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AIMS—The risk of smoking habits for developing the neovascular form of age related macular degeneration (neovascular form of AMD) were studied by a case-control study in Japan. METHODS—56 male patients with the neovascular form of AMD and 82 healthy male controls, aged 50 to 69 years, were enrolled. A self administered questionnaire provided necessary information for the study subjects. Questions on smoking included whether the study subjects have ever smoked or not, and if smoked, depth of smoke inhalation, use of extra filter, age at starting smoking, average number of cigarettes smoked per day, and duration of smoking. When a smoker had stopped smoking, age at cessation was also recorded. Unconditional logistic analysis was adapted to calculate age adjusted odds ratios and their 95% confidence intervals (CIs) for smoking related factors. RESULTS—Age adjusted odds ratio of developing the neovascular form of AMD was 2.97 (95% CI 1.00-8.84) for current smokers and 2.09 (0.71-6.13) for ex smokers, compared with non-smokers. All smoking habit/smoking history related variables such as use of extra filter, smoke inhalation level, age at starting smoking, duration of smoking, and Brinkman index were found to be significantly related to an increased risk of the neovascular form of AMD. CONCLUSIONS—Suggested is the strong possibility that cigarette smoking enhances the neovascular form of AMD risk in late middle aged males, though the magnitude of risk by smoking variables might be overestimated, in part, because of health oriented controls.

To explore risk factors for female breast cancer, a hospital-based case-control study was conducted in Tokyo, from 1990 to 1991. Information on potential risk factors was obtained by a selfadministered questionnaire from 5, 084 out-patients. Of the patients, 300 incident breast cancer cases were recruited, and 900 age-matched controls were randomly selected. Following significant findings emerged : (a) A large number of livebirths was associated with a decreased risk in premenopausal women (relative risk (RR) for 3 or more births relative to none : 0.24; 95% confidence interval (CI): 0.08-0.65). (b) In premenopausal women, regular menstrual cycle increased the risk (2.50; 1.16-5.38). (c) Current smokers experienced an increased risk (1.63; 1.11-2.39). (d) Heavy weight was associated with a greater risk of postmenopausal breast cancer: RR for those weighing 70 kg or more relative to those weighing 50 kg or less being 4.82 (1.53-15.2). (e) The later the age at first livebirth, the higher the postmenopausal breast cancer risk (2.85; 1.16-6.99; 3.54; 1.03-12.2 for ages of 30-34 and 35 years and more, respectively). J Epidemiol, 1994; 4 : 65-71.

Based on national mortality data, the frequency of hip fractures in elderly people was compared between Switzerland and Japan. Age-adjusted annual incidence rates per 100,000 population estimated for Swiss persons over 60 years were around 150 and 200 in males and around 450 in females, while for the Japanese they were only 132 in males and 285 in females. Age-adjusted death rates from hip fracture for the Swiss over 60 were 20.0 in males and 28.9 in females, while for the Japanese they were only 1.6 in males and 2.7 in females. The inclination of the age-dependent slope in hip fracture mortality rates was substantially the same in both countries, but there was a "lag time" of approximately 10 years in Japan. Remarkably, the proportion of deaths due to falls among all accidental deaths was several times greater in both sexes for the Swiss than for the Japanese. This differential might be an important underlying reason for the observed difference between death rates of hip fracture in Switzerland and Japan. Other known behavioral risk factors for hip fracture such as diet, exercise, estrogen use etc. are unlikely to explain the observed difference in hip fracture mortality and morbidity between Switzerland and Japan. However, given the doubts on the reliability and thus comparability of the available data on mortality and morbidity, the present findings should be regarded as preliminary. In conclusion, we believe that the unexplained and large difference in the burden of hip fracture between Switzerland and Japan merits further studies, including new aetiological hypotheses.

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Untuk meneliti faktor. risiko kanker payudara saat ini dilakukan penelitian kasus-kontrol pada rumah-sakit di Tokyo, dari tahun 1990 sampai 1991. Informasi mengenai faktor risiko potensial didapat dari kwesioner yang diisi sendiri oleh 5.084 pasien rawat jalan. Dari pasien tersebut didapat 300 kasus /canker payudara, dan dipilih 900 kontrol secara acak yang umunya sesuai. Temuan bermakna adalah: (a) semakin tinggijumlah kelahiran hidup, semakin kecil risikopada wanita pramenopause (risiko relatif (RR)yang disesuaikan untuk 3 atau lebih kelahiran hidup terhadap tanpa kelahiran hidup: 0,24; 95% interval kepercayaan (JK) : 0,08 - 0,65); (b)pada wanita pramenopause, siklus haid teratur meningkatkan risiko (RR yang disesuaikan: 2,50; 95% IK : 1,16-5,38), danpeningkatan lama siklus mengurangi risiko (P untuk kecenderungan linier ot 50 kg atau kurang adalah 4,82 (95% IK: 1,53-15,2); (e) semakin tua usia melahirkan anak pertama, semakin tinggi risiko kanker payudara pasca menopause (2,85; 1,16-6,99, dan 3,54; 1,03-12,2 untuk umur 30-34 dan 35 tahun atau lebih). Risiko kanker payudara pra menopause dan pascamenopause tidak berhubungan dengan riwayat kankerpayudara pada keluarga, riwayat penyakit payudara jinak, umur saat haid pertama dan menopause, la/etas kebiasaan minum alkohol dan tinggi badan. Abstract To explore the risk factors for recent female breast cancer, a hospital-based case-control study was conducted in Tokyo, from 1990 to 1991. Information on potential risk factors was obtained by a self-administered questionnaire from 5.084 out-patients. Of thepatients, 300 incident breast cancer cases were recruited, and 900 age-matched controls were randomly selected. Significant findings are: (a) the more the number of livebirths, the smaller the risk inpremenopausal women (adjusted relative risk (RR)for 3 or more births relative to none: 0.24; 95% confidence interval (CI): 0.08-0.65); (b) in premenopausal women, regular menstrual cycle increased the risk (adjusted RR: 2.50, 95% Cl: 1.16-5.38), and its increasing duration decreased the risk (Pfor linear trend

