Purpose and Background: To attain the goal of the “Operation Zero Asthma Death” implemented by the Ministry of Health, Labor and Welfare, it is essentially important to make the treatment guidelines known widely and make proper use of inhaled steroid drugs at an early stage. That said, in the area where specialists are in extremely short supply, there are limitations to the development of the operation. The Asthma Control Committee organized by the Tono Chapter of the Medical Association in Gifu Prefecture developed a four-layered system of its own for coordination between hospitals, clinics, drug stores and public care facilities. This year is the third year after the system was worked out. In the present study, we examined the results of the asthma control activities. Methods;In the first layer, hospitals and clinics jointly hold lecture meetings to familiarize the treatment guidelines through asthma cards;in the second layer, medical specialists and pharmacists held inhalation workshops for pharmacists in neighborhood drugstores; in the third layer, emergency paramedics joined forces, and in the forth layer, the aim was to build up a collaborative relationship with nursing care workers. The effects of these activities using the four-layered system on the Operation Zero Asthma Death were assessed in terms of the amount of inhaled steroid drugs prescribed and the change in the number of asthma deaths per 100,000 persons. Results: The amount of inhaled steroid drugs prescribed increased almost twice as much as before the start of these activities. It was found that the inhalation workshops were attended by almost all the druggists in the district, thus laying the foundation for the system of inhalation instruction. Through the nursing care support seminars, the collaborative relationship was established. The open lecture meeting held twice for ordinary people were very well attended, thus playing an important role in increasing the knowledge of asthma among the general public. The asthma deaths in the Tono district dramatically decreased from 4.13/100,000 persons for 1998 to 0.81/100,000 for 2008. The death ratio for 2008 was compared favorably with 1.17/100,000 in the whole prefecture for the same year. Conclusion: The results clearly indicated that the four-layered system worked out by the Asthma Control Committee could surely reduce the number of deaths from asthma even in the area where specialists are in short supply.

Objective: The aim of the study was to assess the effect of rosuvastatin 2.5 mg, an inhibitor of HMG-CoA reductase, on achieving lipid goals defined by the 2007 Japan Atherosclerosis Society guidelines.
Subjects and Methods: Thirty-seven patients with moderate to high risk hypercholesterolemia (Mean age: 64.8 ± 8.4) were treated with 2.5 mg/day of rosuvastatin and their lipid and hepatic function parameters were measured at the baseline and at Weeks 4 and 8.
Results: At 4 and 8 weeks after start of treatment, 74.1% and 92.6% of moderate risk patients, as well as 70% and 80% of high risk patients, achieved their LDL-C goals, respectively. In both moderate and high risk patients, the mean LDL-C/HDL-C ratio, which is considered as a prospective index for plaque regression, was significantly reduced (p<0.001 for both the moderate and high risk groups), and the mean LDL-C/HDL-C ratio decreased to less than 2 in moderate risk patients. No abnormal changes were observed in hepatic function tests during the study.
Conclusion: More than 80% of moderate to high risk patients with hypercholesterolemia achieved their lipid goals and the mean LDL-C/HDL-C ratio was significantly reduced after the 8-week short treatment of rosuvastatin 2.5 mg, suggesting the clinical possibility of continuous use of rosuvastatin for plaque regression.

  Purpose and Background: To attain the goal of the “Operation Zero Asthma Death” implemented by the Ministry of Health, Labor and Welfare, it is essentially important to make the treatment guidelines known widely and make proper use of inhaled steroid drugs at an early stage. That said, in the area where specialists are in extremely short supply, there are limitations to the development of the operation. The Asthma Control Committee organized by the Tono Chapter of the Medical Association in Gifu Prefecture developed a four-layered system of its own for coordination between hospitals, clinics, drug stores and public care facilities. This year is the third year after the system was worked out. In the present study, we examined the results of the asthma control activities. Methods;In the first layer, hospitals and clinics jointly hold lecture meetings to familiarize the treatment guidelines through asthma cards;in the second layer, medical specialists and pharmacists held inhalation workshops for pharmacists in neighborhood drugstores; in the third layer, emergency paramedics joined forces, and in the forth layer, the aim was to build up a collaborative relationship with nursing care workers. The effects of these activities using the four-layered system on the Operation Zero Asthma Death were assessed in terms of the amount of inhaled steroid drugs prescribed and the change in the number of asthma deaths per 100,000 persons. Results: The amount of inhaled steroid drugs prescribed increased almost twice as much as before the start of these activities. It was found that the inhalation workshops were attended by almost all the druggists in the district, thus laying the foundation for the system of inhalation instruction. Through the nursing care support seminars, the collaborative relationship was established. The open lecture meeting held twice for ordinary people were very well attended, thus playing an important role in increasing the knowledge of asthma among the general public. The asthma deaths in the Tono district dramatically decreased from 4.13/100,000 persons for 1998 to 0.81/100,000 for 2008. The death ratio for 2008 was compared favorably with 1.17/100,000 in the whole prefecture for the same year. Conclusion: The results clearly indicated that the four-layered system worked out by the Asthma Control Committee could surely reduce the number of deaths from asthma even in the area where specialists are in short supply.

