Subjective Evaluation of Denture Adhesives: A Multicenter Randomized Controlled Trial.

INTRODUCTION: Many reports show that denture adhesives improve the retention and stability of dentures. However, few randomized controlled trials have examined the effects of denture adhesives. OBJECTIVE: This 10-center randomized controlled trial with parallel groups involving 200 edentulous patients wearing complete dentures aimed to evaluate the effects of short-term use of cream and powder denture adhesives. METHODS: Patients were allocated into 2 cream- and powder-type adhesive groups and 1 control group. Intervention groups were treated with the 2 adhesives (1 each), and the control group received saline solution. Adhesive or control was applied to the denture-mucosal surface for 4 d, and data at baseline and after day 4 of intervention (i.e., 8 meals) were obtained. Patient satisfaction was evaluated with a 100-mm visual analog scale. Oral health-related quality of life was measured with the Japanese version of the Oral Health Impact Profile for Edentulous Patients. Perceived chewing ability was evaluated by a questionnaire regarding ease of chewing and swallowing food. Between-group comparisons were performed with Kruskal-Wallis tests with the Mann-Whitney U test adjusted by Bonferroni correction. Within-group comparisons of pre- and postintervention measurements were performed with the Wilcoxon signed-rank test. Intention-to-treat analysis was also performed. RESULTS: Between-group comparisons showed no significant differences for general satisfaction or Oral Health Impact Profile for Edentulous Patients. However, significant differences in satisfaction with various denture functions with cream- and powder-type adhesives were seen in pre- and postintervention comparisons (P < 0.05). Significant differences were also observed for perceived chewing ability of hard foods (P < 0.05). CONCLUSION: These results suggest that although denture adhesives do not invariably improve denture function, they do affect subjective evaluations and possibly chewing of hard foods. Therefore, the effects of denture adhesive use are insufficient to resolve any fundamental dissatisfaction with dentures ( ClinicalTrials.gov NCT01712802 ). KNOWLEDGE TRANSFER STATEMENT: The results of this study suggest that denture adhesives should be applied under certain conditions; however, an appropriate diagnosis is important before application. These practice-based data provide information to establish evidence-based guidelines for applying denture adhesives.

The auditory evoked magnetic fields to very high frequency tones.

We studied the auditory evoked magnetic fields (AEFs) in response to pure tones especially at very high frequencies (from 4000 Hz to 40,000 Hz). This is the first systematic study of AEFs using tones above 5000 Hz, the upper audible range of humans, and ultrasound. We performed two experiments. In the first, AEFs were recorded in 12 subjects from both hemispheres under binaural listening conditions. Six types of auditory stimulus (pure tones of five different frequencies: 4000 Hz, 8000 Hz, 10,000 Hz, 12,000 Hz, 14,000 Hz, and a click sound as the target stimulus) were used. In the second experiment, we used 1000 Hz, 15,000 Hz, and two ultrasounds with frequencies of 20,000 Hz and 40,000 Hz. The subjects could detect all stimuli in the first experiment but not the ultrasounds in the second experiment. We analyzed N1m, the main response with approximately 100 ms in peak latency, and made the following findings. (1) N1m responses to the tones up to 12,000 Hz were clearly recorded from at least one hemisphere in all 12 subjects. N1m for 14,000 Hz was identified in at least one hemisphere in 10 subjects, and in both hemispheres in six subjects. No significant response could be identified to ultrasounds over 20,000 Hz. (2) The amplitude of the N1m to the tones above 8000 Hz was significantly smaller than that to 4000 Hz in both hemispheres. There was a tendency for the peak latency of the N1m to be longer for the tones with higher frequencies, but no significant change was found. (3) The equivalent current dipole (ECD) of the N1m was located in the auditory cortex. There was a tendency for the ECD for the tones with higher frequencies to lie in more medial and posterior areas, but no significant change was found. (4) As for the interhemispheric difference, the N1m amplitude for all frequency tones was significantly larger and the ECDs were estimated to be located more anterior and medial in the right hemisphere than the left. The priority of the right hemisphere, that is the larger amplitude, for very high frequency tones was confirmed. (5) The orientation of the ECD in the left hemisphere became significantly more vertical the higher the tones. This result was consistent with previous studies which revealed the sensitivity of the frequency difference in the left hemisphere. From these findings we suggest that tonotopy in the auditory cortex exists up to the upper limit of audible range within the small area, where the directly air-conducted ultrasounds are not reflected.

