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Objective: To investigate prognosis and prognostic factors in patients with hypertrophic cardiomyopathy (HCM) in Japan. Design: A nationwide epidemiological study. Setting: Hospitals selected randomly from among all hospitals in Japan. Patients: Clinical and epidemiological information for 2155 patients with HCM were collected in 1999. Main outcome measures: Patients were classified on the basis of baseline prognostic factors. Survival rates up to 5 years were calculated by Cox’s proportional hazard model for 1605 patients. Results: During the follow-up period, 241 deaths were recorded. The crude 5-year survival rate for the entire cohort was 86% (95% CI 84 to 88), and annual mortality ranged from 2.2% to 3.0%. A higher cardiothoracic ratio on chest x ray (HR 1.61; 95% CI 1.26 to 2.05, with 1 SD (6.2%) increase), a lower left ventricular ejection fraction (HR 1.42; 95% CI 1.20 to 1.69, with 1 SD (13%) decrease) and the presence of left bundle branch block (HR 3.14; 95% CI 1.28 to 7.71) were independently associated with a poorer prognosis, whereas the presence of apical hypertrophy at baseline (HR 0.58; 95%CI 0.36 to 0.92) predicted a better chance of survival. Conclusions: The nationwide survey of patients with hypertrophic cardiomyopathy yielded important information on its prognosis and prognostic factors. These observations afford, for the first time, a measure of risk stratification in patients with HCM in Japan.

Objectives The aim of this cohort study was to investigate the effects of shift work on changes in parameters related to metabolic disturbances. Methods The study population included 1529 male blue-collar workers, aged 19–49 years at baseline, working in a sash and zipper factory in Japan. The participants were divided into four groups according to the work schedule at baseline, the end point being workers doing fixed daytime work in both years (day–day), workers who changed from shift work to fixed daytime work (shift–day), workers who changed from fixed daytime work to shift work (day–shift), and workers doing shift work in both years (shift–shift). The changes in body mass index (BMI), blood pressure, serum cholesterol, and glycosylated hemoglobin A1c over a period of 10 years were compared among the groups by work schedule. Results The age-adjusted mean increase in BMI was 1.03 kg/m 2 for the day–shift workers, and it was significantly larger than that of the day–day workers and shift–day workers. The shift–shift workers showed a significantly larger increase in BMI than the day–day workers. These tendencies remained after adjustment for age and all other confounding factors, such as BMI, smoking, drinking, and leisure-time physical activity at baseline. The increase in total cholesterol tended to be higher among the shift–shift workers and the day–shift workers, but there were no significant differences. Blood pressure and hemogrlobin A1c did not differ among the four groups. Conclusions Shift work is considered to be a risk factor for excess weight. However, no significant difference in the biomarkers was found between daytime workers and shift workers.

Indonesia produces over 150million tons of clean coal annually. In Indonesia, most of the coal produced is extracted from opencut mines. Some coal measure rocks are soft in dynamic characteristic and show severely slaking behavior affected by water. Because of tropical rainforest climate, a great variety of problems, such as acid mine drainage, connecting with rock slaking and attendant structural damages have been faced. Accordingly, it is necessary to proceed an effective rehabilitation system which can minimize negative environmental impact of mining activity.This paper describes the slaking behavior of coal measure rocks and the incidence of acid water at Tanjung Enim opencut coal mine in Indonesia. The results shows following highlights: (1) incidence of acid water based on the result of water quality analysis, (2) relationship between the ratio of revegetated area and control acid mine drainage, and (3) slaking behavior of coal measured rocks categorized by NAG test.

This study aims to evaluate the endocrine-disrupting effect of dioxin congeners on adrenal steroid hormones in mother-child pairs. In our previous study, we found that cortisol and cortisone levels were higher in the blood and the saliva of mothers living in a dioxin hotspot area than in mothers from a non-exposed region in Vietnam. In this follow-up study, we determined the salivary steroid hormone levels in 49 and 55 three-year-old children of these mothers in the hotspot and non-exposed region, respectively. Steroid hormones were determined by liquid chromatography-tandem mass spectrometry, and dioxin in the maternal breast milk was determined by gas chromatography-mass spectrometry. Dioxin levels in the breast milk of mothers from the hotspot (median total toxic equivalents polychlorinated dibenzodioxins/polychlorinated dibenzofurans; (TEQ PCDD/Fs) of 11. pg/g lipid) were three to four times higher than those of mothers in the non-exposed region (median TEQ PCDD/Fs of 3.07. pg/g lipid). Salivary dehydroepiandrosterone (DHEA) levels in children were found to be significantly lower in the hotspot than in the non-exposed region, while cortisol and cortisone levels were not different between the two regions. Highly chlorinated dioxin congeners, such as octacholorodibenzodioxin (OCDD), 1,2,3,4,6,7,8-heptacholorodibenzodioxin (HpCDD) and 1,2,3,4 (or 6), 7,8-hexachlorodibenzodioxin Hx(CDD), showed stronger inverse associations with the children's salivary DHEA than other lowly chlorinated dioxin congeners. Glucocorticoid levels in the mothers exhibited a significantly positive correlation with OCDD and HpCDD/F (polychlorinated dibenzofurans). In conclusion, highly chlorinated dioxin congeners are more strongly correlated with endocrine-disrupting effects on adrenal hormones, resulting in high cortisol levels in the mothers and low DHEA levels in their three-year-old children. © 2016 Elsevier B.V., Embargo Period 24 months

PURPOSE: Low-carbohydrate diets (LCD) are a popular dietary strategy for weight reduction. The effects of LCD on long-term outcome vary depending on type of LCD, possibly due to the fact that effects on cardiometabolic risk factors may vary with different types of LCD. Accordingly, we studied these relations. METHODS: We assessed serum concentrations of high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), high-sensitivity C-reactive protein (CRP), total cholesterol, glycated hemoglobin, and uric acid, and nutrient intakes by standardized methods in men and women ages 40–59 years from four population samples of Japanese in Japan (553 men and 544 women, combined). For people consuming usual, animal-based, and plant-based LCDs, we calculated LCD scores, based on relative level of fat, protein, and carbohydrate, by modifying the methods of Halton et al. Instead of calculating scores based on animal or vegetable fat, we used saturated fatty acids (SFA) or monounsaturated fatty acids (MUFA) + polyunsaturated fatty acids (PUFA). RESULTS: In multivariate regression analyses with adjustment for site, age, sex, BMI, smoking, alcohol intake, physical activity, and years of education, all three LCD scores were significantly positively related to HDLc (all P < 0.001), but not to LDLc. The plant-based LCD score was significantly inversely related to log CRP (coefficient = −0.010, P = 0.018). CONCLUSIONS: All three LCD scores were significantly positively related to HDLc. The plant-based LCD score was significantly inversely related to CRP. Carbohydrate intake below 50 % of total energy with higher intakes of vegetable protein and MUFA + PUFA, and lower intakes of SFA may be favorable for reducing cardiometabolic risk factors.

