Health care plan has been established in each secondary medical area. Although health care plan should be focused on needs of people live in such units, studies with a view from residents’ perspective have not always been considered adequately. The aim of this study was to examine the factors that effect on utilization of health care facilities located outside of the secondary medical area in a rural region. The data included 515 patients with hypertension, 253 patients with hyperlipidemia, and 104 patients with diabetes. Factors relating utilization of health care facilities were assessed by age, sex, employment, number of diseases, body mass index (BMI), carotid plaque score, HbA1c, distance to the nearest clinic, and distance to the nearest bus stop. We conducted a logistic regression analyses of that data divided into two groups; car use and non car use. The result showed that sex, BMI, carotid plaque score and distance to the nearest bus stop were statistically significantly associated with the utilization of health care facilities located outside of the secondary medical area in patients with car use. Whereas, there were no statistically significantly associations in patients with non car use. Our findings suggested that it is important to consider health utilization of patients with lifestyle related diseases for making sustainable health care plan.

Objectives: Prevention of obesity is a high priority of health management at workplaces. We conducted a follow-up study of obesity and obesity-related metabolic disorders in Japanese male workers. Subjects and Methods: Ninety-eight male workers engaged in the operation of a nuclear power plant in Shimane Prefecture, aged 41 ± 8 years in 2006, were subjected to regular health check-ups in 1996 and 2006. Results: The changes in their body weights and metabolic parameters (blood pressure, AST, ALT, γ-GTP, LDL-cholesterol, HDL-cholesterol, triglycerides, glucose and uric acid) were compared by BMI class and age group. Twenty-three percent of the subjects fell within the 23.0 to 24.9 BMI range, and 23% were over 25.0 BMI. Body weight increased significantly, by 3.6 ± 5.3 kg in all subjects, but there was no significant difference in weight gain over the 10 years by age or BMI group. Weight gain was positively associated with metabolic parameters, such as the values of systolic blood pressure, ALT, triglycerides and uric acid, and negatively associated with the value of HDL-C. Conclusions: Japanese male workers, regardless of age and BMI at baseline, experienced an increase of body weight and obesity-related metabolic disorders. Therefore, health professionals in the workplace should consider educating workers about stress-coping methods to reduce job stress, promote a health-supportive environment, such as healthy menus in employee cafeterias and fitness clubs, and be cognizant of high-risk factors in the individual employee.
Obesity ; workforce ; seconds ; Male gender ; Body Mass Index

  As the abilitiesof physical and daily life tend to fall by aging, and nutrition improvementis importantin elderly. Effects of nutrition improvement for elderly has verified on the seriously malnutrition elderly in a hospital, but there is little evidencefor elderly in community. We conducted the intervention by milk ingestion based on physical activities program for the frail elderly in community. Subjects were 45 elderly people (73.7±5.7 years old) who participated in the preventive program for three months in Izumo City, and were divided into two groups of 22 milk intervention subjects and 23 controlsubjects. The milk intervention group was provided with milk (180 ml/day) by door-to-door delivery, and the parameters of nutrition and anthropometricwere investigated before and after intervention. BMI, HDL-cholesterol and hemoglobinwere significantly improved in the milk intervention group, but no significant effects in the control. The intervention group had significant health-effects of BMI, albumin, HDL-cholesterol, hemoglobin, HbA1c and essential amino acids/nonessential-amino-acid ratio, compared with the control group. Asphysical activities in the control groupbefore intervention was poorer than the intervention group, the control group improvedsignificantlyby the physical activities program.In conclusion, daily milk ingestion based on physical activities program makes an improvement of nutrient state in frail elderly in community.

