Illness behavior of housewives in a rural area in Japan: A health diary study

A health diary study was conducted to examine the incidence and nature of health problems and illness behavior among rural residents in Japan. Attention was paid in particular to the utilization of folk medicine or alternative practitioners in the context of illness behavior. One hundred and sixty-one health problems were recorded over a 4-week diary period by 28 housewives aged 35–64 years. Headache, tiredness and gastrointestinal problems were among the most common problems. Emotional/psychological problems, the most frequently recorded problems in the health diary studies conducted in the United States or England, were recorded by only 3 participants. Only 6 problems (3.7 percent) resulted in consulting a doctor. Three women utilized an acupuncturist, shinkyshi, during the diary period. Self-care, such as resting by lying down, using home remedies and self-medication including household drugs, Toyama kusuri and folk medicine, was practiced for 101 problems (62.7 percent). Folk medicine or alternative practitioners played important roles in the health seeking process. The health diary method was shown to be suitable not only to Western communities but also in a rural Japanese context.     

Seasonality in mood and behaviours of Japanese residents in high-latitude regions: transnational cross-sectional study

Background

Daylight hours in high-latitude regions tend to be longer than those in Japan in summer, and shorter than those in Japan in winter. For example, daylight hours in London in winter are one-third those of Tokyo. Therefore, this study investigated and compared seasonal changes in mood and behaviours of Japanese individuals living in and outside Japan.

Methods

Surveys were conducted with Japanese residents in summer and winter in the UK (n?=?106), Nordic countries (n?=?40), Southeast Asia (n?=?50), and Japan (n?=?96). First, summer and winter General Health Questionnaire–28 (GHQ28) scores of each regional group were analysed. Subsequently, month-wise differences in mood and behaviours were compared across the four geographical regions.

Results

Summer and winter GHQ28 scores of participants living in the UK and Nordic countries differed significantly, while no seasonal differences were observed for residents in Japan and Southeast Asia. Further, in the UK and Nordic countries, summer was associated with better mood and more activity, while winter was linked to lowered mood and reduced activity.

Conclusion

The results indicate that Japanese living in the UK and Nordic countries (high-latitude regions) experience seasonal fluctuations in depressive symptoms that may be linked to drastic seasonal environmental changes. Observed over a 12-month period, their mood and behaviour declined in winter and improved in summer. Therefore, considering the prevalence of overseas stressors that differ from those in their home country, it is necessary to investigate the effectiveness of support systems that help migrants adapt to seasonal changes in high-latitude regions.

     

Blood selenium concentration in residents of areas in China having a high incidence of lung cancer

Data concerning the blood selenium level and its relation to the mortality from lung cancer are reported. There were 353 samples of blood collected from workers at the Yannan Tin Mine (Yun-Xi) and 75 samples from Beijing residents for comparison. An inverse correlation between blood selenium levels and lung cancer mortalities was observed. The average selenium concentration in whole blood from Beijing residents (age-adjusted mortality rate from lung cancer for males: 12/100,000) and Yun-Xi miners (age-adjusted mortalty from lung cancer for males: 108/100,000) were 12.3 and 8.8 μg/100 mL, respectively. A similar inverse correlation was also observed among young people of comparable sex and age groups. In Yun-Xi, the tin miners working underground with an average lung cancer death rate of 250/100, 000 for males had lower blood selenium concentrations than those working above ground, where the average lung cancer death rate for males was 42/100,000. Workers frequently exposed to arsenic exhibited lower blood selenium contents. Selenium levels in the blood of patients with lung cancer were lower (6.2 μg/100 mL) than those of healthy controls.     

Aerobic power as related to body growth and training in Japanese boys: a longitudinal study

Maximal aerobic power was measured for 5-6 successive years in 50 Japanese schoolboys starting from the age of 9 or 13 yr. and for 2-3 yr in 6 superior junior runners from the age of 14 yr. A large increase in aerobic power was observed during the adolescent growth spurt for 7 schoolboys who trained between the ages of 9 and 14 yr. Aerobic power for 43 average schoolboys increased from 45.0 to 52.2 ml/kg.min between the ages of 13 and 17 yr. The aerobic power of 6 superior junior runners increased from 63.4 to 73.4 ml/kg.min between the ages of 14 and 17 yr. A remarkable increase in aerobic power was not observed in trained boys before the age of peak height growth velocity (PHV). Beginning approximately 1 yr prior to the age of PHV and thereafter, training effectively increased aerobic power above the normal increase attributable to age and growth. The highly developed aerobic power found in superior junior runners may have been derived from strenuous training and partially by genetically superior endowment.     