Magnetic response of human extrastriate cortex in the detection of coherent and incoherent motion.

Although direction selectivity is a cardinal property of neurons in the visual motion detection system, movement of numerous elements without global direction (incoherent motion) has been shown to activate human and monkey visual systems, as does coherent motion which has global direction. We used magnetoencephalography to investigate the neural process underlying responses to these types of motions in the human extrastriate cortex. Both motions were created using a random dot kinematogram and four speeds (0, 0.6, 9.6 and 25 degrees /s). The visual stimuli were composed of two successive motions at different speeds; a coherent motion at a certain speed that changed to incoherent motion at another speed or vice versa. Magnetic responses to the change in motion consisted of a few components, the first of which was always largest. The peak latency of the first component was inversely related to the speed of the preceding motion, but for both motions it was not affected by the speed of the subsequent motion. For each subject, the estimated origin of the first component was always in the extrastriate cortex, and this changed with the speed of the preceding motion. For both motions, the location for the slower preceding motion was lateral to that for the faster preceding motion. Although the latency changes of the two motions differed, their overall response properties were markedly similar. These findings show that the speed of incoherent motion is represented in the human extrastriate cortex neurons to the same degree as coherent motion. We consider that the human visual system has a distinct neural mechanism to perceive random dots' motion even though they do not move in a specific direction as a whole.

Spatiotemporal source analysis of vocalization-associated magnetic fields.

The vocalization-related cortical fields (VRCF) following vowel vocalization were studied by magnetoencephalography (MEG) in eight normal subjects. A multiple-source model, BESA (Brain Electric Source Analysis), was applied to elucidate the generating mechanism of VRCF in the period from 150 ms before to 150 ms after the onset of vocalization. Six sources provided satisfactory solutions for VRCF activities during that period. Sources 1 and 2, which were activated from approximately 150 ms before the vocalization onset, were located in laryngeal motor areas of the left and right hemispheres, respectively. Sources 5 and 6 were located in the truncal motor area in each hemisphere, and they were very similar to sources 1 and 2 in terms of temporal change of activities. Sources 3 and 4 were located in the auditory cortices of the left and right hemispheres, respectively, and they appeared to be activated just after the vocalization onset. However, all six sources were temporally overlapped in the period approximately 0-100 ms after the vocalization onset. The present results suggested that the bilateral motor cortices, probably laryngeal and truncal areas, were activated just before the vocalization. We considered that the activities of the bilateral auditory areas after the vocalization were the response of the subject's central auditory system to his/her own voice. The motor and auditory activities were temporally overlapped, and BESA was very useful to separate the activities of each source.

Hemispheric lateralization in an analysis of speech sounds. Left hemisphere dominance replicated in Japanese subjects.

