Factors associated with earthquake deaths in the great Hanshin-Awaji earthquake, 1995

The authors conducted descriptive and case-control studies to find factors associated with earthquake deaths due to the Great Hanshin-Awaji earthquake on January 17, 1995, in Nishinomiya, Japan. In the case-control study, cases included all 1,104 deaths. Controls were randomly selected from survivors. Earthquake mortality increased for people over age 50 years. Mortality among people who had lived in dwellings that were completely destroyed was much higher. One risk factor was physical disabilities (odds ratio = 1.9, 95% confidence interval (CI): 1.0, 3.4). When the analysis was limited to the people who had lived in intact or partially destroyed dwellings, the odds ratio rose to 5.6 (95% CI: 1.6, 19.8).

[Smoking behaviors among medical doctors in Fukui, Japan]

This study was conducted in order to identify the smoking prevalence among all doctors (N = 874) belonging to the medical associations in Fukui Prefecture and factors that might possibly indicate causal smoking habits. A survey was conducted from December of 1996 to February of 1997, using a self-administered questionnaire, and the response rate for the survey was 91%. The main results of this survey were as follows: The prevalence of smoking among male and female medical doctors was 28% and 8% respectively, which was lower than that of adults in the general population, but higher than that of doctors in the developed countries. The prevalence of smoking among doctors was almost highest when they were 20 to 29 years old, and that among medical practitioners with their own institution was higher than doctors employed by an institution. In particular, medical practitioners who did not smoke were more likely to restrict or ban smoking in their hospitals or clinics.

Behaviors and attitudes towards smoking among the nurses in Japan

The study was carried to investigate on the actual conditions related to smoking of the nurses working in all medical institutions under a regional medical association in Mie Prefecture (regional medical institutions). Results obtained were as follows: smoking prevalence of female nurses is considered to be equal to that of the general female population in Japan. About 35% of the nurses with the smoking habit had an opinion to quit it, and about 45% of them practiced it seriously. Nearly 80% nurses favored restriction. In the way of thinking related to smoking, more than 90% of the nurses answered that women should not smoke for the health of the fetuses and infants, while only about 30% of them agreed to stop smoking working as members of the medical staff. The survey suggests that anti-smoking program is necessary to develop for smoking nurses working at medical facilities.

[Factors related to smoking behavior of nursing students revealed by a cohort study]

PURPOSE

Through a cohort study, changes in smoking behavior of nursing students and the factors related to their smoking behavior were examined.

METHOD

Research through anonymous questionnaires concerning smoking behavior was conducted on nursing students in the first to third grades (as of 1997) at two vocational schools of nursing located in the Tokyo Metropolitan area. The same research was conducted in the same manner on the same subjects the following year.

RESULTS

The smoking prevalence among nursing students of the first and second grades as of 1997 had increased by 10% in one year, and that of nursing students of the third grade (to graduate in 1998) had increased by 5%. The average degree of nicotine dependence of the subjects, who replied that they smoked every day in both surveys, increased from 4.25 to 5.00. As to factors related to smoking behavior, the smoking behavior of friends largely influenced that of the nursing students.

CONCLUSIONS

Education to prevent nursing students from smoking should be started as soon as possible at vocational schools of nursing, because the research showed that more than 70% of the smokers had actually thought of quitting and that their views toward smoking influenced later smoking behavior.

Study of the smoking behavior of medical doctors in Fukui, Japan and their antismoking measures

We conducted a survey on smoking among all members of the medical association in Fukui Prefecture, using a questionnaire to be filled in by the subjects. The survey was conducted from December of 1996 to February of 1997, and the return rate was 90.8%. The main results of this survey were as follows: the prevalence of current smoking among medical doctors was 26.0% (male: 27.8%, female: 5.2%), which was lower than that of adults in the general population. The prevalence of past smoking among doctors 20 to 34 years old by age cohort was highest and that among doctors 35 years old and higher declines as age cohort increased. Doctors' participation in activities for the prevention of smoking in the general society was also found to be at a low level.

