Characteristics of patients with a diagnosis of sarcoidosis: a comparison of the 2006 and 2015 versions of diagnostic criteria for sarcoidosis in Japan / Journal of Rural Medicine

Objective: Histological verification of epithelioid cell granuloma is important in diagnosing sarcoidosis; tissue sampling is a worldwide requirement. In 2006, to reduce medical expenses and avoid invasive procedures, diagnostic criteria without histological verification were permitted by the Japanese government. In 2015, new diagnostic criteria, allowed clinical diagnoses based on only respiratory, ocular, and cardiac systems with at least a two-system involvement, increasing the need to sample tissue from clinically unevaluable organs in suspected sarcoidosis. This study aimed to compare the characteristics of patients who were diagnosed with sarcoidosis according to the 2006 and 2015 criteria.Materials and Methods: Using the 2015 version, we re-evaluated the characteristics of 264 patients with diagnosed or suspected sarcoidosis according to the 2006 criteria, at Jichi Medical University Hospital between 2004 and 2012 (clinical diagnosis, 84; histological diagnosis, 117; suspected sarcoidosis 63).Results: Thirty-nine patients were diagnosed with suspected sarcoidosis due to the absence of at least a two-system involvement; two patients had insufficient laboratory data suggestive of sarcoidosis. Six patients moved from suspected sarcoidosis to a histological diagnosis because of a greater leniency in the criteria for supportive findings. The 2015 diagnostic criteria excluded patients with organ involvement without a requirement for systemic steroids from the clinical diagnosis group. A case of schwannoma, erroneously placed in the clinical diagnosis group by the 2006 criteria, was reclassified according to the 2015 criteria.Conclusion: The 2015 version is preferable for clinically diagnosing sarcoidosis, even without histological specimens, and provides guidance for indications for systemic treatment.

Association between socioeconomic status and prolonged television viewing time in a general Japanese population: NIPPON DATA2010

BACKGROUND@#It has been pointed out that prolonged television (TV) viewing is one of the sedentary behaviors that is harmful to health; however, the association between socioeconomic status (SES) and prolonged TV viewing time has not been sufficiently investigated in Japan.@*METHODS@#The study population are the participants of NIPPON DATA2010, which is a prospective cohort study of the National Health and Nutrition Survey 2010 in Japan. They were residents in 300 randomly selected areas across Japan. This study included 2752 adults. SES was classified according to the employment status, educational attainment, living status, and equivalent household expenditure (EHE). Prolonged TV viewing time was defined as more than or equal to 4 h of TV viewing per day. Multivariable logistic regression analyses were conducted to examine the association of SES with prolonged TV viewing time.@*RESULTS@#The mean TV viewing time was 2.92 h in all participants. Of 2752 participants, 809 (29.4%) prolonged TV viewing, and the mean TV viewing time of them was 5.61 h. The mean TV viewing time in participants without prolonged TV viewing time was 1.81 h. The mean TV viewing time was prolonged as age classes increased and significantly longer in aged ≥60 years. Prolonged TV viewing time was associated with not working for all age classes and sexes. Only among women, education attainment and living status were also associated with prolonged TV viewing time. For education attainment, the lower the received years of education, the higher odds ratios (OR) of prolonged TV viewing time. For living status, in women aged <60 years, living with others had a significantly higher OR compared to living with spouse. On the other hand, in women aged ≥60 years, living alone had a significantly higher OR. EHE did not have any significant associations with prolonged TV viewing time.@*CONCLUSIONS@#In a general Japanese population, it should be noted that the association between SES and prolonged TV viewing time differed by age and sex. Particularly, it must draw attention to the prolonged TV viewing in elderly. The intervention in order to shorten TV viewing time needs to consider these attributes.

cohort study of chronic diseases for Mongolian people: Outline with baseline data of the Moncohort study