Evoked magnetic responses to speech sounds [R. Näätänen, A. Lehtokoski, M. Lennes, M. Cheour, M. Huotilainen, A. Iivonen, M. Vainio, P. Alku, R.J. Ilmoniemi, A. Luuk, J. Allik, J. Sinkkonen and K. Alho, Language-specific phoneme representations revealed by electric and magnetic brain responses. Nature, 385 (1997) 432-434.] were recorded from 13 Japanese subjects (right-handed). Infrequently presented vowels ([o]) among repetitive vowels ([e]) elicited the magnetic counterpart of mismatch negativity, MMNm (Bilateral, nine subjects; Left hemisphere alone, three subjects; Right hemisphere alone, one subject). The estimated source of the MMNm was stronger in the left than in the right auditory cortex. The sources were located posteriorly in the left than in the right auditory cortex. These findings are consistent with the results obtained in Finnish [R. Näätänen, A. Lehtokoski, M. Lennes, M. Cheour, M. Huotilainen, A. Iivonen, M.Vainio, P.Alku, R.J. Ilmoniemi, A. Luuk, J. Allik, J. Sinkkonen and K. Alho, Language-specific phoneme representations revealed by electric and magnetic brain responses. Nature, 385 (1997) 432-434.][T. Rinne, K. Alho, P. Alku, M. Holi, J. Sinkkonen, J. Virtanen, O. Bertrand and R. Näätänen, Analysis of speech sounds is left-hemisphere predominant at 100-150 ms after sound onset. Neuroreport, 10 (1999) 1113-1117.] and English [K. Alho, J.F. Connolly, M. Cheour, A. Lehtokoski, M. Huotilainen, J. Virtanen, R. Aulanko and R.J. Ilmoniemi, Hemispheric lateralization in preattentive processing of speech sounds. Neurosci. Lett., 258 (1998) 9-12.] subjects. Instead of the P1m observed in Finnish [M. Tervaniemi, A. Kujala, K. Alho, J. Virtanen, R.J. Ilmoniemi and R. Näätänen, Functional specialization of the human auditory cortex in processing phonetic and musical sounds: A magnetoencephalographic (MEG) study. Neuroimage, 9 (1999) 330-336.] and English [K. Alho, J. F. Connolly, M. Cheour, A. Lehtokoski, M. Huotilainen, J. Virtanen, R. Aulanko and R.J. Ilmoniemi, Hemispheric lateralization in preattentive processing of speech sounds. Neurosci. Lett., 258 (1998) 9-12.] subjects, prior to the MMNm, M60, was elicited by both rare and frequent sounds. Both MMNm and M60 sources were posteriorly located in the left than the right hemisphere.

Automatic discriminative sensitivity inside temporal window of sensory memory as a function of time.

Neural representation of preceding sound-patterns stored in the human brain, as reflected by mismatch negativity (MMN) related to the automatic discriminative process, is restricted to a duration of 160-170 ms due to the short form of auditory sensory memory termed the temporal window of integration (TWI). To examine the temporal uniformity of deviation-sensitivity inside TWI of sensory memory, magnetic MMN (MMNm) responses were measured with a dual 37-channel magnetometer for complex sounds of 170 ms duration containing an omitted (silent) segment. Frequent standard stimuli (probability of 80%) consisted of five tone segments. Deviant stimuli were different from standard stimuli in that one of four segments was occasionally (probability of 5%) omitted and replaced by a silent segment. The stimulus duration of 170 ms was intended to correspond to the postulated duration of TWI. When the silent segment occurred later in deviant stimulus, the MMNm peak amplitude was attenuated and MMNm peak latency, measured from the onset of each silent segment, was delayed. Thus, automatic deviation-detection sensitivity declines nonlinearly toward the end of TWI in auditory sensory memory. In the second experiment, two types of deviant stimuli, which differed from each other only in the period after the occurrence of the silent segment, elicited MMNm with the same peak latency but with a different peak amplitude. Thus, mismatch process is triggered at the moment of change but still lasts after the detection of deviation. In other words, both standard and deviant stimuli are treated as a unitary event within a TWI.

Hearing the sound of silence: a magnetoencephalographic study.

We visualized the brain activity for retrieval imagery of a sound using dual 37-channel magnetometers in seven right-handed healthy subjects. A soundless video image of a hammer striking an anvil was presented on a screen. Significantly larger evoked magnetic fields were recorded, dominantly in the right hemisphere, in six subjects when they imagined the sound than when they did not. The initial peak of the response was 151.0 +/- 26.5 ms (mean +/- s.d.) after the blow. Equivalent current dipoles (ECDs) for the responses recorded from the right hemisphere were located around the inferior frontal sulcus in three subjects and in the insular region in three subjects, but reliable ECDs were not estimated from the left hemisphere. The results suggested that the initial activity for sound retrieval imagery appeared around the inferior frontal and insular areas, dominantly in the right hemisphere.

The masking effect in foreign speech sounds perception revealed by neuromagnetic responses.

The backward masking effect on non-native consonants by a following vowel was examined using neuromagnetic responses to synthesized speech sounds. Native speakers of Japanese were presented with sequences of frequent (85%) and infrequent (15%) speech sounds (/ra/ and /la/ respectively, no /l/ /r/ contrast in Japanese language). The duration of the stimuli was 110 ms in a short session and 150 ms in a long session. In the short session, the stimuli were terminated in the course of the transition from the consonant to the vowel to diminish the masking effect from the vowel part. A distinct magnetic counterpart of mismatch negativity (MMNm) was observed for the short session, whereas a smaller MMNm was observed for the long session.

