Vaccination, regular exercise, and prevention of chronic lung disease reduce exacerbation of COVID-19 severity in northern Okinawa, Japan: A cross-sectional study.

BACKGROUND: As at June 14, 2023, the coronavirus disease 2019 (COVID-19) pandemic had affected more than 767 million people and caused more than 6.9 million deaths worldwide. This study aimed to clarify the lifestyle factors that influence the exacerbation of COVID-19 severity. METHODS: This was a cross-sectional study of patients with COVID-19 whose severity classification of "moderate or severe" (COVID-19 exacerbation) was defined as an objective variable. The 1,353 participants were selected from 4,899 patients with COVID-19 between August 10, 2020 and December 10, 2022. Participants who underwent a specific health checkup before the date for a COVID-19 consultation were included. Using binominal logistic regression analysis, we evaluated the odds ratios (ORs) for COVID-19 exacerbation according to lifestyle-related factors. Limitations were discussed using a target trial emulation framework which clarifies problems in observational studies. RESULTS: The explanatory variables extracted as factors that exacerbated COVID-19 severity were gender (OR [man vs. woman]: 2.533, 95% confidence interval [CI] 1.484-4.322); age (OR [50s vs. 10s, 20s, or 30s]: 4.858, 95% CI 2.319-10.177; OR [60s]: 9.738, 95% CI 4.355-21.777; OR [70s + 80s + 90s]: 8.327, 95% CI 3.224-21.507); and comorbid chronic lung disease (OR ['yes' vs. 'no']: 2.892, 95% CI 1.227-6.818). The explanatory variables extracted as factors that reduce the severity of COVID-19 were hospital consultation year (OR [2022, predominantly Omicron variant prevalent vs. 2020, predominantly Alpha variant prevalent]: 0.180, 95% CI 0.058-0.559); number of vaccinations (OR [2 doses vs. 0 or one doses]: 0.223, 95% CI 0.114-0.436; OR [≥3 doses vs. 0 or one doses]: 0.090, 95% CI 0.035-0.229); regular exercise (exercising ≥2 days/week ≥30 minutes each at an intensity that causes a slight sweat for ≥1 year) (OR ['yes' vs. 'no']: 0.458, 95% CI 0.242-0.866). CONCLUSIONS: These results suggest the importance of vaccination, regular exercise, and prevention of chronic lung disease as measures against exacerbation of COVID-19 severity.

Association between lifestyle and metabolic syndrome incidence of workers in northern Okinawa, Japan: A cohort study.

In Japan, specific health checkups were implemented to prevent metabolic syndrome (MetS) and cardiovascular diseases in April 2008. This study aimed to clarify the relationship between lifestyle factors and the MetS incidence to understand how the disease can be prevented and to improve the public health policy. A retrospective cohort study was conducted using the specific health checkup data of 2,781 workers. Lifestyle factors were assessed using lifestyle-related items in the general health questionnaire included in the specific health checkups. The hazard ratio values for the incidence of MetS according to lifestyle-related items were determined from the data of the specific health checkup for 12 years. The Cox proportional hazard survival model was used to evaluate hazard ratio values after adjusting for confounding factors. The limitations of this research method are discussed using a target trial emulation framework which investigates problems such as biases in observational studies. The crude incidence rates per 1,000 person-years of MetS in women and men were 15.25 and 47.58, respectively. Three dietary lifestyle-related factors, namely "Eating snacks and sweet beverages other than breakfast, lunch, and dinner," "Eating faster than others," and "Skipping breakfast at least three times a week," were identified, with the hazard ratio values 1.262 (95 % confidence interval [CI] 1.032-1.542, p = 0.023), 1.220 (95 % CI 1.032-1.442, p = 0.020) and 1.189 (95 % CI 1.012-1.397, p = 0.036), respectively. These results suggest that lifestyle improvements related to extracted lifestyle-related items contribute to the prevention of MetS.

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.

