Mortality reduction from gastric cancer by endoscopic and radiographic screening.

To evaluate mortality reduction from gastric cancer by endoscopic screening, we undertook a population-based cohort study in which both radiographic and endoscopic screenings for gastric cancer have been carried out. The subjects were selected from the participants of gastric cancer screening in two cities in Japan, Tottori and Yonago, from 2007 to 2008. The subjects were defined as participants aged 40-79 years who had no gastric cancer screening in the previous year. Follow-up of mortality was continued from the date of the first screening to the date of death or up to December 31, 2013. A Cox proportional hazards model was used to estimate the relative risk (RR) of gastric cancer incidence, gastric cancer death, all cancer deaths except gastric cancer death, and all-causes death except gastric cancer death. The number of subjects selected for endoscopic screening was 9950 and that for radiographic screening was 4324. The subjects screened by endoscopy showed a 67% reduction of gastric cancer compared with the subjects screened by radiography (adjusted RR by sex, age group, and resident city = 0.327; 95% confidence interval [CI], 0.118-0.908). The adjusted RR of endoscopic screening was 0.968 (95%CI, 0.675-1.387) for all cancer deaths except gastric cancer death, and 0.929 (95%CI, 0.740-1.168) for all-causes death except gastric cancer death. This study indicates that endoscopic screening can reduce gastric cancer mortality by 67% compared with radiographic screening. This is consistent with previous studies showing that endoscopic screening reduces gastric cancer mortality.

Survival analysis of patients with interval cancer undergoing gastric cancer screening by endoscopy.

AIMS: Interval cancer is a key factor that influences the effectiveness of a cancer screening program. To evaluate the impact of interval cancer on the effectiveness of endoscopic screening, the survival rates of patients with interval cancer were analyzed. METHODS: We performed gastric cancer-specific and all-causes survival analyses of patients with screen-detected cancer and patients with interval cancer in the endoscopic screening group and radiographic screening group using the Kaplan-Meier method. Since the screening interval was 1 year, interval cancer was defined as gastric cancer detected within 1 year after a negative result. A Cox proportional hazards model was used to investigate the risk factors associated with gastric cancer-specific and all-causes death. RESULTS: A total of 1,493 gastric cancer patients (endoscopic screening group: n = 347; radiographic screening group: n = 166; outpatient group: n = 980) were identified from the Tottori Cancer Registry from 2001 to 2008. The gastric cancer-specific survival rates were higher in the endoscopic screening group than in the radiographic screening group and the outpatients group. In the endoscopic screening group, the gastric cancer-specific survival rate of the patients with screen-detected cancer and the patients with interval cancer were nearly equal (P = 0.869). In the radiographic screening group, the gastric cancer-specific survival rate of the patients with screen-detected cancer was higher than that of the patients with interval cancer (P = 0.009). For gastric cancer-specific death, the hazard ratio of interval cancer in the endoscopic screening group was 0.216 for gastric cancer death (95%CI: 0.054-0.868) compared with the outpatient group. CONCLUSION: The survival rate and the risk of gastric cancer death among the patients with screen-detected cancer and patients with interval cancer were not significantly different in the annual endoscopic screening. These results suggest the potential of endoscopic screening in reducing mortality from gastric cancer.

Psychological factors and mortality risk in a rural area of Japan.

BACKGROUND: The purpose of this study is to assess the association between psychological factors and mortality risk from all causes. METHODS: We used follow-up data for 4,181 persons from 40 to 79 years over a period of 17.6 years from one part of the Japan Collaborative Cohort Study (JACC Study). The status of the individuals comprising the data of the study as of the end of December 2006 was determined from their registration cards and death records. We calculated the proportions of selected variables among 5 psychological factors by sex. Cox's proportional hazards model was used to evaluate the associations between psychological factors and mortality risk from all causes. Data were adjusted for age, medical history, education, job status, marital status, drinking, smoking, physical activity, sleeping duration, body mass index and breakfast. RESULTS: During the follow-up period, a total of 791 deaths were recorded. Men who reported feelings of being trusted had a decreased risk for mortality risk from all causes compared with the risk of those who reported "maybe", whereas those without feelings of being trusted had increased risk for mortality risk from all causes. CONCLUSION: This study suggests that the absence of feelings of being trusted increases the risk of all causes of mortality among middle-aged and elderly men in a rural area. Our findings suggest that interpersonal relationships comprise an important factor in longevity.