Japanese national survey of adolescent drinking behavior in 1996

BACKGROUND

Despite legal prohibition of drinking by minors, there has been no systematic attempt to monitor drinking by young Japanese. This research, the first Japanese national survey of Japanese adolescent drinking behaviors, was conducted in 1996.

METHODS

In this survey, information on drinking frequency was obtained from questionnaires completed by 42,183 junior high school and 72,396 senior high school students in randomly selected schools representing all areas of Japan.

RESULTS

Sixty percent of junior high school students and 70% of senior high school students reported having drinking experiences; 5% of junior high school students and 10% of senior high school students drank one or more times per week. Many of the junior high school students usually drank with their families and consumed small amounts, but many of senior high school students drank on various occasions and consumed larger amounts. These Japanese high school students reported being offered alcohol frequently by their parents, found it easy to buy alcoholic beverages, and believed that they had the right to determine whether to drink. Japanese adolescents' drinking has increased over the past 20 years, whereas drinking by U.S. adolescents has decreased.

CONCLUSIONS

Japanese policies aimed at decreasing adolescent drinking are inadequate. A system for monitoring and potentially modifying adolescent drinking behavior is needed.

[Qualitative study of municipalities' maternal and child health promotion planning]

From 1997, basic maternal and child health services have been provided through municipalities. The ministry of Health and Welfare has requested all municipalities to publish a MCH promotion plan. We conducted a qualitative analysis of important contents of the plans using an evaluation index of original dichotomous variables. Out of 3,256 municipalities, 2,873 developed the plans for MCH promotion. Most of the plans present descriptions of the significance of MCH promotion planning, goals of the plans, problems of current MCH statistics and services, and plans of providing services. The proportion was low for plans which have needs assessment of target population, indicators of evaluation of plans, description of the relationship between objectives and services, importance of objectives, action plans, specific chapter or evaluation of the plan, monitoring of the plan, and plans for informing public of the MCH plan. Therefore, the MCH promotion plans have weaknesses in evaluation and action. The MCH promotion plans of middle sized cities were more likely to have these important contents. We will continue to analyze the processes for producing of excellent MCH promotion plans to extract universal promoting factors for producing MCH promotion plans.

Smoking behaviors and attitudes among school teachers in Mie, Japan

We conducted a questionnaire survey of public kindergarten, elementary and high school teachers in Mie Prefecture, concerning smoking habits and attitudes from November 1995 to February 1996. A self-reporting questionnaire was sent to approximately 16,000 teachers and school employees. The questionnaires were collected in a way which took into consideration the privacy of the respondents. A total of 13,998 questionnaires were returned. The percentages of smokers among the teachers were 44.7% for males and 3.1% for females, percentages which are lower than those for the general Japanese population. Almost all of the men and women agreed that anti-smoking education is needed. Most of those who did not feel anti-smoking education was needed were smokers themselves. Seventy percent of both men and women responded that anti-smoking education was a teachers' duty, however, only thirty-six percent of the male and twenty-one percent of the female teachers had actual experience at such education. Finally, almost all teachers wish wish that schools were totally smoke-free or had a partial ban on smoking and believe that school anti-smoking policies in Japan should be introduced.

A U-shaped association between home systolic blood pressure and four-year mortality in community-dwelling older men

BACKGROUND

Several studies in older people have found a U-shaped or J-shaped association of blood pressure with mortality. The increased mortality associated with the lowest levels of blood pressure in older people have been explained by concurrent illnesses and frailty, but previous studies used blood pressure measured on a single occasion. Such a casual value is different from the long-term average of blood pressure. We investigated the relation between the average level of 5-day consecutive home blood pressure and mortality in older people while adjusting for potential confounding factors including morbidity and frailty at baseline.

METHODS

In 1992, 1186 community residents of a rural Japanese town, Kahoku, aged 65 or older, measured their blood pressure in their homes 20 times (four times per day, 5 consecutive days). The mean value of the 20 measurements was used to examine the association between home BP and subsequent 4-year mortality. A proportional hazards model was fitted while adjusting for activities of daily living impairment, medical history, antihypertensive medication, smoking, use of alcohol, and depression.

