Epidemiological approach to nosocomial infection surveillance data: the Japanese Nosocomial Infection Surveillance System

Surveillance of nosocomial infection is the foundation of infection control. Nosocomial infection surveillance data ought to be summarized, reported, and fed back to health care personnel for corrective action. Using the Japanese Nosocomial Infection Surveillance (JANIS) data, we determined the incidence of nosocomial infections in intensive care units (ICUs) of Japanese hospitals and assessed the impact of nosocomial infections on mortality and length of stay. We also elucidated individual and environmental factors associated with nosocomial infections, examined the benchmarking of infection rates and developed a practical tool for comparing infection rates with case-mix adjustment. The studies carried out to date using the JANIS data have provided valuable information on the epidemiology of nosocomial infections in Japanese ICUs, and this information will contribute to the development of evidence-based infection control programs for Japanese ICUs. We conclude that current surveillance systems provide an inadequate feedback of nosocomial infection surveillance data and, based on our results, suggest a methodology for assessing nosocomial infection surveillance data that will allow infection control professionals to maintain their surveillance systems in good working order.

Low back pain deprives the Japanese adult population of their quality of life: a questionnaire survey at five healthcare facilities in Japan

<p><b>OBJECTIVES</b>To estimate the degree to which low back pain (LBP) deprives the Japanese adult population of their quality of life (QOL) in terms of quality-adjusted life-years (QALYs).</p><p><b>METHODS</b>A questionnaire survey was conducted among participants of health examinations at five healthcare facilities in Japan. Age- and sex-specific mean values of the EQ-5D score were calculated for (1) those who reported LBP and interference with daily activities (IDA) due to the pain (n = 251), (2) those who reported LBP but no IDA (n = 955), and (3) those who reported no musculoskeletal pain (n = 2887). To estimate the loss of QALYs due to LBP in the Japanese adult population, we multiplied the age- and sex-specific mean differences of the EQ-5D scores between the LBP with (or without) IDA group and the no pain group by the corresponding age- and sex-specific numbers of people with LBP with (or without) IDA in Japan.</p><p><b>RESULTS</b>Among the entire Japanese adult population of 103 million people, 11,800,000 (4,910,000 men and 6,890,000 women) were estimated to suffer from LBP, and 2,403,000 (976,000 men and 1,427,000 women) people were estimated to encounter IDA due to the pain. The loss of QALYs due to LBP in the Japanese adult population was estimated at 947,000 (9.18 per 1000 population). The loss of QALYs due to IDA in the LBP people was estimated at 139,000 (1.35 per 1000 population).</p><p><b>CONCLUSIONS</b>The estimated loss of QALYs due to LBP suggests that LBP substantially deprives the Japanese adult population of their QOL.</p>

A Case of Lithium-Associated Painless Thyroiditis / Journal of Rural Medicine

Lithium, prescribed for bipolar disorder, is known to induce thyroid dysfunction, most commonly hypothyroidism. Thyrotoxicosis due to lithium-induced painless thyroiditis is a rare complication. We have previously reported that the serum concentration of immunosuppressive acidic protein (IAP), an α1-acid glycoprotein, increased during the acute phase of subacute thyroiditis, but was within the normal range in patients with painless thyroiditis. In the present case, a 31-year-old woman, receiving long-term lithium therapy for bipolar disorder, had a recurrent episode of painless thyroiditis, and her serum IAP was increased. The pathogenic mechanism for lithium-associated painless thyroiditis may differ from that of autoimmune conditions.