Auditory response following vocalization: a magnetoencephalographic study.

OBJECTIVE: We recorded vocalization-related cortical fields (VRCF) under complete masking of a subject's own voice to identify the auditory component evoked by a subject's own voice in the VRCF complex. METHODS: We recorded VRCF during simple vowel (/u/) vocalization in 10 right-handed healthy volunteers under two conditions: (1) no masking (control) and (2) masking of the subject's own voice by weighted-white noise during vocalization. In the second experiment, we recorded auditory evoked magnetic fields (AEF) following stimulation of a speech sound applied by voice-recorder. RESULTS: The onset of VRCF appeared gradually before the vocalization onset, and a clear phase-reversed deflection was identified after the onset of vocalization. The difference waveform obtained by subtracting the VRCF of the masking condition from that of the control showed a deflection (1M) at 81.3+/-20.5 (mean+/-SD) ms after the onset of vocalization, but there was no consistent deflection before the vocalization onset. The AEF following voice sound in the second experiment showed the M100 component at 94.3+/-18.4 ms. The equivalent current dipole of the 1M component for different waveforms was located close in the auditory cortex to that of the M100 for AEF waveforms in each hemisphere. CONCLUSION: We successfully separated the auditory feedback response from the VRCF complex, using an adequate masking condition during vocalization of a subject's own voice. The masking effect was crucial to the auditory feedback process after the onset of vocalization. The present results suggested that the 1M component was mainly generated from the auditory feedback process by the subject's own voice. The activated auditory area for simple own voice might be similar to that for simple external sound.

Identification of auditory evoked potentials of one's own voice.

OBJECTIVE: We recorded vocalization related cortical potentials (VRCP) with complete masking of one's own voice, and separated the feedback auditory potentials following vocalization from the VRCP complex. METHODS: We used 9 right-handed healthy subjects. We recorded VRCP during simple vowel vocalizing under two conditions, (1) without masking (control); (2) with masking. Electroencephalography (EEG) was recorded from seven areas, Fz, Cz, Pz, C3, C4, T3 and T4, of the International 10-20 system. The trigger point was the onset of vocalized sound recorded through a microphone. RESULTS: In both control and masking conditions, similar negative potentials prior to the vocalization were observed. However, the amplitude just after the onset of vocalization was significantly smaller in the masking than the control condition. The difference waveform, obtained by subtracting the waveforms in the masking from those in the control condition, showed a simple negative peak after the vocalization onset. CONCLUSIONS: We considered that the difference waveform indicated the auditory evoked potentials following own voice in the auditory feedback process. Since there was no difference of the negative potentials before vocalization between the two conditions, we speculated that the masking effect on auditory feedback following vocalization was crucial, while its effect on the preparatory process of simple vocalization might be minimal.

The influence of system factors upon the macro-economic efficiency of health care: implications for the health policies of developing and developed countries.

This paper aims to clarify the global association of system factors with the attainment of health policy goals, through economic analyses of cross-country data. In the case of OECD (the Organization for Economic Co-operation and Development) data for 1990, the variation in total expenditure on health among 24 countries can be explained by various factors including Gross Domestic Product (GDP). Among these, the variables representing the level of public sector involvement through social protection or public-private mix within a health care system, such as the Public-to-Total Expenditure Ratio, Coverage Rate and Public Cost Sharing, are significantly negative when factors such as GDP are controlled. This suggests that countries attaining higher equity or accessibility are in a better position to gain higher cost-containment or macro-economic efficiency. The results of this study may be helpful for developing countries searching for a long-term health care system as well as for developed countries facing health care system reforms.

Risk factors for ischemic heart disease in an urban area of Japan: a case-control study in AMHTS.