  As is often the case with rural communities in Japan, a dearth of health resources poses a serious problem in a mountainous region of Shimane Prefecture. Although a medical care plan focusing on needs of people should be devised with a view to building up a sustainable health care system, studies have not always adequately been pursued. The aim of this study was to assess the data on the patients with lifestyle-related health problems to and from health care facilities. A Geographic Information System was used for measuring the travel time and road distance. The data for 255 patients with hypertension, 114 patients with hyperlipidemia, and 42 patients with diabetes were amassed. The results showed that the average travel time and distance were much longer in patients with diabetes than those with hypertension. Statistically no significant difference was observed in severity of diabetes (HbA1c, BMI and LDL-c) and blood pressure levels between patients who received regular treatment at clinics in the two towns and those who went all the way to clinics outside of the towns. In addition, compared with the patients with diabetes aged 75 years or over, the average travel time and road distance for aged of 74 years or younger were much longer. Similarly, compared with the patients with hypertension aged 75 years or over, the average travel time and road distance for aged of 74 yeras or younger were also much longer. These results indicated that the diabetics and the elderly age 74 or younger tended to go to health facilities beyond the secondary-medical care zone. These findings also suggested that a closer cooperation between facilities in the neighboring secondary-medical care zones to improve the quality of medical services and support general practitioners to review the existing disease management program would make it possible to cope with the present situation.

　　The establishment of a sustainable healthcare system based on residents’ needs is an urgent issue in a rural region. For this purpose, considering the structure of a healthcare system, such as the numbers of beds, doctors, and nurses is important. In addition, the study of healthcare utilization using the date gathered through geographic information systems (GIS) would be very helpful in building such a healthcare system. In Japan, however, there are few published studies available on how health services are utilized. The aim of this paper was to review articles of GIS research on healthcare utilization. We conducted a systematic search of published peer-reviewed literature on PubMed. We found 38 articles that satisfied our inclusions criteria for review. Of them, 12 articles had a map for understanding health needs or demands, 23 articles carried analyses of distance and time for health utilizations, and seven articles had a buffer or database for analyses of healthcare utilization. Most of these articles have dealt with pediatric care and emergency care. Given the aging population in a rural region, we concluded that a more evidence-based approach should be taken to rural health focussing on lifestyle-related diseases.

;Small, dense low density lipoprotein (LDL) has been suggested to be highly atherogenic as a result of their low-binding affinity to LDL receptors, their prolonged plasma half-life and low resistance to oxidative stress. Although marine n-3 polyunsaturated fatty acids (PUFAs) have beneficial effects for the prevention of cardiovascular diseases, there is little information on detailed fatty acid composition in LDL particles. In the present study, LDL subfractions were isolated from the plasma of 45 clinically healthy Japanese women by density gradient ultracentrifugation using a light fraction of 1.025-1.034 g/ml (LDL-I), an intermediate fraction of 1.034-1.044 g/ml (LDL-II), and a dense fraction of 1.044-1.060 g/ml (LDL-III). A clear relationship between the frequency of fish intake and increases in plasma n-3 PUFAs was apparent. Although plasma n-3 PUFAs in women with small-sized LDL using non-denaturing gradient gel electrophoresis (GGE) did not show a significant difference, n-3 PUFAs and n-3 PUFAs/n-6 PUFAs in dense LDL-III subfraction increased in the small-sized LDL group using GGE, compared to those with buoyant LDL particles. The result of enriched n-3 PUFAs in dense LDL subfraction suggests that n-3 PUFAs may help prevent atherosclerosis in the arteries of Japanese women with small-sized LDL.
Low density lipoprotein cholesterol measurement ; Lower case en ; Human Females ; Japanese language ; Plasma

Objective: Clinical studies suggest that maintaining a lower postprandial glycemic response is important for improvement and prevention of metabolic syndrome and type 2 diabetes mellitus. Amylose, an ingredient in many food grains, is a major factor for the lowering of postprandial glycemic and insulinemic response. The aim of the present study was to determine the influence of rice with different level of amylose on postprandial glycemic and insulinemic response in mice and humans.Materials and Methods: The two types of rice used in the study contained 29 wt% (high amylose rice) or 17 wt% (low amylose rice) amylose. In mice and humans, postprandial glycemic and insulinemic responses were measured and then the area under the response curves of both rice groups were compared.Results: In mice, comparisons of postprandial glycemic response showed high amylose rice was lower than that for low amylose rice in all time points. Notably postprandial glycemic responses for high amylose rice at 15, 30, 45 and 60 min were significantly lower (19%, 31%, 16% and 17% respectively). The area under the glycemic response curve for high amylose rice was a remarkably 16% less than for the low amylose rice. In humans, postprandial glycemic response at 30 min and insulinemic response at 60 min for high amylose rice were significantly lower than for low amylose rice (15% and 40% lower, respectively). Furthermore, general linear measurement multivariate analysis after adjustment for eating time and hemoglobin A1c at baseline showed that postprandial glycemic response at 30 and 60 min and insulinemic response at 60 min, and the area under the glycemic response curve for high amylose rice were significantly lower than for low amylose rice in human.Conclusion: The higher amylose content of the rice lowered the postprandial glycemic and insulinemic response, demonstrating the potential to prevent or improve metabolic syndrome and type 2 diabetes mellitus.
Rice ; Minute of time ; Laboratory mice ; Syndrome ; Diabetes Mellitus, Non-Insulin-Dependent