OBJECTIVES We examined the effects on employee vegetable intake of a long-term intervention in an employee work cafeteria. METHODS The subjects were approximately 1,200 employees (aged 19-61 years) of an industrial company in Fukui prefecture. We promoted the intake of typical Japanese style meals that combined three elements (staple foods, main dishes and vegetable dishes) to increase vegetables intake. We displayed all items on the menus of the employee cafeteria using three colors (yellow, red and green to denote three elements) to indicate healthy food choices for the maintenance of a healthy food environment. We advised employees to choose meals containing the three elements at the time of payment, for nutritional education (appropriate portion choice: APC). We evaluated the ratio of APC at the same time. To calculate the mean daily intake per person, we carried out a questionnaire survey similar to the "semi-quantitative food frequency questionnaire" and asked about the frequency and approximate intake of vegetables. RESULTS The APC was 63.5% after one year of intervention, significantly increased to 82.1% after two years (p < 0.001), and was 80.0% after three years of intervention (p < 0.001). Vegetable intake at breakfast (p < 0.001), lunch (p < 0.001) and dinner (p = 0.011), and from vegetable juice (p = 0.030) significantly increased after three years of intervention. The consumption of pickles significantly decreased after three years of intervention (p = 0.009). It was estimated that the vegetable intake of men increased from 167.3 to 184.6 g, and that of women from 157.9 to 187.7 g. CONCLUSIONS Employee estimated vegetable intake was significantly increased and that of pickles was significantly decreased by a long-term intervention (three years) in the employee work cafeteria.

Bien Hoa Air Base is the largest dioxin contamination hot spot in Vietnam. In 2012, we recruited 216 mothers who were living in 10 communities around Bien Hoa Air Base and had delivered newborns at a prefecture hospital, and we investigated recent exposure levels of dioxins and nonortho PCBs in their breast milk. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (2,3,7,8-tetraCDD) was present at 2.6 pg/g lipid in primiparae and 2.2 pg/g lipid in multiparae. Among multiparae and total subjects, significant high prevalence of 2,3,7,8-tetraCDD≥5 pg/g lipid and 2,3,7,8-tetraCDD contribution≥40% were observed in mothers living in the five communities closest to Bien Hoa Air Base. The TEQ for nonortho PCBs was 1.6 pg-TEQ/g lipid for primiparae, and this was even lower than that in the unsprayed area. The length of residency was a strong factor to increase dioxins, including 2,3,7,8-tetraCDD. Residency in the five communities with the highest exposure was a specific risk factor for increased 2,3,7,8-tetraCDD in breast milk. Food intake might contribute partly to the increased levels of dioxin congeners other than 2,3,7,8-tetraCDD in breast milk. These results suggest that Bien Hoa Air Base has led to elevated 2,3,7,8-tetraCDD levels in breast milk of mothers in nearby areas even in the recent years.

Introduction: Sizable numbers of people have tried low carbohydrate diets (LCD) of varied types; data are sparse on effects on cardiometabolic risk factors with different types of LCD. Hypothesis: We assessed the hypothesis that relationships of LCD score to cardiometabolic risk factors and an inflammatory marker, high-sensitivity C-reactive protein (CRP), are different among usual, animal-based, and plant-based LCD. Methods: We assessed serum concentrations of high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), high sensitivity C-reactive protein (CRP), and nutrient intakes by standardized methods in men and women ages 40 to 59 years from four population samples of Japanese in Japan (553 men and 544 women, combined). For people consuming usual, animal-based, and plant-based LCDs, we calculated LCD scores, based on relative level of fat, protein, and carbohydrate, by modifying the methods of Halton, et al. Instead of calculating scores based on animal or vegetable fat, we used saturated fatty acids (SFA) or monounsaturated fatty acids (MUFA) +polyunsaturated fatty acids (PUFA). Multiple linear regression analyses were used to examine relations of LCD scores to log-CRP and cardiometabolic risk factors. Results: In multivariate regression analyses with adjustment for site, age, sex, BMI, smoking, alcohol intake, physical activity, years of education, and Keys dietary lipid score, all three LCD scores were significantly directly related to HDLc (all Ps Conclusions: All three LCD scores were significantly directly related to HDLc, but not to LDLc. The plant-based LCD score, associated with higher PUFA and lower SFA and dietary cholesterol in comparison with the other two LCD scores, was significantly inversely related to log-CRP.

The aim of this study is to estimate the reference level of lifetime cadmium intake (LCd) as the benchmark doses (BMDs) and their 95% lower confidence limits (BMDLs) for various renal effects by applying a hybrid approach. The participants comprised 3,013 (1,362 men and 1,651 women) and 278 (129 men and 149 women) inhabitants of the Cd-polluted and nonpolluted areas, respectively, in the environmentally exposed Kakehashi River basin. Glucose, protein, aminonitrogen, metallothionein, and β

To investigate the association between homebound status and functional decline over a 2 year follow-up period and the sex difference in its association.The study subjects were 2956 independently living older individuals (1267 men, 1679 women). Homebound persons were defined as individuals who left home less than once a week. Subjects judged to be eligible for a support program or long-term care by the committee of the long-term care insurance system were considered functionally dependent. Using a Cox proportional hazard model, the present authors evaluated the association between homebound status and onset of functional dependence.Of the 2946 subjects, 223 (7.6%) were homebound. During the follow-up period, 153 subjects became functionally dependent. Adjusting for age and household type, the hazard ratio (HR) for onset of functional dependence in the homebound group (compared with the non-homebound group) was 5.46 (95% confidence interval [CI], 3.00-9.94) for men and 2.62 (95% CI, 1.66-4.14) for women. After adjustment for locomotor function, cognitive function, depressive state, age, and household type, the HR for onset of functional dependence in association with homebound status remained significantly increased in men (HR, 3.12 [95% CI, 1.59-6.10]), but not in women (HR, 1.43 [95% CI, 0.87-2.35]).This study suggests that homebound status is a risk for functional dependence in both men and women. In men, being homebound despite intact functional ability was also a risk for functional dependence. Considering the respective characteristics of each sex may be important for planning support programs to prevent homebound for older persons.

No large-scale, longitudinal studies have examined the combined effects of blood pressure (BP) and total cholesterol levels on long-term risks for subtypes of cardiovascular death in an Asian population. To investigate these relationships, a meta-analysis of individual participant data, which included 73 916 Japanese subjects (age, 57.7 years; men, 41.1%) from 11 cohorts, was conducted. During a mean follow-up of 15.0 years, deaths from coronary heart disease, ischemic stroke, and intraparenchymal hemorrhage occurred in 770, 724, and 345 cases, respectively. Cohort-stratified Cox proportional hazard models were used. After stratifying the participants by 4 systolic BP ×4 total cholesterol categories, the group with systolic BP ≥160 mm Hg with total cholesterol ≥5.7 mmol/L had the greatest risk for coronary heart disease death (adjusted hazard ratio, 4.39; P P P for interaction ≤0.04). Systolic BP was positively associated with ischemic stroke and intraparenchymal hemorrhage death, and total cholesterol was inversely associated with intraparenchymal hemorrhage, but no significant interactions between BP and total cholesterol were observed for stroke. High BP and high total cholesterol can synergistically increase the risk for coronary heart disease death but not for stroke in the Asian population.