Many Mongolian people suffer from non-communicable chronic diseases. In order to plan preventive strategies against such diseases, we designed a community-based prospective cohort study of chronic diseases, called the Moncohort study, in Mongolia. This is the first nationwide large-scale cohort study of chronic diseases. This paper describes the study's rationale, design and methods with baseline data. Mongolian residents aged P40 years were selected nationwide from many geographic regions in 2009. Data were collected on demographics, socioeconomic status, lifestyle, and anthropometric and biochemical measurements. In total, 2280 Mongolian residents were registered in the survey. Socioeconomic, lifestyle, anthropometric and biochemical characteristics were differentiated by gender and geographical area in descriptive data. Aging, low social class, physical inactivity and infrequent fruits intake were positively associated with histories of chronic disease in men, while aging was positively associated with histories of chronic disease in women. Factors associated with chronic diseases reveal gender-oriented strategies might be needed for their prevention. Detailed prospective analyses will illustrate the impact of risk factors on chronic diseases and lead to evidence for designing programs aimed at preventing chronic diseases and related disorders in Mongolia

Bathing in Hot Water, Bathing in Japanese Style Hot Spring and Drinking Green Tea May Contribute to the Good Health Status of Japanese / 日本温泉気候物理医学会雑誌

Among lots of lifestyle factors thought to be related to the Japanese health status, bathing in hot water, utilizing onsen (hot spring) facilities, and drinking green tea are very special in Japan. With this study we aimed to determine the contribution of these lifestyle factors to Japanese health condition estimated by self-rated health (SRH), sleep quality and rest, and stress level as the dependent variable. A cross-sectional questionnaire survey was conducted of 5,000 residents in Shizuoka prefecture aged≥20 years in 2011. Using unconditional logistic models, odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for several factors that were considered to affect SRH. The lifestyle habits of bathing in hot water every day, utilizing onsen facilities often, and drinking green tea a lot showed a strong association with good SRH. Bathing in hot water was also related to lower perceived stress. In conclusion, the promotion of daily bathing in hot water, utilizing onsen facilities often, consuming a lot of green tea examined in this study may help to enhance people’s own perception of their general health. It is possible that these lifestyle habits may contribute to good health status of the Japanese.

Bathing in Hot Water, Bathing in Japanese Style Hot Spring and Drinking Green Tea May Contribute to the Good Health Status of Japanese / 日本温泉気候物理医学会雑誌

Among lots of lifestyle factors thought to be related to the Japanese health status, bathing in hot water, utilizing onsen (hot spring) facilities, and drinking green tea are very special in Japan. With this study we aimed to determine the contribution of these lifestyle factors to Japanese health condition estimated by self-rated health (SRH), sleep quality and rest, and stress level as the dependent variable. A cross-sectional questionnaire survey was conducted of 5,000 residents in Shizuoka prefecture aged≥20 years in 2011. Using unconditional logistic models, odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for several factors that were considered to affect SRH. The lifestyle habits of bathing in hot water every day, utilizing onsen facilities often, and drinking green tea a lot showed a strong association with good SRH. Bathing in hot water was also related to lower perceived stress. In conclusion, the promotion of daily bathing in hot water, utilizing onsen facilities often, consuming a lot of green tea examined in this study may help to enhance people’s own perception of their general health. It is possible that these lifestyle habits may contribute to good health status of the Japanese.

