Discipline ; Mental association

As a health care measure for the people in the prime of life, the Ministry of Health and Welfare (now the Ministry of Health, Labor and Welfare) of the Japanese government started off the first 5-year program for the senior citizens in 1983 with the enforcement of the Law Concerning Health and Medical Services for the Aged, followed by the second five-year program in 1988 and the third eight-year program in 1992. The screening project for colon cancer was incorporated in the third program with a target set of holding an increasing rate of morbidity at zero in a year-to-year comparison. The response rate to colon cancer screening (the ratio of the number of participants responding to colon cancer screening to the total number of qualified persons) was also to be raised steadily to reach a target of 30% in 1999. In Gifu Prefecture, the total number of examinees in 1999 increased twice the figure in 1992, but the response rate was 14.8%, which was only about half the target and below the national average of 15.3%. The detection ratio of colon cancer and the early cancer ratio in the prefecture were much the same as the national average. It could be taken that there is nothing wrong as far as the precision of screeming and management are concernd. To decrease the rate of mortality from cancer of the colon, the most important is to raise the response rate. For this purpose, we would like to propose that the cost should be covered by national health insurance in those health screening projects approved of by the competent authorities.
Malignant tumor of colon ; Aspects of disease screening ; Health ; Cancer treatment response rate ; Federal Government

We report 3 cases of sudden death while the students are at school. In Japan 120-150 cases, mainly related to sports, are reported in a year. In Gifu Prefecture (population: 2, 000, 000), only 1 or 2 cases probably occur in a year. While here in Mizunami City (population: 40, 000), we had 3 cases for the last 10 years. This is a higher occurrence rate than in other cities.
The 1st case was caused by brain-stem bleeding; the 2nd, rupture of the wall of the aorta associated with Marfan syndrome, and the 3rd, fatal arrythmia related to Wolff-Parkinson-White syndrome.
Measures to prevent the incidence are summed up as follows:
(1) Teachers, school doctors and hospital staffs should have closer contact
(2) We should critically review the standards for cardiac disease management and make a thorough examination of the heart at the time of regular health screening by several ways, such as UCG, Holter ECG and treadmill ECG, to find high-risk students.
(3) 60% of the cases of sudden death were of cardiac origin, and 40% were due to central nervous system disorder, bronchial asthma etc., so we should also watch over these conditions.

[Background]: Fluticasone propinate (FP), an inhaled steroid agent, has greater clinical efficacy in bronchial asthma than Beclomethasone dipropionate (BDP), but it has been reported that the rate of oropharyngeal candidiasis becomes high. In this study, we evaluated the medium-term pharyngeal candidiasis rate in elderly patients after BDP was replaced with FP in maintenance therapy.
[Method]: A total of 53 elderly patients 65 and over, who had previously received stable maintenance therapy with BDP, were switched to treatment with half doses of FP, and they were taught to gargle again.
Eight weeks and six months later, pharyngeal swabs were taken for culture and assessment of candidiasis. These results were compared with those of 24 patients 64 and below. We also measured the inspiratory peak flow rate with inhaled FP.
[Results]: Eight weeks later, candidiasis appeared in 11 patients in the advanced age group (20.8%), which was significantly high compared with only one patient in the age group under 65 (4.2%). Although the pharyngeal candidiasis of 8/11 patients became negative by teaching them thoroughly how to gargle with povidone-iodine, candidiasis appeared in another seven patients six months later, bringing the total up to 10/53 (18.9%).
[Conclusion]: The appearance rate of pharyngeal candidiasis in the elderly patients, who changed for FP, was unexpectedly high. It was suggested that the frequncy of gargling after inhaling FP and the inspiratory peak flow rate when FP is inhaled could be big influential factors. When we use FP, it may be important to give medium and long term-persistent instructions to patients.