Objective— We investigated whether dietary factors explain higher plasma fibrinogen levels in Japanese emigrants living a Western lifestyle in Hawaii compared with Japanese in Japan. Methods and Results— Plasma fibrinogen and nutrient intakes were examined by standardized methods in men and women 40 to 59 years of age from a Japanese-American sample in Hawaii (100 men and 106 women) and 4 population samples in Japan (569 men and 567 women). Multiple linear regression models were used to examine the relationship between dietary factors and the plasma fibrinogen difference between Hawaii and Japan. Average plasma fibrinogen was significantly higher in Hawaii compared with Japan ( P Conclusions— Higher intake of iron, sugar, and caffeine, in addition to obesity, account largely for higher fibrinogen levels with Westernized lifestyle.

Previously, we investigated the association between urinary cadmium (Cd) concentration and indicators of renal dysfunction, including total protein, beta2-microglobulin (beta2-MG), and N-acetyl-beta-D-glucosaminidase (NAG). In 2778 inhabitants 50 years of age (1114 men, 1664 women) in three different Cd nonpolluted areas in Japan, we showed that a dose-response relationship existed between renal effects and Cd exposure in the general environment without any known Cd pollution. However, we could not estimate the threshold levels of urinary Cd at that time. In the present study, we estimated the threshold levels of urinary Cd as the benchmark dose low (BMDL) using the benchmark dose (BMD) approach. Urinary Cd excretion was divided into 10 categories, and an abnormality rate was calculated for each. Cut-off values for urinary substances were defined as corresponding to the 84% and 95% upper limit values of the target population who have not smoked. Then we calculated the BMD and BMDL using a log-logistic model. The values of BMD and BMDL for all urinary substances could be calculated. The BMDL for the 84% cut-off value of beta2-MG, setting an abnormal value at 5%, was 2.4 microg/g creatinine (cr) in men and 3.3 microg/g cr in women. In conclusion, the present study demonstrated that the threshold level of urinary Cd could be estimated in people living in the general environment without any known Cd-pollution in Japan, and the value was inferred to be almost the same as that in Belgium, Sweden, and China.

We examined the influence of the A1330V variant in the low-density lipoprotein receptor-related protein 5 gene on blood pressure in a large cohort of Japanese workers. This study used analysis of covariance in a multivariate general linear model to adjust for other potential factors such as age, body mass index, blood chemistry and lifestyle. The target subjects were 1440 males and 1169 females selected from 3834 male and 2591 female workers in a single company. Hypertension was defined as systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg or the use of antihypertensive medications. Genotype distributions for A1330V in hypertensive males (AA = 139(54.5%), AV = 101(39.6%), VV = 15(5.9%)) and females (AA = 48(63.2%), AV = 24(31.6%), VV = 4(5.3%)) were not significantly different from normotensive males (AA = 594(50.1%), AV = 488(41.2%), VV = 103(8.7%)) and females (AA = 568(52.0%), AV = 441(40.3%), VV = 84(7.7%)). Allele distributions were not significantly different in either sex. In males, analysis of covariance showed that the VV genotype was associated with a 2.5 mm Hg lower diastolic blood pressure and a 2.3 mm Hg lower mean blood pressure than the AA genotype. This study indicates that the 1330V allele is an independent factor for lower diastolic and mean blood pressure in Japanese males.

Objectives: This study was undertaken to examine the association between sickness absence in Japanese employees and job demand/control and occupational class as psychosocial work characteristics. Methods: The study was cross-sectional in design with data collected from 20,464 male and 3,617 female employees, whose mean age was 40.9 years (SD ± 9.1 years) and 36.9 years (SD ± 10.8 years), respectively. The participants were asked to write the total number of sick leaves they had taken during the past year, and a comparison was made between the group with more than 6 days of sickness absence and the group with 0–6 days as a reference group. Job demands, job control, and worksite support from supervisors and colleagues were analyzed by the Job Content Questionnaire, and likewise by the Generic Job Stress Questionnaire of the National Institute for Occupational Safety and Health. Results: Both low job control and low support at the worksite were associated with a high frequency of sickness absence. But there was no clear relationship between job demands and sickness absence. The lowest sickness absence rate was found in male managers and the highest in male and female laborers. Conclusion: This is the first report of a large-scale survey of Japanese employees to show a high frequency of sickness absence associated with increased work stress and a socioeconomically low occupational class.

The influence of cadmium (Cd) body burden on mortality remains controversial. Excess mortality and the dose-response relationship between mortality and urinary cadmium excretion were investigated in this study among environmentally exposed subjects. A 15-year follow-up study was carried out on 3119 inhabitants (1403 men and 1716 women) of the Cd-polluted Kakehashi River basin, whose urinary Cd concentration was examined in a 1981-1982 health impact survey. The mortality risk of high urinary Cd (or = 10 microg/g Cr) subjects after adjustment for age using Cox's proportional hazard model was higher than that of moderate urinary Cd (10 microg/g Cr) subjects in both sexes. When the subjects were divided into five groups according to the amount of urinary Cd (3, 3-5, 5-10, 10-20,or = 20 microg/g Cr), the mortality risk was significantly increased among the subjects with urinary Cdor = 3 microg/g Cr in proportion to the increases in the amount of urinary Cd concentration after adjustment for age, especially in women. Furthermore, special causes of death among high and moderate urinary Cd were investigated, and mortality risk ratio for heart failure, which is a cause of death often diagnosed in cases with a gradual deterioration culminating in death, was significantly increased in both sexes, compared with the moderate urinary Cd subjects. Also, in women the mortality risk for renal diseases in the high urinary Cd subjects was significantly higher than that in the moderate urinary Cd subjects. These results suggest that a causal association between Cd body burden and mortality exists among inhabitants environmentally exposed to Cd but that no special disease may be induced except renal diseases.

Acid mine drainage is a profound environmental problem in many mining environments that compromises the quality of surrounding surface and ground water resources. The process initiates when pyrite and other metal sulfides are exposed to near-surface atmospheric conditions and in presence of oxygen and water, oxidize to produce various hydrated metal sulfate salts. When reaching streams, lakes and rivers, the acid mine drainage can compromise natural equilibria and incorporate toxic metals into the aquatic food chain.A large amount of flyash from the coal combustion is produced. About 80% of flyash in Japan is now utilized and the remains are dumped at disposal sites; however, the life of these sites is limited. Therefore, in this study, an effort was made to analyze the filling materials by applying flyash as a part of its recycle and utilization. This paper describes some factors to generate acid mine drainage and discusses measures to control acid mine drainage in order to avoid environmental impacts from coal mines in Indonesia. Also, rehabilitation method using flyash is discussed and the fundamental study using the leaching test is carried out.