Implementation of TB/HIV collaboration program in Phnom Penh, Cambodia / 国際保健医療

<B>Background</B><br>The national tuberculosis (TB) control program established Phnom Penh as a pilot area for TB and human immunodeficiency virus (HIV) infection collaborative activities because of the high prevalence of HIV among patients with TB.<br><B>Process</B><br>In 2005, we provided transportation fees so that patients could travel to an operational district referral hospital for HIV counseling and testing by dispatched counselors. However, only around 10.3 patients with TB (range 0-21) per month in all 4 operational districts made use of this service. In 2006, we modified the program by providing HIV counseling and testing by four trained TB/HIV coordinators in TB wards. Thereafter, in-depth, individual, semi-structured interviews were conducted with the TB staff (not the coordinators) of 18 health facilities from April through November 2006 to identify problems in the current TB/HIV collaborative activities in Phnom Penh and to investigate ways for further improving the program.<br><B>Results</B><br>TB staff members encouraged their patients to undergo an HIV test under directly observed treatment, short course. Some TB staff lacked confidence to discuss HIV issues because they lacked sufficient HIV/ acquired immunodeficiency disease syndrome (AIDS) knowledge. Furthermore, there was no formal referral structure between TB and HIV services or sharing of information on the treatment of patients co-infected with TB/HIV with the antiretroviral treatment clinic.<br><B>Conclusions</B><br>We started the program to enable TB patients to receive HIV counseling and testing at the same venue as they received TB treatment. However, problems such as low confidence among TB staff in discussing HIV/AIDS and weak collaboration between TB and HIV services were identified. We found that training of TB staff, development of Information, Education and Communication (IEC) materials, regular meetings among stakeholders, and encouragement for the TB/HIV coordinators to supervise all TB/HIV activities in their operational districts were needed to improve the program.

Use of computers among Jichi Medical University students / 医学教育

Medical students must have knowledge and skills related to medical informatics, including data analysis, the retrieval of biomedical literature, the creation of presentations, and the use of the Internet.The purpose of this study was to analyze the changes over time in the ability of Jichi Medical University students to use the tools of information technology.<BR>1) Questionnaires were distributed to all Jichi Medical University students during epidemiology classes in 1998, 2002, and 2006.<BR>2) The questionnaires included questions about the frequency of the use of computers, word-processing software, spreadsheet software, statistical software, and the Internet.<BR>3) The first survey showed that ownership of a computer and the use of word-processing software were most common, followed in turn by the use of spreadsheet software, statistical software, and the Internet.The percentage of stu dents who had not used a computer decreased from 22% in 1998 to 2% in 2006.<BR>4) With the rapid changes and progress in our information-oriented society, medical students need to be appropriately prepared to make optimal use of available resources.

A Cross-Sectional Study on the Present State of Spa Bathing and Health Condition in Male White- and Blue-Collar Employees / 日本温泉気候物理医学会雑誌

The purpose of this study was to clarify the relationship between frequency of bathing in a spa and at home and the characteristics of the body, blood, and lifestyle of white-collar and blue-collar male employees.<br>To recruit subjects, two baseline data for randomized controlled trials in two places in Shimane Prefecture and in Nagano Prefecture were used. In the two-month period between August and September 2006, 43 of 311 white-collar male employees aged between 30 and 57 years in the Unnan municipal office volunteered to participate in this study. Similarly, 44 blue-collar workers in Nagano Prefecture volunteered to be involved in this study as a result of an appeal for volunteers in local newspapers and public information journals published by large local enterprises from September through November 2006. A total of 87 men were subjects of this study. Items evaluated in this study with respect to physique included height, weight, body mass index, waist circumference, hip circumference, and percent of body fat. With respect to strength, they were grip strength, abdominal strength, back strength, and anteflexion. With respect to characteristics of the blood, they were serum glucose, hemoglobin A1c, fructosamine, lactic acid, total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, free fatty acid, GOT, GPT, γ-GTP, cholinesterase, natural killer cell activity, T cell, B cell, CD4+, CD8+, CD4/8 and uric acid. With respect to mood, Profile of Mood States was evaluated. With respect to lifestyle, the frequency of monthly bathing in a spa and at home was evaluated.<br>No significant correlation was revealed between frequency of monthly spa bathing and the health indices in the white and blue-collar male workers. The items that were significantly correlated (p<0.05) with frequency of monthly bathing at home were GOT (positive), CD8+ (positive), and mental stress (negative).<br>In this study, frequency of monthly spa bathing was found to have no significant correlation with the health indices.