RESULTS

A total of 134 persons died during the four-year follow-up period. There was no significant evidence that frailty is more prevalent in the lowest or highest systolic BP group than in intermediate groups. A U-shaped association between the average level of home systolic blood pressure and mortality was found in men while adjusting for potential confounding factors, including morbidity and frailty. We also showed the U-shaped curve of the association of systolic BP with all cause and noncardiovascular mortality in the whole population and the linear association of systolic BP with cardiovascular mortality.

CONCLUSIONS

We showed a U-shaped association between the average level of systolic blood pressure measured at home and mortality in older men while adjusting for potential confounding factors including morbidity and frailty. Not only high home systolic BP, but also low home systolic BP, is an independent risk factor for mortality in older men. The mechanisms underlying the association between BP and mortality differ by levels of systolic BP. Cardiovascular deaths tended to be higher in the highest SBP group, and only noncardiovascular deaths were increased in the lowest SBP group. The latter finding suggests that low SBP may be not only an independent risk of mortality but also an indicator of a subclinical noncardiovascular comorbid condition.

[A comparison of smoking habits between nursing school and nursing college students]

This study was conducted through anonymous questionnaires in order to compare the smoking habits of nursing school students with those of nursing college students, and to identify factors that might possibly indicate causes of smoking habits, among students of two major courses (a 3-year nursing school course and a 4-year nursing college course) for becoming nurses. The subjects were students in two nursing schools and two nursing colleges in the Tokyo Metropolitan area. The results showed that the smoking prevalence among nursing school students in the first to the third grades was 26%, and that among nursing college students of the same grades was 12%. As to factors related to smoking habits of the students the smoking patterns of mothers and friends were shown to largely influence those of the nursing students. Among nursing college students, 21% agreed to a smoking ban in their schools, compared with 14% of the nursing school students.

[Nationwide survey on alcohol use among junior and senior high school students in Japan]

We conducted the first nationwide survey on alcohol use by Japanese junior and senior high school students using a representative sampling procedure. Sample schools were selected by stratified cluster sampling. Response rates for self-administered anonymous questionnaires sent to sample schools for all students to fill out were 65.6% for junior high schools and 67.0% for senior high schools. A total of 117,325 students responded and 115,814 questionnaires were subjected to analysis. The proportion of current alcohol use (drank alcohol on > = 1 of the 30 days preceding the survey) among seventh graders was 26.0% for boys and 22.2% for girls, and it increased with age to reach 54.9% for boys and 43.4% for girls in the twelfth grade. The experience rate of alcohol drinking on ceremonial occasions was much higher than for any other modes of drinking. However, the experience rates of drinking with peers at parties, in bars, and drinking alone increased with age. The proportion of heavy drinkers also increased with age. The cumulative experience rate of drinking with peers was dramatically increased in senior high school students. The most popular alcohol drink among boys was beer, whereas it was liquor with sweet taste among girls. Most important routes of purchase of alcohol were convenience stores, bars, liquor shops, and vending machines.

A comparison of correlates of cigarette smoking behavior between Jiangxi province, China and Japanese high school students

We conducted surveys on cigarette smoking among junior and senior high school students in Jiangxi province, China and throughout Japan using the same anonymous, self-administered questionnaire in order to compare correlates of adolescent smoking between the two areas. Cross-sectional surveys were used to measure smoking behavior and correlates in two samples of 57,566 Japanese students and 11,836 Jiangxi students. The correlate on smoking with the highest relative risk was friend's smoking in both sexes in each area. The magnitude of the relative risk was bigger for Japanese students. The relative risk of the variable that a student doesn't think cigarette smoking harms his/her health was higher among Jiangxi students than among Japanese students. Mother's smoking and sister's smoking were significantly related to smoking experiment of Japanese students. In Japan, important measures are to support students getting coping techniques against peer pressure and to elevate concern toward adolescent smoking among family members and society. In Jiangxi, the anti-smoking education to teach students to correctly recognize the harm of smoking to their health is more important.