A case-control study regarding relative factors for behavioural and psychological symptoms of dementia at a Canadian regional long-term extended care facility: a preliminary report.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) are prevalent and have an impact on the care of persons with dementia. Previous studies regarding predisposing factors have included pharmacotherapy, but other factors may not have been sufficiently studied. We hypothesized that psychotropic medications, past history, comorbid psychiatric disorders and other factors may be relevant factors related to BPSD. METHODS: Data were collected from patients' medical charts at an extended care facility over a 2-year period from 1 May 2008 to 30 April 2010. Information obtained included the presence of BPSD, gender, age, marital status, past history, comorbid psychiatric disorder and medication use. Patients were divided into two groups: a group with BPSD (n = 29) and a group without BPSD (n = 10). A binomial logistic regression analysis was performed for the above factors. RESULTS: Comorbid major depression was linked to BPSD (odds ratio = 12.57, 95% confidence interval: 1.31-120.74) as well as to the use of antidepressants (odds ratio = 6.49, 95% confidence interval: 1.02-41.25). There was a trend towards statistical significance in the relationship between greater use of antidepressants for the patients with comorbid major depression and the presence of BPSD. Past history of depression (Fisher's exact test; P = 0.03) and cerebral vascular accident (degrees of freedom = 1, χ(2) = 4.44, P = 0.04) were linked to the presence of BPSD and comorbid major depression. CONCLUSION: Accurate evaluation and treatment of comorbid major depression may affect BPSD. In order to reduce the burden of BPSD on patients and caregivers, there should be a careful and thoughtful diagnosis of comorbid major depression in patients with dementia.

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.

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.

Impact of the great East Japan earthquake on caregiver burden: a cross-sectional study.

OBJECTIVE: After the great East Japan earthquake of 2011, residents with intellectual disabilities and their caregivers in Fukushima were evacuated to the prefecture of Chiba. We investigated the impact of the earthquake on the caregivers' burden. METHODS: Between August 2011 and January 2012, 46 caregivers evacuated from Fukushima and 46 caregivers at similar facilities in Chiba who were not forced to evacuate completed a survey including the 12-item General Health Questionnaire (GHQ-12) and additional questions. A logistic regression analysis and median tests were performed. RESULTS: The evacuation was linked to GHQ-12 global scores ≥3, indicating psychiatric morbidity (relative risk [RR]=2.81), as well as to scores ≥8, indicating a more severe condition (RR=3.57). There was a trend for evacuated caregivers to have more social dysfunction than psychological distress. CONCLUSIONS: A statistically significant difference in emotional stress was observed among caregivers who were forced to evacuate after the earthquake.

Mobile phone use does not discourage adolescent smoking in Japan.

OBJECTIVE: The possibility that smoking prevalence among junior and senior high school students may decrease with increasing mobile phone bill was reported by the mass media in Japan. We conducted a nationwide survey on adolescent smoking and mobile phone use in Japan in order to assess the hypothesis that mobile phone use has replaced smoking. METHODS: A total of 70 junior high schools (response rate; 71%), and 69 high schools (90%) from all over Japan responded to 2005 survey. Students in the responding schools were asked to fill out an anonymous questionnaire about smoking behavior, mobile phone bill, and pocket money. Questionnaires were collected from 32,615 junior high school students and 48,707 senior high school students. RESULTS: The smoking prevalence of students with high mobile phone bill was more likely to be high, and that of students who used mobile phones costing 10,000 yen and over per month was especially high. When "quitters" were defined as students who had tried smoking but were not smoking at the time of survey, the proportion of quitters decreased as the mobile phone bill increased. The proportion of students who had smoking friends increased with the increase in the mobile phone bill per month. CONCLUSION: The hypothesis that the decrease in smoking prevalence among Japanese adolescents that has been observed in recent years is due to a mobile phone use can be rejected.

Association of gene polymorphism of the fat mass and obesity associated gene with metabolic syndrome: a retrospective cohort study in Japanese workers.

To investigate whether gene polymorphism of the fat mass and obesity associated gene (FTO) is associated with metabolic syndrome (MS), we used two MS criteria, the National Cholesterol Education Program-Adult Treatment panel III (NCEP-ATPIII) definition in 2003 and the Japanese definition in 2005. Subjects were respectively 859 and 865 Japanese workers at a company in Shimane Prefecture, Japan. They were non-MS individuals in 1998 and had regular health checkups between 1998 and 2006. The Cox proportional hazard regression was used to predict MS. Three SNPs in the FTO, rs9939609, rs1121980 and rs1558902, were genotyped by the TaqMan PCR assay and a retrospective study was performed. The three SNPs in the FTO were significantly associated with body mass index, and rs1121980 and rs1558902 were associated with fasting plasma glucose. MS defined by the NCEP-ATPIII definition was significantly associated with additive and dominant models of rs9939609 and rs1121980, and the dominant model of rs1558902, even after adjusting for confounding factors such as age, sex and lifestyle. MS defined by the Japanese definition was significantly associated with the additive model of rs1121980 and additive and dominant models of rs1558902 in multivariate analysis. These results suggested that FTO gene polymorphisms, rs9939609, rs1121980 and rs1558902, were associated with an increased risk of MS among Japanese workers.

