[Discussing AIDS with their junior high school children by parents. A study on parents education about AIDS]

PURPOSE

This study was performed to determine the extent of parental participation in talking to their children regarding AIDS, and to determine what intervening factors existed. FOCUS GROUP: Parents of children who attend a public junior high school in Yokohama, Japan. TERM: November 9, 1995 to November 16, 1995.

METHOD

Anonymous questionnaires addressed to both parents were distributed to children in the classroom. After the parents had completed the form, the children brought it back to the school.

PARTICIPANTS

616 Families or 1,117 individuals (509 fathers, 608 mothers) Response Rate: 72.4%.

RESULTS

1. Percent of parents who have talked to their children about AIDS (Experience Rate): Fathers 26%, Mothers 63%. 2. Percent of parents willing to discuss AIDS with their children (Willingness Rate): Fathers 49%, Mothers 70%. 3. In 70% of the families either the father or mother have talked with their children about AIDS (Experience Rate). In 95% of the families either the father or mother expressed a willingness to talk with their children about AIDS (Willingness Rate). 4. Factors related to Experience Rate were: Fathers--No consistent pattern was shown in responses. Mothers--1. Have enough knowledge about AIDS. 2. Understand basic facts about the route of infection of HIV. 3. Have expectations of an increase in the number of PWA/H (People with AIDS/HIV) in the near future. 4. Recognize the risk of HIV infection for their children. 5. Factors related to Willingness Rate were: Fathers--1. Understand that AIDS is not only someone else's problem. 2. Recognize the risk of HIV infection for their children. Mothers--1. Understand that AIDS is not only someone else's problem. 2. Have an accepting attitude toward their children's friend who is infected with HIV.

Mitochondrial abnormalities in selenium-deficient myopathy

We report a man who developed selenium-deficient myopathy during long-term parenteral nutrition. Muscle biopsy showed marked mitochondrial depletion in the deep sarcoplasm and enlarged mitochondria at the periphery mainly in type 2 fibers. Muscle weakness improved gradually after the second course of selenium supplementation. The peculiar mitochondrial abnormalities in muscle fibers appear to play a key role in the pathogenesis of selenium-deficient myopathy.

Postural dysregulation in systolic blood pressure is associated with worsened scoring on neurobehavioral function tests and leukoaraiosis in the older elderly living in a community

BACKGROUND AND PURPOSE

Postural hypotension, which occurs frequently in community-living, apparently healthy elderly adults, is usually asymptomatic. However, the relation between postural changes in blood pressure and quantitative higher cerebral function or silent brain lesions remains unclear. We examined the association of exaggerated postural changes in systolic blood pressure with cognitive and quantitative neurobehavioral functions and with brain lesions on MRI in the community-dwelling older elderly.

METHODS

The study population consisted of 334 community-dwelling elderly adults, aged 75 years or older (mean age, 80 years). Postural changes in systolic blood pressure (SBP) were assessed using an autosphygmomanometer (BP-203 I). By the difference between the mean of two measurements of SBP at standing and at supine position (dSBP = SBP at upright-SBP at supine position), we divided the subjects into three groups: (1) 20 subjects with postural hypotension (d-SBP < or = -20 mm Hg), (2) 29 subjects with postural hypertension (dSBP > or = 20 mm Hg), and (3) 285 subjects with postural normotension (20 < dSBP < 20 mm Hg). We defined the former two groups as the postural dysregulation group. Scores in four neurobehavioral function tests (Mini-Mental State Exam. Hasegawa Dementia Scale Revised, computer-assisted visuospatial cognitive performance score, and the Up and Go Test) and activities of daily living were compared among the three groups. Brain lesions on MRI, including number of lacunes and periventricular hyperintense lesions, were compared among 15 age- and sex-matched control subjects with postural hypotension, 15 with postural hypertension, and 30 with postural normotension.

RESULTS

Twenty subjects (6.0%) exhibited postural hypotension and 29 (8.7%) postural hypertension. Scores in neurobehavioral functions and activities of daily living were significantly lower in the postural dysregulation group (both postural hypotension and hypertension groups) than in the postural normotension group. The postural dysregulation group exhibited significantly more advanced periventricular hyperintensities than the normotension group.

CONCLUSIONS

Asymptomatic community dwelling elderly individuals with postural hypotension as well as those with postural hypertension had poorer scores on neurobehavioral function tests and more advanced leukoaraiosis demonstrated on MRI than those without exaggerated postural changes in SBP.

[Smoking prevalence of nurses in national hospitals of Japan]

We surveyed nurses in 14 randomly sampled national hospitals about their smoking behavior and some relating factors. The main results were as follows: 1) The prevalence of smoking among male and female nurses was 67.8% and 18.5% respectively. These figures are higher than in the general population. 2) The smoking prevalence of female nurses was highest among those in their thirties and lowest among those in their twenties, and 56% of those who smoke daily started smoking between the age of 20 and 24. 3) Smoking was more prevalent among practical nurses than among registered nurses. 4) Smoking was more prevalent among nurses who where not satisfied with their career choice than those who stated that they were satisfied with being nurses. 5) Among smokers, 80% had considered quitting, 44% had seriously tried to quit smoking, and 80% wanted to quit smoking. For this reason, it is important to provide smoking cessation programs for nurses. 6) The nurses surveyed, 93% agreed with the opinion that women should not smoke for the sake of both their own and their infant's health. However only 30% agreed with the opinion that nurses should not smoke as medical professionals.

