Shuntaro Abe

Underlying Factors for the Rapid Increase of Suicide in Mie Prefecture, Japan

The number of suicides in Japan increased from about 22,000 per year during the period 1988 to 1997 to over 30,000 since 1998. The number of suicides has also been increasing in Mie Prefecture. In the present study we examined the incidence and the circumstances for all suicidal cases during the seven-year period, 1996-2002, that were reported to Mie Prefectural Police Headquarters. In Mie Prefecture, the number of suicides per year averaged 421 cases: from a minimum of 319 in 1997 to a maximum of 501 in 1998. The most frequent month for suicides was July, while the lowest number occurred in February. Suicide was most common in the 50-59 year age group in men, and in the 70-79 year group in women. Regarding the means of suicide, hanging was the most frequent (61.6%) in both sexes. Psychiatric disorders were the most serious causative factors in all generations, accounting for 23.8% in general but being especially prevalent in the younger generation of people under 39 years. Further reasons for suicide were economic problems for the 40-64 age-group in men and suffering from illness for the elderly age-groups in both sexes. In order to prevent suicide, urgent strategies for effective medical treatments and improved working circumstances are required.

A Promoter Polymorphism in the ALDH2 Gene Affects Its Basal and Acetaldehyde/Ethanol-Induced Gene Expression in Human Peripheral Blood Leukocytes and HepG2 Cells

AIMS To assess the effect of the -360G/A polymorphism in the promoter region of the human aldehyde dehydrogenase-2 (ALDH2) gene on its transcription, basal and acetaldehyde/ethanol-induced gene expression was examined by in vivo and in vitro experiments. METHODS Human peripheral blood leukocytes were collected before and after alcohol ingestion (0.4 g/kg body weight) in 21 healthy young Japanese volunteers with a deficient phenotype of ALDH2 ((487)Glu/Lys), and the levels of ALDH2 mRNA were quantified by real-time RT-PCR. The transcriptional activity of the ALDH2 promoter was investigated by a reporter assay using HepG2 cells in the presence or absence of acetaldehyde/ethanol. RESULTS The basal level of ALDH2 mRNA was significantly higher in -360A heterozygous subjects than in -360G homozygous subjects. In all subjects, regardless of the genotype, ALDH2 mRNA increased following ethanol ingestion. The promoter activity of a reporter plasmid for -360G was significantly lower than that of a reporter plasmid for -360A. Exposure to acetaldehyde induced a significant increase in the transcriptional activity of the -360G reporter, but not the -360A reporter. CONCLUSIONS In vivo and in vitro experiments showed that the -360G allele has lower basal transcriptional activity than the -360A allele, whereas acetaldehyde/ethanol-induced gene expression, in general, seems to be more enhanced in individuals homozygous for the -360G allele than in those with the -360A allele. Thus, the promoter polymorphism may be involved in individual differences in acetaldehyde elimination.

Causative factors as cues for addressing the rapid increase in suicide in Mie Prefecture, Japan: comparison of trends between 1996-2002 and 1989-1995.

Abstract  The number of suicides in Japan has increased from approximately 22 000 per year from 1988 to 1997 to >30 000 per year since 1998. Likewise, the number of suicides has been increasing in Mie Prefecture. The purpose of the present study was to examine the incidence of and circumstances surrounding all suicide cases during 1996–2002 in Mie Prefecture and to compare the data with those from 1989 to 1995. In Mie Prefecture, the age‐specific suicide rate during the second 7‐year period included marked increases among men aged 50–59 and 60–69 years. Among women, the age‐specific suicide rate increased with age during both 7‐year periods. During the second period, psychiatric disorders as causative factors increased in all generations. They were especially important for women of the younger generation, whereas economic problems were the most common causative factor among men aged 40–64. Physical illness as a causative factor in suicide was high among the elderly, but among the other age groups this factor trailed behind economic difficulties for men and psychiatric disorders for women. To prevent suicide, social cooperation as well as a plenitude of visiting nurses and psychiatric care is required, and early detection and treatment are also important.

Sudden death of a child because of an intestinal obstruction caused by a large congenital mesenteric defect

Transmesenteric hernias are internal hernias caused by a congenital defect in the mesentery. They are rare causes of intestinal obstruction, but most commonly affect the small bowel. We report an unexpected death of an infant with a bowel obstruction caused by a congenital mesenteric defect, which was undiagnosed despite visits to three different hospitals. Mesenteric defects are usually 2-3 cm in diameter. At autopsy, we found an oval, 14 × 7 cm congenital defect in the ileal mesentery through which the small bowel had herniated. Diagnosis of such defects remains difficult, even with currently available imaging techniques. Diagnosis is particularly difficult in infants who usually have nonspecific symptoms. Therefore, it is important that sudden unexpected deaths in children undergo full forensic evaluation to establish the precise cause of death. It is also important for forensic physicians to inform clinicians of the risk of such diseases, particularly in emergency situations.