OBJECTIVES: In Japan controversy exists as to whether or not the risk factors for ischemic heart disease (IHD) are the same as in western countries. We conducted a case-control study on IHD to clarify the risk factors in males in an urban area of Japan using our automated multiphasic health testing and services (AMHTS) system. METHOD: Cases were the clients who took the health check-up between January 1987 and July 1994 and had onset of IHD after the check-up. For each case five clients were selected as controls by conditional matching. The check-up data were compared between cases and controls 11 years, 6 years and just before the onset of the heart diseases. RESULTS: The statistically significant items were as follows: (1) Eleven years before the onset: Total cholesterol (T-Chol) for myocardial infarction (MI), and fasting blood sugar (FBS) for angina pectoris (AP). (2) Six years before the onset: T-Chol, electrocardiographic (ECG) findings and the complaint of palpitation or breathlessness for MI, and FBS and palpitation or breathlessness for AP. (3) Just before the onset: T-Chol, the complaint of chest pain, FBS, smoking index and hypertensive status for MI and palpitation or breathlessness, ECG findings, chest pain, systolic blood pressure and erythrocyte sedimentation rate at 60 minutes for AP. In conclusion, the risk factors for MI in males in an urban area of Japan are the same as in western countries. The most significant risk factor for AP in males in an urban area of Japan is fasting blood sugar.

[Effects of high- and low-intensity training on cardiorespiratory system and serum lipids].

The differences between the effects of high- and low-intensity exercise training on cardiorespiratory system and serum lipid levels were examined under conditions in which the total work load was same. Twenty-two healthy, untrained female students, aged 18 to 24 years, participated in the 8-week training experiment. Two training groups exercised on bicycle ergometers 4-5d/wk for 8 wk with high-intensity (H: 70% VO2 max 13 min/session; N = 8) or in low-intensity (L: 36% VO2 max 33 min/session; N = 8). The control group (C: N = 6) continued its sedentary life style. Data of 6 students (H: N = 2, L: N = 2, C: N = 2) were excluded from the analysis, because they did not carry out their duties. The results of this study were as follows; 1) Aerobic capacity increased in both training groups. 2) After training, both heart rates and oxygen uptake during submaximal work loads significantly decreased in group H, but only heart rates significantly decreased in group L. 3) Heart rates with a same oxygen-uptake load during submaximal work seemed to increase in group H, but significantly decreased in group L. 4) The mechanical efficiency during the submaximal work load significantly increased in group H, but not in group L. 5) DBP and MBP during the submaximal work load in group L significantly decreased compared with those before the training. SBP with a same oxygen-uptake load during submaximal work increased in group H, but decreased in group L. 6) Rate pressure products both at rest and during submaximal exercise decreased significantly in group L. 7) Serum lipid levels remained in all groups. These results suggested that when the amount of exercise is the same, low-intensity exercise training with 35% VO2 max was more effective to increase endurance capacity and was safer than high-intensity exercise training.

[The relationship between coronary risk factors and body weight--gender and age difference].

METHODS: The association between Coronary Risk Factors (CRF) and Body Mass Index (BMI, defined as the weight in kilograms divided by the square of the height in meters) was examined in 1,551 Japanese in an urban health promotion sports center. These subjects were 20-84 years of age and free of known cardiovascular disease. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), High Density Lipoprotein-Cholesterol (HDL-C), Low Density Lipoprotein-Cholesterol (LDL-C), triglyceride (TG), Fasting Blood Sugar (FBS), smoking habits and sports habits were measured for CRF and converted to a score for overall estimation of individual CRF. RESULTS: In analysis, a linear relation was observed between BMI and the sum of CRF scores (CRFI) in both men and women. Men had a higher CRFI and greater increase in CRFI by BMI than women. When examined separately by age strata, women showed a greater increase in CRFI by BMI with the increase in age. In contrast, men over 50 years old showed no increase in CRFI by BMI.

[Relationships among physical activity, physical fitness and coronary risk factors in adult women--comparison between premenopausal and postmenopausal women].

