Cigarette smoking, alcohol drinking, and oral and pharyngeal cancer mortality in Japan.

OBJECTIVES: To prospectively examine the association of cigarette smoking and alcohol drinking with oral and pharyngeal carcinogenesis, we analyzed data from a nation-wide large-scale cohort study in Japan. METHODS: A total of 34 136 men and 43 711 women aged 40-79 years were included in the study. The Cox proportional hazard model was used to estimate the relative risk (RR) and 95% confidence interval (95% CI) of oral and pharyngeal cancer for smoking and drinking by sex, while adjusting for age, consumption of green tea, preference for salty foods, and consumption of green yellow vegetables. RESULTS: Current smokers were found to have a higher risk of death caused by oral and pharyngeal cancer compared with non-smokers in both sexes: the RR was 2.6 (95% CI: 1.0-6.7) in men and 8.2 (95% CI: 2.1-32.1) in women. Men who drank more than 46 g ethanol per day had an approximately threefold increased risk of oral and pharyngeal cancer. Simultaneous exposure to both factors was significantly associated with an elevated risk of oral and pharyngeal cancer (RR: 3.3, 95% CI: 1.1-9.6). CONCLUSIONS: The result supports the carcinogenic effect of cigarette smoking and alcohol drinking on the oral cavity and pharynx.

Individual and joint impact of family history and Helicobacter pylori infection on the risk of stomach cancer: a nested case-control study.

We used 202 cases of stomach cancer and 394 controls nested within the Japan Collaborative Cohort Study For Evaluation of Cancer Risk (JACC study) to investigate whether family history has an independent effect on the risk of stomach cancer after controlling for the Helicobacter pylori infection. A positive history of stomach cancer in one or more first-degree relatives was associated with an increased risk of the disease in women, but not in men after controlling for H. pylori infection and other confounding variables. Women with both a family history and H. pylori infection were associated with more than five-fold increased risk of the disease (OR 5.10, 95% CI 1.58-16.5) compared to those without these factors. These results suggest the existence of inherited susceptibility to the disease in women, and that measurements of H. pylori infection together with the family history allow meaningful evaluation of risk beyond that provided by either factor alone.

A nested case-control study of stomach cancer in relation to green tea consumption in Japan.

To evaluate whether green tea consumption provides protection against stomach cancer, the relative risks (RRs) were calculated in the Japan Collaborative Study for Evaluation of Cancer Risk, sponsored by the Ministry of Health and Welfare (JACC Study). The study was based on 157 incident cases and 285 controls aged 40-79 years. Cox proportional hazards regression analysis was used to estimate the RRs for stomach cancer. It was found that green tea consumption had no protective effect against stomach cancer. After adjustment for age, smoking status, H. pylori infection, history of peptic ulcer, and family history of stomach cancer along with certain dietary elements, the risks associated with drinking one or two, three or four, five to nine, and 10 or more cups of green tea per day, relative to those of drinking less than one cup per day, were 1.3 (95% confidence interval (CI): 0.6-2.8), 1.0 (95% CI: 0.5-1.9), 0.8 (95% CI: 0.4-1.6), and 1.2 (95% CI: 0.6-2.5), respectively (P for trend=0.899). We found no inverse association between green tea consumption and the risk of stomach cancer.

Renal ultrasonography is useful for evaluating diabetic renal failure.

AIM: It has been reported that the course of renal function is heterogeneous in patients with diabetic nephropathy. This study was undertaken to examine the clinical usefulness of renal ultrasonography in evaluating diabetic chronic renal failure (CRF) patients. METHODS: The renal sizes of type 2 diabetic patients with various degrees of renal injury, non-diabetic subjects without renal diseases and patients with non-diabetic CRF were measured by ultrasonography. The renal area index (RAI) was calculated from renal measurements and body surface area. The rate of renal function decline (delta l/cre) was analyzed by calculating the slope of the regression line for the reciprocal of serum creatinine concentrations over time. The correlations between delta l/cre and various clinical and laboratory parameters, including RAI, were analyzed. RESULTS: The RAI values of type 2 diabetic patients with nephropathy increased on the whole. It was also found that the RAI value of diabetic CRF patients was heterogeneous. There was a significant correlation between RAI and log delta l/cre (r = 0.492, p < 0.01). In addition to RAI, urinary protein excretion, serum albumin concentration and mean blood pressure significantly correlated with log delta l/cre. The correlation between RAI and log delta l/cre remained significant after adjustment for age, gender and serum albumin concentration. However, it was no longer significant after inclusion of mean blood pressure in the multivariate analysis. CONCLUSION: Although RAI is not a completely independent predictor of the risk of progression of diabetic renal failure, RAI could be a useful marker for the evaluation of diabetic renal failure. Renal involvement in diabetic patients is heterogeneous, and since renal ultrasonography is non-invasive and safe to perform, it is useful in evaluating diabetic CRF patients.

