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Diagnoses and symptoms are recorded by physicians in the chapter E of the Minimum Data Set (MDS), if they are relevant to disabilities of activities of daily living, cognition, behavior, medical treatments or risk of death. We improved the chapter so that it is suited to disease patterns in Japan in a format useful not only for nursing and ADL care but for medical treatment in our practice. In E1, diseases directly underlying the current disability states were recorded in the international classification of Disease, 9th Revision (ICD9). In 24, 670, 195, and 45 patients respectively, there were 0, 1, 2, and 3 separate recorded diseases. A Total of 63 ICD9 codes were observed, but only four codes; 290, 332, 431, and 434, were underlying diseases for 3% or more patients. These codes included mostly ischemic and degenerative disease of the brain.

Diagnoses recorded in the chapter E of Minimum Data Set (MDS) were analyzed in patients requiring care admitted in a geriatric hospital in Sapporo, Japan. They were classified as: A-diseases causing care-requiring conditions, B-their symptoms, and C-coexisting diseases requiring no care. Orthopedic diseases were not analyzed because they were not adequately recorded in MDS system. Class A diagnoses varied, but only five diagnoses were responsible for 3% or more of the total patients who required care. They were 1) Alzheimer's disease (AD), 2) Parkinson's disease, 3) dementia other than AD without neurological symptoms, 4) dementia other than AD with sequelae of stroke, and 5) sequelae of stroke without dementia. These diagnoses pooled represented over 90% of all patients. "Diagnoses and symptoms" in MDS were useful to 1) describe medical problems briefly in a predetermined format, 2) evaluate urgent or unstable conditions separately from stable diagnoses and symptoms, and 3) use common information by various professions, but have difficulties because 1) preselected diagnoses were few and unsuited to practices in Japan, 2) it is impossible to record a previous disease in the past that initiated the process leading to the present disabilities, and 3) it is also impossible to record the severities of the diseases and symptoms.

A Minimum Data Set (MDS) was recorded in two geriatric hospitals every 4 months for about 5 years. The initial records were available in a total of 1,735 disabled elderly. In MDS, about 360 trigger items were recorded. A selection was made to determine whether there were problems of care in 18 areas of Resident Assessment Protocols. We analyzed errors and biases in selection of the diagnosis in the chapter E of MDS disclosing that: 1) they were almost satisfactorily made in diseases except dementias, 2) diagnosis of dementias was biased in several ways, particularly Alzheimer's disease was overselected, and 3) preprinted diagnostic options in MDS were not suited with the Japanese practice and were insufficient for comprehensive medical/nursing service and caregiving.

Preclinical events, especially life styles associated with myocardial infarction (MI), were evaluated in a case-control study. A total of 56 male cases were studied along with matched (1:2) controls. Cases were diagnosed at the Department of Cardiovascular Medicine, Hokkaido University School of Medicine and its related hospitals. Cases were matched to two controls each according to sex, age (+/- 3 year) and residence in central Hokkaido. Preclinical life events (diet, alcohol and smoking, working environment, health behaviors, social life etc.) were inquired in a one-to-one personal structurized interview. In order to evaluate univariate effects and the combined effects of the major multivariate variables, unconditional logistic model was used. The 14 independent variables revealing significant associations with MI were screened in the four areas of lifestyles, 1) diet: more consumption of rice-based non-fat sweets, less consumption of vegetable salads, irregular meal times, 2) alcohol and smoking: non-drinker as well as excessive drinker of alcohol, more than 30 cigarettes per day, 3) working environment, social association and personality: more than 10 hours work per day, feelings not shared with family about work, difficulty in reorientation during concentration, being easily moved to tears and 4) health-promotion, leisure and life style: not eager to watch TV programs on health, not eager to read health articles in newspaper, irregular sleep times, not watching TV in leisure time. Combined odds ratios were calculated in a multivariate logistic analysis, which disclosed phenomenal elevation of the risks in those having more lifestyle factors associated with MI.

Attitudes and behaviours of young women toward dieting and the relationship between body mass index (BMI) and subjective symptoms were studied by a questionnaire survey applied to all the students of a two-year women's college in Sapporo, Hokkaido. The response rate was 96% to yield a total of 608 subjects. 1) Young women showed excessive thinness-oriented attitudes. 2) Over 30 percent of the women reported irregular menstruation, neck pain, fatigue and oversensitiveness to cold. 3) Those who reported oversensitiveness to cold, wearied eyes or stomachache had significantly lower average BMI than those who did not. 4) A U-shaped relationship, with a higher prevalence of complaints of these three symptoms with a low BMI, was shown. Considering these findings, it appears that being excessively thin is related to symptoms and young women's thinness-oriented attitudes are unhealthful.