We examined the influence of the Q89R variant in low-density lipoprotein receptor-related protein 5 on hypertension in a large Japanese cohort. We used multivariate logistic regression analysis to adjust for the effects of other factors known to influence hypertension such as age, body mass index, blood chemistry and lifestyle. Our cohort consisted of 1444 males and 1161 females selected from 3834 male and 2591 female workers in a single company. Hypertension was defined as systolic blood pressure 140 mmHg and/or diastolic blood pressure 90 mmHg or the use of antihypertensive medication. Because the RR genotype was so rare (three normotensive males and three normotensive females), they were excluded from analyses. Genotype distributions for Q89R in hypertensive females (QR = 14, QQ = 60) were significantly different (p = 0.033) from normotensive females (QR = 113, QQ = 971). In contrast, those in hypertensive males (QR = 26, QQ = 230) and in normotensive males (QR = 145, QQ = 1040) were similar. Allele distributions were not significantly different in either gender. In females, multivariate logistic regression showed that the QR genotype was associated with hypertension with odds ratio of 2.1 compared to the QQ genotype. This study indicates that the Q89R polymorphism is an independent factor for hypertension in Japanese females.

We examined how the influence of smoking on blood and urinary cadmium (Cd) concentrations was modified by the level of environmental Cd. We measured blood and urinary Cd concentrations of 1134 men over 50 yr of age in three areas in Japan that were exposed to different levels of environmental Cd. Analysis of variance was used to compare Cd concentrations in blood and urine of smokers with those of nonsmokers living in the three areas. Correlation coefficients between the number of cigarettes smoked per day or smoking indices (the number of cigarettes smoked per day multiplied by the number of years smoked) and blood and urinary Cd concentrations were calculated. No significant difference in Cd concentrations between smokers and nonsmokers was observed in areas where the average Cd concentration in blood was over approx 2.4 ng/g, 2.0 mug/L in urine, and 2.3 mug/g creatinine in urine, respectively. Therefore, it was suggested that an influence of smoking on blood and urinary Cd concentrations was not observed in areas exposed to relatively high levels of environmental Cd.

The prevalence of overweight (body mass index (BMI)=25.0-29.9 kg m(-)(2)) and obesity (⩾30.0 kg m(-)(2)) has been increasing over the last several decades in Japan. We examined trends of the impact of overweight and obesity on hypertension (systolic/diastolic blood pressure ⩾140/90 mm Hg or antihypertensive drugs use) using four national surveys in Japan, from which the participants were randomly sampled from the entire population. Study participants aged 30-79 years were selected for each survey (10 370 in 1980, 8005 in 1990, 5327 in 2000 and 2547 in 2010). The results showed that the impact of overweight and obesity on hypertension had increased significantly (P=0.040 and 0.006 in men and women, respectively). From 1980 to 2010, the multivariable-adjusted odds ratios for hypertension, comparing overweight and obesity with normal weight (BMI =18.5-24.9 kg m(-)(2)), went from 1.94 (95% confidence intervals: 1.64, 2.28) to 2.82 (2.07, 3.83) in men, and from 2.37 (2.05, 2.73) to 3.48 (2.57, 4.72) in women. Most of the association was observed in overweight participants, as only 3% of the Japanese were obese. In addition to the relationship between excessive BMI and other adverse health conditions, the rise in the association with hypertension increases the urgency in addressing weight control. We need to address the overweight and obesity epidemic.

We determined polychlorinated dibenzodioxin (PCDD) and polychlorinated dibenzofuran (PCDF) levels in breast milk of 143 primiparae living around the three most dioxin-contaminated areas of Vietnam. The women sampled lived in the vicinity of former U.S. air bases at Bien Hoa (n. =. 51), Phu Cat (n. =. 23), and Da Nang (n. =. 69), which are known as dioxin hotspots. Breast milk samples from Bien Hoa City, where residents live very close to the air base, showed high levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), with 18% of the samples containing >. 5. pg. TCDD/g lipid. However, Phu Cat residents lived far from the air base and their samples showed lower TCDD levels, with none containing >. 5. pg. TCDD/g lipid. In Da Nang, TCDD levels in mothers from Thanh Khe (close to the air base, n. =. 43) were significantly higher than those in mothers from Son Tra (far from the air base, n. =. 26), but not other PCDD and PCDF (PCDD/F) congeners. Although TCDD levels in Bien Hoa were the highest among these hotspots, levels of other PCDD/F congeners as well as the geometric mean concentration of total PCDD/F level in Bien Hoa (9.3. pg toxic equivalents [TEQ]/g lipid) were significantly lower than the level observed in Phu Cat (14.1. pg. TEQ/g lipid), Thanh Khe (14.3. pg. TEQ/g lipid), and Son Tra (13.9. pg. TEQ/g lipid). Our findings indicated that residents living close to former U.S. air bases were exposed to elevated levels of TCDD, but not of other PCDD/F congeners.

Pediatric burns are frequently observed: twenty-year burn analysis was performed in a single department, and 354 cases, aged 0-6 years old. The major cause of pediatric burns was scalding (68%) and hot water comprised over half of the scald burns. At 1 year old and younger, the total burn surface area (TBSA) was significantly smaller than from 1 to 6 years old (4.8+/-9.56 versus 10.5+/-18.86%, respectively, p

This study was undertaken to estimate the amount of cadmium (Cd) exposure needed for the development of Itai-itai disease. The investigated subjects comprised 82 Itai-itai disease patients and 11 persons requiring observation who were admitted in 1977 and 1978 for medical testing. With the period when the Itai-itai disease patients started to perceive leg/back pain defined as the 'mild disease onset', and the period when they experienced the most severe manifestations such as ambulatory disturbance and bone fractures defined as 'severe disease onset'. Relative cumulative person number distribution according to life time cadmium intake (LCD) at mild disease onset, severe disease onset, and time of death was depicted as an sigmoid curve and the establishment of probit regression lines was demonstrated between them. LCD at the time when mild disease onset and severe disease onset were recognized in half of the Itai-itai disease patients was 3.1 and 3.8 g, respectively. Furthermore, LCD at the time when mild disease onset and severe disease onset were recognized in 5% of the Itai-itai disease patients was calculated to be 2.6 and 3.3 g, respectively. The present results clarify that Itai-itai disease, the most severe stage of chronic Cd poisoning, occurs at levels of Cd consumption amounting to approximately three-fold of those currently seen in Japan.

The present study investigated the effects of job stress on cellular immune function, such as NK cell activity and NK cell subsets. The participants were 61 female nurses aged 23-59, who worked in a public psychiatric hospital in Ishikawa, Japan. Each subject completed the Nursing Job Stressor Scale (NJSS) and their NK cell activity and lymphocyte surface antigens (CD16+56+) were evaluated as immune system parameters. The NJSS has seven subscales: conflict with other nursing staff, nursing role conflict, conflict with physicians or autonomy, conflict with death or dying, quantitative work load, qualitative work load and conflict with patients. Factors influencing NK cell activity, and the proportion and cell counts of CD16+56+ lymphocytes were evaluated. Increase in quantitative work load significantly decreased NK cell activity. Conversely, no linear relationship was observed between qualitative work load and immunological variables, with the highest percentage of CD16+56+ lymphocytes observed among participants in the medium work load group. The other five NJSS subscales did not relate to immune parameters. In conclusion, the results suggest that perceived job strains, particularly quantitative work load, decreased NK cell function.