Body image, body satisfaction and dieting behavior in Japanese preadolescents: The Toyama birth cohort study

<p><b>OBJECTIVES</b>To examine the relationships between body image, body satisfaction and dieting behavior in the context of pubertal changes in Japanese preadolescents.</p><p><b>METHODS</b>A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture.</p><p><b>RESULTS</b>The percentages of those who perceived themselves fat, wanted to be thinner, and had tried dieting, which increased with body mass index (BMI), were significantly higher in girls than in boys (34.2% vs. 20.0%, 58.0% vs. 26.0%, and 17.3% vs. 5.7%, respectively). Independent of sex and BMI, those who wanted to be thinner and those who had tried dieting were more frequently observed in those who perceived themselves fat, and those who had tried dieting were more frequently observed in those who wanted to be thinner. Pubertal changes were significantly associated with dieting behavior, but their relationships to body image and body satisfaction differed between sexes; for boys, those who perceived themselves fat were more frequently observed in those without pubertal changes; whereas for girls, those who wanted to be thinner were more frequently observed in those with pubertal changes.</p><p><b>CONCLUSIONS</b>Dieting behavior of Japanese preadolescents was associated with whether they perceived themselves fat and wanted to be thinner, sometimes independent of whether they were actually overweight. Pubertal changes might induce a positive perspective of growing fat among boys and a desire to be thinner among girls, with the consequence that dieting behavior would be reinforced in those with pubertal changes.</p>

Incidence and outcome of sepsis in Japanese intensive care units: The Japanese nosocomial infection surveillance system

<p><b>OBJECTIVES</b>To determine the incidence of sepsis in Japanese intensive care units (ICUs) and to evaluate the impact of sepsis on mortality and length of stay (LOS).</p><p><b>METHODS</b>Using the JANIS database for the period between June 2002 and June 2004, 21,895 eligible patients aged ≥16 years, hospitalized in 28 participating ICUs for ≥24 hours, were monitored until ICU discharge. Adjusted hazard ratio (HR) with 95% confidence interval (CI) for the incidence of sepsis was calculated using Cox's proportional hazard model. Standardized mortality ratio (SMR) was calculated on the basis of the crude mortality in patients without nosocomial infection (NI) for respective APACHE II categories. Mean LOS for survivors was assessed by two-way analysis of variance with adjustment for APACHE II.</p><p><b>RESULTS</b>Sepsis was diagnosed in 450 patients (2.1%), with 228 meeting the definition on ICU admission and 222 during the ICU stay. The overall incidence of sepsis was 1.02/100 admissions or 2.00/1000 patient-days. A significantly higher HR for the incidence of sepsis was found in men (1.54, 95% CI: 1.14-2.07), APACHE II ≥21 (2.92, 95% CI: 1.92-4.44), ventilator use (3.30, 95% CI: 1.98-5.49), and central venous catheter use (3.45, 95% CI: 1.90-6.28). SMR was determined to be 1.18 (95% CI: 0.82-1.21) in NI patients without sepsis and 2.43 (95% CI: 1.88-3.09) in NI patients with sepsis. Mean LOS for survivors was calculated to be 11.8 days (95% CI: 11.3-12.4) in NI patients without sepsis and 15.0 days (95% CI: 13.3-17.0) in NI patients with sepsis compared with 3.8 days (95% CI: 3.8-3.9) in patients without NI.</p><p><b>CONCLUSIONS</b>Sepsis is not very common in Japanese ICUs, but its development leads to further increases in mortality and LOS in patients with NI.</p>

Incidence and Outcome of Sepsis in Japanese Intensive Care Units: The Japanese Nosocomial Infection Surveillance System