Diabetes related knowledge among residents and nurses: a multicenter study in Karachi,Pakistan

The existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA). In a prospective study we screened for PA in a non-selected (NSP) and selected hypertensive population (SP), to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP) and two primary care centres, (230 NSP) from the same catch-up area. Serum aldosterone and plasma renin activity (PRA) were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS) and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral. After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP) had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively). After diagnostic verification, 20 patients (6%) had PA, (14.5% SP and 1.4% NSP). Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation. The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.     

Diabetes related knowledge among residents and nurses: a multicenter study in Karachi, Pakistan

ABSTRACT: BACKGROUND: Assessment of knowledge among resident trainees and nurses is very important since majority of patients admitted in hospital have underlying diabetes which could lead to adverse clinical outcomes if not managed efficiently. Therefore, the purpose of this study was to evaluate and compare the knowledge related to the management of diabetes among registered nurses (RN) and trainee residents of internal medicine (IMR), family medicine (FMR) and surgery (SR) at tertiary care hospitals of Karachi, Pakistan. METHODS: A validated questionnaire consisting of 21 open ended questions related to diabetes awareness was acquired through a study done at Thomas Jefferson University Hospital, Philadelphia with the permission of primary author. RESULTS: 169 IMR, 27 FMR, 86 SR and 99 RN completed a questionnaire that assessed the knowledge related to different aspects of management of diabetes. The results were further stratified by participant's specialty and level of training. The percentage of knowledge based questions answered correctly was found to be low. The overall mean correct percentage among all the participants was 50% +/- 21. There was no statistical difference in terms of knowledge between IMR & FMR residents (64% +/- 14 vs. 60% +/- 16, p = 0.47) respectively. The total scores of SR and RN were quite low (40 % +/- 16 & 31% +/- 15 respectively).SR and RN were found to have profound deficit in both inpatient and outpatient knowledge of diabetes. We did not observe any improvement in level of knowledge of FMR & SR with increase in duration of their training (p = 0.47 & 0.80 respectively). In contrast, improvement in the level of knowledge of IMR was observed from first to second year of their training (p = 0.03) with no further improvement thereafter. RN's didn't respond correctly on most of the items related to in-patient management of diabetes (Mean score 40% +/- 20). CONCLUSION: As there are no prior studies in our setting evaluating knowledge related to diabetes management among residents and nurses, this study is of paramount importance. Based on these results, considerable knowledge gaps were found among trainee residents and nurses pointing towards need of providing additional education to improve the delivery of diabetes care.     

Stress status and related characteristics among urban residents: a six-province capital cities study in China

Objectives

To estimate current prevalence levels of stress, and to identify related characteristics among urban residents in China.

Design

A cross-sectional, multilevel study. Selected through multi-stage quota-sampling, survey participants were 4,735 urban residents aged 15 years and older who resided in one of six selected Chinese capital cities. Data were collected on stress levels and sociodemographic characteristics. Stress was assessed using the Perceived Stress Scale, Chinese version (CPSS). A multilevel variance component model was employed to analyze associations between sociodemographic variables and stress.

Results

The mean stress score for urban residents was 22.34 (SD: 3.22), and 36.8% of those surveyed (95% CI: 33.5–40.2%) were severely stressed (>25). Multilevel regression analysis indicated that residents aged 55 years and older were less stressed than residents under age 25. The most educated and higher income earners had lower stress levels than the least educated and poorest. High levels of stress were apparent among all other occupational groups, relative to managers and clerks, except retirees and operational workers. Residents in the north of China exhibited higher stress levels than counterparts in the south.

Conclusions

This study suggests that higher stress levels are positively associated with social class in China. Our findings could inform health policy, guide prevention strategies, and justify the design and implementation of targeted interventions.     