Purpose of review Recent dietary guidelines for the prevention and treatment of hypertension emphasized a healthy eating pattern called the Dietary Approaches to Stop Hypertension (DASH) diet, in addition to avoidance of obesity, high salt intake, and excessive alcohol intake. Our new challenge is to examine the long-term efficacy and effectiveness of dietary change, including the DASH diet, on blood pressure in the general population, or in a high-risk population. We reviewed recent short-term and long-term studies, both observational and interventional, which investigated whether dietary change can reduce blood pressure. Recent findings The efficacy of several nutrients has been investigated in short-term trials (e.g. polyunsaturated fatty acids, including omega-3 fatty acids, and trans fatty acids), but no substantial effect of these nutrients on blood pressure has been proved, except for dietary fiber. The PREMIER trial showed the effectiveness of implementing the DASH diet for 6 months in addition to the established recommendations on lifestyle modification, but other long-term trials of dietary modification did not show sufficient blood pressure reduction. However, long-term observational studies have shown that a higher intake of fruit and vegetables and a lower intake of red meat (except fish) can prevent higher blood pressure increase with age. Summary More effective programs of dietary modification are needed to achieve greater reduction of blood pressure. Long-term studies of population-wide dietary interventions to decrease the blood pressure level of a whole population are also needed.

高分解能衛星ステレオ画像からの高精度数値標高データ (DEM) 作成手法を用いて, 2004年新潟県中越地震に伴う斜面災害の検出と災害規模の推定を試みた. 震災前後に新潟県小千谷市・山古志村周辺域を撮影したSPOT 5衛星ステレオペア画像から, 震災前後の5mメッシュDEMデータを抽出し, DEMデータの標高値変化を解析して地すべり・崩壊箇所の検出と規模の分析を行った. 精度評価の結果, 大規模な地すべり・崩壊域で標高変化の検出が確認された. 最大で約±50mの標高変化が計測され, 合計でおよそ25,000,000m3規模の標高変化体積が推定された.

Information has been sparse on the comparison of 4 blood pressure (BP) indexes (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean BP [MBP]) in relation to long-term stroke incidence, especially in middle-aged and older Asian people. A prospective cohort study was performed in 4989 Japanese (1523 men and 3466 women) aged 35 to 79 at baseline with 10 years of follow-up. End points included stroke incidence (total, ischemic, and hemorrhagic). Multivariate-adjusted hazard ratios with a 1-SD higher value for each BP index were determined by Cox proportional hazard analyses; Wald χ 2 tests were used to compare the strength of relationships. Analyses were also done for each of 4 age-gender groups consisting of men and women aged 35 to 64 and 65 to 79 years. During follow-up, 132 participants developed stroke. Adjusted hazard ratios for all strokes were 1.68 for SBP, 1.72 for DBP, and 1.80 for MBP, which were higher than that for PP (1.34). SBP and DBP were related positively to stroke risk after adjustment of each other. PP was not the strongest predictor in any age-gender groups among 4 BP indexes. In men aged 65 to 79 years, SBP showed the strongest relationship to all stoke risk (hazard ratio 1.62) among 4 BP indexes. In women aged 65 to 79 years, hazard ratios for all strokes were 2.48 for MBP, 2.46 for DBP, 2.25 for SBP, and 1.57 for PP. The long-term incident stroke risk of high BP in Asians should be assessed by SBP and DBP together, or by MBP, not by PP.

The aim of the present study was to clarify the relationship between urinary cadmium concentration (U-Cd) and total cadmium intake (T-Cd) based on individual data of Cd in urine. Morning urine specimens were collected from 198 persons (100 men with average age of 45.8 years and 98 women with average age of 50.7 years) living in the Kakehashi River basin in Ishikawa Prefecture, Japan. The method used to calculate T-Cd basically mirrored that used in our previous study. Correlation coefficients between U-Cd and T-Cd of 0.879 and 0.835 were obtained in men and women, respectively, with both values statistically significant. Therefore, T-Cd is confirmed to be a useful indicator for external Cd exposure even on the basis of individual data of U-Cd.

To clarify the methodological issues for the High-risk and population Strategy for Occupational Health Promotion Study (HIPOP-OHP study), which is a 4-year non-randomized control trial, an interim assessment of male participants was performed 3 years after the baseline survey.We had approximately 2,500 and 4,000 participants in the intervention and control groups, respectively. The population measures and prevalence of risk factors at each year, and between the baseline and 4th examinations were compared between the two groups. The personal trends of returning participants who were in the study at the 1(st) and 4(th) examinations were also evaluated.During the 3 years, an increase in serum HDL cholesterol (2.7 mg/dl), and a reduction in the prevalence of hypertriglycemia detected with fasting blood samples (3.6%) and current smokers (5.4%) were observed in the intervention group. The mean HDL cholesterol level was significantly higher in the intervention group than in the control group at the 4th examination, reversed from the baseline survey. The serum non-HDL cholesterol level was significantly increased only in the control group. There was also a significant increase in the prevalence of hypertriglycemia nad high plasma glucose detected with fasting blood samples in the control group. The return participation rate after 3 years was 72.2% for the intervention group and 74.9% for the control group. The above-mentioned changes for risk factors were mainly due to returning participants at each examination.These interventional methods may be effective in improving overall cardiovascular risk factors in the population. However, the low return participation rate will dilute the effect of the intervention.

It has not been fully clarified whether exercise blood pressure (BP) in young adult men and women is useful to predict future BP, especially in Asian people. A long-term prospective study was conducted in graduates of a medical school in Japan; 138 men and 76 women whose mean age was 19.8 and 19.2, respectively, at baseline. A 5-min exercise tolerance test was performed at baseline, and BP immediately after exercise was measured. BP at 50% intensity exercise was also calculated. Multiple regression analysis was carried out to clarify the relationship of exercise BP at baseline to follow-up BP after an average of 12 years. In multivariate-adjusted models, the relationship of systolic blood pressure (SBP) at follow-up was stronger to SBP immediately after exercise (F=7.7, P=0.006) than to resting SBP (F=3.7, P=0.055) in men. The models in men showed that SBP immediately after exercise was a stronger predictor of follow-up SBP than SBP at 50% intensity exercise, and the results were similar for diastolic blood pressure (DBP) in men. For SBP in women, resting SBP was the strongest predictor of follow-up SBP (F=14.3, P

