Validity of the Framingham Risk Model Applied to Japanese Men

Objectives: To examine whether the Framingham Risk Model can appropriately predict coronary heart disease (CHD) events detected by electrocardiography (ECG) in Japanese men.

Methods: Using the annual health examination database of a Japanese company 5611 male workers, between the ages of 30 to 59, who were free of cardiovascular disease, were followed up to observe the occurrence of CHD events detected by ECG over a period of five to seven years. The probability of CHD was calculated for each individual from the equations of the Framingham risk model (with total cholesterol).

Results: The incidence of CHD increased with the estimated CHD risk. The Hosmer-Lemeshow goodness of fit test showed an adequate fit of the risk model to the data of the study subjects. In the receiver operating characteristic analysis, the area under the curve reached 0.67 which indicated an acceptable discriminatory accuracy of the risk model.

Conclusions: The Framingham risk model provides useful information on future CHD events in Japanese men.

Health Risk Appraisal Using Internet Technology

Objective: To develop a Web-based Health Risk Appraisal (HRA) system as a tool for health education based on personal health examination data.

Methods: A Japanese health examination database was analyzed to develop models for HRA, which were designed to predict each of ten laboratory values in a year with and without lifestyle modifications. The HRA models were embedded into a server.

Results: The Web-based HRA system has been introduced into a Japanese health care association having 37 branch centers. Following a health examination, an individual health education program using the Web-based HRA system is provided to a given client at each branch center or at a client’s office. A measured laboratory value and corresponding predicted laboratory values in a year with and without lifestyle modifications are displayed on the screen in forms of both numerical values and graphs. A trained nurse or another health care provider operates the system and explains the HRA result.

Conclusion: The Web-based HRA system will be a practical tool for individual health education following health examination.

Impact of body mass index on cholesterol of Japanese adults

There have been few studies that examine the relation between body mass index (BMI) and cholesterol in consideration of potential interactions between age, sex, BMI and cholesterol. We determined age-, sex- and BMI-specific cholesterol levels of Japanese adults using the 2001 health examination data (337,690 men and 293,918 women). Both total cholesterol (T-C) and low-density lipoprotein cholesterol (LDL-C) levels increased with age until 50 years of age in men and until 60 years of age in women. Linear regression analysis showed significant BMI-dependent increases of T-C and LDL-C in all age groups, but the regression coefficients of BMI in relation to T-C and LDL-C became lower in older age groups until 60 years of age, with the highest value at ages 20-29 years in men and at ages 30-39 years in women. This result was consistent with the result of multiple logistic regression analysis regarding the risk of having hypercholesterolaemia. Weight reduction should be more strongly recommended to younger people, especially men aged under 40 years and women aged under 50 years, to prevent developing hypercholesterolaemia.

A practical tool to assess the incidence of nosocomial infection in Japanese intensive care units: the Japanese Nosocomial Infection Surveillance System

SUMMARY

Infection control professionals have the means to calculate infection rates in their hospitals but not to assess them. They require a practical tool that enables them to compare observed infection rates with external standards. Based on the data obtained from the intensive care unit (ICU) component of the Japanese Nosocomial Infection Surveillance (JANIS) system, a spreadsheet was developed to calculate a standardized infection ratio (SIR) as a risk-adjusted indicator. Out of the factors associated with the development of nosocomial infections in a multi-variate analysis, the following three factors were selected for stratification: APACHE II score (0-10, 11-20, 21+), operation (yes, no) and ventilator use (user, non-user). Infection rates in 2001 were determined (per 1000 patient-days), stratified by the three factors, as a benchmark. The spreadsheet was designed to calculate SIRs on the basis of the Japanese benchmark infection rates using Microsoft Excel software. The user of the spreadsheet should input the number of observed nosocomial infections and patient-days by APACHE II score, operation and ventilator use. When applied to eight Japanese ICUs, the spreadsheet revealed relative differences and temporal changes in the incidence of nosocomial infections within these ICUs.

Health Risk Appraisal using Internet technology

OBJECTIVE

To develop a Web-based Health Risk Appraisal (HRA) system as a tool for health education based on personal health examination data.

METHODS

A Japanese health examination database was analyzed to develop models for HRA, which were designed to predict each of ten laboratory values in a year with and without lifestyle modifications. The HRA models were embedded into a server.

RESULTS

The Web-based HRA system has been introduced into a Japanese health care association having 37 branch centers. Following a health examination, an individual health education program using the Web-based HRA system is provided to a given client at each branch center or at a client's office. A measured laboratory value and corresponding predicted laboratory values in a year with and without lifestyle modifications are displayed on the screen in forms of both numerical values and graphs. A trained nurse or another health care provider operates the system and explains the HRA result.

CONCLUSION

The Web-based HRA system will be a practical tool for individual health education following health examination.

Validity of the Framingham risk model applied to Japanese men

OBJECTIVES

To examine whether the Framingham Risk Model can appropriately predict coronary heart disease (CHD) events detected by electrocardiography (ECG) in Japanese men.