Mental health problems of homeless children and families: longitudinal study

Objective: To establish the mental health needs of homeless children and families before and after rehousing. Design: Cross sectional, longitudinal study. Setting: City of Birmingham. Subjects: 58 rehoused families with 103 children aged 2-16 years and 21 comparison families of low socioeconomic status in stable housing, with 54 children. Main outcome measures: Children’s mental health problems and level of communication; mothers’ mental health problems and social support one year after rehousing. Results: Mental health problems remained significantly higher in rehoused mothers and their children than in the comparison group (mothers 26% v 5%, P=0.04; children 39% v 11%, P=0.0003). Homeless mothers continued to have significantly less social support at follow up. Mothers with a history of abuse and poor social integration were more likely to have children with persistent mental health problems. Conclusions: Homeless families have a high level of complex needs that cannot be met by conventional health services and arrangements. Local strategies for rapid rehousing into permanent accommodation, effective social support and health care for parents and children, and protection from violence and intimidation should be developed and implemented.

Key messages

• Homeless children and their mothers have a high level of mental health problems
• Homeless families experience many risk factors, such as domestic violence, abuse, and family and social disruption
• In two fifths of children and a quarter of mothers, mental health problems persisted after rehousing
• In contrast with a comparison group of families of low socioeconomic status, a substantial proportion of homeless families remained residentially and socially unstable

     

Body adiposity in later life and the incidence of dementia: the health in men study

Objective

To determine if adiposity in later life increases dementia hazard.

Methods

Cohort study of 12,047 men aged 65–84 years living in Perth, Australia. Adiposity exposures were baseline body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). We used the Western Australian Data Linkage System (WADLS) to establish the presence of new cases of dementia between 1996 and 2009 according to the International Classification of Diseases (ICD). Crude and adjusted hazard ratio (HR, 95% confidence interval, 95%CI) of dementia for each adiposity marker was calculated using Cox regression models. Other measured factors included age, marital status, education, alcohol use, smoking, diet, physical activity, and prevalent hypertension, diabetes, dyslipidaemia and cardiovascular disease.

Results

Compared with men with BMI<25, participants with BMI between 25–30 had lower adjusted HR of dementia (HR = 0.82, 95% CI = 0.70–0.95). The HR of dementia for men with BMI≥30 was comparable to men with BMI<25 (HR = 0.82, 95%CI = 0.67–1.01). Waist circumference showed no obvious association with dementia hazard. Men with WHR≥0.9 had lower adjusted HR of dementia than men with WHR <0.9 (HR = 0.82, 95%CI = 0.69–0.98). We found a “J” shape association between measures of obesity and the hazard of dementia, with the nadir of risk being in the overweight range of BMI and about 1 for WHR.

Conclusions

Higher adiposity is not associated with incident dementia in this Australian cohort of older men. Overweight men and those with WHR≥0.9 have lower hazard of dementia than men with normal weight and with WHR<0.9.     

Sexual cannibalism: high incidence in a natural population with benefits to females

Background

Sexual cannibalism may be a form of extreme sexual conflict in which females benefit more from feeding on males than mating with them, and males avoid aggressive, cannibalistic females in order to increase net fitness. A thorough understanding of the adaptive significance of sexual cannibalism is hindered by our ignorance of its prevalence in nature. Furthermore, there are serious doubts about the food value of males, probably because most studies that attempt to document benefits of sexual cannibalism to the female have been conducted in the laboratory with non-natural alternative prey. Thus, to understand more fully the ecology and evolution of sexual cannibalism, field experiments are needed to document the prevalence of sexual cannibalism and its benefits to females.

Methodology/Principal Findings

We conducted field experiments with the Mediterranean tarantula (Lycosa tarantula), a burrowing wolf spider, to address these issues. At natural rates of encounter with males, approximately a third of L. tarantula females cannibalized the male. The rate of sexual cannibalism increased with male availability, and females were more likely to kill and consume an approaching male if they had previously mated with another male. We show that females benefit from feeding on a male by breeding earlier, producing 30% more offspring per egg sac, and producing progeny of higher body condition. Offspring of sexually cannibalistic females dispersed earlier and were larger later in the season than spiderlings of non-cannibalistic females.

Conclusions/Significance

In nature a substantial fraction of female L. tarantula kill and consume approaching males instead of mating with them. This behaviour is more likely to occur if the female has mated previously. Cannibalistic females have higher rates of reproduction, and produce higher-quality offspring, than non-cannibalistic females. Our findings further suggest that female L. tarantula are nutrient-limited in nature and that males are high-quality prey. The results of these field experiments support the hypothesis that sexual cannibalism is adaptive to females.     