OBJECTIVE To examine the association between hypertension and the C825T polymorphism in the G-protein beta 3 subunit gene in Japanese workers. METHODS This study used logistic regression analysis and multiple regression analyses to investigate whether the C825T polymorphism was associated independently with hypertension or blood pressure when factors such as age, body mass index, blood chemistry and lifestyle were taken into consideration. The target subjects were 1452 male and 1169 female workers selected from 3834 male and 2591 female workers in a single company. Hypertension was defined as a systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg, or taking antihypertensive medication. The power of the study was estimated as 83% for males and 41% for females based on allelic frequencies in Caucasians. RESULTS Genotype distributions for C825T in hypertensive males (CC = 58, CT = 135, TT = 63) and females (CC = 20, CT = 36, TT = 20) were not significantly different from normotensive males (CC = 300, CT = 614, TT = 282) or females (CC = 274, CT = 602, TT = 217), respectively. Allele distributions were not significantly different in either sex. Multiple logistic regression analysis showed that genotype was not associated significantly with hypertension, whereas there was a significant relationship between hypertension and age, family history of hypertension, body mass index, hematocrit, platelet count, gamma-glutamyl transpeptidase (gamma-GTP) and uric acid. Data analysis using one-way analysis of variance and multiple regression showed that the C825T allele had no significant influence on either systolic, diastolic or mean blood pressure. CONCLUSIONS This study indicates that the C825T polymorphism is not a significant factor for hypertension or blood pressures in Japanese people. Targeting of this polymorphism is therefore unlikely to be beneficial when attempting to prevent hypertension in the general Japanese population.

In order to establish the methodology of a population strategy for improving cardiovascular risk factors, we have planned the High-risk and Population Strategy for Occupational Health Promotion Study (HIPOP-OHP study). This study is a nonrandomized control trial in approximately 6500 participants in six intervention and six control companies. Our population strategy is based on three factors, nutrition, physical activity, and smoking. For each factor, a researcher's working team was organized and has been supporting the intervention. A standardized method to obtain comparable data has also been established. In the baseline survey, urinary sodium excretion in male subjects was higher, and urinary potassium excretion was lower in both genders in the intervention group compared to the control group. The prevalence of hypertension for both genders was also higher in the intervention group. Male subjects in the intervention group had higher serum total cholesterol than controls, while high-density lipoprotein cholesterol was lower in both genders in the intervention group compared to the control group. These differences were reflected by our finding that the predicted relative risk of coronary heart disease for male subjects was significantly higher in the intervention group (relative risk, RR: 1.17; 95% confidence interval, 95% CI.: 1.09, 1.25) and significantly lower in the control group (RR: 0.93; 95% CI.: 0.89, 0.98) compared to a model Japanese population. Similar results were observed in the female subjects. Taken together, these findings indicate that it is possible to compare trends of predicted relative risk for coronary heart disease between two groups.

Background Detailed epidemiological investigations on the relationship of environmental factors, especially occupational and microbiological factors, to the development of idiopathic dilated cardiomyopathy (IDC) are scarce. Methods and Results A multi-hospital case - control study was conducted in 38 hospitals throughout Japan in order to survey IDC cases and age, sex-matched outpatient controls at each hospital. Crude and adjusted odds ratios (ORs) by various environmental factors were calculated in 135 pairs of cases and controls. Univariate analyses revealed significantly increased ORs for lower education, passive smoking in the workplace, cold and/or hot workplace, symptoms of fatigue and history of bacterial infection; in contrast, decreased ORs were associated with a history of rubella and gastroduodenal diseases. Based on multivariate adjusted analyses, lower education (OR 1.96, 95% confidence interval (CI) 1.13-3.40), cold or hot workplace (OR 1.84, 95%CI 1.08-3.12) and history of measles (OR 1.78, 95%CI 1.01-3.08) exhibited a significant positive relationship with IDC risk. History of rubella (OR 0.17, 95%CI 0.06-0.52) and gastroduodenal diseases (OR 0.14, 95%CI 0.07-0.29) were inversely related to the risk. Conclusions Some occupational and microbiological factors appear to relate independently to the development of IDC and further investigation is required to establish their respective mechanisms. (Circ J 2004; 68: 1011 - 1017)

The construct validity of the Maslach Burnout Inventory (MBI) has been a major point of focus for many studies. The validity of the MBI-General Survey (MBI-GS), a newly developed instrument intended for use outside the human services has not been sufficiently investigated. The aim of this present study is to investigate the validity of the MBI-GS. The Japanese language version of the MBI-GS was prepared for this research and it was administered to a sample of intermediate managers (n = 696) working for a manufacturing company in Japan. The total of 691 effective data were obtained. The exploratory factor analysis replicated the same three-factor structure (Exhaustion, Cynicism, and Professional Efficacy) as the original whereas inter-factor correlation between Exhaustion and Cynicism was moderate. Cronbach's alpha coefficients for all three subscales were above 0.80. The confirmatory factor analysis supported a three-factor model whereas Exhaustion and Cynicism were moderately related. To investigate the construct validity, three subscales of the MBI-GS were then related to selected work characteristics. Based on conservation of resources theory, differential patterns of effects were predicted among the correlates and the burnout subscales. A path analysis revealed that the expectations were largely supported, suggesting that the meaning of the three subscales is quite different with a path from Exhaustion to Cynicism. The study found support for the construct validity of the MBI-GS. Copyright © 2004 John Wiley & Sons, Ltd.

We examined the association of the G-protein beta3 subunit gene (GNB3) C825T polymorphism with overweight in Japanese workers. This cross-sectional study used multivariate analysis to investigate whether a polymorphism in the C825T polymorphism was associated independently with overweight when factors such as age and lifestyle were taken into account. The study in 1453 men and 1172 women involved identifying subjects with the C825T genotype using the polymerase chain reaction, followed by restriction fragment-length polymorphism analysis. Overweight was defined as a BMI > or = kg/m(2). Genotype distributions for C825T in overweight men (CC = 80, CT = 162, TT = 80) and women (CC = 52, CT = 91, TT = 40) were not significantly different from normal-weight men (CC = 278, CT = 588, TT = 265) and women (CC = 242, CT = 549, TT = 198). The allele distributions were also not significantly different between either sex. The power of the study was estimated as 98% in men and 81% in women based on the allelic frequencies reported in a previous positive study in Chinese subjects. Multiple logistic regression analysis showed that the genotype was not significantly associated with overweight. In conclusion, this study indicated that the GNB3 C825T polymorphism is not a significant factor for overweight in Japanese people.

Monitoring in Ishikawa Prefecture (mean population; 1,150,000), during the 20-year period from 1981 to 2000, involved monitoring the prevalence of congenital anomalies starting at gestational week 22. The main objectives of the present study were (1) to investigate the trend over the past 20 years in the prevalence of congenital anomalies, and (2) to investigate whether there is area accumulation in congenital anomalies or not. In addition, the prevalence of well-known risk factors such as smoking, drinking and family history among cases with congenital anomalies was analyzed to obtain clues to the background of such anomalies. During the 20 years, more than 200,000 births have been observed. Thirty-three selected congenital anomalies, consisting mainly of external anomalies, were analyzed in this study. The percentage of children born with congenital anomalies did not change markedly between the first and second halves of the monitoring period, remaining at approximately 4.5/1,000 births. There was also no significant change in annual trends in either Ishikawa Prefecture as a whole or in the three regions within Ishikawa. The prevalence of congenital anomalies by type showed a significant decrease in anencephaly and spina bifida. In contrast, Down syndrome and microcephaly increased significantly. The mean maternal age for Down syndrome increased significantly from the first-half period to the second-half period. The percentage of children with polydactyly whose mother smoked were relatively higher than that for the other congenital anomalies.

