. Gender, age, specialty, length of practice, status of home visiting, requests for community pharmacists, awareness of a home visiting service by community pharmacists, status of issues about home visiting orders to community pharmacists and the criteria for deciding to issue an order, recognition of the necessity of a home visiting service by pharmacists, expectation value to the community of the pharmacists' participation in the home care service and requests, recognition of cooperation with other home care related professions, ease of cooperation with community pharmacists, disincentives for cooperation with community pharmacists, factors necessary to promote cooperation between practitioners and community pharmacists, and factors necessary to promote the home care system were surveyed. Using the results, chi 2 test and principal component analysis were performed. RESULTS: It was found that the general practitioners' main demands were support and management of pharmaceutical therapy. Meanwhile, the practitioners' low cognition of pharmacists' home visiting seemed to be one disincentive to cooperation with pharmacists. Every practitioner who had issued visiting orders to pharmacists practiced home visiting and issued the visiting orders based on patients' condition at home. Practitioners who practiced home visiting were more active in promoting the home care system and had a better cognition and more extensive demands for pharmacists' home visiting compared to practitioners with no home visiting. Practitioners with good recognition of cooperation with community pharmacists had better cognition, realized the necessity of, and expected pharmacist's home visiting compared to practitioners with low awareness. However, practitioners' overall recognition of cooperation with pharmacists was relatively low. As disincentives, practitioners pointed out lack of acquaintance, the unclear function of pharmacists, and no opportunity for cooperation. So, enhancing practitioners' awareness of home care, clarifying the pharmacist's role, establishing a relationship of mutual trust through information feedback and/or exchange based on practice would be effective in promoting service cooperation with community pharmacists.

[Individual background factors for "cannot go out alone to distant places" among medium elderly persons living alone in a metropolitan suburb].

OBJECTIVE: To verify whether the statement "cannot go out alone to distant places" should be considered a risk factor for disability among medium elderly persons living alone autonomously in a metropolitan suburban environment, the present cross-sectional study was performed. METHODS: Self-rated mobility levels in elderly persons living alone were surveyed by questionnaire in 1,216 elderly people (209 male, 1007 female) aged 65 to 74 years, living in a metropolitan suburb, who had autonomy and ambulation competence. Two categories were used for evaluation of the self-rated mobility level: the A group were those who were able to go out alone to distant places and the B group were those who were able to do so in the locality, but not to distant places without help (cannot go out alone to distant places). Factors such as everyday lifestyle, self-rated health, and psychological, functional, physical and social items were investigated. RESULTS: Although the frequency of going out was nearly the same between the A and B groups, the B group showed the lower hobby and association activity in social communities. Individual factors such as self-rated health, instrumental activities of daily living (Tokyo Metropolitan Institute of Gerontology), eyesight, masticatory ability, 1 km continuous walking, pedestrian crossing walking on a green light, and fracture history, medicine intake, cerebrovascular disorder related subjective symptoms, intermittent claudication related subjective symptoms, physical pain, symptoms of depression, daytime sleep, number of meals, and no regular walking and light gymnastic exercises demonstrated significant differences in levels between the A and B groups. The B group had characteristics of lower social activities in social communities, deterioration of physical functions, subjective symptoms of sickness and depression, and a worse self-rated level of health. On stepwise multiple logistic regression analysis, individual frailty-risk factors related to "cannot go out alone to distant places", were "inability to continuously walk a distance of 1 km", "lower masticatory ability", "having depressive symptoms", and "having symptoms of intermittent claudication". CONCLUSIONS: The findings from this study show that with autonomous medium elderly persons, those who "cannot go out alone to distant places" have risk factors for a trend toward disability.

[The relationship between ambulatory blood pressure variation and symptoms of depression and sleep disturbance in community-dwelling elderly persons with independent activities of daily living].

OBJECTIVE: To clarify the relationship between ambulatory blood pressure variation and symptoms of depression and sleep disturbance in community-dwelling elderly persons with independent activities of daily living. METHODS: The subjects were 41 volunteers in a health education class for the elderly in a rural community. We carried out: (1) an interview about symptoms of depression using the Geriatric Depression Scale (GDS), competence of daily living, subjective daily sleep complaints and past history of disease,; (2) ambulatory blood pressure measurements over 24 hours with a portable device,; (3) sleep-awake judgment by wrist actigrams,; and (4) instructions for self-records of his/her life activities. RESULTS: (1) The average value for 24 hour-mean diastolic blood pressure was significantly higher in subjects undergoing hypertension treatment. (2) No significant relationship was observed between subjective sleep disturbance and ambulatory blood pressure variation. (3) No significant relationship was observed between objective sleep disturbance assessed by wrist-actigraphy and ambulatory blood pressure variation. (4) Severe depression was related to a lower degree of night decrease in both systolic and diastolic blood pressure in subjects undergoing hypertension treatment, while it was associated with higher average values for 24 hour- and awaking-mean systolic and diastolic blood pressure in subjects not receiving such treatment. CONCLUSIONS: In community-dwelling elderly persons with independent activities of daily living, severer depression was associated with the higher mean blood pressure in subjects not taking medicine for hypertension and with a low degree of night decrease in diastolic blood pressure in those receiving hypertension treatment, while no significant relationship was observed between sleep disturbance and ambulatory blood pressure variation.