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.

Influence of beta 3-adrenergic receptor Trp64Arg polymorphism on the improvement of metabolic syndrome by exercise-based intervention in Japanese middle-aged males.

OBJECTIVES: To date, there have been few intervention studies concerning the association of metabolic syndrome with beta 3-adrenergic receptor (ADRB3) Trp64Arg polymorphism, although ADRB3 Trp64Arg polymorphism has been reported to be associated with weight gain and insulin resistance by several intervention programs. We examined the influence of ADRB3 Trp64Arg polymorphism on the improvement of metabolic syndrome by an exercise-based intervention program. METHODS: Thirty-six male employees who satisfied the metabolic syndrome criteria participated in a three-month exercise-based intervention program (average age, 49 ± 6 years old). The improvement rate of metabolic syndrome after the intervention was compared between subjects with and without ADRB3 Trp64Arg polymorphism. The Mantel-Haenszel test was employed to adjust the age, diet, and exercise in analysis of the influence of ADRB3 Trp64Arg polymorphism on metabolic syndrome. The Trp64Arg genotype of the ß3-adrenoceptor gene was examined in peripheral blood leukocyte DNA by TaqMan PCR assay. RESULTS: The distribution of polymorphism was 23 (Trp/Trp), 13 (Trp/Arg), and 0 (Arg/Arg). The metabolic syndrome improvement rates after intervention were 21.7% (Trp/Trp) and 53.8% (Trp/Arg) (p = 0.050). After adjustment individually for age, calorie limitation, and 10,000 or more and 12,000 or more steps of walking per day during intervention, the odds ratios of the Trp/Arg genotype for improvement of metabolic syndrome relative to that of the Trp/Trp genotype were 5.1 (p = 0.043), 4.9 (p = 0.051), 3.7 (p = 0.074), and 5.0 (p = 0.045), respectively. CONCLUSION: The results suggested that ADRB3 Trp64Arg polymorphism influences the metabolic syndrome improvement rate by exercise-based intervention program.

Effect of the ß3-adrenergic receptor gene polymorphism Trp64Arg on BMI reduction associated with an exercise-based intervention program in Japanese middle-aged males.

OBJECTIVES: The ß3-Adrenergic receptor gene polymorphism Trp64Arg (ADRB3 Trp64Arg) may be associated with weight gain, especially in the East Asian populations. To date, however, the results of various investigations aimed at determining whether ADRB3 Trp64Arg has any effect on weight reduction after intervention have been inconsistent. The aim of this study was to assess the effect of ADRB3 Trp64Arg on weight reduction in a non-pharmacological intervention program. METHODS: Fifty-seven Japanese men (average age 48.1 ± 5.9 years) whose body mass index (BMI) was >23.0 kg/m(2) participated in an intervention program in which they were encouraged to exercise by walking with a pedometer for 12 weeks. The BMI was measured at the start of the intervention program and on weeks 4, 8, and 12 (end) of the intervention period. The reduction in the BMI (ΔBMI) was calculated as the BMI value obtained at each point in comparison to the baseline (initial) BMI. The participants were classified into two groups: Arg allele non-carriers (Trp/Trp) and Arg allele carriers (Trp/Arg or Arg/Arg), respectively. RESULTS: Among the participants, 61.4% were Trp/Trp homozygous, 38.6% were Trp/Arg heterozygous, and 0.0% were Arg/Arg homozygous. There was no significant difference in the ΔBMI between Arg allele non-carriers and Arg allele carriers at week 4 [non-carrier mean ± standard deviation (SD) vs. carrier mean ± SD: 0.25 ± 0.43 vs. 0.24 ± 0.35, respectively; p = 0.954], week 8 (0.56 ± 0.68 vs. 0.58 ± 0.61, respectively; p = 0.913), and week 12 (0.70 ± 0.86 vs. 0.84 ± 0.80, respectively; p = 0.545). CONCLUSIONS: Our results suggest that ADRB3 Trp64Arg does not influence BMI reduction after an exercise-based intervention program.

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.