High prevalence of anti-hepatitis B virus serological markers in patients with hepatitis C virus related chronic liver disease in Japan

BACKGROUND/AIMS

Evidence is accumulating that hepatitis B virus (HBV) is present in patients who are hepatitis B surface antigen negative but have antibody to hepatitis B core antigen (anti-HBc). Furthermore, recent studies have shown that patients with hepatocellular carcinoma who have antibody to hepatitis C virus (HCV) often possess HBV related serological markers. Data on the seroprevalence of HBV infection in patients with HCV related chronic liver disease were collected to evaluate the significance of the presence of antibodies to HBV.

METHODS

The prevalence of HBV related serological markers was analysed in a total of 2014 Japanese patients with HCV infection. The control group comprised 352 subjects without liver disorder.

RESULTS

A large number of patients (49.9%) with HCV related chronic liver disease including hepatocellular carcinoma were positive for anti-HBc. In addition, the prevalence of anti-HBc closely correlated with the clinical stage of the liver disease. There was no relation between a past history of blood transfusion and the prevalence of anti-HBc. Notably, anti-HBc was the only serological marker for HBV infection in a significant number of patients with HCV related chronic liver disease (24.1%).

CONCLUSIONS

Our data provide further evidence for the high prevalence of anti-HBc in patients with HCV related chronic liver disease, particularly those with hepatocellular carcinoma, suggesting that HBV infection, probably including latent infection, may play an important role in carcinogenesis in these patients.

Smoking prevalence of female nurses in the national hospitals of Japan

OBJECTIVE

To estimate the prevalence of smoking and the attitudes towards the restriction of smoking at work among female nurses in the national hospitals in Japan.

DESIGN

Questionnaires mailed to 14 randomly selected national hospitals and sanitariums in Japan in 1993.

SUBJECTS

2207 female nurses.

MAIN OUTCOME MEASURES

Smoking status and history, and attitudes towards the restriction of smoking at work.

RESULTS

The prevalence of smoking among female nurses was 18.6%, which was higher than the age-adjusted prevalence of the general female population using this study's subjects as a standardised population. Banning smoking in the hospital in which they worked was supported by 15.0%, whereas 81.6% supported the restriction of smoking.

CONCLUSIONS

The results showed that smoking is more common among female nurses than among the general female adult population. The survey suggested that nurses favour restriction, but not banning, of smoking.

Estimating adolescent cigarette consumption in Japan

We estimated the cigarette consumption among Japanese adolescents based on the data which was obtained from a 1990 nationwide school-based questionnaire survey of smoking prevalence among high school students. Cigarette consumption for adolescents was estimated using the data on current smokers' rate and cigarette consumption per day. Participants were 57,189 high school students (aged 13-18 years) including 4666 current smokers. The estimated adolescents' consumption was calculated at 3.5 to 4.3 billion units in 1990. The proportion of adolescents' consumption to the total sales was 1.1% to 1.3%. The corresponding tax amounted to between 21 and 25 billion yen in 1990. The difference between the total sales and the crude cigarette consumption for adults has increased gradually over 20 years. Logically, some part of this increase should be attributed to cigarettes consumed by adolescents. The increase in this difference seemed to keep pace with the increasing number of cigarette vending machines. These results indicate that a considerable amount of cigarettes were consumed by adolescents in 1990.

[Factors associated with earthquake deaths in the Great Hanshin-Awaji Earthquake, 1995]

BACKGROUND

In order to find factors associated with earthquake deaths due to the Great Hanshin-Awaji earthquake, we conducted a descriptive epidemiological and a case-control study.

METHODS

The study area was Nishinomiya city. Earthquake mortality was calculated by age group, sex and the degree of damage to dwelling. Cases in the case-control study included all 1,104 earthquake-caused deaths. Randomly selected survivors living in the same neighborhood and matching sex, age, and the degree of damage to dwelling were used as controls. Seven kinds of information about subject's health and welfare on January 16, one dey before the earthquake, were used for analysis.