The report in the correlation between the factor of unemployment and suicide in Japan.

To the Editor: The number of suicides in Japan has increased from approximately 22,000 per year in 1988–1997 to over 30,000 per year since then, and this increase in numbers is one of the most important problems in Japan. Among Japanese, the 34,427 recorded suicides in 2003 was the highest ever. The unemployment rates in Japan have increased rapidly since 1998. In Japan, Yoshioka has reported a large-scale study of suicide covering the 7 years from 1989 to 1995. According to his report, economic difficulties, which include suffering from unemployment, are an important factor in increased suicide rates. The present study provides a more detailed correlation between rates of unemployment and the suicide rate than other related studies in Japan. In the present report, we examined all the suicide numbers and rates throughout Japan between 1985 and 2004 in cooperation with the national police agency (Tables 1 and 2), and we investigated the unemployment rates throughout Japan between 1985 and 2004 in cooperation with the Department of Work (Table 3). We focused on the correlation of annual suicide rates in Japan from 1985 to 2004 (Table 2) with the annual unemployment rates in Japan from 1985 to 2004 (Table 3). The statistical analysis was performed using single regression analysis. During the test period, the number of suicides was 355,737 males and 169,833 females (Table 1). The annual suicide rates by sex were 29.0 males and 13.3 females per 100,000 population (Table 2). Annual suicide rates in total correlated significantly with the unemployment rates in Japan: r 0.91, r 0.83, F(1, 18) 86.18, P 0.001 (y 2.87x 11.13); the rates in males correlated significantly with the unemployment rates in Japan: r 0.95, r 0.90, F(1, 18) 168.92, P 0.001 (y 5.00x 11.57); while the rates in females did not correlate with unemployment rates: r 0.45, r 0.20, F(1,18) 4.49, P 0.05 (y 0.52x 11.54). We therefore conclude that the rate of unemployment is an important factor in suicide that is significantly relevant to the increase in suicide rates in total and in males. It is considered that when unemployment rates become high, people experience more stress. It should be noted that suicide seems to be less related to the level of unemployment, but rather to the change in an individual’s situation from employment to unemployment. The risk of suicide increases when people lose their jobs. Effective preventive intervention of suicide as related to first-time job loss has not yet been reported in Japan. It is clear, however, that psychosocial health care should be a part of occupational affairs administered by industrial physicians, primary care physicians, and psychiatrists in an attempt to prevent suicide. According to the report of Voss et al, an increased risk of death from external causes implies a need for support for those experiencing unemployment, and particularly for susceptible individuals. When the patient is in a bad situation because of unemployment, the family and the medical staff should pay close attention to the patient. TABLE 1. The No. Suicides in Japan for the Years 1985–2004: (Population)

Significant correlation of yearly suicide rates with the rate of unemployment among men results in a rapid increase of suicide in Mie Prefecture, Japan.

The number of suicides in Japan has increased from approximately 22 000 per year in 1988‐1997 to >30 000 per year since then. Likewise, the number of suicides has been increasing in Mie Prefecture. Many researchers consider that a major factor related to the number of suicides is an increase of unemployment in men; 1,2 but it has not been described clearly in Mie Prefecture so far. According to Yoshioka, Mie Prefecture had intermediate suicide rates similar to the rates for Japan as a whole. 3 It is possible to analyze enough suicide data for this prefecture to investigate the causes of suicide in detail. In the present study, we investigated the incidence and the circumstances of all suicide cases between 1989 and 2002 in cooperation with the First Department of Criminal Investigation of the Mie Prefectural Police Headquarters, and we investigated the unemployment rate from 1989 to 2002 in cooperation with the Department of Work in Mie Prefecture. In Japan, the annual rate of unemployment among the whole Japanese population and the current rate of unemployment are available for each Prefecture every 5 years, but the annual rate of unemployment is not available in each Prefecture. Therefore we calculated the correlation between the rate of unemployment every 5 years in the total Japanese population and that in Mie Prefecture for each sex. The correlations were r = 0.80 and r = 0.97 for men and women, respectively. Accordingly we considered that the rate of unemployment in the Japanese total reflected the rate of unemployment in Mie Prefecture. We focused on the correlation of yearly suicide rates in Mie Prefecture from 1989 to 2002, with the rate of unemployment in Japan from 1989 to 2002. The statistical analysis was performed using single regression analysis and Fisher’s exact test. During the test period, 3276 male and 1772 female suicides were reported to Mie Prefectural Police Headquarters. The suicide rates by sex were 26.2 (male) and 13.4 (female) per 100 000 (P < 0.05). Among the causative factors, ‘economic difficulties (including suffering from unemployment)’ was the second most prevalent in men (20.0%), and the least prevalent in women (5.0%). The yearly suicide rates for men correlated significantly with the unemployment rate in Japan: r(14) = 0.92, P < 0.001; the yearly sucidie rates for women also showed some correlation with the unemployment rate in Japan: r(14) = 0.56, P = 0.04. The factor of ‘economic difficulties’ is particularly relevant for the increase in suicide in men. When economic conditions become worse, people are exposed to more stress in the workplace. 3‐6 It should be noted that suicide rates were less related to the level of unemployment than to the change in situation from employment to unemployment. One typical case was the significant increase in suicide rates in the year 1997‐1998 when such worsened changes of working conditions were observed. In 1997 and 1998, yearly suicide rates were 17.19 and 26.91, and the unemployment rates were 3.5 and 4.3, respectively. We conclude that psychosocial health care should be considered to be part of occupational affairs by industry physicians, primary care physicians and psychiatrists in order to prevent suicide, which is now a national increasing trend in Japan. When the patient is in a bad situation because of unemployment, the family and medical staff should be aware of the correspondence between suicide rates and unemployment. REFERENCES