Deaths from Pesticide Poisoning in Japan, 1968-2005: Data from Vital Statistics / Journal of Rural Medicine

Objective: We analyzed the number of deaths due to poisoning by pesticides over 38 years through vital statistics published annually by the Ministry of Health, Labour and Welfare of the Japanese government, from 1968 through 2005. Materials and Methods: Data not published as vital statistics were obtained from the Ministry of Health, Labour and Welfare Statistics and Information Department. The vital statistics provide the numbers of deaths with individual causes of death classified by sex and 5-year age group. We also calculated age-adjusted death rates by this classification, using a direct method based on the 1985 Japanese model population. Results: Deaths from pesticide poisoning increased rapidly beginning in 1982, reached a peak in 1986 (death rate per 100,000 population: 2.6 in males and 1.7 in females) and declined gradually thereafter. In the most recent several years, these figures have declined to levels previously unseen (death rate per 100,000 population: 0.4 in males and 0.3 in females). A difference in death rates between the sexes was observed at every age level, with death rates of males approximately 1.1-1.5-fold those of females. In the 1985-1987 data, these figures were highest in the three prefectures of northern Kanto (Tochigi, Gunma, and Ibaraki Prefectures; crude death rates per 100,000 population: 6.8, 6.8, 6.2, respectively), followed by that in Kagoshima Prefecture (5.0). In the 2003-2005 data, the figure was highest in southern Kyushu (Miyazaki Prefecture; crude death rate per 100,000 population: 1.9), followed by Tochigi (1.6), Ibaraki (1.4), and Kagoshima (1.4). Conclusions: Deaths from pesticide poisoning were extremely well correlated to the history of paraquat. Through the 1985 Advisory Resolution on Paraquat Regulations by the Japanese Association of Rural Medicine and other public health-oriented efforts, the concentration of highly fatal paraquat formulations was reduced, leading to discontinuation of its production, customer identification was strictly enforced when purchasing pesticides, and people's safety consciousness regarding pesticides improved. We regard and these developments as having had the greatest contribution to the reduction in deaths from pesticide poisoning.

Opinions of Japanese Medical Students on the Necessity of Experience in Community-based Learning Programs / 医学教育

We conducted a questionnaire survey of all sixth-year students at 10 Japanese medical schools asking their opinions on the necessity of experience in community-based learning (CBL) programs. We developed a detailed questionnaire to examine students' experiences in CBL and their opinions of its necessity using the students' reports from CBL by Delphi process. After excluding data from 1 medical school because of a low response rate, we analyzed data from 659 students (response rate, 75%). The necessity of each item in the required programs, except “seeing labor in medical facilities, ” was more likely to be recognized by students who had experienced the item than by students who had not experienced it. The differences between experiencing and nonexperiencing students in recognizing necessity were greatest for “conversation with patients in their homes, ” “seeing physicians' consultation or referral to other medical institutions, ” “observing nurses work in the outpatient clinic, ” and “participation in conferences with various professional staff.” These results suggest that medical students can recognize the significance and meaning of CBL through experience.

Effectiveness of Comprehensive Health Education Combining Hot Spa Bathing and Lifestyle Education in Middle-Aged and Elderly Women: Randomized controlled trial of three- and six-month interventions / 日本温泉気候物理医学会雑誌