RESULTS

The likelihood of earthquake-caused mortality steadily increased after 50 years of age. Mortality among people who lived in completely destroyed dwellings was much higher than that among people who lived in intact or partially-destroyed dwellings. In the case-control study, a significant risk factor for earthquake death was physical disability (odds ratio (OR) = 1.9; 95% confidence interval (95% C.I.), 1.0 to 3.34). When the analysis was limited to those who lived in intact or partially-destroyed dwellings, the odds ratio of physical disability increased to 5.6 (95% C.I., 1.6 to 19.8).

CONCLUSIONS

The most important risk factors were age and degree of damage to dwelling. Physical disability was suggested as a risk factor.

[Smoking behavior of nurses in Mie Prefecture, Japan]

Nurses who work in hospitals and clinics belonging to a regional medical association in Mie prefecture were surveyed regarding their smoking behavior and several related factors. The results are summarized as follows: 1) Smoking prevalence in male and female nurses was 75.5% and 14.6% respectively. In the present study the rate of female nurses was almost equal to results reported in a national survey. 2) Smoking prevalence was higher among licensed practical nurses than registered nurses, and it was highest among psychiatric nurses. 3) Smoking prevalence among hospital and clinical nurses was 15.7% and 9.1% respectively. Smoking prevalence was lower among clinical nurses, even though, they have a higher number of licensed practical nurses. Also smoking prevalence was higher in hospitals with a smaller nursing staff than in hospitals with a larger nursing staff. 4) Among smokers, 44.5% seriously had attempted to quit smoking, and 34.1% had considered quitting but never tried. Therefore, the results suggest the importance of providing smoking cessation programs for nurses.

Post-stroke hypertension correlates with neurologic recovery in patients with acute ischemic stroke

To examine the clinical implications of post-stroke hypertension, defined as the rise in blood pressure on admission after the onset of ischemic stroke as compared with the blood pressure before stroke, and to assess the relationship between the value of post-stroke hypertension and neurologic recovery, we retrospectively studied 28 patients admitted to the hospital within 24 h (mean+/-SD, 6.7+/-7.0 h) after a first-ever, acute non-embolic ischemic stroke, whose blood pressure had been recorded at the outpatient clinic within 3 mo before stroke. The Canadian Neurological Scale was used to assess stroke severity, and neurologic recovery during the acute phase was calculated. The average duration of hospitalization was 18+/-9 d. The value of post-stroke hypertension and stroke severity on admission independently and significantly correlated with neurologic recovery (odds ratio, 1.06; 95% confidence interval, 1.00-1.12 and odd ratio, 0.20; 95% confidence interval, 0.06-0.72, respectively). There was also a significant linear correlation between the value of post-stroke hypertension and neurologic recovery (r= 0.50, p< 0.01). Furthermore, blood pressure after the onset of ischemic stroke was quite independent of blood pressure before stroke. We conclude that the value of post-stroke hypertension correlates with neurologic recovery in patients with acute non-embolic ischemic stroke. These results suggest that blood pressure control mechanisms change after the onset of acute ischemic stroke.

Dual-isotope SPECT diagnosis of a skull-base metastasis causing isolated unilateral hypoglossal nerve palsy

We describe a 48-year-old female with an isolated unilateral hypoglossal nerve palsy caused by a skull base metastasis from breast cancer. The patient had a medical history of conservative breast therapy for breast cancer. Although the cause of such a neurological deficit includes various pathologies, the reports focusing on metastatic tumor have been limited in number. Radiologic investigation showed a mass involving both the right hypoglossal canal and the clival edge. Swelling of the hypoglossal nerve was observed in views including its canal. Three-dimensional CT images demonstrated the tumor protruding from the enlarged external orifice of the hypoglossal canal. In the present report we mentioned a nuclear medicine procedure to visualize and characterize the small, abnormal tissue in the skull base. Dual-isotope SPECT confirmed an abnormal uptake of 99mTc-HMDP around the hypoglossal canal and a 201Tl-positive elongated lesion running along the hypoglossal nerve.