[Bronchial asthma complicated by myasthenia gravis]

A 52-year-old woman had a 14-year history of stridor attacks. Pulmonary function tests revealed reversible airway obstruction, and bronchial asthma was diagnosed. She also has bilateral ptosis, diplopia, and moderate weakness of all four limbs; a positive edrophonium test confirmed the diagnosis of myasthenia gravis. Although the parasympathetic system plays an important role in the regulation of bronchial tone, in this patient the edrophonium test did not provoke an asthmatic attack or exacerbate pulmonary function, except for increases in sputum production and in frequency of cough. The general weakness was usually worse in the afternoon. The decrease in grip strength and the shortening of arm elevation time also occurred after asthma attacks, which means that general muscle fatigue was caused by the work of breathing. Furthermore, dyspnea increased and pulmonary function worsened when an anti-cholinesterase inhibitor was discontinued, probably because of respiratory muscle weakness. Accordingly, the clinical status of bronchial asthma seemed to change in parallel with that of the myasthenia gravis.

Cigarette smoking among junior and senior high school students in Japan

PURPOSE

To estimate the smoking prevalence among junior and senior high school students in Japan.

METHODS

We conducted a nationwide survey of adolescent smoking habits in 1990. Sample schools were selected by single random sampling. Self-administered anonymous questionnaires were sent to sample schools for all students to fill out. Seventy junior high schools and 33 senior high schools responded. A total of 57,189 students responded.

RESULTS

The current smoking rate (the proportion of students who had smoked at least once during the previous month) was much higher among boys than girls. The current smoking rate among seventh graders was 4.0% for boys and 1.5% for girls, and it increased with age to reach 25.5% for boys and 4.9% for girls in the twelfth grade. The percentage of regular smokers in the seventh grade was less than 1% for both sexes, but it increased to 20.3% for boys and 2.2% for girls in twelfth grade. Among current smokers, the proportion of boys smoking 1-9 cigarettes per day decreased, and the proportion of boys smoking 10 or more cigarettes per day increased, as age increased. Most current smokers buy their cigarettes from cigarette vending machines or tobacconist shops.

CONCLUSIONS

Since this survey reveals that smoking prevalence among students is not low even in junior high school, health education about smoking must start earlier and carry a greater emphasis within the curriculum. These results also indicate the importance of urging families to have greater concern for the smoking behavior of their children, of banning cigarette vending machines, and of preventing illegal sale of cigarettes to anyone under the age of 20 years.

[Vogt-Koyanagi-Harada disease with cerebellar lesions demonstrated on MRI: a case report]

We reported unique magnetic resonance imaging (MRI) findings of a 57-year-old Japanese man who was diagnosed as Vogt-Koyanagi-Harada disease. This patient presented with complaints of a transient severe headache followed by a bilateral loss of visual acuity and truncal ataxia. Magnetic resonance imaging revealed abnormal contrast enhancement of both the uveas and the cerebellar vermis corresponding to his neurological abnormalities. The distribution and the nature of the resolution of this unusual pattern of contrast enhancement suggested that these MRI findings might illustrate transient destruction of the blood brain barrier or vascular extravasations. Such events might be representative of pathophysiology involving the central nervous system that occurred in patients with Vogt-Koyanagi-Harada disease.

[Personnel requirements for health examination of infants under 5 months in municipalities in Japan]

Municipalities offer health education, health counseling, health examinations, and home visitation service for infants and their mothers. In order to determine what the personnel staffing requirements were for health examination of infants under 5 months for municipalities in Japan in 1989, a questionnaire survey was conducted in 1990. Questionnaires were sent to all municipalities and 3,198 responses were received for a response rate of 97.9%. Responses from 912 municipalities were considered invalid, leaving a total of 2,286 responses that were analysed. Results showed that 79.2% of the 2,286 municipalities were able to perform health examinations for infants under 5 months independently, while in 6.5% of the municipalities these examinations were performed by the clinical hospitals. Analysis by size of municipalities showed that 85.7% of the cities with populations of 500,000 or more were able to perform health examinations independently. In the large cities designated by the Government, the health personnel system adequately supported these health examinations. However in rural towns and villages with small populations, it was necessary for public health nurses to be assisted by other staff, most of whom were public health nurses from prefectural health centers. For example, in areas with populations of less than 3,000, about 60% of the total volume of the work required to be performed by public health nurses during the health examinations had to be covered by assistance from prefectural public health nurses.