Hochdimensionale medizinische Bildgebungsverfahren und “Virtual-reality-Technologie“

The development of real-time imaging techniques with 3D and 4D technologies has led to the possibility of virtual reality procedures. Autopsies can now be carried out with non-invasive procedures and globally transmitted via the internet to virtually any place in the world.ZusammenfassungDie Entwicklung von “Real-time-imaging-Verfahren” mit drei- und vierdimensionalen Technologien ermöglicht „Virtual-reality-Abläufe“. Obduktionen können nun nichtinvasiv durchgeführt werden. Die Dokumentationen können über das Internet an fast alle Orte in der ganzen Welt übertragen werden.

Psychosomatic tendency for suicide among the elderly in Mie Prefecture, Japan

Background:  The aim of the present study is to show the causative factors of suicide among the elderly (over 65) in Mie Prefecture, Japan, and to discuss the prevention of the suicidal influences in elderly patients.

Effects of functional polymorphisms related to catecholaminergic systems on changes in blood catecholamine and cardiovascular measures after alcohol ingestion in the Japanese population.

BACKGROUND The polymorphism of human aldehyde dehyrogenase-2 (ALDH2) Glu(487)Lys is well known to be a crucial factor underlying the genetic background for alcohol sensitivity in Asian populations. Subjects with the inactive Lys(487) allele show a marked increase in blood acetaldehyde level after alcohol intake, which results in facial flushing and various cardiovascular-related symptoms. However, other polymorphisms related to catecholaminergic systems that tightly regulate the activity of the sympathetic nervous system may also influence the physiological changes after acute alcohol intake. METHODS We investigated whether, together with the ALDH2 Gly(487)Lys and ADH1B Arg(47)His genotype, putative functionally important polymorphisms, including 9 loci in 7 human genes, were associated with changes in blood catecholamine levels and cardiovascular measures after alcohol ingestion. Forty-nine young Japanese males were subjected to blood catecholamine analysis after alcohol ingestion. Among them, 28 were also subjected to heart rate variability and blood pressure analysis. The contribution of polymorphisms to the alcohol-induced response was analyzed by multiple regression analysis. RESULTS Among the polymorphisms examined in this study, haplotypes of the phenylethanolamine N-methyltransferase (PNMT) promoter [(-182bpG/A)_(-387bpG/A)] and catechol-O-methyltransferase (COMT) exon 4 [(Ex4 + 119bpC/G)_(Ex4 + 138bpG/A), Leu(136)Leu_Val(158)Met] are suggested to have functionally important effects on alcohol-induced cardiovascular symptoms by affecting blood catecholamine levels. The neuropeptide Y (NPY) promoter C-1450T genotype is also suggested to be involved in the individual differences in regulation of catecholamine secretion. CONCLUSIONS This study suggested that these common polymorphisms of genes related to catecholaminergic systems, as well as those of the alcohol metabolizing system, are significant for understanding the basis of individual differences in alcohol sensitivity.

Detection of butane gas inhalation at 16 days after hypoxic encephalopathy: A case report

In Japan, there are increasing reports of death by poisoning following butane abuse. To determine the specific cause of death in such cases, it is important to confirm the presence of fuel gas components in the body, although careful analysis is required because of their volatile properties. In most reported cases, the subject died suddenly during or immediately after butane aspiration. Thus, the butane concentration in the samples from the deceased should be relatively high. Herein, we present a case of an 18-year-old man found with cardiopulmonary arrest, who then exhibited hypoxic encephalopathy for 16days in a hospital. At autopsy, we detected hypoxic encephalopathy, pneumonia, and ischemia-reperfusion injury of the myocardium, while the cause of cardiac arrest remained unclear. Toxicological analysis was then performed for fuel gas components in several specimens collected at autopsy. Results showed that n-butane and isobutane were detected in the adipose tissue at 16days after inhalation, indicating a role of butane gas inhalation as the cause of death. These data suggest that adipose tissue may be the most appropriate analysis sample to be collected at postmortem in cases where involvement of volatile and fat-soluble gas inhalation is suspected.