[Functional characteristics of pharmacy services related to home care--results from two pharmaceutical association surveys in suburban and old town areas].

In order to investigate the implementation about pharmacy services focusing on home care and to identify differences in functional characteristics in accordance with pharmacy location, questionnaire surveys were conducted on all 75 pharmacies belonging to T-City Pharmaceutical Association in a suburban area and on all 161 belonging to K-Ward Pharmaceutical Association in a central downtown district. Using data, a principal component analysis was performed. The following services were investigated: medication guidance for patients and their families; provision of drug information to patients; management of patients' drug history; dispensing; advice to physicians; inquiries; management of prescriptions for home infusion services; sales of items such as over-the-counter [OTC] drugs [commercially available drugs that do not require a physician's prescription]; display and catalogue sales of nursing items; consultation on home care; holding events such as health education programs; guidance for drug management by home visits; and information exchange with other medical professionals and social workers. The results of these surveys were as follows. (1) The following services were regularly performed in both urban and suburban areas: medication guidance for patients and their families; provision drug information to patients; management of patients' drug history; dispensing; advice to physicians; inquiries; and sales of OTC drugs. (2) The following services were not difficiently regularly performed in both areas: display and catalogue sales of nursing items; consultation on home care; holding events such as health education programs; guidance for drug management by home visits; and information exchange. (3) As to principal component analysis, pharmacy functions were divided into 3 components and the dispensing service strongly influenced the functional characteristics in T-City. Whereas, in K-Ward, pharmacy functions were divided into 4 components and consultation and information exchange were strong influences. (4) Home care-relate pharmacy services were closely associated with information exchange on both areas. This implies that enforcing information exchange among pharmacists and other health practitioners and social welfare practitioners is an essential factor to expand implementation of home-care related pharmacy services.

[Characteristics of the stages of change in physical behavior of male workers suffering from impaired glucose tolerance].

OBJECTIVE: The purpose of this study was to describe the characteristics of the stages of change in physical behavior of workers with diabetes and impaired glucose tolerance according to their dietary behavior, BMI, FBS, and HbA1c. SUBJECT AND METHODS: The annual health checkup records of 15,317 male employees of an automobile corporation were examined. The stages of change in physical behavior were assessed through a self-reported questionnaire about "regular exercise" related to the five transformation stages and the date were used to analyze analyzes its relationship to dietary behavior, BMI, FBS, and HbA1c. RESULTS AND DISCUSSION: The older age groups reported that the time spent on the "Action" and the "Maintenance" stages increased gradually over time. From the results we deduced that activity in the 30-39-year-old age group is low, which may be due lifestyle influence. The groups with advanced HbA1c levels reported that the time spent on the "Action" and the "Maintenance" stages increased. This may reflect the effects of present health management and continued research on its effects is needed. Significant correlations between the stages of change for physical and dietary behavior were observed in every age group and in every HbA1c level group. Developing regular exercise habits was closely related to developing adequate dietary habits in every age group and in every HbA1c level group. The correlation between exercise and dietary habits is so strong that future research into the causes inhibiting individuals from developing regular exercise habits is needed for workers with diabetes and impaired glucose tolerance. Developing regular exercise habits did not have a significant relation to FBS disorders in the 30-39 yr old age group or obesity in any age group. The results suggest that the effect and the limit of the physical behavior can be appropriately guided, and the offer of that encourages and supports the maintenance of the education physical behavior established is important. CONCLUSION: Health management systems for the prevention of diabetes mellitus should include independent education programs for encouraging regular exercise habits combined with diet programs in consideration of characteristics of the stages of change in physical behavior of working populations.

Effects of vital exhaustion on cardiac autononomic nervous functions assessed by heart rate variability at rest in middle-aged male workers.

We investigated the effects of vital exhaustion (VE) on cardiac autonomic functions in relation to working conditions such as overtime and frequent business trips, and to lifestyles such as smoking on 52 healthy middle-aged male workers. VE was evaluated by an abbreviated Maastricht Vital Exhaustion Questionnaire. Cardiac autonomic function at supine rest was assessed by spectral analysis of heart rate variability in an annual health checkup. The mean amplitude of the high frequency (HF: 0.15-0.4 Hz) component was lower in the high-VE group, whereas no significant difference in the ratio of the low frequency (LF: 0.04-0.15 Hz) component power to HF power (the LF/HF ratio) was observed among VE groups. There were significant interactive effects of VE and smoking on HF amplitude, and of VE and frequent business trips on the LF/HF ratio. VE symptoms were related to the suppression of the cardiac para-sympathetic nervous function at rest in middle-aged male workers, but not to the alteration in sympathovagal balance. Smoking and overwork such as frequent business trips may amplify the autonomic dysfunction in relation to VE among workers with a pronounced feeling of VE.