Objectives: To determine the incidence of sepsis in Japanese intensive care units (ICUs) and to evaluate the impact of sepsis on mortality and length of stay (LOS). Methods: Using the JANIS database for the period between June 2002 and June 2004, 21,895 eligible patients aged ³16 years, hospitalized in 28 participating ICUs for ³24 hours, were monitored until ICU discharge. Adjusted hazard ratio (HR) with 95% confidence interval (CI) for the incidence of sepsis was calculated using Cox's proportional hazard model. Standardized mortality ratio (SMR) was calculated on the basis of the crude mortality in patients without nosocomial infection (NI) for respective APACHE II categories. Mean LOS for survivors was assessed by two-way analysis of variance with adjustment for APACHE II. Results: Sepsis was diagnosed in 450 patients (2.1%), with 228 meeting the definition on ICU admission and 222 during the ICU stay. The overall incidence of sepsis was 1.02/100 admissions or 2.00/1000 patient-days. A significantly higher HR for the incidence of sepsis was found in men (1.54, 95% CI: 1.14–2.07), APACHE II ³21 (2.92, 95% CI: 1.92–4.44), ventilator use (3.30, 95% CI: 1.98–5.49), and central venous catheter use (3.45, 95% CI: 1.90–6.28). SMR was determined to be 1.18 (95% CI: 0.82–1.21) in NI patients without sepsis and 2.43 (95% CI: 1.88–3.09) in NI patients with sepsis. Mean LOS for survivors was calculated to be 11.8 days (95% CI: 11.3–12.4) in NI patients without sepsis and 15.0 days (95% CI: 13.3–17.0) in NI patients with sepsis compared with 3.8 days (95% CI: 3.8–3.9) in patients without NI. Conclusions: Sepsis is not very common in Japanese ICUs, but its development leads to further increases in mortality and LOS in patients with NI.

Body Image, Body Satisfaction and Dieting Behavior in Japanese Preadolescents: The Toyama Birth Cohort Study

Objectives: To examine the relationships between body image, body satisfaction and dieting behavior in the context of pubertal changes in Japanese preadolescents. Methods: A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12–13) born in Toyama prefecture. Results: The percentages of those who perceived themselves fat, wanted to be thinner, and had tried dieting, which increased with body mass index (BMI), were significantly higher in girls than in boys (34.2% vs. 20.0%, 58.0% vs. 26.0%, and 17.3% vs. 5.7%, respectively). Independent of sex and BMI, those who wanted to be thinner and those who had tried dieting were more frequently observed in those who perceived themselves fat, and those who had tried dieting were more frequently observed in those who wanted to be thinner. Pubertal changes were significantly associated with dieting behavior, but their relationships to body image and body satisfaction differed between sexes; for boys, those who perceived themselves fat were more frequently observed in those without pubertal changes; whereas for girls, those who wanted to be thinner were more frequently observed in those with pubertal changes. Conclusions: Dieting behavior of Japanese preadolescents was associated with whether they perceived themselves fat and wanted to be thinner, sometimes independent of whether they were actually overweight. Pubertal changes might induce a positive perspective of growing fat among boys and a desire to be thinner among girls, with the consequence that dieting behavior would be reinforced in those with pubertal changes.

Body image and body satisfaction play important roles in the path to dieting behavior in Japanese preadolescents: The Toyama birth cohort study

<p><b>OBJECTIVES</b>To analyze the path to dieting behavior in Japanese preadolescents.</p><p><b>METHODS</b>A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture.</p><p><b>RESULTS</b>While increasing with body mass index (BMI), the percentage of those who had tried dieting was higher in those who perceived themselves fat than in those who perceived themselves thin or average. Of those who wanted to be thinner, 16.1% of boys and 26.8% of girls had tried dieting. Path analysis in nonobese subjects (2,116 boys and 2,334 girls) showed that (1) body image was primarily based on BMI, (2) body image led to body dissatisfaction, and (3) body dissatisfaction led to dieting behavior. Pubertal changes had a significant effect on body image (path coefficient <0)for boys and body satisfaction (path coefficient >0) for girls, in addition to that on BMI. Maternal BMI had a significant effect on BMI but not on body image, body satisfaction, or dieting behavior.</p><p><b>CONCLUSIONS</b>Body image and body satisfaction play important roles in the path to dieting behavior in Japanese preadolescents. Pubertal changes may reinforce dieting behavior, but the mechanism may differ by sex.</p>

Body Image and Body Satisfaction Play Important Roles in the Path to Dieting Behavior in Japanese Preadolescents: The Toyama Birth Cohort Study