A prospective study of stomach cancer death in relation to green tea consumption in Japan.

To evaluate whether green tea consumption provides protection against stomach cancer death, relative risks were calculated using Cox proportional hazards regression analysis in the Japan Collaborative Study for Evaluation of Cancer Risk, sponsored by the Ministry of Health and Welfare (JACC Study). The study was based on 30 370 men and 42 481 women aged 40-79. After adjustment for age, smoking status, history of peptic ulcer, family history of stomach cancer along with certain dietary items, the risks associated with drinking one or two, three or four, five to nine, and 10 or more cups of green tea per day, relative to those of drinking less than one cup per day, were 1.6 (95% CI: 0.9-2.9), 1.1 (95% CI: 0.6-1.9), 1.0 (95% CI: 0.5-2.0), and 1.0 (95% CI: 0.5-2.0), respectively, in men (P for trend=0.669), and 1.1 (95% CI: 0.5-2.5), 1.0 (95% CI: 0.5-2.5), 0.8 (95% CI: 0.4-1.6), and 0.8 (95% CI: 0.3-2.1), respectively, in women (P for trend=0.488). We found no inverse association between green tea consumption and the risk of stomach cancer death.

Angiotensin-converting enzyme inhibitors and probucol suppress the time-dependent increase in urinary Type IV collagen excretion of Type II diabetes mellitus patients with early diabetic nephropathy.

BACKGROUND: A multicenter prospective clinical trial was carried out in 9 National Hospitals in Japan to elucidate the time-dependent change in urinary Type IV collagen excretion rate of Type II diabetes mellitus (DM) patients, and to investigate whether an angiotensin-converting enzyme inhibitor (ACE-I) or probucol is effective in preventing progression of renal involvement of diabetics by evaluating urinary Type IV collagen excretion. METHODS: Normo- and microalbuminuric patients with Type II DM were recruited. Patients were assigned to either the control (n = 88), ACE-I (n = 43) or probucol (n = 37) group and treated for 24 months. Besides albumin excretion rate (AER), urinary Type IV collagen excretion rate was also measured. RESULTS: Although, AER, urinary N-acetyl-beta-D-glucosaminidase and beta2-microglobulin excretion rates in the control group did not vary over 24 months, urinary Type IV collagen excretion rate in the control group increased time-dependently (p < 0.01 vs baseline at 18 months and p < 0.005 vs baseline at 24 months). In the ACE-I and probucol groups, time-dependent increases in urinary Type IV collagen excretion rates were not observed. In the ACE-I group, the urinary Type IV collagen excretion rate was significantly lower than that in the control group at 24 months (p < 0.05). In the probucol group, the urinary Type IV collagen excretion rate was significantly lower than that in the control group at 6 months (p < 0.05). In the ACE-I group, AER decreased significantly compared with baseline at 18 months (p < 0.05) and at 24 months (p < 0.005). CONCLUSIONS: ACE-I has a beneficial effect and probucol may have a beneficial effect in preventing the progression of early diabetic nephropathy. Measurement of the urinary Type IV collagen excretion rate in combination with AER would be useful for the management of early renal involvement in Type II DM.

[Comparison of the amount of nursing and caregiving at home for cancer patients and for patients with cerebrovascular disease].