Objective: The purpose of this study was to evaluate the efficacy of risedronate for the improvement of the quality of life (QOL) in patients with primary osteoporosis.Methods: Twenty-seven Japanese patients who had receutly been diagnosed with primary osteoporosis (mean age: 73.8 ± 9.1yr, 18 men and 9 women) were the subjects of this study. Using the Japan Osteoporosis Society Quality of Life Questionnaire (JOQOL), each patient's QOL was evaluated before treatment with oral risedronate 2.5mg once daily, and 3, 6, and 12 months during treatment. We also measured the bone mineral density (BMD), serum bone-specific alkaline phosphatase (BAP), and serum N-terminal telopeptide of type I collagen (NTx) before treatment and at 6 and 12 months.Results: The JOQOL total score gradually increased and significantly improved after 12 months of treatment in both male (p=0.026) and female patient groups (p=0.021). The pain scores in the female group first improved significantly at 3 months (p=0.018) and continued to improve over the remaining 9 months of the study, while improvement in the male group reached a significant level at 12 months (p=0.048). Along with the improved pain scores, the other five scores (assessment of activities of daily living, entertainment and social activity, overall health, posture, and falls and anxiety) also tended to improve. Although risedronate did not significantly improve the BMD over the 12 months of this study, the serum BAP levels decreased over the 12 months period and significantly decreased in male (p=0.004) and female groups (p<0.001) at 6 months. The serum NTx level also decreased significantly in male (p=0.003) and female groups (p=0.046) at 12 months.Conclusion: The administration of risedronate for 12 months significantly improved the QOL in patients with primary osteoporosis and resulted in improved bone metabolism. The JOQOL may be an efficacious index for judging the outcome of osteoporosis treatment.
month ; lower case pea ; Osteoporosis ; Risedronate ; therapeutic aspects

  Purpose and Background: To attain the goal of the “Operation Zero Asthma Death” implemented by the Ministry of Health, Labor and Welfare, it is essentially important to make the treatment guidelines known widely and make proper use of inhaled steroid drugs at an early stage. That said, in the area where specialists are in extremely short supply, there are limitations to the development of the operation. The Asthma Control Committee organized by the Tono Chapter of the Medical Association in Gifu Prefecture developed a four-layered system of its own for coordination between hospitals, clinics, drug stores and public care facilities. This year is the third year after the system was worked out. In the present study, we examined the results of the asthma control activities. Methods;In the first layer, hospitals and clinics jointly hold lecture meetings to familiarize the treatment guidelines through asthma cards;in the second layer, medical specialists and pharmacists held inhalation workshops for pharmacists in neighborhood drugstores; in the third layer, emergency paramedics joined forces, and in the forth layer, the aim was to build up a collaborative relationship with nursing care workers. The effects of these activities using the four-layered system on the Operation Zero Asthma Death were assessed in terms of the amount of inhaled steroid drugs prescribed and the change in the number of asthma deaths per 100,000 persons. Results: The amount of inhaled steroid drugs prescribed increased almost twice as much as before the start of these activities. It was found that the inhalation workshops were attended by almost all the druggists in the district, thus laying the foundation for the system of inhalation instruction. Through the nursing care support seminars, the collaborative relationship was established. The open lecture meeting held twice for ordinary people were very well attended, thus playing an important role in increasing the knowledge of asthma among the general public. The asthma deaths in the Tono district dramatically decreased from 4.13/100,000 persons for 1998 to 0.81/100,000 for 2008. The death ratio for 2008 was compared favorably with 1.17/100,000 in the whole prefecture for the same year. Conclusion: The results clearly indicated that the four-layered system worked out by the Asthma Control Committee could surely reduce the number of deaths from asthma even in the area where specialists are in short supply.

Aim and background: Chronic insomnia in elderly patients significantly affects their health and quality of life (QOL). Nocturia also worsens sleep condition. The aim of this study was to evaluate the improvement effects of quazepam, a long-term acting benzodiazepine, on insomnia and nocturia in elderly patients. Method: Forty-one elderly outpatients (mean age 77.1 ± 5.6 yr) suffering from chronic insomnia while on regular a short- or ultra-short-acting hypnotic treatment were enrolled. We prescribed 7.5-15 mg of quazepam, which was administered regularly by the subjects before bedtime. A questionnaire was used to compared changes in quality of sleep and frequency of nocturia for before treatment and at 2 and 4 weeks after initiation of treatment. QOL was also examined using the 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36). Results: Thirty-seven subjects (90.2%) completed the study. All subscales of the sleep quality questionnaire improved significantly (p<0.001) after 2 weeks, as did the total scores (p<0.001) after 4 weeks. Frequency of nocturia decreased significantly from 3.6 ± 1.7 times to 1.5 ± 0.8 (p<0.001) and 1.2 ± 1.0 times (p<0.001) after 2 and 4 weeks, respectively. Every SF-36 subscale also showed significant improvement after 4 weeks. The total SF-36 scores of the group showing a decrease in the frequency of nocturia (>/= 2 times) improved significantly compared with that with a frequency of < 2 times (p=0.016). Conclusion: Quazepam significantly improves sleep, QOL and nocturia in elderly patients that respond poorly to short-acting or ultra-short-acting hypnotics.
Nycturia ; Elderly ; week ; lower case pea ; Sleep