Objectives: To analyze the path to dieting behavior in Japanese preadolescents. Methods: A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture. Results: While increasing with body mass index (BMI), the percentage of those who had tried dieting was higher in those who perceived themselves fat than in those who perceived themselves thin or average. Of those who wanted to be thinner, 16.1% of boys and 26.8% of girls had tried dieting. Path analysis in nonobese subjects (2,116 boys and 2,334 girls) showed that (1) body image was primarily based on BMI, (2) body image led to body dissatisfaction, and (3) body dissatisfaction led to dieting behavior. Pubertal changes had a significant effect on body image (path coefficient <0) for boys and body satisfaction (path coefficient >0) for girls, in addition to that on BMI. Maternal BMI had a significant effect on BMI but not on body image, body satisfaction, or dieting behavior. Conclusions: Body image and body satisfaction play important roles in the path to dieting behavior in Japanese preadolescents. Pubertal changes may reinforce dieting behavior, but the mechanism may differ by sex.

Impact of intensive care unit-acquired infection on hospital mortality in Japan: A multicenter cohort study

<p><b>OBJECTIVES</b>To elucidate factors associated with hospital mortality in intensive care unit (ICU) patients and to evaluate the impact of ICU-acquired infection on hospital mortality in the context of the drug resistance of pathogens.</p><p><b>METHODS</b>By using the Japanese Nosocomial Infection Surveillance (JANIS) database, 7,374 patients who were admitted to the 34 participating ICUs between July 2000 and May 2002, were aged 16 years or older, and who stayed in the ICU for 48 to 1,000 hours, did not transfer to another ICU, and did not become infected within 2 days after ICU admission, were followed up until hospital discharge or to Day 180 after ICU discharge. Adjusted hazard ratios (HRs) with the 95% confidence intervals (CIs) for hospital mortality were calculated using Cox's proportional hazard model.</p><p><b>RESULTS</b>After adjusting for sex, age, and severity-of-illness (APACHE II score), a significantly higher HR for hospital mortality was found in ventilator use, central venous catheter use, and ICU-acquired drug-resistant infection, with a significantly lower HR in elective or urgent operations and urinary catheter use. The impact of ICU-acquired infection on hospital mortality was different between drug-susceptible pathogens (HR 1.11,95% CI:0.94-1.31) and drug-resistant pathogens (HR 1.42,95% CI: 1.15-1.77).</p><p><b>CONCLUSIONS</b>The use of a ventilator or a central venous catheter, and ICU-acquired drug-resistant infection were associated with a high risk of hospital mortality in ICU patients. The potential impact on hospital mortality emphasizes the importance of preventive measures against ICU-acquired infections, especially those caused by drug-resistant pathogens.</p>

Association between APACHE II score and nosocomial infections in intensive care unit patients: A multicenter cohort study

<p><b>OBJECTIVE</b>To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients.</p><p><b>METHODS</b>Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator; central venous catheter, and APACHE II score (0-5, 6-10, 11-15, 16-20, 21-25, 26-30, and 31+).</p><p><b>RESULTS</b>There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection.</p><p><b>CONCLUSIONS</b>Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.</p>

Association between APACHE II Score and Nosocomial Infections in Intensive Care Unit Patients: A Multicenter Cohort Study

Objective: To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients. Methods: Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator, central venous catheter, and APACHE II score (0-5, 6-10, 11-15, 16-20, 21-25, 26-30, and 31+). Results: There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection. Conclusions: Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.