Suatu penelitian kanker payudara secara multi disipliner telah dilaksanakan di Rumah Sakit Umum Pusat Nasional Dr.Cipto Mangunkusumo Jakarta dari lahun 1988 sampai tahun 1991. Bagian studi epidemiologi dari proyek ini mempergunakan disain Case'Control dalam upaya penilaian pengaruh berbagai faktor kausal untuk kejadian kanker payudara di kalangan wanita Indonesia. Berdasarkan hasil penelitian sebelumnya maupun literatur yang ada, telah disusun suatu konsep yang spesifik bagi penelitian ini. Kerangka konsep penelitian ini menyoroti hubunganyang diperkirakan ada dalam perkembangan kanker payudara dengai fahor-fahor berikut: 7) keturunan genetik dalam keluarga, 2) pajanan hormonal, baik intrinsik maupun ekstrinsik, i) penumpukai lemaktubuh, 41 trauma dan pajanan langsung lainnya atas jaringan payudara, 5) pota hidup yang spesifik. Penelitian ini melibatkan 300 kasus baru kanker payudara dan 600 kontrol serasi yang dipitih dari pengunjung bukan tumor d.i RSCM pada periode waktu yang sama. Faktor penentu keserasian kontrol adalah kelompok usia dan status sosial ekonomi

Untuk meneliti faktor risiko kanker payudara yang berkaitan dengan status menopause, dilakukan penelitian kasus kontrol pada rumah sakit di Indonesia. Pada 300 kasus dan 600 kontrol yang berpasangan menurul umur dan keadaan sosial ekonomi dilakukan wawancara . Kasus dan kontrol dikelompokkan berdasarkan status menopausenya dan dianalisis terpisah. Diperoleh temuan-temuan bermakna berikut ini.Di antara penderita kanker payudara pra menopause ditemukan peningkatan risikopada yang mengalami trauma payudara (RR: 2,62; 95% JK: 1,09-6,31), menggunakan kontrasepsi oral (4,96; 1,51-16,24), mengkonsumsi susu (1,81; 1,01-3,35 konsumsi tiap hari versus nir konsumsi), makan buah sega r (2,42; 1,16-5,05, 3-4x per minggu versus kurang dari seka li per minggu). Penurunan risiko ditemukan pada wanita pengkonsumsi sayuran tiap hari (0,34; 0,15-0,77, konsumsi tiap hari versus tidak tiap hari). Di antara penderita kanker payudara pasca menopause ditemukan peningkatan risiko pada wanita dengan usia menard1e 15 tahun atau lebih (2,25 ·1,35-3,76), haid teratur setelah usia 30 tahun (4,61-· 2,45-8,67), konsumsi susu (5,84; 2,92-11,66, konsumsi tiap hari versus nir konsumsi). Penurunan risiko ditemukan pada wanita yang cerai atau janda (0,33; 0,18-0,58), jumlah melahirkan hidup atau bayi yang disusuinya tinggi (0,32; 0,13-0,76), menyusui 6 atau lebih bayi versus tidak menyusui). Abstract To clarify the risk factors of breast cancer in premenopausal and postmenopausal women, a hospital-based case-control study was conducted in Indonesia. Three hundred inciden.t cases were inlerviewed and 600 controls were selected, matching for age and socio-economic class. Cases and controls were divided according to their menopausal status and analyzed separately. Following significant findi ngs were revea led. For premenopausal breast cancer, an increased risk was detected in women with breast trauma (adjus ted RR: 2.62; 95% Cl: 1.09-6.31), oral contraceptive u e (4.96,- 1.51-16.24), milk consumption (1.81; 1.01-3.35, daily intake vs no intake), fresh frui ts intake (2-42; 1.16-5.05, 3-4 times/week vs less than once/week intake). A decreased risk was detected in women with cooked-vegetable intake (0.34; 0.15-0.77, daily intake vs not daily intake). For postmenopausal breast cancer, an increased risk wasfound in women having menarche at the age of 15 years or over (2.25; 1.35-3.76), regular menstruation after thirty years old (4.61; 2.45-8 .67), milk consumption (5.84; 2.92-11.66, daily intake vs no intake), and a decreased risk in women who were divorced or widowed (0.33; 0. 18-0.58), and whose number of live birth or breast-fed children was high (0.32; 0.13-0.76, six or more breast-fed children vs no breast-fed child). Keywords :case-control study, pr emenopausal women, p ost menopausal women, breast cancer, risk factors