The relationships among daily physical activity, physical fitness and the risk factors for coronary heart disease (CHD) were studied comparing 477 premenopausal women (36.1 +/- 7.6 yr) and 178 naturally postmenopausal women (56.7 +/- 5.8 yr). The results were as follows. 1) No relationship between physical fitness and daily activity level was found in either groups. 2) In premenopausal women, daily activity was associated with blood pressure, triglycerides (TG) and blood sugar only in the low-fitness group. But there was no relation between risk factors and the level of daily activity in the high-fitness group. 3) In postmenopausal women, the low-fitness group showed increasing TC/HDLC and decreasing HDLC associated with the low daily activity. TC, LDLC and TC/HDLC were lower in the high-fitness-with-high-daily-activity group than in the high-fitness-with-low-daily-activity group. 4) In both groups, the levels of TG and TC/HDLC were lower in the high-fitness group than in the low-fitness group. This suggests that serum lipids have a closer relation to fitness than to daily activity. These results indicate that the relationships among daily activity, physical fitness and CHD risk factors are different in menopausal status, and that daily activity is one of the most important factors to reduce CHD risk factors, especially in unfit or postmenopausal women.

[A study on the primary prevention of essential hypertension (1). Evaluation of blood pressure response during exercise and effect of habitual exercise].

Hypertension is one of the risk factors of cardiovascular diseases, which are widely prevalent maladies that result in burdensome medical expenditures. Therefore, it is important to explore primary preventive measures for hypertension. Until recently, it was thought that exercise was a risk factor for hypertension, but recent reports have suggested that low-intensity physical training actually lowers blood pressure. However, habitual physical exercise has still not been clearly proven to prevent the development of hypertension. To clarify this point, one must first establish a method for predicting hypertension and second examine the possibility of preventing the development of hypertension by changing the subject's environment. In this study we have investigated a method for predicting hypertension by classifying blood pressure responses to increasing exercise intensity and the effect of habitual exercise on blood pressure response. This study was composed of three experiments. Experiment one involved female students (n = 42) and experiment two, male students (n = 38), in whom blood pressure response rates during exercise were recorded. In experiment three, the same group of female students (n = 23) was subjected to training in order to chart its effects on blood pressure response, both while exercising and while at rest. The exercises were performed with a bicycle ergometer in an upright position. There were four different degrees of work intensity. Blood pressure was measured using the auscultation method, with Riva-Rocci mercury measured by the same investigator. High blood pressure responses at rest were noted among some normotensive female and male students. The systolic blood pressure responses during the peddling exercise showed significant individual differences at the lowest work load; the distribution of the increment of the systolic blood pressure ratio at the lowest work load against the increment while resting showed two peaks. This result suggests that this increment ratio is an important variable related to the prediction of hypertension. The increment ratio showed no significant change in female students after three months of aerobic exercise. The high-response group showed high readings of the TPR indicator (MBP/VO2). Aerobic training was shown to be effective in significantly lowering the TPR indicator both at rest and during exercise. This result suggests that habitual exercise may contribute to preventing the development of hypertension.

[Baroreceptor reflex function in young normotensive men with a family history of hypertension].

The purpose of this study is to evaluate the baroreflex function using lower body negative pressure (LBNP) and neck suction in young normotensive men with or without a family history of hypertension. Twenty-two young normotensive men with a family history of hypertension (FH+) and eight young normotensive men who had no family history of hypertension (FH-) were studied. FH(+) consisted of men who had a family history of hypertension within second degree relatives. We studied cardiopulmonary baroreflex function using LBNP and carotid sinus baroreflex function using neck suction and evaluated the reflex function under stimulated conditions using both LBNP and neck suction at the same time. Systolic arterial pressure (SAP)(F = 5.42, p < 0.0001) and pulse pressure (PP)(F = 15.57, p < 0.0001) decreased similarly in both groups in response to LBNP. SAP and PP responses to LBNP were not significantly affected by the family history of hypertension. Diastolic arterial pressure (DAP) increased (F = 2.89, p < 0.005) in both groups. There was a relationship between the LBNP level and family history of hypertension (F = 2.53, p < 0.013), and the increment in DAP during LBNP -30, -40 mmHg was larger in the FH(+) group. Through mean arterial pressure (MAP) was not effected by LBNP, there LBNP level was related to the family history of hypertension (F = 2.23, p < 0.02). Heart rate increased progressively (F = 25.7, p < 0.0001) with increasing levels of LBNP; however, these changes did not differ significantly in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Relationship between medical services utilization and preventive health behavior].