Assessment of Effects of Air Pollution on Daily Outpatient Visits using the Air Quality Index.

BACKGROUND: The air quality index (AQI) is widely used to characterize the quality of ambient air. Chinese cities officially report the AQI on a daily basis. To assess the possible effects of air pollution on daily outpatient visits, we examined the association between AQI and the daily outpatient count. METHODS: Daily data on outpatient visits to each clinical department were collected from the Z county hospital of Datong City, China. The collection period was between 5 April and 30 June, 2012. Daily AQI data and meteorological information were simultaneously recorded. We compared outpatient counts between the index days and comparison days, and calculated Pearson's product moment correlation coefficient between outpatient counts and AQI levels. RESULTS: The average AQI level for index days was significantly higher than that for comparison days. No significant difference was observed in temperature or relative humidity between index days and comparison days. The outpatient counts for pediatrics were significantly higher on index days than on comparison days, and no significant difference was noted in other clinical departments. The outpatient counts for pediatrics positively correlated with the AQI level, and no correlation was noted in other clinical departments. CONCLUSION: The present study assessed the association between daily outpatient visits and air pollution using AQI. The results obtained suggest that air pollution could increase the outpatient count for pediatrics.

A community-based, case-control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan.

AIMS: Although the incidence of gastric cancer has decreased in the last 3 decades, it remains the second leading cause of cancer death worldwide. In Asian countries, the burden of gastric cancer has remained, and cancer screening is normally expected to reduce gastric cancer death. We conducted a community-based, case-control study to evaluate the reduction of mortality from gastric cancer by endoscopic screening. METHODS: Case subjects were defined as individuals who had died of gastric cancer between 2003 and 2006 in 4 cities in Tottori Prefecture, and between 2006 and 2010 in Niigata City, Japan. Up to 6 control subjects were matched by sex, birth year (±3 years), and the residence of each corresponding case subject from the population lists in the study areas. Control subjects were required to be disease-free at the time when the corresponding case subjects were diagnosed as having gastric cancer. The odds ratios (ORs) were calculated for those who had participated in endoscopic or radiographic screening before the reference date when the case subjects were diagnosed as having gastric cancer, compared with subjects who had never participated in any screening. Conditional logistic-regression models for matched sets were used to estimate the ORs and 95% confidence intervals (CIs). RESULTS: The case subjects consisted of 288 men and 122 women for case subjects, with 2,292 matched control subjects. Compared with those who had never been screened before the date of diagnosis of gastric cancer in the case subjects, the ORs within 36 months from the date of diagnosis were 0.695 (95% CI: 0.489-0.986) for endoscopic screening and 0.865 (95% CI : 0.631-1.185) for radiographic screening. CONCLUSIONS: The results suggest a 30% reduction in gastric cancer mortality by endoscopic screening compared with no screening within 36 months before the date of diagnosis of gastric cancer.

Long-term effects of livestock loss caused by dust storm on mongolian inhabitants: a survey 1 year after the dust storm.

BACKGROUND: Every spring, windblown dust storms damage human health and cause many domestic animal deaths in Mongolia. In particular, mass livestock death results in severe, direct economic loss to inhabitants. However, there is little empirical evidence to demonstrate the long-term effects of dust storm, especially in terms of health-related quality of life (HRQoL) secondary to livestock loss. We evaluated the long-term effects of livestock loss on Mongolian inhabitants. METHODS: We performed a cross-sectional survey of HRQoL using 36-item short-form health survey (SF-36, an index of the health condition) 1 year after a dust storm. The study subjects were 64 inhabitants of stricken areas of Mongolia. The data collection method was a face-to-face interview with a questionnaire. RESULTS: A total of 64 subjects were interviewed, 81% in the victims group and 19% in the non-victims group. The mean number of livestock victims was 83.3, s = 128.3. The SF-36 subscale scores were lower among people who lost livestock than among those who did not. Multiple regression analysis displayed a significant association between livestock loss and HRQoL (general health: = -0.476, P = 0.021; vitality: = -0.359, P = 0.013). CONCLUSION: Our results provide preliminary evidence that livestock loss has long-term effects on HRQoL. Thus, it is necessary to conduct epidemiologic surveys on disorders associated with dust storms and devise countermeasures for the future.