Objective: The aim of the study was to assess the effect of rosuvastatin 2.5 mg, an inhibitor of HMG-CoA reductase, on achieving lipid goals defined by the 2007 Japan Atherosclerosis Society guidelines. Subjects and Methods: Thirty-seven patients with moderate to high risk hypercholesterolemia (Mean age: 64.8 ± 8.4) were treated with 2.5 mg/day of rosuvastatin and their lipid and hepatic function parameters were measured at the baseline and at Weeks 4 and 8. Results: At 4 and 8 weeks after start of treatment, 74.1% and 92.6% of moderate risk patients, as well as 70% and 80% of high risk patients, achieved their LDL-C goals, respectively. In both moderate and high risk patients, the mean LDL-C/HDL-C ratio, which is considered as a prospective index for plaque regression, was significantly reduced (p<0.001 for both the moderate and high risk groups), and the mean LDL-C/HDL-C ratio decreased to less than 2 in moderate risk patients. No abnormal changes were observed in hepatic function tests during the study. Conclusion: More than 80% of moderate to high risk patients with hypercholesterolemia achieved their lipid goals and the mean LDL-C/HDL-C ratio was significantly reduced after the 8-week short treatment of rosuvastatin 2.5 mg, suggesting the clinical possibility of continuous use of rosuvastatin for plaque regression.
Carbon ion ; Risk ; Lipids ; Low density lipoprotein cholesterol measurement ; High density lipoprotein measurement

  Purpose and Background: To attain the goal of the “Operation Zero Asthma Death” implemented by the Ministry of Health, Labor and Welfare, it is essentially important to make the treatment guidelines known widely and make proper use of inhaled steroid drugs at an early stage. That said, in the area where specialists are in extremely short supply, there are limitations to the development of the operation. The Asthma Control Committee organized by the Tono Chapter of the Medical Association in Gifu Prefecture developed a four-layered system of its own for coordination between hospitals, clinics, drug stores and public care facilities. This year is the third year after the system was worked out. In the present study, we examined the results of the asthma control activities. Methods;In the first layer, hospitals and clinics jointly hold lecture meetings to familiarize the treatment guidelines through asthma cards;in the second layer, medical specialists and pharmacists held inhalation workshops for pharmacists in neighborhood drugstores; in the third layer, emergency paramedics joined forces, and in the forth layer, the aim was to build up a collaborative relationship with nursing care workers. The effects of these activities using the four-layered system on the Operation Zero Asthma Death were assessed in terms of the amount of inhaled steroid drugs prescribed and the change in the number of asthma deaths per 100,000 persons. Results: The amount of inhaled steroid drugs prescribed increased almost twice as much as before the start of these activities. It was found that the inhalation workshops were attended by almost all the druggists in the district, thus laying the foundation for the system of inhalation instruction. Through the nursing care support seminars, the collaborative relationship was established. The open lecture meeting held twice for ordinary people were very well attended, thus playing an important role in increasing the knowledge of asthma among the general public. The asthma deaths in the Tono district dramatically decreased from 4.13/100,000 persons for 1998 to 0.81/100,000 for 2008. The death ratio for 2008 was compared favorably with 1.17/100,000 in the whole prefecture for the same year. Conclusion: The results clearly indicated that the four-layered system worked out by the Asthma Control Committee could surely reduce the number of deaths from asthma even in the area where specialists are in short supply.

Objective: The comparative effect of telmisartan and valsartan upon insulin resistance and adipocytokines in nondiabetic patients with mild hypertension is unclear. Methods: Fifty nondiabetic patients with untreated mild hypertension were randomly assigned to telmisartan (40 mg/day) and valsartan (80 mg/day) groups and were switched in a crossover manner at 3-month intervals. Serum leptin, adiponectin, hsCRP and the HOMA-R were measured before and at 3 months during each treatment period. Results: The HOMA-R significantly improved over the 3 months in the high insulin resistance group (HOMA-R>/=2.5) during the telmisartan treatment period (p=0.042), but not during the valsartan period. Both telmisartan and valsartan significantly decreased serum leptin levels in each female group during each treatment period (p<0.001 and p<0.001, respectively), but not in the male groups. Serum adiponectin did not increase in either treatment group. Serum hsCRP levels also significantly decreased in the high hsCRP subjects (>/=0.1) of both treatment groups (p=0.044 and p=0.015, respectively). Conclusions: Telmisartan significantly improved insulin resistance, possibly through the effect on PPAR-gamma, while both telmisartan and valsartan significantly decreased serum leptin levels in female groups and hsCRP in both genders, suggesting no significantly different effects on adipocytokines by either drug in nondiabetic patients with mild hypertension.

[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.