Prospective study of school injuries: incidence,types, related factors and initial management.

The rates of school injuries were examined by means of a prospective study of 212 schools during the 1981-82 school year. The results showed an annual incidence rate of 5.4 injury events/100 children, which appears to be an underestimate of the actual rate. Of all the injury events 28.7% resulted in serious injuries. Injuries were significantly more frequent in the elementary as opposed to the secondary schools, and the boys were injured significantly more often than the girls. Most of the injuries occurred during athletic activities. Most of the children with either serious or minor injuries were sent to the school office or returned to the classroom, which indicates that the present level of first-aid training among school personnel is inadequate.     

Correction to: Prevalence,incidence, and medications of narcolepsy in Japan: a descriptive observational study using a health insurance claims database

Sleep and Biological Rhythms -     

Mental health problems among children one-year after Sichuan earthquake in China: a follow-up study

Background

On May 12, 2008, a destructive earthquake registering 8.0 on the Richter scale struck Sichuan Province, southwest China. Beichuan County was the epicenter which was one of the areas nearly completely destroyed by the earthquake. In Beichuan, about 15000 people died and 3000 people were missing. Specially, the earthquake took 1587 students'' and 214 teachers'' lives from the elementary and middle schools there. The main purpose of the study was to provide a better understanding of mental health problems and associated risk factors among children after earthquake.

Method

Three hundred and thirty grades 3–5 children completed the questionnaire of disaster –related experience and the Trauma Symptom Checklist for Children-Alternate Version (TSCC-A). The first survey was carried out six months after the earthquake, and the second one was carried out six months later. The measurements and methodology applied in the two sessions were identical.

Results

The prevalence rates of the problems at two time-points were 23.3% and 22.7% for anxiety, 14.5% and 16.1% for depression, and 11.2% and 13.4% for PTSD, respectively. Among demographic variables, no significant age difference existed, while it was found that 6 months after the earthquake, symptoms of anxiety, depression and PTSD were significantly more common among students in grades 4 and 5 than those in grade 3, Initial exposure to death, bereavement and extreme fear were significant predictive factors for the occurrence of anxiety, depression and PTSD.

Conclusions

Findings of this study suggest that posttraumatic mental health problems after natural disaster in children may have reached epidemic proportions and remain high for a long period. Psychologist and social workers should pay more attention to children who experienced more traumatic stresses and provide appropriate mental health interventions. Implications and limitations of these findings were discussed.     

Factors related to the non-attendance in a clinical oral health study on the home-dwelling old elderly

Objective: To evaluate how elderly home-dwelling subjects’background factors, state of health, functional capacity and edentulousness related to their attendance in a comprehensive clinical dental study. Design: Cross-sectional population study; interview and clinical dental data. Setting: The City of Helsinki; clinical dental examinations at the Institute of Dentistry, University of Helsinki. Subjects: 600 elderly aged 76, 81 and 86 years, participants in the medical examinations in the Helsinki Ageing Study one year earlier, 81% being home-dwelling. Measures : Age, gender, marital status, family structure, educational level, former line of work, self-perceived general health, dentulousness, ability to move, sense of hearing, state of memory, clinical findings of dementia, other medical diagnoses, and intake of drugs. Outcome measure: Participation in clinical dental examinations. Results: The overall participation was 63% being reduced by high age and female gender, 75% of the 76-year-olds, but only 53% of those aged 81 or 86 years were clinically examined, figures were for men 72% and for women 60%. As shown by a multifactorial logit model, the strongest factors related to non-participation were the home-dwelling subjects’old age (OR=3.6), deteriorated ability to move (OR=5.3), clinically diagnosed symptoms of dementia (OR=4.1), or edentulousness (OR=2.5). Conclusion: Non-participation selectively by those edentulous will lead to prevalence figures on numbers of teeth being too optimistic for the entire elderly population.     