Sensitivity of endoscopic screening for gastric cancer by the incidence method.

Although radiographic screening for gastric cancer has been conducted in Japan, it is anticipated that endoscopy will become a new screening method because of its high detection rate. The sensitivities of endoscopic and radiographic screening were calculated by the detection method and the incidence method based on the results of community-based screening in Japan. There were 56,676 screenings for gastric cancer using endoscopy and radiography from April 2002 to March 2007 in Yonago, Japan. The target age group was from 40 to 79 years. Screen-detected and interval cancers were investigated based on a screening database linked to the Tottori Cancer Registry. All gastric cancers diagnosed within 1 year after a negative screen were considered interval cancers. Based on the screening history, these were divided into prevalence screening and incidence screening. Prevalence screenings included 7,388 for endoscopic screening and 5,410 for radiographic screening, whereas incidence screenings included 18,021 for endoscopic screening and 11,417 for radiographic screening. The sensitivity of prevalence screening calculated by the incidence method was 0.886 (95% confidence interval [CI] = 0.698-0.976) for endoscopic screening and 0.831 (95% CI = 0.586-0.964) for radiographic screening; however, the difference was not significant (p = 0.626). The sensitivity of incidence screening calculated by the incidence method was 0.954 (95% CI = 0.842-0.994) for endoscopic screening and 0.855 (95% CI = 0.637-0.970) for radiographic screening (p = 0.177). Endoscopic screening for gastric cancer had a higher sensitivity than radiographic screening by the incidence method in both screening rounds. However, further study is needed to evaluate mortality reduction and to estimate overdiagnosis with endoscopic screening for gastric cancer.

The relationship between skin symptoms and allergic reactions to Asian dust.

Asian dust events result from displacement of atmospheric pollutants from the Chinese and Mongolian deserts, causing associated health issues throughout Northeast Asia. We investigated the relationship between skin symptoms in Asian dust events and contact allergy to Asian dust and associated metals. Increases in atmospheric levels of heavy metals such as Ni, Al, and Fe occurred during the severe Asian dust event on March 21, 2010. We conducted a case-control study (n = 62) with patch testing to compare skin symptoms on an Asian dust day with metal allergic reactions. Skin symptoms were observed in 18/62 subjects. Nine subjects with skin symptoms (group A) and 11 without (group B) were patch tested for six metals and Asian dust particles. Metal and dust samples were applied to the subjects' backs for 2 days and the reactions were scored according to the International Contact Dermatitis Research Group guidelines. Differences in the positive rates between the groups were analyzed. Skin reactions to ferric chloride (p = 0.015), aluminum chloride (p = 0.047), nickel sulfate (p = 0.008), and Asian dust particles (p = 0.047) were more common in group A than in group B. Skin symptoms during Asian dust events may be allergic reactions to Asian dust particle-bound metals.

Evaluation of Relationships among Occupational Stress, Alcohol Dependence and Other Factors in Male Personnel in a Japanese Local Fire Fighting Organization.

Recent large-scale disasters have made middle-ranked fire defense officers responsible for routine fire fighting activities, and a tendency of alcohol dependence associated with other stressful problems is noted in Japan. We assessed the alcohol dependence tendency with the alcohol use disorders identification test (AUDIT) in firefighters. Occupational stress, depression and other factors were evaluated with the brief job stress questionnaire, Center for Epidemiologic Studies depression scale, K10 and a face sheet. Subjects were 294 male personnel in a local fire defense headquarters, and 246 of them (83.4%) answered effectively. Data were analyzed first with univariate analysis between the AUDIT score and other items, and then with multivariate analysis of the AUDIT score as a dependent variable and other items as independent variables. The AUDIT score (mean ± SD) in the 246 respondents classified by age ranges was 7.9 ± 5.4 points (the lowest, 0 points; the highest, 27 points). The multivariate analysis showed significant correlations of the AUDIT score with the workplace environment (P = 0.003) and the rank of work (P = 0.019). The present survey was cross-sectional, and we could not clarify the subjects' past drinking states and applicability of the results to the whole Japan personnel. It is necessary to further investigate the relationship between alcoholism and depression in the present subjects. As a pilot study, we first clarified the state of alcohol dependence in personnel in a Japanese local fire fighting organization, and examined related factors.

Metabolic syndrome and incidence of liver and breast cancers in Japan.