This paper reports the findings of a follow-up survey on non-smoking carried out in 2005. The previous survey was conducted in 2004 by distributing questionnaires to public facilities, schools, nursery schools and post offices in Mizunami. Method:The questionnaires consisted of the same questions as the previous ones and were sent to the same 64 facilities. Results:The questionnaires were recovered from 59 facilities(92.2%). Compared with the results of the previous survey, the number of public facilities, schools, offices and resting rooms where smoking is totally prohibited increased. In post offices, smoking corners disappeared. Progress was also made remarkably in division of public space and a workplace into smoking and nonsmoking areas. The smoking ratio of employees in these facilities surveyed decreased from 20% to 17%. Conclusion:Our survey confirmed that nonsmoking has steadily won public acceptance in a matter of one year.
Surveys ; Smoking ; public ; Schools, Nursery ; After values

To investigate the attitude of personnel at public facilities toward cigarette smoking, a poll was taken at 27 municipal facilities, 14 schools, 15 nursery schools, and 10 post offices in Mizunami City. Questionnaires were distributed to a total of 936 employees, asking them whether they smoke and whether their workplaces are divided into smoking and nonsmoking areas.All the questionnaires were collected, with the names of facilities entered. Of the pollees, 20.0% was found smokers. At about 80% of the facilities surveyed, smoking was prohibited at offices and resting rooms for employees. As it turned out, nosmoking zones were limited to only 30% of public space utilized by citizens. At most of the nursery schools surveyed, smoking was banned, but in many schools, smoking was not prohibited in the resting rooms for the teaching and clerical staff. Post offices, compared to the other facilities surveyed, were too lax in regulating smoking. The survey also found that less than half of the facilities have a good knowledge of Article 25 of the Health Promotion Law.The findings of the latest survey were such that we deemed it necessary to conduct more positively a campaign against smoking in public facilities open to local residents.
Smoking ; Surveys ; cigarette smoking ; seconds ; Questionnaires

A 46-year-old female patient with non-alcoholic steatohepatitis (NASH) was administered nateglinide, an insulin secretagogue, for 7 months, and then polyenephosphatidylcholine, an anti-oxidant medication, in accordance with the two-step hypothesis of NASH, with insulin resistance as the initial pathogenesis and oxidative stress as the second. HOMA-R, an index of insulin resistance, improved, and hepatic marker levels improved markedly by four weeks after initiation of polyenephosphatidylcholine. The beneficial effects of treatment continued over the 24 months of the study. A liver biopsy evaluated using Brunt's criteria showed improvement from stage 2 to stage 0 after 9 months. These findings suggest the therapeutic efficacy of step by step treatment of NASH in accordance with the two-stage hypothesis.
therapeutic aspects ; month ; Diagnostic Neoplasm Staging ; agreement ; Oral

[Introduction] Fluticasone propionate (FP), an inhaled corticosteroid, has almost twice as much clinical efficacy as Beclomethasone dipropionate (BDP) in the management of asthma. The inhalation of FP dry powder by using a handy and portable inhalator is effective for young and middle-aged patients with bronchial asthma. However, the inhalator are not always easy for elderly patients to operate because it requires some manual dexterity and a knack for quick inhalation.
[Methods] A total of 47 outpatients aged 65 years or above who had achieved a stable asthmatic condition were enrolled for this study, and changed the drugs from BDP to FP. The amount of FP to be taken at one time was equivalent to half the dose of BDP. Twelve check points of inhalation skills were repeatedly taught until patients understoodfully. We checked these points after 2-4 weeks and 8 weeks. We used a questionnaire to survey the patients' impression of FP and its adverse effects. We also evaluated peak flow values (PEF) in the morning and at night, results of pulmonry function tests and asthmatic grades.
[Results] We found clear weak points for the 12 skills in the elderly patients. PEF both in the morning and at night significantly improved after 2-4 week treatment with FP, but pulmonary function tests found no statistically significant change. Eventually 71.4% of the patients in the 65-74 year age range and 50.0% of those of 75 years or above hoped to continue to receive FP therapy. The total number of the patients with adverse effects was 14 (29.8%): These were 7 cases of dryness in the mouth, 5 cases of hoarseness and 2 cases of nausea and vomiting.
[Discussion] Although we confirmed the clinical usefulness of FP in elderly patients with asthma, we must recognize that it requires much time and labor for the eldrely to get used to FP inhalation and that it is important to give them repeated instruction.