成都地区中老年居民血清尿酸相关危险因素分析

目的：分析成都地区中老年居民血清尿酸水平及其影响因素,为防治心脑血管事件提供策略支持。方法：利用2007代谢综合征研究调查资料（共1061人）,把人群依据血尿酸水平分为增高组（男性〉420umol/L,女性〉357umol/L）及正常组（男性≤420umol/L,女性≤357umol/L）,分析两组人群的多个代谢性指标的分布特征,并采用logistic回归分析寻找与尿酸相关的危险因素。结果：①两个分组间年龄、收缩压、男性比重、高血压家族史、人体质量指数、腰围、臀围、空腹血糖、肾功能等指标尿酸增高组明显高于尿酸正常组,舒张压则是尿酸增高组明显低于尿酸正常组。②血脂各成分中,总胆固醇、低密度脂蛋白水平尿酸增高组高于正常组,其余甘油三酯、高密度脂蛋白分组间无统计学差异。③尿酸增高组其代谢综合征、高血压、糖尿病、肥胖、腹型肥胖、血脂异常等患病率皆高于尿酸正常组,差异有统计学意义。④Logistic回归分析提示尿酸与你男性性别、年龄、收缩压、BMI、腰围、臀围、空腹血糖、肌酐、总胆固醇、低密度脂蛋白水平呈正相关,与女性性别及舒张压呈负相关。结论：成都地区尿酸与代谢性指标及肾功能相关指标关系密切,可能可以通过减少尿酸来减少心脑血管疾病、代谢性疾病及肾脏疾病的发生。     

Advancing heart health in North Carolina primary care: the Heart Health NOW study protocol

Background

The objective of Heart Health NOW (HHN) is to determine if primary care practice support—a comprehensive evidence-based quality improvement strategy involving practice facilitation, academic detailing, technology support, and regional learning collaboratives—accelerates widespread dissemination and implementation of evidence-based guidelines for cardiovascular disease (CVD) prevention in small- to medium-sized primary care practices and, additionally, increases practices’ capacity to incorporate other evidence-based clinical guidelines in the future.

Methods/design

HHN is a stepped wedge, stratified, cluster randomized trial to evaluate the effect of primary care practice support on evidence-based CVD prevention, organizational change process measures, and patient outcomes. Each practice will start the trial as a control, receive the intervention at a randomized time point, and then enter a maintenance period 12 months after the start of the intervention. The intervention will be randomized to practices in one of four strata defined by region of the state (east or west) and degree of practice readiness for change. Seventy-five practices in each region with a high degree of readiness will be randomized 1:1:1 in blocks of 3 sometime prior to month 8 to receive the intervention at month 9, 11, or 12. An additional 75 practices within each region that have a low degree of readiness or are recruited later will be randomized 1:1 in blocks of 2 prior to month 13 to receive the intervention at month 14 or 16. The sites will be ordered within each strata based on time of enrollment with the blocking based on this ordering. Evaluation will examine the effect of primary care practice support on (1) practice-level delivery of evidence-based CVD prevention, (2) patient-level health outcomes, (3) practice-level implementation of clinical and organizational changes that support delivery of evidence-based CVD prevention, and (4) practice-level capacity to implement future evidence-based clinical guidelines.

Discussion

Results will indicate whether primary care practice support is an effective strategy for widespread dissemination and implementation of evidence-based clinical guidelines in primary care practices. Discernible reductions in cardiovascular risk in 300 practices covering over an estimated 900,000 adult patients would likely lead to prevention of thousands of cardiovascular events within 10 years.

Trial registration

ClinicalTrials.gov NCT02585557

     

Ophthalmologic changes related to radiation exposure and age in adult health study sample, Hiroshima and Nagasaki

A 2-year ophthalmologic study of age and radiation-related ophthalmologic lesions among the atomic bomb survivors in Hiroshima and Nagasaki was conducted in 1978-80. The study sample in both cities was composed of all persons exposed to 100+ rad, their controls, and all other persons with a previous record of axial opacities or posterior subcapsular changes. Most of the losses were due to persons who refused to participate or for whom it was not possible to arrange for an ophthalmologic examination at the time of the regularly scheduled medical examination. It should be emphasized, however, that the loss of persons in both the control and the 100+ rad groups did not change systematically with increasing age by city. Increased lenticular opacities, other lens changes, and loss of visual acuity and accommodation occurred with increasing age in both exposed and control subjects as manifestations of the normal aging process. A highly significant excess risk for all age categories in the 300+ rad group in comparison to those in the control group was observed for both axial opacities and posterior subcapsular changes in Hiroshima, but not in Nagasaki. A stronger radiosensitive aging effect for persons who were under 15 years old at the time of the bombing (ATB) was observed for both axial opacities and posterior subcapsular changes in Hiroshima.