METHODS

Using the annual health examination database of a Japanese company 5611 male workers, between the ages of 30 to 59, who were free of cardiovascular disease, were followed up to observe the occurrence of CHD events detected by ECG over a period of five to seven years. The probability of CHD was calculated for each individual from the equations of the Framingham risk model (with total cholesterol).

RESULTS

The incidence of CHD increased with the estimated CHD risk. The Hosmer-Lemeshow goodness of fit test showed an adequate fit of the risk model to the data of the study subjects. In the receiver operating characteristic analysis, the area under the curve reached 0.67 which indicated an acceptable discriminatory accuracy of the risk model.

CONCLUSIONS

The Framingham risk model provides useful information on future CHD events in Japanese men.

Application of the updated Framingham risk score to Japanese men

Few tools for risk assessment of coronary heart disease (CHD) have yet been made available in Japan. This study aims to examine the validity of the updated Framingham risk score as applied to a Japanese male population. Using the annual health examination database of a Japanese company, we followed-up 5,611 male subjects, aged 30 to 59 years, who had initially recorded neither history of cardiovascular disease nor electrocardiographical ischemic changes, in order to observe the occurrence of CHD over a period of 5 to 7 years. The total score calculated by the Framingham risk score sheet (the Framingham point score) was used as an indicator of CHD risk for the subject individually. The mean of the Framingham point score for 80 CHD cases was significantly higher than that for 5,531 non-CHD cases. The incidence of CHD gradually increased with the Framingham point score. In the receiver operating characteristic analysis, the area under the curve reached 0.71. At 6 points, the curve came closest to the upper left-hand corner, with a specificity of 0.74 and sensitivity of 0.59. On the other hand, multivariable-adjusted relative risks associated with old age, high blood pressure, low HDL cholesterol and smoking in the Japanese male population were different from those in the Framingham population. Despite the low incidence of CHD, the updated Framingham risk score could provide a reasonable rank ordering of CHD risk and could identify Japanese men (and possible other individuals) at high risk for CHD with considerable accuracy. However, further study of Japanese populations may be required to reappraise several coefficients of risk factor in the risk scoring model.

[Risk factors for hypertension. A longitudinal study of middle-aged Japanese male workers]

OBJECTIVE

To identify factors related to the development of hypertension among middle-aged Japanese men.

METHODS AND RESULTS

A cohort of normotensive male workers aged 30-59 years (n = 6,306) were followed from 1991 through 1998 to observe the development of hypertension, using data from annual health checkups in a Japanese company. With hypertension defined as initiation of antihypertensive therapy or a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher, the incidence rate was 33.4/1000 person-years in the 30-39 year old group, 63.8/1000 person-years in the 40-49 year old group, and 75.4/1000 person-years in the 50-59 year old group. Multivariate analysis by using Cox's proportional hazard model indicated that high-normal blood pressure at baseline, obesity (body mass index > or = 25 kg/m2), drinking 5 days/week or more, and no regular exercise were independent factors related to the development of hypertension. Although each age group had a different pattern of risk factors, high-normal blood pressure at baseline was the strongest risk factor in all cases. Glucose intolerance was significantly observed as a hazard only in the 30-39 year old group, hazard rations for obesity and physical inactivity also being highest in this younger age group.

CONCLUSIONS

High-normal blood pressure, obesity, glucose intolerance, regular alcohol intake, and physical inactivity are risk factors for hypertension among middle-aged Japanese men. Insulin resistance may play an important role in the development of hypertension in young males.

Dietary induction of ornithine decarboxylase in male mouse kidney

In male mouse kidney, ornithine decarboxylase (ODC) is induced after feeding, and the induction depends on dietary protein content. 24 h after feeding with 50% casein-containing meal, ODC activity and amount of immunoreactive ODC protein increased more than 10-fold, ODC mRNA level increased 2-fold, and the ODC half-life extended 7-fold. The renal ODC induction after feeding is, therefore, due mainly to stabilization of ODC protein. Urinary excretion of putrescine increased in response to the ODC induction, but the renal polyamine contents scarcely changed. Consistently, the level of antizyme, a polyamine-inducible protein, determined as the ODC-antizyme complex level, scarcely changed after feeding, and the antizyme/ODC ratio in the kidney largely decreased, resulting in the stabilization of ODC protein. The present results suggest that the strong excretion system of the kidney for newly synthesized polyamines enables renal ODC escape from antizyme-mediated feedback regulation.

High production of type VI collagen in multiple fibromatosis with multiple articular dysplasia

A patient with multiple fibromatosis occurring at the sites of multiple cartilagenous dysplasia was described. Collagen types solubilized with pepsin from the fibromatous tissue were fractionated by a different salt concentration and analyzed by SDS-polyacrylamide gel electrophoresis, which indicated that the tissue produces predominantly "short-chain" collagen. Western blotting of the subunits indicated a cross reaction with antisera of the type VI collagen. The results of rotatory shadowing electron microscopy confirmed the characteristic short-chain structure.