Impact of Intensive Care Unit-Acquired Infection on Hospital Mortality in Japan: A Multicenter Cohort Study

Objectives: To elucidate factors associated with hospital mortality in intensive care unit (ICU) patients and to evaluate the impact of ICU-acquired infection on hospital mortality in the context of the drug resistance of pathogens. Methods: By using the Japanese Nosocomial Infection Surveillance (JANIS) database, 7,374 patients who were admitted to the 34 participating ICUs between July 2000 and May 2002, were aged 16 years or older, and who stayed in the ICU for 48 to 1,000 hours, did not transfer to another ICU, and did not become infected within 2 days after ICU admission, were followed up until hospital discharge or to Day 180 after ICU discharge. Adjusted hazard ratios (HRs) with the 95% confidence intervals (CIs) for hospital mortality were calculated using Cox’s proportional hazard model. Results: After adjusting for sex, age, and severity-of-illness (APACHE II score), a significantly higher HR for hospital mortality was found in ventilator use, central venous catheter use, and ICU-acquired drug-resistant infection, with a significantly lower HR in elective or urgent operations and urinary catheter use. The impact of ICU-acquired infection on hospital mortality was different between drug-susceptible pathogens (HR 1.11, 95% CI: 0.94-1.31) and drug-resistant pathogens (HR 1.42, 95% CI: 1.15-1.77). Conclusions: The use of a ventilator or a central venous catheter, and ICU-acquired drug-resistant infection were associated with a high risk of hospital mortality in ICU patients. The potential impact on hospital mortality emphasizes the importance of preventive measures against ICU-acquired infections, especially those caused by drug-resistant pathogens.

The Trial Introduction of Lectures and Practical Instruction in Eastern Medicine and Alternative Medicine and a Assessment of Medical Students' Level of Interest / 医学教育

Recently, alternative medicine has been re-evaluated and increasingly recognized as effective treatments in the United States and Europe. Caregivers have shown a greater interest in obtaining information about of and practical experience in alternative medicine. Accordingly, the possible reorganization of the medical education curriculum has been examined and alternative medicine classes have been started in many medical schools in the United States. St. Marianna University has started lectures and practical instruction in alternative medicine as part of the preventive medicine course. We also investigated the efficacy of acupuncture and obtained favorable results. A questionnaire survey showed that most students have a great interest in alternative medicine and would like to see it introduced as soon as possible.

Preventive strategy for hypertension based on attributable risk measures

<p><b>OBJECTIVES</b>To examine the effective preventive strategy for hypertension in a Japanese male population, based on attributable risk measures.</p><p><b>METHODS</b>A 7-year follow-up study of hypertension among 6,306 middle-aged male office workers in a Japanese telecommunication company.</p><p><b>RESULTS</b>In terms of population attributable risk percentage (PAR%), regular alcohol intake and physical inactivity showed great contributions to the development of hypertension in the population no less than obesity. The PAR% of each risk factor varied by age group, and the total PAR% of the three modifiable risk factors was considerably higher in the 30-39 year old group (71%) than in the older groups.</p><p><b>CONCLUSIONS</b>Reduced alcohol intake and increased physical activity, as well as weight control, may have a larger impact on prevention of hypertension in younger groups than in older groups.</p>

The impacts of health examinations and smoking on disease mortality risk in Japan: a longitudinal cohort of 720,611 Japanese life insured persons

<p><b>OBJECTIVES</b>To evaluate the impacts of health examinations (HE) and smoking on disease mortality risk in Japan.</p><p><b>METHODS</b>By using the large cohort database of a Japanese life insurance company, 720,611 subjects aged 20 to 80 years, who had contracted for life insurance between April 1, 1995 and March 31, 1998, were followed up until September 30, 1999. Cox's proportional hazard model was used to estimate age-adjusted relative risk (RR) for disease death.</p><p><b>RESULTS</b>After adjusting for age, disease mortality in smokers was significantly higher than that in non-smokers (men, RR 1.51, 95% CI: 1.25-1.81; women, RR 1.54, 95% CI: 1.12-2.11). Meanwhile, disease mortality in HEees (those who had got HE within the past 2 years) was significantly lower than that in non-HEees (men, RR 0.70, 95% CI: 0.56-0.88; women, RR 0.71, 95% CI: 0.54-0.92). The magnitude of the impact of HE on disease mortality risk varied according to smoking status. Non-smokers showed a significantly lower risk associated with HE, whereas smokers did not.</p><p><b>CONCLUSIONS</b>HE may allow an appreciable reduction in disease mortality, however, the reduction effect may be limited to non-smokers. Smoking cessation may be essential to improve the preventive effects of HE.</p>