This study attempted to clarify the effects of 3- and 6-month comprehensive health education programs based on hot spa bathing, lifestyle education and physical exercise on physique, psychological vigor, blood properties, pains in the knee and back, and mental and psychological aspects of women. We examined middle-aged and elderly women who were randomly divided into two groups and followed up until six months and one year later, respectively.<br>Spa programmers, an exercise instructor, and a dietician instructed subjects to one hour of life-style education and physical exercise (lecture on behavior modification, walking, rhythmic exercise, cooking practice, etc.) and one hour (including time for changing clothes and washing body) of a half bath (salt spring, temperature at 41.5) once a week. The program for the 3-month group (n=19) was repeated in the 6-month group (n=14).<br>The evaluation items were BMI, PWC75%HRmax (by a bicycle ergometer as aerobic capacity), blood properties (total cholesterol, HDL cholesterol, arteriolosclerotic index, uric acid, and HbAlc), profile of mood states, self-rating depression scale, subjective happiness, and pains in the knee and back.<br>Compared with pre-intervention data (26.3±3.6), the BMI decreased significantly (p<0.05) immediately after the intervention (25.7±3.5) and at the follow up six months later (25.7±3.3) in the group of 6-month intervention. In addition, the PWC75%HRmax, HbAlc, pains in the back, vigor, depression, and subjective happiness remained significantly improved (p<0.05), as measured at the 6-month follow-up. On the other hand, some of the items improved in the 3-month intervention group immediately after the intervention, but returned to nearly the same levels as those before intervention at the 1-year follow-up. Significant differences (p<0.05) were found in the PWC75%HRmax, HbAlc, and fatigue between the two groups, all of which were improved in the 6-month intervention group.<br>These results suggest that a low frequency, once-a-week intervention requires duration longer than three months to maintain the effects, and that the effects should be monitored over years for a correct assessment.

Nationwide Survey of Primary Care Curricula for Undergraduate Medical Students in Japan / 医学教育

We conducted a nationwide survey to examine the primary care (PC) curricula for undergraduates at Japanese medical schools. The present status of PC curricula and the degree of recognition of the need for improvement were examined. Seventy (88%) of the medical schools in Japan responded. PC education programs have been organized and are carried out by various departments in each school. Of the 69 medical schools, 42% have a PC education program with lectures to teach the role of PC physicians, 65% have a program to provide experience in community medical care, and 80% have programs to provide experience in health care institutions and welfare facilities. Although the number of schools with lectures and experience programs for PC has increased at least three-fold in the past decade, many medical school presidents (more than 60%) recognize PC education should be improved. By comparing medical schools with and without experience programs in clinic more presidents of schools without such programs recognized the need to improve PC education.

Characteristics of the Aged Persons Requiring Care for Bathing / 日本温泉気候物理医学会雑誌

To determine the background of aged people who need bathing assistance, we analyzed data of the Survey on Demand for Health and Welfare Services of Japan as of 1997. The survey covered 21, 723 persons aged 65 years or older, and 1, 193 caregivers who provide care to persons 65 years or older throughout Japan. The main parameters were aged people's sex, age, marital status, health condition, degree of bed rest, and needs of care in daily life; relation between caregivers and aged people; life with care giver; job; family composition; use of home care services; demand for home care services; caregivers' sex, age, health condition, and employment status; and demand for home care services. Subjects were divided into three groups, those who need bathing assistance, those who do not need bathing assistance, and those who do not need care in daily life, and the rate was shown for each item. The results indicated that the rate of those who need bathing assistance was higher among (1) aged people who were older, have poor health, and are in bed alweys or almost alweys, (2) aged people who needed care in daily life, used home care service, and required home care service, and (3) aged people whose caregivers required home care services.<br>Aged people who need bathing assistance are subject to frequent bathing accidents, so we need to pay attention to safe bathing service.

The Need of Guidelines for Judgment of the Bathing Advisability in the Aged Taking Bathing Service / 日本温泉気候物理医学会雑誌

To determine the need of guidelines for judgment of the bathing advisability for the aged in Councils of Social Welfare, we had a cross-sectional study in 1999.<br>A questionnaire survey by mail for Councils of Social Welfare which were extracted by systematic sampling (n=828, extraction rate was 25%) was conducted. The response rate was 83% and the proportion of respondents who answered the guidelines were necessary was 86% (n=642). Chi-square tests and logistic regressions analyses showed that bathing service in facility, existence of guidelines for judgment of the bathing advisability by body temperature, and respondents judging were independent factors associated with the need of guidelines for judgment on the bathing advisability in aged. Our results suggest the necessity to make guidelines for judgment of the bathing advisability in the aged.