Eiji Marui

Effect of the helmet act for motorcyclists in Thailand

OBJECTIVES This study investigated the effect of the helmet act for motorcyclists on increasing helmet use and reducing motorcycle-related deaths and severe injuries in Thailand. METHODS Data were derived from a trauma registry at the Khon Kaen Regional Hospital in the northeast Thailand. Helmet use and outcome in motorcycle crashes were compared 2 years before (1994-1995) and after (1996-1997) enforcement of the helmet act. During the study period, there were 12002 injured motorcyclists including 129 death cases in the municipality of Khon Kaen Province who were brought to the regional hospital. RESULTS After enforcement of the helmet act, helmet-wearers increased five-fold while head injuries decreased by 41.4% and deaths by 20.8%. Those who had head or neck injuries or died were less likely wearing a helmet. Compliance of helmet use was lower at night. Fatality of injured motorcyclists did not significantly decrease in the post-act period and among helmet-wearers. CONCLUSION Enforcement of the helmet act increased helmet-wearers among motorcyclists but helmet use did not significantly reduce deaths among injured motorcyclists. Motorcyclists should be instructed to properly and consistently wear a helmet for their safety.

A study of home deaths in Japan from 1951 to 2002

BackgroundSeveral surveys in Japan have indicated that most terminally ill Japanese patients would prefer to die at home or in a homelike setting. However, there is a great disparity between this stated preference and the reality, since most Japanese die in hospital. We report here national changes in home deaths in Japan over the last 5 decades. Using prefecture data, we also examined the factors in the medical service associated with home death in Japan.MethodsPublished data on place of death was obtained from the vital statistics compiled by the Ministry of Health, Labor and Welfare of Japan. We analyzed trends of home deaths from 1951 to 2002, and describe the changes in the proportion of home deaths by region, sex, age, and cause of death. Joinpoint regression analysis was used for trend analysis. Logistic regression analysis was performed to identify secular trends in home deaths, and the impact of age, sex, year of deaths and cause of deaths on home death. We also examined the association between home death and medical service factors by multiple regression analysis, using home death rate by prefectures in 2002 as a dependent variable.ResultsA significant decrease in the percentage of patients dying at home was observed in the results of joinpoint regression analysis. Older patients and males were more likely to die at home. Patients who died from cancer were less likely to die at home. The results of multiple regression analysis indicated that home death was related to the number of beds in hospital, ratio of daily occupied beds in general hospital, the number of families in which the elderly were living alone, and dwelling rooms.ConclusionThe pattern of the place of death has not only been determined by social and demographic characteristics of the decedent, but also associated with the medical service in the community.

Parental Knowledge and Perceptions of Fever in Children and Fever Management Practices : Differences Between Parents of Children With and Without a History of Febrile Seizures

Objectives: The aim of this study was to compare maternal knowledge and perceptions of fever, fever management practices, and information sources of mothers of children with and without a history of febrile seizures. Methods: A questionnaire was used to survey mothers of children who visited health departments for a routine 18-month-old well baby check-up. Results: A total of 386 responses were analyzed. More mothers of children with a history of febrile seizures than mothers of children without it stated that high fever caused febrile seizures and antipyretics prevented it. Fewer mothers of children with a history of febrile seizures than mothers in the other group thought that high fever caused brain damage and antipyretics prevented the disease from worsening and warmed the childs body during fever episode. Many mothers in both groups stated that they considered physicians to be their primary information source. Spouse and own parents were named as information sources among mothers of children with a history of febrile seizures, whereas books and the Internet were named in the other group. Conclusions: Mothers of children with a history of febrile seizures demonstrated a higher rate of accuracy in their knowledge of fever than those in the other group. Mothers of children with a history of febrile seizures used personal communication, whereas those in the other group relied on mass communication for health information. Providing accurate information to family members is essential to provide mothers with both accurate information and emotional support.

Does fever phobia cross borders? The case of Japan

Background:  Undue parental fear of fever in children was termed “fever phobia” by Schmitt following a survey in the USA in 1980. In 2000, Crocetti et al. conducted the same survey and concluded that fever phobia existed even 20 years later. In this study, we explore differences in fever phobia between these two US populations and a Japanese sample, and determine whether parents of a single child or those whose child was previously hospitalized or had a febrile seizure report greater anxiety about fever.