The interrelations of the seven elements, calcium (Ca), magnesium (Mg), sodium (Na), potassium (K), phosphorus (P), copper (Cu), zinc (Zn), and cadmium (Cd) in human breast milk were examined in Japanese mothers to clarify the effects of Cd exposure on these important elements for infant growth. Breast milk and urine samples were obtained from 68 mothers, aged 19-38 years, at 5-8 days postpartum. The concentrations were determined by inductively-coupled plasma atomic emission spectrometry for Ca, Mg, Na, K, P, by flame atomic absorption spectrophotometry for Cu and Zn, and by flameless atomic absorption spectrophotometry for Cd. Geometrical mean Cd concentrations were 0.28 (geometrical standard deviation=1.82) microg/l in breast milk and 1.00 (1.93) microg/g creatinine in urine. Among the above elements only Cd concentration in breast milk was significantly correlated with urinary Cd concentration (r=0.451, P

The aim of the present study was to ascertain the role of social support and individual styles of coping on employee well-being. The subjects were intermediate managers working for a zipper and sash manufacturing company in Japan. Measurements were made of the following: depression using the Self-rating Depression Scale (SDS), job demand, job control, social support using Karasek's Job Content Questionnaire, and of three coping styles: emotion-oriented coping, task-oriented coping and avoidance-oriented coping using the Coping Inventory for Stressful Situations (CISS). Data was analysed by structural equation modeling. Each coping style had a direct effect on depression. Emotion-oriented coping had a negative effect. On the other hand, task-oriented coping and avoidance-oriented coping had a positive effect. Moreover, there was an indirect effect that coping styles precede and determine the perception of social support as well as job demand and control. Social support showed a direct positive effect on depression. However, the overall impact on employee well-being was greater for individual coping styles as compared to social support from either supervisors or co-workers. The present study showed the effectiveness of coping strategies in the workplace. Copyright © 2003 John Wiley & Sons, Ltd.

The overall goal of this study was to examine the relationship between burnout and two parameters: job strains and coping styles. The subjects were 568 nurses from a university hospital in Ishikawa Prefecture of Japan. A packet of self-administered questionnaires was distributed to the nurses. Four hundred and forty nurses completed the questionnaires. The Japanese version of the Maslach Burnout Inventory (MBI) was used to measure burnout. The Japanese MBI is consisted of three factors: Physical Exhaustion, Emotional Exhaustion/Depersonalization, and Personal Accomplishment. We developed the Nursing Job Stressor Scale (NJSS) to assess perceived job strains. The analysis identified seven major sources of strain. The seven subscales were: conflict with other nursing staffs, nursing role conflict, conflict with physicians/autonomy, dealing with death and dying, qualitative work load, quantitative work load, and conflict with patients. The Japanese version of the Coping Inventory for Stressful Situations (CISS) assessed coping styles. The three coping patterns include: Task-oriented coping, Emotion-oriented coping, and Avoidance-oriented coping. Stepwise multiple regression analysis resulted in significant predictors for Physical Exhaustion being quantitative and qualitative work load strains, the strain variables: quantitative work load, conflict with other nursing staffs, and conflict with patients for Emotional Exhaustion/Depersonalization, qualitative work load strain for diminished Personal Accomplishment, nursing role conflict strain for Personal Accomplishment. Emotion-oriented coping style was a significant predictor for Emotional Exhaustion/Depersonalization and diminished Personal Accomplishment, while both Task-oriented and Avoidance-oriented coping styles were significant predictors for Personal Accomplishment

Objective: The effects of cadmium (Cd) on birth weight have been discussed in the scientific literature. However, investigations on the effects of maternal body burden of Cd on the next generation during pregnancy and lactation have been limited. The relation between maternal exposure to Cd and pregnancy outcome or Cd in breast milk in Japanese mothers was investigated. Methods: Cd concentrations in urine and colostrum milk samples of 57 mothers were measured by atomic absorption spectrophotometery. The relations between maternal urinary Cd and infant growth, gestational age at birth, and Cd in breast milk were investigated. Results: The rate of perterm deliveries of mothers with higher urinary Cd (≥2 nmol/mmol creatinine (Cr)) was higher than that of mothers with lower urinary Cd ( Conclusion: Maternal exposure to Cd seems to increase early delivery, which leads to a lower birth weight. Also, the Cd is transferred in part to the next generation through breast milk after birth.

A follow-up survey was conducted to investigate the relationship between total Cd intake and mortality in the Jinzu River basin for 6128 days among 757 inhabitants who ingested household rice. When the subjects were divided into two groups, standardized mortality ratios (SMRs) were 0.94 in men and 1.36 in women for theor = 2.0 g group and 0.68 in men and 0.29 in women for the2.0 g group (significant in the women). Cox's hazard ratios for men, women, and men+women for theor = 2.0 g group relative to those in the2.0 g group were 1.406, 3.955 and 1.950 (significant in the men+women). Using total Cd intake as a continuous variable, the hazard ratios were 1.045, 1.146 and 1.049 in men, women, and men+women (significant in the women), respectively. In the Jinzu River basin, increased total Cd intake appears to exert an adverse influence on life prognosis.

A follow-up study was conducted on 5725 inhabitants (men 2858, women 2867) in and around the Jinzu River basin to determine the influence of environmental Cd exposure on mortality. In the Jinzu River basin, standardized mortality ratios (SMRs) investigated according to urinary findings (protein, glucose, and protein+glucose) were significantly low in the urinary protein-, glucose-, and protein+glucose-negative groups. SMRs calculated after dividing urinary protein- and glucose-positive status into two levels were lowest in the proteinuria- and glycosuria-negative groups and tended to be high in the higher positive groups. In the Jinzu River basin, Cox's hazard ratios were significantly higher for men and women in the urinary protein, glucose and protein+glucose-positive-groups. In the same analysis where the urinary protein- and glucose-positive subjects were divided into two levels, mortality was demonstrated to be higher in the groups with the greater degrees of proteinuria and glycosuria. In the Jinzu River water system almost all SMRs and Cox's hazard ratios showed statistical significance. This was not the case in the other water systems. Mortality of inhabitants with Cd-induced renal injury is increased in the Jinzu River basin.