Relation of the Glu298Asp polymorphism of the nitric oxide synthase gene to hypertension and serum cholesterol in Japanese workers.

OBJECTIVE: To assess whether the Glu298Asp polymorphism of the endothelial nitric oxide synthase (eNOS) gene possibly mediates the relation of blood pressure and serum cholesterol. METHOD: Regular health examination in 2003 of 1,694 Japanese workers from the Shimane Prefecture, Japan. RESULTS: The frequencies of the Glu/Glu, Glu/Asp, and Asp/Asp genotypes were 85.9%, 13.4%, and 0.7%, respectively. After adjustment for age, sex, BMI, and lifestyle (drinking, smoking, exercise and stress), the odds ratio (OR) of hypertension associated with high (> or = 220 mg/dl or under treatment) total cholesterol was 2.08 (95% Confidence Interval (CI) 1.02-4.24) among carriers of the eNOS 298Asp allele versus 1.18 (95% CI 0.89-1.55, p for interaction=0.50) among non-carriers. Similarly, the ORs of hypertension associated with counseling-need (120-139 mg/dl) and high (> or = 140 mg/dl) levels of LDL cholesterol among carriers of the eNOS 298Asp allele were significantly higher than those among non-carriers, at 2.65 (95% CI 1.16-6.01) versus 1.03 (95% CI 0.77-1.39, p for interaction=0.01), and 2.80 (95% CI 1.33-5.89) versus 0.95 (95% CI 0.71-1.26, p for interaction=0.04), respectively. CONCLUSION: These results indicate that the eNOS 298Asp allele, which is weakly associated with hypertension, may increase the risk of hypertension when associated with high serum lipid levels.

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.

Insufficient smoking restrictions in restaurants around junior high schools in Japan.

Controls for second hand smoke (SHS) and adolescent smoking have been still sociomedical concerns in Japan. Restaurant smoking restrictions are associated with community social norms affecting adolescent smoking behavior, and the status in areas around Junior high schools (JHSs) in the community could be a sign of community practices on regulating SHS for adolescents. To examine whether restaurant smoking restrictions are seen especially in areas around JHSs in Japan, a survey using the direct inspection of a total of 163 restaurants (64 restaurants within and 99 outside a 1-km radius from the nearest JHSs) was conducted in May 2003 in Yonago city, Japan. We assessed smoking restriction status in each restaurant and classified them into 2 groups according to the distance from the nearest JHSs. There were only 2 (3.1%) restaurants with 100% non-smoking and 11 (17.2%) with some partial restrictions among the restaurants within a 1-km radius of JHSs. There were 1 (1.0%) restaurant with 100% non-smoking, 3 (3.0%) with complete non-smoking sections and 17 (17.2%) with some partial restrictions among the restaurants outside a 1-km radius of JHSs. Among restaurants with some partial restrictions, restriction methods were considered insufficient. The smoking restriction status was not significantly different between the restaurant groups within and outside a 1-km radius of JHSs. These results suggest that the public awareness of and attitude toward adolescent smoking problems remains low in Japan. Further SHS control actions for adolescents are needed in Japan.

[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.

A survey of restaurant smoking restrictions in a Japanese city.

Japan has been behind the times in terms of promoting smoking control. The health-promotion law, which included the aim of preventing environmental tobacco smoke (ETS) in public places, was newly introduced in Japan in 2003. The community-based survey on the present state of restaurant smoking restrictions and restaurant owners' concern of smoking is important as it is a reflection of the community's desire to prevent ETS. Data on the smoking restrictions in 163 restaurants in Yonago, one Japanese community, and the owners' smoking-related awareness were collected just one month after the law was enacted. This study revealed that only 6 (3.6%) restaurants were under sufficient conditions: 3 with totally smoke-free and 3 with complete non-smoking sections. The styles (e.g., Western-, Japanese- and Chinese-styles) and kinds of restaurants (e.g., family restaurants and tearooms) were not related to the state of smoking restrictions. Rates of smokers were relatively high among owners, and smoking owners significantly provided insufficient smoking restrictions. 26.4% of owners knew about the new law. However, there were no restaurants that started their smoking restrictions due to the law. Owners' knowledge of the law did not correlate with smoking restrictions. The owners especially feared the negative effects on business due to smoking restrictions. These survey findings suggested little protection from ETS in a sample of restaurants and a large gap in restaurant smoking restrictions compared to other countries. More widespread adoption of the health-promotion law in restaurants is an issue.