OBJECTIVE: This study was carried out to qualify and quantify the amount of care estimated to be needed by the nurse and home-helper, the amount actually being given and the amount demanded by patient with cancer or cerebrovascular disease under condition of nursing and caregiving at home. METHODS: Fifty-five patients with cancer and fifty-five with cerebrovascular disease registered at Visiting Care Stations in Aichi, Nagano and Tokyo, under nursing services of visiting workers dispatched by the respective station during the test period, were studied. A survey was conducted from September-December 1998 for cancer patients and from January-May 1999 for cerebrovascular disease patients. During the same periods, surveys of visiting nurses and home-helpers were conducted on the kinds and amount of service actually given and estimated to be needed, with questionnaire completed using a self-entry system. Addition of surveys was conducted with a visiting nurse's home-interviewing system. Items surveyed were sex, age, stage of disease, services given by family members and/or by visiting nursers and home-helpers, and the mean person-hours for each service. CONCLUSION: 1. The amount of excess burden placed on the families of patients with cerebrovascular disease was significantly greater than with cancer patients (P < 0.01, rank sum test). 2. Demands on nurses by cancer patient families were greater than those on home-helpers (P < 0.01, rank sum test), for daily attendant care, counseling and guidance, and coordination. 3. Demands from families of cerebrovascular disease patients on home-helper were greater than those on nurse, for daily attendant care, assistance in medical treatment, and counseling and guidance.

[The correlation between the exacerbation of bronchial asthma and picornavirus (human rhino virus) infection in throat gargles by RT-PCR].

Viral infection is one of important factors to cause the exacerbation of bronchial asthma. We have investigated 167 adults of asthmatics to clarify the correlation between viral infection and exacerbation of asthma. Patients were classified to four group by the symptoms of common cold and asthma attack. Furthermore, we have examined Picornavirus and Human rhino virus RNA from throat gargles of patients using RT-PCR (reverse transcription--polymerase chain reaction) method. Forty of 65 (61.5%) asthmatics with common cold revealed asthma attack and common cold was significantly associated with acute exacerbation of asthma (p < 0.01). We identified Picornavirus RNA, which include 113 of Human rhino virus serotypes and enterovirus, from the samples of 16 of 52 (30.8%) patients who had acute exacerbation. It was significantly higher than the detection rate of viral RNA from patient without asthma attack. Furthermore, we analyzed Human rhino virus RNA from the same samples by RT-PCR and 93.7% of Picornavirus were identified as Human rhino virus. Taken together, these findings suggest that common cold is significantly associated with the exacerbation of bronchial asthma. Human rhino virus infection might be one of important virus in this procedure.

Colocutaneous fistula after percutaneous endoscopic gastrostomy in a remnant stomach.

An 82-year-old woman underwent percutaneous endoscopic gastrostomy (PEG) 5 years after partial gastrectomy for cancer. Four months after PEG insertion, a colocutaneous fistula was noted at exchange of the PEG tube. Colocutaneous fistula is a rare and major complication of PEG with 10 reported cases to date. In eight of the 11 reported cases, including this case, fistulas appeared late (>6 weeks) after PEG insertion. This complication may heal after removal of the PEG alone, if the fistula has formed completely; otherwise a surgical approach is necessary for the treatment. Since five of the 11 reported patients had previously undergone abdominal surgery, prior abdominal surgery may increase the risk of a colonic injury after PEG. Open surgical gastrostomy is a wiser option when performing gastrostomy in patients with prior abdominal surgery.

Association of lifestyle parameters with the prevention of hypertension in elderly Japanese men and women: a four-year follow-up of normotensive subjects.

To study the association of lifestyle parameters with the future risk of hypertension in normotensive subjects, a baseline questionnaire and a four-year follow-up were performed in 445 normotensive Japanese at 35 to 89 years of age. In 60 to 69 year old subjects, the changes of blood pressure during four years were negatively correlated with the amount of boiled rice intake in men and with Japanese tea intake in women. Multiple logistic regression analysis revealed that miso-soup intake at two bowls per day or over was protective against hypertension during follow-up (p < 0.05). These results indicate that food intake is important in the prevention of hypertension in the elderly.

[Blood products use and related factors in Japan].