To investigate the association of calcium intake independently of other nutrients already known as predictors of hypertension, a cross-sectional study was carried out on the same population in Japan as used for the INTERSALT study. Dietary calcium intake was estimated from a 1-day 24-h recall. Sodium and potassium intakes were evaluated by 24-h urinary excretion. Data from 476 subjects aged 20-59 years, 230 men and 246 women, were analysed. The mean dietary calcium intake ranged from 557 to 608 mg/day among men, and from 528 to 639 mg/day among women. Among men, the pooled estimate of the regression coefficients of blood pressure (mm Hg) per 100 mg increase of calcium intake, adjusted for age and body mass index (BMI), were -0.42 mm Hg for systolic blood pressure (SBP) and -0.35 mm Hg for diastolic blood pressure (DBP), but there was no statistical significance. Among women, the pooled estimates of regression coefficients adjusted for age and BMI were -0.92 mm Hg for SBP and -0.83 mm Hg for DBP with statistical significance. After adjustment for age, BMI, alcohol intake and urinary excretion of sodium and potassium, the pooled estimate of calcium intake was -0.66 mm Hg for DBP with statistical significance and -0.70 mm Hg for SBP. A significant negative association of calcium intake with blood pressure was observed among the subjects in Osaka. Our study suggests that increased calcium intake may provide a benefit of lowering blood pressure independently of other minerals such as sodium and potassium.

In order to estimate the salt and potassium intake in a population and to compare their annual trends, we developed a simple method to estimate population mean levels of 24-h urinary sodium (24HUNaV) and potassium (24HUKV) excretion from spot urine specimens collected at any time. Using 591 Japanese data items from the INTERSALT study as a gold standard, we developed formulas to estimate 24-h urinary creatinine (24HUCrV), 24HUNaV and 24HUKV using both spot and 24-h urine collection samples. To examine the accuracy of the formulas, we applied these equations to 513 external manual workers. The obtained formulas were as follows: (1) PRCr (mg/day) = -2.04 x age + 14.89 x weight (kg) + 16.14 x height (cm) -2244.45; (2) estimated 24HUNaV (mEq/day) = 21.98 x XNa (0.392); (3) estimated 24HUKV (mEq/day) = 7.59 x XK(0.431); where PRCr = predicted value of 24HUCr, SUNa = Na concentration in the spot voiding urine, SUK = K concentration in the spot voiding urine, SUCr = creatinine concentration in the spot voiding urine, XNa (or XK) = SUNa (or SUK)/SUCr x PRCr. In the external group, there was a significant but small difference between the estimated and measured values in sodium (24.0 mmol/day) and potassium (3.8 mmol/day) excretion. In every quintile divided by the estimated 24HUNaV or 24HUKV, the measured values were parallel to the estimated values. In conclusion, although this method is not suitable for estimating individual Na and K excretion, these formulas are considered useful for estimating population mean levels of 24-h Na and K excretion, and are available for comparing different populations, as well as indicating annual trends of a particular population.

Nationwide clinico-epidemiological surveys of cardiomyopathies in Japan were carried out. Disorders surveyed included idiopathic dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive cardiomyopathy (RCM), arrhythmogenic right ventricular dysplasia (ARVD), mitochondrial disease, Fabry's disease of the heart and prolonged Q-T interval syndrome. The total number of patients was estimated at 17,700 for DCM, 21,900 for HCM, 300 for RCM, 520 for ARVD, 640 for mitochondrial disease, 150 for Fabry's disease of the heart, and 1,000 for prolonged Q-T interval syndrome. The prevalence of both DCM and HCM was higher in men than women: the male-to-female ratios were 2.6 and 2.3 for DCM and HCM, respectively. Detailed data on patients with DCM or HCM were collected by a follow-up survey. In 1 year more patients with DCM (5.6%) died than with HCM (2.8%): congestive heart failure (CHF) and arrhythmias were the leading causes of death for DCM and HCM, respectively. Angiotensin converting enzyme inhibitors (64.6%) and beta-adrenergic blockers (40.9%) are commonly used to treat the CHF complicating DCM and may be associated with the clinical improvement in a significant number of DCM patients. Thus, the nationwide surveys of Japanese patients have yielded important current epidemiological and clinical information on the characteristics of cardiomyopathies in Japan.

Objective To clarify the causes of deaths among patients with Itai-itai disease and severe cadmium (Cd) poisoning. Design Nested case–control analysis of a population-based cohort study. Setting Database of patients with Itai-itai disease and residents of Cd-polluted areas, maintained by the Ministry of Environment, Japan. Participants Subjects included 142 women with Itai-itai disease, 111 women with Cd-induced renal tubular dysfunction and 253 controls matched for sex, age and occupation. All subjects participated in a health impact survey between 1979 and 1984 and were followed until 30 November 2005. Main outcomes and measures Adjusted HRs with 95% CIs for cause of death in women with Itai-itai disease and screened female cases with tubular dysfunction were compared with matched pair controls, using Cox’s proportional hazard model. Vital statistics data were used to determine cause of death. Direct causes of death from autopsy records were used in 29 patients who died from Cd poisoning. Results The most common cause of death among patients with Itai-itai disease was pneumonia, with a significantly increased adjusted HR of 4.54 (95% CI 2.65 to 7.76). Renal diseases were the most common cause of death in renal tubular dysfunction cases, with an increased HR of 12.0 (95% CI 3.92 to 36.8). The adjusted HR for renal diseases was also significantly increased in patients with Itai-itai disease (19.49 (95% CI 6.43 to 59.09)), with a greater impact on mortality of patients with Itai-itai disease than screened cases. The HR for gastrointestinal (GI) diseases was significantly increased (13.79 (95% CI 3.87 to 49.10)) in patients, especially in the first 10 years (37.1 (4.81 to 286.0)). Conclusions Among patients with Itai-itai disease, pneumonia and GI diseases contributed to increased mortality risk. Renal disease is also a significant mortality risk in patients with Itai-itai disease and women with renal tubular dysfunction.

Habitual high-salt intake raises blood pressure and risk of cardiovascular diseases. To prevent/control these risks, reduced salt diet (RSD) is recommended in many countries and some people report practicing it; however, little is known about actual achievement. This population-based study assessed level of 24-h dietary sodium intake of participants reporting RSD and others.Participants were 4680 men and women ages 40-59 years randomly selected from 17 populations in People's Republic of China (PRC), Japan, UK and USA, for an observational study on diet and blood pressure (INTERMAP). Daily sodium intake was determined by two timed 24-h urine collections. Antihypertensive treatment status and RSD were ascertained by questionnaire.Participants reporting RSD were few; 3.1% (Japan), 1.3% (PRC), 2.5% (UK), 7.2% (USA); 15.1, 7.9, 16.7 and 16.8% of people with treated hypertension. For those reporting RSD, 24-h urinary sodium excretion was significantly, but only modestly lower than for others, by 17.9 mmol/day (Japan), 56.7 (PRC) and 14.7 (USA), but higher by 10.5 in UK. Sodium intakes for participants reporting RSD remained higher than recommended; 181.0 mmol/day (Japan), 171.5 (PRC), 155.2 (UK) and 148.9 (USA). For these people, as for others, main sources of salt were processed foods in Japan, UK and USA; in PRC, salt added in preparation at home.Enhanced sustained efforts are needed to raise general awareness of the harmful effects of salt on health and the benefits of salt reduction. Population approaches are needed to reduce salt content of processed foods and restaurant meals.