Parental influence on the development of obesity in 9-year-old Japanese children: the Toyama birth cohort study

<p><b>OBJECTIVES</b>To examine parental influence on the development of obesity in 9-year-old Japanese children.</p><p><b>METHODS</b>A 6-year follow-up study of obesity among 6,102 children born in Toyama prefecture.</p><p><b>RESULTS</b>After adjusting for obesity at age 3, either paternal obesity or maternal obesity at the age 3 survey more than double the risk of obesity at age 9 in both genders. Increases in parental body mass indexes (BMIs) from the age 3 survey through the age 9 survey were significantly associated with obesity at age 9 in girls.</p><p><b>CONCLUSIONS</b>Not only parental obesity but also increases in parental BMIs were likely to be associated with development of obesity in children.</p>

Parental Influence on the Development of Obesity in 9-year-old Japanese Children: the Toyama Birth Cohort Study

Objectives: To examine parental influence on the development of obesity in 9-year-old Japanese children. Methods: A 6-year follow-up study of obesity among 6,102 children born in Toyama prefecture. Results: After adjusting for obesity at age 3, either paternal obesity or maternal obesity at the age 3 survey more than doubled the risk of obesity at age 9 in both genders. Increases in parental body mass indexes (BMIs) from the age 3 survey through the age 9 survey were significantly associated with obesity at age 9 in girls. Conclusions: Not only parental obesity but also increases in parental BMIs were likely to be associated with development of obesity in children.

The Impacts of Health Examinations and Smoking on Disease Mortality Risk in Japan: a Longitudinal Cohort of 720,611 Japanese Life Insured Persons

Objectives: To evaluate the impacts of health examinations (HE) and smoking on disease mortality risk in Japan. Methods: By using the large cohort database of a Japanese life insurance company, 720,611 subjects aged 20 to 80 years, who had contracted for life insurance between April 1, 1995 and March 31, 1998, were followed up until September 30, 1999. Cox’s proportional hazard model was used to estimate age-adjusted relative risk (RR) for disease death. Results: After adjusting for age, disease mortality in smokers was significantly higher than that in non-smokers (men, RR 1.51, 95% CI: 1.25−1.81; women, RR 1.54, 95%CI: 1.12−2.11). Meanwhile, disease mortality in HEees (those who had got HE within the past 2 years) was significantly lower than that in non-HEees (men, RR 0.70, 95% CI: 0.56−0.88; women, RR 0.71, 95% CI: 0.54−0.92). The magnitude of the impact of HE on disease mortality risk varied according to smoking status. Non-smokers showed a significantly lower risk associated with HE, whereas smokers did not. Conclusions: HE may allow an appreciable reduction in disease mortality, however, the reduction effect may be limited to non-smokers. Smoking cessation may be essential to improve the preventive effects of HE.

Preventive Strategy for Hypertension Based on Attributable Risk Measures

Objectives: To examine the effective preventive strategy for hypertension in a Japanese male population, based on attributable risk measures.Methods: A 7-year follow-up study of hypertension among 6,306 middle-aged male office workers in a Japanese telecommunication company.Results: In terms of population attributable risk percentage (PAR%), regular alcohol intake and physical inactivity showed great contributions to the development of hypertension in the population no less than obesity. The PAR% of each risk factor varied by age group, and the total PAR% of the three modifiable risk factors was considerably higher in the 30−39 year old group (71%) than in the older groups.Conclusions: Reduced alcohol intake and increased physical activity, as well as weight control, may have a larger impact on prevention of hypertension in younger groups than in older groups.