PURPOSES: To examine the use of blood products in Japan by prefectures and to determine the factors associated with the amount of blood products used. METHODS: The amounts of blood products used in November 1995 were surveyed in 8,723 hospitals throughout Japan. The survey also included whether the blood products in hospitals were stored and managed based on the guidelines for appropriate use of blood products. RESULTS: 1. 4,675(90.9%) of the 5,141 respondents used blood products in 1995. 2. The amount of use of each blood product was considerably different among the prefectures. Larger amounts of red blood products and plasma products were used in urban areas. 3. The amounts of use of red blood cell products, plasma products and platelet concentrates showed similar geographical distributions at a significant correlation (r > or = 0.6) each other. The amount of use of albumin products correlated significantly (r = 0.69) with that of immunoglobulin products. 4. Among the various blood products surveyed in this study, the amount of use of only red blood cell products was comparatively larger in the prefectures where blood products were appropriately stored and managed. 5. The number of surgical operations performed under general anesthetization correlated positively with the amount of use of red blood cell products, plasma products and platelet concentrates; a similar correlation was observed between the number of operations for malignant neoplasm and cardiac diseases. CONCLUSION: The amounts of use of blood products used were significantly different among the prefectures in Japan. The amount of use of red blood cell products possibly reflects demand and consumption of blood products as a whole.

[Relationship between health services and medical care expense].

The relationship of health services for the elderly to medical care expenses for persons over 40 in age was studied by examining data for fiscal year 1992 in 393 municipalities among the municipalities throughout the country where actual conditions have been surveyed. Analysis was by multiple regression analysis. Results showed that medical expenses for every disease were lower in the municipalities which had a higher rate of execution of general health examinations, stomach cancer examinations, and home-visit guidance. This tendency was particularly remarkable in the case of diseases of the circulatory system. In contrast, medical care expenses were high in the municipalities which had a higher demand rate for medical counseling or a higher rate of attendance in health consultation. However the relation of rate of execution of functional training, or attendance rate at the health education sessions, or the rate of performance of detailed examinations was not clear.

Joint risks in a case-control study of esophageal cancer in Shanxi Province, People's Republic of China.

A multifactorial analysis on the etiology of esophageal cancer was conducted based on a case-control study conducted in Shanxi. The study analyzed the data of 326 cases and 396 controls. The joint risks of two factors were calculated from dichotomous distributions. Three models of factor combinations were assessed: (1) two risk-enhancing factors, (2) two risk-reducing factors, and (3) a risk-enhancing and a risk-reducing factor. The observed joint risks were in the neighborhood of the multiplicative products of single acting risks of individual factors. This was a uniform pattern across three models.

A case-control study of colorectal cancer and its relation to diet, cigarettes, and alcohol consumption in Saitama Prefecture, Japan.

A case-control study of colorectal cancer in relation to dietary, smoking, and drinking habits was undertaken in Saitama Prefecture, Japan. The study was based on 181 newly diagnosed cases of adenocarcinoma of the colorectum at a single institution and 653 general population controls. Dietary habits were investigated on the basis of the intake of 12 foods and 12 food groups in a food intake frequency questionnaire, together with individual food preferences. Preference for salty foods was positively related to the risk of both colon and rectal cancer, and the consumption of seaweed was inversely related to these cancers, both with a dose-response relation. Cigarette smoking was inversely related to colon cancer risk, but not to rectal cancer risk. Alcohol intake tended to be associated inversely with colon cancer, but not with rectal cancer. In the multiple logistic regression, preference for salty foods (positively) and the consumption of seaweed (inversely) were independently related to both colon and rectal cancer risks.

A case-control study of stomach cancer and its relation to diet, cigarettes, and alcohol consumption in Saitama Prefecture, Japan.

A case-control study of stomach cancer in relation to dietary, smoking, and drinking habits was undertaken in Saitama Prefecture, Japan. The study was based on 294 cases of newly diagnosed adenocarcinoma of the stomach at a single institution, 294 general population controls (matched by sex, age, and administrative division), and 202 hospital controls. Dietary habits were investigated based on the intake of 12 separate foods and 12 food groups in a food frequency questionnaire, together with individual food preferences. The consumption of raw vegetables was inversely related to the risk of stomach cancer, with a dose-response relation observed consistently in the comparisons with both sets of controls. Current cigarette smokers (1-29/day) had an increased risk (relative risk = 1.8, 95 percent confidence interval = 1.1-3.0) compared with nonsmokers in the general population controls, but no dose-response effect with heavier cigarette smoking. Alcohol use did not affect the risk of stomach cancer. In the multiple logistic regression, the consumption of raw vegetables showed a protective effect on stomach cancer while cigarette smoking had no significant association, in both sets of controls.