AIM OF THE STUDY: To clarify the relationship between the presence of metabolic syndrome and the incidence of cancer in a general Japanese population. METHODS: A retrospective cohort study was conducted among 8329 male and 15,386 female subjects between 1992 and 2000. The analysis used five definitions of metabolic syndrome. The information on the site-specific cancer was obtained from the population-based cancer registry. A Cox proportional hazard model was adapted for the statistical analyses. The average follow-up period was 9.1 years. RESULTS: The National Cholesterol Education Program Adult Treatment Panel III 2001 criteria of metabolic syndrome revealed that the hazard ratio of metabolic syndrome for liver cancer was 1.89 (95% confidence interval (CI) 1.11-3.22) for males, and 3.67 (CI 1.78-7.57) for females. The hazard ratio for female breast cancer was 2.87 (CI 1.67-4.94). When the analysis was limited to postmenopausal women (55 years of age or older), the ratio increased to 6.73 (CI 2.93-15.43). The NCEP-ATPIII 2001 criteria were superior to the other four proposed criteria for predicting the incidence of cancer. In the statistical model, which included all components of the metabolic syndrome and the metabolic syndrome (present or absent), high blood glucose was a significant associated factor for all sites and liver cancers, whereas the metabolic syndrome was found to be a significant associated factor for breast cancer. CONCLUSION: Metabolic syndrome may play an important role in the incidence of breast cancer. High fasting plasma glucose level is considered to be useful as an associated factor for the incidence of all-sites and liver cancer.

The current status of hand washing and glove use among care staff in Japan: its association with the education, knowledge, and attitudes of staff, and infection control by facilities.

OBJECTIVE: Hand hygiene is a basic measure to prevent infections. The purpose of this study was to obtain suggestions for the improvement of hand hygiene by evaluating the education, knowledge, and attitudes of care staff at facilities for the elderly in regard to hand washing and glove use, as well as infection control policies by those facilities. METHODS: Among a total of 147 special nursing homes and health service facilities for the elderly in Yamaguchi Prefecture, Japan, questionnaires were sent from October to November 2007 to 56 facilities which had agreed to participate in this survey. Two types of questionnaire, one for the facility manager and the other for care staff, were sent to each facility. RESULTS: The questionnaire was responded to by 42 managers (response rate 28.6%) and 1,323 staff members (response rate 26.3%). The rate of compliance with hand hygiene among them was 34.0%. Personal factors promoting hand hygiene were education and attitudes, while facility-related factor was the implementation of hand-washing evaluation. CONCLUSION: Since the hand hygiene compliance rate is low among care staff at facilities for the elderly, it is necessary to take measures to improve hand hygiene. Educational programs for hand hygiene should be developed in view of the conditions of individual facilities.

Polymorphism of Trp64Arg in beta3-adrenergic receptor gene and serum LDL-cholesterol concentrations in healthy Japanese.

BACKGROUND: Polymorphism of Trp64Arg in the beta(3)-adrenergic receptor (beta(3)-AR) gene may play a critical role in lipid and lipoprotein metabolism by mediating lipolysis and thermogenesis. Since the frequency of Arg alleles of the beta(3)-AR gene is generally low among many populations, studies on the Arg/Arg genotype in relation to lipid and lipoprotein metabolism are required in countries such as Japan which has a relatively high frequency of the Arg allele. METHODS: We genotyped 275 clinically healthy Japanese (male/female, 134/141, mean 45.7 years) without medication for beta(3)-AR gene polymorphism by polymerase chain reaction-restriction fragment length polymorphism analysis, and investigated the effects of the gene polymorphism on clinical parameters including body mass index (BMI), blood pressure and serum lipid and lipoprotein concentrations. RESULTS: The genotype frequencies were: Trp/Trp, 68.0%; Try/Arg, 28.0% and Arg/Arg, 4.0%, with an allele frequency of 0.18 for Arg64. When subjects were divided into three groups according to the genotype, a significant increase of serum LDL-cholesterol (LDL-C) concentration in the Arg/Arg group (3.48 +/- 1.59 mmol/L) was observed when compared with those of the Trp/Trp and Arg/Trp groups (3.15 +/- 0.80, 3.25 +/- 0.92 mmol/L, respectively). Genotype differences did not show any significant effect on other parameters. Spearman's rank correlation demonstrated a significant relationship between LDL-C concentrations and the number of Arg alleles, age and BMI. Multiple regression analysis, using LDL-C concentration as a criterion variable and some factors including beta(3)-AR gene polymorphism as explanatory variables, revealed that the number of Arg alleles was a significant and independent factor for LDL-C concentrations, along with age and BMI. CONCLUSIONS: These findings suggested a role of the beta(3)-AR gene polymorphism in regulating lipid and lipoprotein metabolism, showing small but significant effects on elevated LDL-C values in subjects with Arg/Arg, but not Trp/Arg and Trp/Trp genotypes.