Evidence-based new service package vs. routine service package for smoking cessation to prevent high risk patients from cardiovascular diseases (CVD): study protocol for randomized controlled trial

BackgroundSmoking cessation is a high-priority intervention to prevent CVD events and deaths in developing countries. While several interventions to stop smoking have been proved successful, the question of how to increase their effectiveness and practicality in developing countries remains. In this study, a newly devised evidence-based smoking cessation service package will be compared with the existing service in a randomized controlled trial within the community setting of Thailand.Method/DesignThis randomized control trial will recruit 440 current smokers at CVD risk because of being diabetic and/or hypertensive. Informed, consented participants will be randomly allocated into the new service-package arm and the routine service arm. The study will take place in the non-communicable disease clinics of the Maetha District Hospital, Lampang, northern Thailand. The new smoking-cessation service-package comprises (1) regular patient motivation and coaching from the same primary care nurse over a 3-month period; (2) monthly application of piCO + smokerlyzer to sustain motivation of smoker’s quitting attempt and provide positive feedback over a 3-month period; (3) assistance by an assigned family member; (4) nicotine replacement chewing gum to relieve withdrawal symptoms. This new service will be compared with the traditional routine service comprising the 5A approach in a 1-year follow-up. Participants who consent to participate in the study but refuse to attempt quitting smoking will be allocated to the non-randomized arm, where they will be just followed up and monitored. Primary outcome of the study is smoking cessation rate at 1-year follow-up proven by breath analysis measuring carbomonoxide in parts per million in expired air. Secondary outcomes are smoking cessation rate at the 6-month follow-up, blood pressure and heart rate, CVD risk according to the Framingham general cardiovascular risk score, CVD events and deaths at the 12-month follow-up, and the cost-effectiveness of the health service packages. Intention-to-treat analysis will be followed. Factors influencing smoking cessation will be analyzed by the structure equation model.DiscussionThis multicomponent intervention, accessible at primary healthcare clinics, and focusing on the individual as well as the family and social environment, is unique and expected to work effectively.Trial registrationCurrent Controlled Trials ISRCTN89315117

Reducing salt intake for prevention of cardiovascular diseases in high-risk patients by advanced health education intervention (RESIP-CVD study), Northern Thailand: study protocol for a cluster randomized trial

BackgroundDecreasing salt consumption can prevent cardiovascular diseases (CVD). Practically, it is difficult to promote people’s awareness of daily salt intake and to change their eating habits in terms of reducing salt intake for better cardiovascular health. Health education programs visualizing daily dietary salt content and intake may promote lifestyle changes in patients at high risk of cardiovascular diseases.Methods/DesignThis is a cluster randomized trial. A total of 800 high-CVD-risk patients attending diabetes and hypertension clinics at health centers in Muang District, Chiang Rai province, Thailand, will be studied with informed consent. A health center recruiting 100 participants is a cluster, the unit of randomization. Eight clusters will be randomized into intervention and control arms and followed up for 1 year. Within the intervention clusters the following will be undertaken: (1) salt content in the daily diet will be measured and shown to study participants; (2) 24-hour salt intake will be estimated in overnight-collected urine and the results shown to the participants; (3) a dietician will assist small group health education classes in cooking meals with less salt. The primary outcome is blood pressure change at the 1-year follow-up. Secondary outcomes at the 1-year follow-up are estimated 24-hoursalt intake, incidence of CVD events and CVD death. The intention-to-treat analysis will be followed.Blood pressure and estimated 24-hour salt intake will be compared between intervention and control groups at the cluster and individual level at the 1-year follow-up. Clinical CVD events and deaths will be analyzed by time-event analysis. Retinal blood vessel calibers of CVD-risk patients will be assessed cross-sectionally. Behavioral change to reduce salt intake and the influencing factors will be determined by structured equation model (SEM). Multilevel regression analyses will be applied. Finally, the cost effectiveness of the intervention will be analyzed.DiscussionThis study is unique as it will recruit the individuals most vulnerable to CVD morbidity and mortality by applying the general Framingham CVD risk scoring system. Dietary salt reduction will be applied as a prioritized, community level intervention for the prevention of CVD in a developing country.Trial registrationISRCTN39416277

Daily salt intake estimated by overnight urine collections indicates a high cardiovascular disease risk in Thailand.

This cross-sectional study (February 2012 to March 2013) was conducted to estimate daily salt intake and basic characteristics among 793 community-dwelling participants at high risk of cardiovascular disease (Framingham risk score >15%), who had visited diabetes or hypertension clinics at health centres in the Muang district, Chiang Rai, Thailand. We performed descriptive analysis of baseline data and used an automated analyser to estimate the average of 24-hour salt intake estimated from 3 days overnight urine collection. Participants were divided into two groups based on median estimated daily salt intake. Mean age and proportion of males were 65.2 years and 37.6% in the higher salt intake group (>=10.0 g/day, n=362), and 67.5 years and 42.7% in the lower salt intake group (<10.0 g/day, n=431), respectively (p=0.01, p<0.01). The higher salt intake group comprised more patients with a family history of hypertension, antihypertensive drug use, less ideal body mass index (18.5-24.9), higher exercise frequency (>=2 times weekly) and lower awareness of high salt intake. Among higher salt intake participants, those with lower awareness of high salt intake were younger and more often had a family history of hypertension, relative to those with more awareness. Our data indicated that families often share lifestyles involving high salt intake, and discrepancies between actual salt intake and awareness of high salt intake may represent a need for salt reduction intervention aiming at family level. Awareness of actual salt intake should be improved for each family.