A case-control study of single and multiple stomach cancers in Saitama Prefecture, Japan.

A case-control study of stomach cancer was done in Saitama Prefecture, Japan, in relation to dietary, smoking, and drinking habits. The study was based on two sets of cases (216 male single and 35 male multiple stomach cancer cases newly diagnosed and of adenocarcinoma type), and 483 male controls derived from residents of Saitama Prefecture. Dietary habits were investigated for the intake of 12 separate foods and 12 food groups by means of a food frequency questionnaire, including individual taste preferences. Among the single stomach cancer series, dose-response relationships were observed for 7 dietary items (preference for salty foods, miso soup, boiled fish, pickled vegetables, nuts, raw vegetables, and seaweed) in the multiple logistic regression analysis. As for the multiple stomach cancer case series, dose-response relationships were observed for 3 dietary items (miso soup, fruits, and seaweed) in the multiple logistic regression analysis. Cigarette smoking and alcohol use were not significantly related to the risk of either single or multiple stomach cancer.

Esophageal cancer in Shanxi Province, People's Republic of China: a case-control study in high and moderate risk areas.

Dietary, smoking, and drinking habits, as well as sociopsychological factors and familial history, were investigated in a case-control study on the etiology of esophageal cancer (EC) in two areas of Shanxi (Yangcheng and Linfen), north central China. Data were analyzed from 326 cases and 396 controls. We identified several factors associated with high or low risk; some were common across the areas and others were area-specific. Consumption of millet gruel was associated positively with EC, in a dose-response relationship. An increase in EC risk was seen for consumption of millet soup with noodles, and also with certain sociopsychological factors, in both areas. A large increase in risk was found with consumption of boiled vegetables in Linfen, with a dose-response relationship. EC risk tended to become greater with the increasing intake of moldy foods and of pickled vegetable juice. A positive association between EC risk and family history of EC was observed only in Yangcheng. Soybean consumption was found to be associated with reduced risk. Dental hygiene (brushing teeth) was associated with reduced risk in Linfen. There was a suggestion of increased risk associated with heavy tobacco smoking, but it was not significant in either area. Alcohol consumption had a marginally significant association with risk in the high risk area, but not in Linfen.

Clustering of liver cancer deaths in Saitama Prefecture, Japan.

Cancer statistics in 1965 revealed that people in the eastern part of Saitama had a high risk of developing cancer of the liver. Clusters of liver cancer were also observed in 1975, though less for males than for females. In 1985, traces remained of clusters with higher death rates from liver cancer. A field survey revealed absence of correlation between geographical clustering of liver cancer and HBsAg positivity, geographical HBsAg positivity differences between sexes, and lack of correlation between geographical distribution of HBsAg positivity and death rates from liver diseases (cancer or cirrhosis). There was no geographical relationship of death rates from liver cancer to liver cirrhosis in Saitama. Statistics of the Saitama Cancer Center revealed lower averages than in the rest of Japan for the percentage of HBsAg positivity in HCC inpatients, the percentage of HCC inpatients with liver cirrhosis, and the ratio between the number of patients with HCC and those with cholangio carcinoma. A mail questionnaire revealed that farmers in the eastern part of Saitama had a strong positive association with death from liver cancer. These results suggest that HBV does not play an important role in the clustering of high death rates from liver cancer in Saitama.

[An epidemiological approach to increase mass screening efficiency, by finding high-risk group of esophageal cancer].

An improvement of mass screening efficiency for esophageal cancer was studied by a simple form of questionnaire on the basis of case-control study in Saitama prefecture. This questionnaire consisted of several questions on risk-associating factors and the answers were scored such that the exposure to plural factors was quantified. The high-scored group is then regarded to be at high risk and to be examined for the cancer. The selection of factors for questionnaire was made by estimating the efficiency of screening. The expected detection rates were high with the range from 0.16 to 0.27% for males and 0.04 to 0.09% for females, contrasting to the rates of 0.05 and 0.01% without pre-screening by the questionnaire.