The traditional Japanese diet with its high intake of fruits and vegetables that are rich in antioxidants is believed to effectively ward off cardiovascular disease. Oxidative stress, related to reactive oxygen and nitrogen species produced by aerobic organisms, is responsible for the pathogenesis of most chronic diseases. Oxidative low density lipoprotein (LDL) is thought to play a key role in the pathogenesis of early atherosclerosis. There has been increasing interest in antioxidant substances derived from edible plants. It has been suggested that the measurement of LDL antioxidant activity is physiopathologically more important and informative for screening antioxidant activity to prevent atherosclerosis than other methods. We assessed by LDL oxidation assay the antioxidant characteristics of various edible plants from rural areas. The mulberry (Morus alba L.) leaf showed comparatively high antioxidant activity. We identified the antioxidant compounds and investigated compound levels in the mulberry leaf and found the antioxidant activity of mulberry leaves to be mainly attributable to quercetin 3-(6-malonylglucoside) (Q3MG). Dietary consumption of mulberry leaves and/or Q3MG may enhance resistance to oxidative modification of LDL and attenuated atherosclerotic lesion development. However, the outcome of intervention trials suggested that a single antioxidant had little effect on the risk of developing cardiovascular disease. The synergic effect of certain combinations may determine outcome. We need to widen our understanding of the synergic effect of diets and nutrient-gene interactions related to nutrient/disease risk.
Antioxidants ; seconds ; Low density lipoprotein cholesterol measurement ; Pathogenesis ; Oxidative Dietary Supplements

Effects of gender and employment situation on weight loss and lifestyle modification were assessed in a 3-month intervention study done for overweight and obesity. A total of 384 individuals in Izumo City Japan, participated from 2000 to 2006. Lifestyle modifications were quantitatively evaluated by calculating calories of energy intake and expenditure. Eleven men and 15 women failed to complete the intervention; they were significantly younger in both genders, and the women had a higher rate of employment than the completing group (91 men and 267 women). Intervention induced a weight loss of 1.9 kg for men and 1.6 kg for women, with no significant differences by gender. Significant differences were found in changes in energy intake and expenditure in both genders, but these disappeared after adjusting for weight. There were significant decreases in weight (1.6 kg in unemployed, 2.5 kg in employed) in men. Increases in walking and exercise for the employed were smaller than those for the unemployed. The relationship between changes in weight and energy balance by employment status was independently significant using multiple regression analysis. Employment is associated with difficulty in losing weight due to limited exercise time in behavioral intervention.

A cluster of certain metabolic abnormalities has been recognized as metabolic syndrome, which is characterized by resistance to insulin-stimulated glucose uptake, glucose intolerance, hyperinsulinemia, hypertriglyceridemia, hypo- HDL cholesterolemia (HDL-C) and hypertension, with or without hyperglycemia. These multiple metabolic disorders put a person at high risk for cardiovascular disease. With the goal to eliminate all adverse consequences of multiple metabolic disorders, the optimal approach would be through its prevention. Since visceral obesity has been proposed as the most important determinant of multiple metabolic disorders by the International Diabetes Federation and the Japanese Association of Internal Medicine in 2005, health practitioners were thrown into confusion to use any definitions of metabolic syndrome. The Japanese Ministry of Health, Labor and Welfare has decided to introduce a new policy for the prevention of metabolic syndrome and type 2 diabetes mellitus from April 2008. The Ministry of Health, Labor and Welfare conducts to establish a screening system and guidance of the metabolic syndrome. We review the history and concept of metabolic syndrome, insulin resistance and central obesity, pathophysiology and definition, and countermeasures against the metabolic syndrome, to improve the community health care system for the metabolic syndrome and cardiovascular disease.
Syndrome ; seconds ; Metabolic Diseases ; Health ; Prevention