Retrospective cohort study of smoking and lung cancer incidence in rural prefecture, Japan.

OBJECTIVES: We conducted an epidemiological study of the relationship between lung cancer incidence and smoking, with special reference to the benefits of smoking cessation for reducing lung cancer incidence, to promote a local smoking control program. METHODS: The study was a retrospective cohort study. The population studied was 16,383 male examinees of lung cancer health examinations in 1995 in Tottori Prefecture, Japan. Smoking status from the questionnaire during the health examination was used as the exposure variable. Endpoint (lung cancer incidence) was obtained from the Tottori population-based cancer registry. A multivariable analysis using the Cox proportional hazard model was adapted for statistical analysis. The average follow-up period was 4.3 years. RESULTS: The hazard ratio of current smokers for the incidence of lung cancer was 4.9, whereas that of ex-smokers was 2.2. The dose-response relationship between lung cancer incidence and lifetime cigarette consumption (pack year) was determined. The ratio increased among younger subjects (under 65 years old). The hazard ratio of ex-smokers decreased with years just after quitting smoking, and reached the level of never smokers after 10-19 years from smoking cessation. CONCLUSIONS: We reconfirmed that the magnitude of risk estimates of smoking for lung cancer incidence was similar to those of previous studies, and smoking cessation was effective for reducing lung cancer risk.

[Prevalence of the homebound in the elderly population within a community determined by using three measurement scales].

OBJECTIVES: In this cross-sectional study, we examined the prevalence of the homebound among community-dwelling elderly people who were independent in daily living and similarity in the criteria of three measurement scales of homebound. METHODS: Of all residents aged 65 and older residing in Kishimoto town, Tottori Prefecture (n = 1,383), 1,316 (95.2%) who were living at home participated in a baseline survey in October 2001. All the subjects were independent in daily living. They were asked to fill out a questionnaire, which was delivered to them by a member of a public committee. We examined the prevalence of the homebound using three measurement scales (capability of leaving the house independently, frequency of going outdoors, and place of daily activities) with the chi-square test. RESULTS: The prevalences of the homebound were 4.2% for the capability of leaving the house independently, 26.8% for the frequency of going outdoors, and 8.4% for the place of daily activities. The significant factors for the homebound were age and gender. Differences in prevalence were noted by judging the three measurement scales. In typical farming villages, the prevalence of the homebound going outdoors less than once a week was higher than that in other areas. The criteria of the three measurement scales for the homebound were not similar (Cohen's Kappa = 0.13, 0.12, 0.27). CONCLUSIONS: We considered that using three measurement scales together in the study of the prevalence of the homebound is practical. The monitoring of the rate of mortality and disabilities associated with being homebound should be continued.

Relationship between coffee and green tea consumption and all-cause mortality in a cohort of a rural Japanese population.

We conducted a cohort study to investigate the effects of coffee and green tea consumption on all-cause mortality in a rural Japanese population. Data were obtained from 2,855 men and women aged 40-79 years in 1989, and during the subsequent 9.9 years of follow-up. Using the Cox regression model to adjust for potential confounding factors, we calculated the multivariate hazard ratios of death from all causes separately for men and women. The multivariate hazard ratio of mortality for men who consumed two or more cups of coffee per day, compared with those who consumed less than half a cup per day, was 0.43 (95% confidence interval, 0.30-0.63), and the ratio for those who consumed half to one cup of coffee per day was 0.70 (95% confidence interval, 0.52-0.94). Exclusion of subjects with less than 5 years of follow-up did not substantially change the findings. No other statistically significant associations were identified between consumption of the two beverages and all-cause mortality. For men, multivariate hazard ratios of death from apoplexy showed a significant inverse association with increasing coffee consumption. The effects of habitual coffee consumption and its related factors on health in Japan need to be studied in greater detail.