Effect of exercise on bone status and body composition in Japanese students

PURPOSE We evaluated the effect of exercise on stiffness and fat-free mass (FFM), which consists of bone and muscle, in Japanese students. It is uncertain whether exercise or sports activities will help to accumulate overall peak bone mass in Japanese adolescents. METHODS A total of 710 Japanese students (age = 15-20 yr) were enrolled. Students who regularly engage in physical exercise were assigned to an exercise group; other students were assigned to a nonexercise group. Body composition, including height, weight, waist circumference, hip circumference, body mass index, and waist-to-hip ratio, were measured and calculated. Lung volume, body volume, and body fat percentage were evaluated by air displacement plethysmography. Fat mass and FFM were derived from body fat percentage and body weight. Bone status, such as speed of sounds, broadband ultrasound attenuation, and stiffness, which is defined as bone density, was assessed by quantitative ultrasound. RESULTS In both sexes, height, weight, body mass index, circumferences, waist-to-hip ratio, lung volume, and body volume between the exercise and nonexercise groups did not show any significant differences. FFM, speed of sounds, broadband ultrasound attenuation, and stiffness in the exercise group were statistically higher than those in the nonexercise group (P < 0.05). Although stiffness positively correlated with age with the exception of the nonexercise group in females (P < 0.01), stiffness correlated with FFM in the exercise and nonexercise groups in both sexes (P < 0.01). CONCLUSIONS Ours is the first analysis of a trend in peak bone mass, including the effect of exercise in Japanese students. For Japanese pubertal females who did not have a history of regular exercise, stiffness slowly decreased with age. Exercise habits in early childhood are important in the relationship between stiffness and FFM.

Disease patterns of outpatient visits by Japanese expatriate children in Thailand

Aim: To clarify the health‐related conditions of Japanese expatriate children in Thailand.

Fever phobia; can we blame the trend to nuclear family or having a single child?

Fever is one of the most common reasons that parents seek medical attention for their children. Fever phobia is the undue parental fear of fever in children, which was first reported by Schmitt in 1980 (1). Some argue that fever phobia in Japan is attributable to the Japanese’s lack of child-rearing experience as a result of declining national birthrates, and also to a reduction of generational child-rearing tips as a result of a trend toward nuclear families (2). In this study, we introduce fever phobia in Japan to the international community and explored the influence of the nuclear family and the single-child family structure on fever phobia. An anonymous, self-administered questionnaire was administered to parents of children who visited one of the five health departments in Tokyo for a routine 18-month well-baby check-up between February and March 2006. Although many people responded to our questionnaire, including fathers and grandparents, we selected responses only from mothers. The purpose was to minimize confounding factors. The questionnaire included basic parental characteristics (number of children, residing with grandparents, etc.), body temperature considered indicating fever, possible complications of fever, use of antipyretics, sources of information relied upon during episodes of fever and management of fever at home. A written explanation of our study objectives was distributed at the well-baby clinics. Those who consented to the study were ushered to another room and handed the questionnaire. Questionnaires were later collected on site. SPSS 11.0J for Windows (SPSS Inc., Chicago, USA) was used for the analysis of data. The Mantel–Haenszel test was used to evaluate the differences between the parental groups; p < 0.05 was considered to indicate statistical significance. Differences between the two parental groups for questions that required numeric responses such as ‘temperatures that are considered to indicate fever’ were evaluated at 95% confidence intervals (CI). A total of 480 parents agreed to participate in the study and all of them returned the questionnaire. Of these, 418 responses—excluding 9 responses from fathers, 4 responses from grandparents and 49 responses which did not answer the number of children or residing with grandparents—were analysed. The number of mothers in nuclear families was 374 (89.5%). The number of mothers who had a single child was 216 (51.7%), that of mothers who had 2 children was 156 (37.3%), that of mothers who had 3 children was 38 (9.1%), and that of mothers who had more than 4 children was 8 (1.9%). As for temperatures considered by mothers to indicate fever (open-ended question), the mean was 37.8◦C, in the range of 37.7 to 37.8◦C at 95% CI. A total of 407 mothers (97.4%) believed that fever results in some type of complication and only 11 mothers (2.6%) answered that fever did not cause any complications. As for possible complications of fever (multiple answers allowed), ‘dehydration’ received the highest response rate (69.4%), followed by ‘febrile seizure’ (58.9%) and ‘brain damage’ (43.3%). As for temperatures that cause complications (openended question), responses from 376 parents—excluding 11 parents who answered, ‘Fever alone does not cause any complications,’ and 31 parents who did not answer this question—were analysed. The mean temperature was 39.2◦C, in the range of 39.1 to 39.3◦C at 95% CI. As for management of fever at home (multiple answers allowed), ‘give fluids’ received the highest response rate at 88.0%, followed by ‘cool the head’ (54.1%), ‘cool the body’ (23.2%), ‘use antipyretics’(13.6%), and ‘keep the body warm’ (11.7%). As for temperatures that determine whether or not to consult a healthcare provider, 404 mothers, excluding 14 mothers who answered ‘did not seek medical attention for fever alone’, were analysed. A total of 137 mothers (33.9%) answered that they did not seek treatment based on the height of their child’s fever. Among those who an-