Waveform changes of compound muscle action potential (CMAP) with muscle length

Changes in finger positions influence the waveform of CMAP recorded from the muscle that moves that finger. The present study suggested that the muscle length, dependent on the finger position, was a main factor affecting the waveform. On shortening the muscle length, the amplitude of CMAP increased with concomitant reduction in the duration, and on lengthening, the amplitude decreased with concomitant increase in the duration. These changes are considered due to changes in propagation velocities of muscle fibers dependent on the muscle length. In nerve conduction studies, it is important to carefully monitor the finger position to distinguish the waveform changes with muscle length from those due to nerve lesions.

[Antimutagenic and bactericidal substances in the fruit body of a Basidiomycete Agaricus blazei, Jun-17]

The fruit body of a Basidiomycete Agaricus blazei, Jun-17 (Himematsutake) was extracted with hexane and chloroform-methanol (2:1, v/v), and the antimutagenic effect of the extracts was examined using an Ames/Salmonella/microsome assay. Both extracts of Agaricus inhibited the mutagenicity of benzo[a]pyrene(B[a]P). The hexane extract was purified by silica gel column chromatography and high performance liquid chromatography (HPLC), and linoleic acid was isolated as a main substance having antimutagenic activity. Fr. IIa, IIb, IIc and IIb, which reduced the number of His+ revertant colonies induced by B[a]P, were separated from the chloroform-methanol extract by silica gel column chromatography and HPLC. An antimutagenic substance in Fr. IIa was linoleic acid. From Fr. IIb, a bactericidal, not antimutagenic, substance was isolated and identified as 13-hydroxy cis-9, trans-11-octadecadienoic acid (13ZE-LOH). Antimutagenic substances in Fr. IIc and IId were not purified. The possible source and mechanism of formation of 13ZE-LOH are discussed.

[Working hours of maternal and child health service personnel by type of occupation and municipality]

The working hours of maternal and child health service personnel were surveyed to describe the characteristics of maternal and child health activities by municipality in 1989. Questionnaires were sent to 24 health centers and the 122 municipalities they represent, and responses from 19 health centers and 103 municipalities were received. The results were as follows: 1) Of all health service personnel, the working hours for public health nurses per 100 births per year was the highest, followed by maternal and child health volunteers, office workers, nurses and physicians. 2) Total working hours increased with number of births per year. 3) No significant correlation was found in total working hours of personnel in health centers with those in the municipalities they represent. Total working hours of personnel of health centers and the municipalities they represent decreased as population size increased. 4) The number of types of occupation involved in maternal and child health service increased as the size of population of the municipality increased. 5) Of the total working hours for all types of occupations, the proportion of working hours for public health nurses averaged about 40% to 50%. 6) The proportion of working hours for infant health examinations increased with increasing population size of the municipality. However, the proportion of the hours for planning and evaluation decreased with increasing population size of the municipality. From this survey, it appears that maternal and child health activities by municipalities differed according to the population size of the municipality.

[Correlates of cigarette smoking among junior and senior high school students in Japan]

Data from a nationwide cross-sectional survey of the smoking status among junior and senior high school students in Japan conducted in 1990, were utilized to provide sociodemographic correlates of the use of cigarettes. The study was based on data from 57, 189 students. The analyses examined the relationship between smoking status and 9 explanatory variables, using multiple logistic regression for both males and females. The results of logistic regression analyses revealed the following main effects: 1) Smoking by a friend had the strongest relationship to smoking status of students for both sexes. The relative risks for having a smoking experience if a friend smoked were 3.45 for junior high school boys, 5.24 for junior high school girls, 3.65 for senior high school boys and 5.54 for senior high school girls and the risks for current smoking if a friend smoked were 8.54, 15.28, 6.99 and 12.47, respectively. 2) Among both boys and girls, smoking experience and current smoking was significantly more likely if a brother or sister, or mother smoked. Awareness of the harm of smoking was also an important correlate in both sexes. Whether the students enjoyed their school life was significantly related to current smoking status for females, but not for males. 3) The relative risks for current smoking if their mothers smoked were 1.60 for junior high school boys, 1.78 for junior high school girls, 1.61 for senior high school boys and 1.61 for senior high school girls. Fathers' smoking was not selected in this stepwise multiple logistic regression model. Therefore, mothers' smoking appears to be a stronger correlate of smoking status among students than fathers' smoking. 4) The relative risks for smoking experience and current smoking if there were smokers in the family, were higher among junior high school students than senior high school students.

[A survey of goals and the utilization of numerical goals in the health planning of 47 prefectures]

Health plans of 47 prefectural governments based on the Medical Law of 1985, were evaluated regarding four health planning factors: final goal, implementation plan, development of resources, and evaluation planning. Results of the evaluation showed that 8.5% of the 47 prefectures had defined future level of health based on numerical goals. On the other hand, all of the prefectures had developed numerical goals specifying the number of hospital beds in each medical district. A major component of health planning is improvement in the accomplishment of the implementation plan. There were 14 prefectures which had numerical goals for the upgrading of facilities and for manpower development to meet future health care activities. The following factors are required in the health planning to meet the needs for improving the health status of the population. 1) Including in the future health goals, in addition to the number of medical bed in regional areas, objective levels of health that should be attained. 2) Development of practical plans for evaluation of effectiveness of health planning.