Objective: The diagnostic criteria for the metabolic syndrome (MetS) were published in Japan in April 2005. However, there have been no large-scale studies in rural areas to confirm these criteria. We examined the prevalence of MetS in subjects who had undergone a routine medical health checkup at our hospital, located in a rural area. This data was used to investigate the appropriateness of the diagnostic criteria for MetS.Subjects and Methods: The MetS status was examined retrospectively in 2340 subjects (1408 men, 932 women ; mean age 49.6 ± 9.7 years) who underwent a routine medical health checkup at our hospital between April 2004 and March 2005.Results: Of the 1408 men and 932 women, 209 men (14.8%) and 23 women (2.5%) were diagnosed with MetS. Forty-four men (3.1%) and 4 women (0.4%) met all three diagnostic criteria for metabolic disorders. In the female group, only 8.7% of the 932 women met the waist circumference criterion of ≥90 cm. Because this waist circumference criterion was used during the first screening but was not met by most of the women, they were eliminated from our study. Using receiver operating characteristic (ROC) analysis, the cutoff values for waist circumference were 85.0 cm (sensitivity 0.750, specificity 0.564) in men and 79.5 cm (sensitivity 0.787, specificity 0.709) in women. If the women's waist circumference criterion had been set at the value of ≥79.5 cm, this would have resulted in 48 (5.2%) women meeting the criterion.Conclusion: From the viewpoint of preventive medicine, the Japanese male MetS diagnostic criteria are fairly appropriate. However, for the women, the waist circumference criterion of ≥90 cm has been set too high and was not met by most of the female subjects. Therefore, the Japanese MetS criteria for women, particularly the cutoff value for waist circumference, requires further verification.
Human Females ; Male population group ; diagnostic criteria ; Japanese language ; Health

The purpose of this study was to shed light on the prevalence of the metabolic syndrome (MetS) in a rural community and examine whether or not serum adipocytokine levels are associated with the Diagnostic Criteria for MetS and how many MetS components laid down in the standards subjects have. The subjects were 2,858 people (1,744men and 1,114 women, mean age 49.8+/-9.9 yrs) who had participated in our health screening program between April and December, 2005. After obtaining informed consent from them, we measured serum leptin, adiponectin and high-sensitivity C-reactive protein levels, while performing routine blood tests. In the present study, these measurements were used in combination with the number of MetS components applicable to the conditions of our subjects. Two hundred men (11.5%) and 25 women (2.2%) were diagnosed with MetS. The number of MetS women was extremely small. Those women who were above the standard waist circumference of above 90cm accounted for 8.7% of the total. Thus, most women subjects were excluded as MetS candidates here. The leptin levels of the MetS group were higher than those of the non-MetS group in accordance with the number of applicable components in the diagnostic standards for MetS. Especially, the MetS group which met three MetS criteria showed significantly high leptin levels (p/5=0.0081) of 5.26+/-1.86 (ng/ml) compared to 3.31+/-1.44 (ng/ml) of the non-MetS group with waist circumference below 85cm. On the other hand, no significant difference was noted between the groups in adiponectin level. However, in contrast to leptin levels, adiponectin levels were lower in the group having three MetS components than the non-MetS group 4.37+/-1.57 (ng/ml) as against 5.52+/-3.34 (ng/ml). High-sensitivity CRP levels did not show any significant difference between the two groups.As regards the cutoff value of women's waist circumference, further study needs to be done. It was suggested that serum leptin levels might be closely related to the diagnostic criteria for MetS and the number of MetS components applicable.
Human Females ; Leptin ; ng/mL ; seconds ; adiponectin