The purpose of this study was to examine the relationship between medical services utilization and preventive health behavior and to seek the factors affecting them. Subjects were 568 persons who were from 40 to 59 years old and lived in a community. Preventive health behaviors they actually performed and their interests in health were asked by questionnaire. Preventive health behaviors assessed included smoking behavior, drinking behavior, adequate hours of sleep, physical exercise, regularity of meals, and medical checkups. Medical services utilization, which included the number of visits to medical care providers, was measured by their medical claims during one year. Except for adequate hours of sleep, preventive health behaviors correlated positively with each other. A strong positive correlation was found between medical services utilization and medical checkups. However, correlations between medical services utilization and other preventive health behaviors were not statistically significant. Persons who performed preventive health behaviors and persons who utilized medical services scored higher in interest in health than persons who didn't. These results show that medical services utilization and preventive health behavior are strongly associated with interest in health, but are weakly correlated with each other.

[Medical services utilization of the elderly during the last six months of life].

The purpose of this study was to describe the characteristics of medical services utilization during the last six months of life. Subjects were 150 elderly who lived in a community and died in 1990. By each subject's medical claims during the last six months of life, the number of hospital days, the number of visits for ambulatory care, the number of physicians' and nurses' visits for home care, medical expenditure, and the utilization of medical care activities were measured as utilization variables. Subjects were classified into four subgroups by the combination of cancer and cerebrovascular disease. These diseases have an important impact on medical services utilization during the last six months of life. Utilization variables of each subgroup were compared. The findings were as follows; 1. During the last six months of life, hospital stays of cerebrovascular disease patients were for long periods, while cancer patients frequently and repeatedly changed the place of care between hospital and home. 2. The number of visits for ambulatory care and the number of medical care providers utilized by cancer patients were greater than that of cerebrovascular disease patients. Cerebrovascular disease patients whose stay at the hospital was short made greater use of physicians' and nurses' visit for home care. 3. The medical expenditure of cancer patients was higher than that of cerebrovascular disease patients, although the number of hospital days of cancer patients was less. 4. Most of the cancer patients utilized transfusion and urological treatment. These results suggest that the utilization of medical care activities of cancer patients was more intensive than that of cerebrovascular disease patients. However cancer patients made little use of resuscitation procedures.

[Public health nurse staffing requirements for health examination of infants and children in municipalities of Japan].

In accordance with the Maternal and Child Health Service Act, public health centers and municipalities offer health education, health counseling, health examinations, and home visits for children and their mothers in their jurisdiction. On the basis of the new Maternal and Child Health Service Act, municipalities will have the responsibility to effectively promote health examination for three-year-old children beginning in 1997. To provide health examinations to infants and children, establishing a health personnel system, especially the public health nurse program, is extremely important. The purpose of this study is to determine fundamental facts concerning health manpower development among public health nurses in the municipalities, by reviewing research on health examinations for both infants and children. To determine personnel staffing requirements necessary for health examinations of infants and children in the municipalities of Japan, pertinent references were systematically reviewed. The main results are as follows; 1) The correlation coefficients between the total working hours of the public health nurse for MCH and the population per area and number of birth per year were significantly positive. 2) Total working hours for health examination of three-year-old children per 100 births per year, by the public health nurse were 143 hours, of which 79% were spent just for performing the examination itself. 3) Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with a population of less than 3,000, 43% of the total volume of work performed by public health nurses during the health examinations of three-year-old children required the assistance of prefectural public health nurses. 4) On the other hand, in those areas with populations more than 10,000, 88% of the total volume of work required to be performed by public health nurses during the health examinations for three-year-old children was covered by municipal public health nurses. 5) When the total number of working hours of the public health nurse for Maternal and Child Health was divided into the four parts of planning, implementation, evaluation and training, 86.7% of working hours were spent on implementation itself. 6) In those cities designated by the Government, the health personnel system was sufficient to carry out these health examinations. 7) It was found that in towns and villages with small populations, the health examinations for infants and children can be better carried out in combination with assistance by prefectural public health nurses. 8) The review of the findings suggests that it is important to clarify by further studies not only the relationship between the health manpower system and implementation of the health examination but also the relationship between this system and the effectiveness of the health examination in near future.