Takehito Takano

Accumulation of health risk behaviours is associated with lower socioeconomic status and women's urban residence: a multilevel analysis in Japan

BackgroundLittle is known about the socioeconomic differences in health-related behaviours in Japan. The present study was performed to elucidate the effects of individual and regional socioeconomic factors on selected health risk behaviours among Japanese adults, with a particular focus on regional variations.MethodsIn a nationally representative sample aged 25 to 59 years old (20,030 men and 21,076 women), the relationships between six risk behaviours (i.e., current smoking, excessive alcohol consumption, poor dietary habits, physical inactivity, stress and non-attendance of health check-ups), individual characteristics (i.e., age, marital status, occupation and household income) and regional (N = 60) indicators (per capita income and unemployment rate) were examined by multilevel analysis.ResultsDivorce, employment in women, lower occupational class and lower household income were generally associated with a higher likelihood of risk behaviour. The degrees of regional variation in risk behaviour and the influence of regional indicators were greater in women than in men: higher per capita income was significantly associated with current smoking, excessive alcohol consumption, stress and non-attendance of health check-ups in women.ConclusionIndividual lower socioeconomic status was a substantial predictor of risk behaviour in both sexes, while a marked regional influence was observed only in women. The accumulation of risk behaviours in individuals with lower socioeconomic status and in women in areas with higher income, reflecting an urban context, may contribute to their higher mortality rates.

The pathogenesis of carbon monoxide encephalopathy in the acute phase—Physiological and morphological correlation

SummaryExperimental studies were performed to elucidate the significance of various physiological factors contributing to the pathogenesis of carbon monoxide (CO) encephalopathy, such as systemic blood pressure (BP), common carotid artery blood flow (CF), local blood flow (LBF) of the brain and blood gas including pH, and to analyse the morphological character of the cerebral white matter lesions in the acute phases with light and electron microscopes; 14 adult cats were exposed to 0.3% CO/air gas under respiratory control for 1 h and 17 min to 2 h and 50 min and killed 1.5 h to 3 weeks later.During the 1st h the CF and LBF increased along with the concentration of CO haemoglobin and the BP showed slight decrease in all the CO-exposed cats. After the 1st h, the BP dropped progressively as well as the CF and LBF. The LBF of the cortex and white matter changed in parallel, but often that of the latter approximated or exceeded that of the former in the cerebrum. During CO exposure, acidosis occurred in all the cats and haemoconcentration resulted in almost all of the cats. In all the cats except one which showed the least BP drop, lesions occurred selectively in the cerebral white matter and in six or seven cats focal coagulation necrosis or ischaemic changes occurred in the nerve cells in the bilateral pallidum, substantia nigra, and hippocampus similar to human patients. The cerebral white matter lesions were suggestive of those caused by circulatory disturbance. The severity of the white matter damage showed a good positive correlation with the intensity of the BP drop, but not with other factors, such as the duration of CO-exposure, CO-haemoglobin level, acidosis, or haemoconcentration. On the basis of such physiological and morphological findings, we have found the following to be essential for the selective damage of the cerebral white matter rather than the cerebral cortex or white matter of other regions of the CNS: (1) the coexistence of the initial phase of increase in and the succeeding decrease in the cerebral blood flow and (2) the anatomical finding that the cerebral white matter is supplied by its own long nourishing arteries with small amounts of capillary beds and a thinner media compared with that of the subarach-noidal artery.

Comparative study on pathogenesis of selective cerebral lesions in carbon monoxide poisoning and nitrogen hypoxia in cats

SummarySince in a previous study hypoxia and subsequent hypotension were considered to be essential for the pathogenesis of carbon monoxide encephalopathy (CO-encephalopathy), experiments were conducted to see whether a combination of nitrogen hypoxia and subsequent systemic hypotension of similar degree and duration as in the previous experimental CO poisoning could induce the same lesion in the CNS of cats. The partial pressure of blood oxygen was reduced to less than 26 mm Hg by increasing the concentration of nitrogen in N2/O2 gas to be inhaled in 1.5 h and then the aortic blood pressure (BP) was reduced to 60–80 mm Hg by blood depletion and ganglion-blockage for 1 h. In 11 of the 15 cats, lesions were produced in the CNS which were similar by light and electron microscopy to those in CO-encephalopathy. In control groups which were treated by hypoxemia only, hypotension only or a combination of CO2-gas inhalation and hypotension without hypoxemia, such lesions were not found in the cerebral white matter.Considering the pathogenesis of lesions in the cerebral white matter in both nitrogen hypoxia and CO-poisoning, two factors, i.e., hypoxemia and subsequent systemic hypotension, are common and essential. Further, the enormous vasodilation in the cerebral white matter induced by hypoxemia and subsequent drop in BP seem to cause a more severe circulatory disturbance in the cerebral white matter than in the cortex.

The effectiveness of videophones in home healthcare for the elderly.

OBJECTIVES This study evaluates the effectiveness of telecare, the use of videophones in healthcare for the elderly in communities, and proposes an effective application of telecare in home healthcare. METHODS An intervention study design was applied to evaluate the add-on benefits to home healthcare from a videophone system using Integrated Services Digital Network (ISDN) installed in individual homes of clients and service providers. An intervention group of home healthcare cases were provided with videophones (VHHC group), and it was compared to a reference group of regular healthcare cases (HHC group). Persons from the 2 groups were individually matched according to sex, age, and their independence in activities of daily living. The functional independence of the individuals in the 2 groups was assessed before and 3 months after home healthcare was started, with and without videophones. The effectiveness of videophones was assessed by analyzing the improvements in functional independence using a paired t test. RESULTS Improvements in functional independence of 5 pairs of males and 11 pairs of females were analyzed. Improvements in ADL, communication, and social cognition independence of the VHHC group over the 3-month trial period measured by the Functional Independence Measure were 1.5 points, 0.7 points, and 1.9 points, respectively; statistically, these were significantly greater than those of the HHC group (individually P < 0.05). CONCLUSIONS The effectiveness of the videophones in home healthcare service was found to be significant. This evidence supports the use of videophones in home healthcare to improve the quality of service.

An analysis of health levels and various indicators of urban environments for Healthy Cities projects

STUDY OBJECTIVES (1) To identify and to categorise the various city indicators that are related to health levels; (2) to demonstrate the extent of the influence on health of these categorised health determinants; and (3) to demonstrate both the interactive associations among the health determinants and the magnitude of influence of each health determinant on the peoples health. DESIGN By using city statistics of study areas, the health index and health determinant indices were formulated. The extent of influence of health determinants on the health index was examined by regression analysis; the interrelations between the health determinants and the health index were examined by correlation analysis. SETTING All the administrative units in Japan with populations more than 100 000 were selected as study areas to analyse the relation of health and health determinants. MAIN RESULTS The nine health determinant indices used—healthcare resources, preventive health activities, environmental quality, housing, urban clutter, local economy, employment, income, and education—explained 51.6% of the variances of the health index as a whole in the cities studies. The health determinant indices showed interrelations with each other, in addition to individual health determinant indices having a high correlation with the health level index of the population. CONCLUSIONS Both individually and collectively the health determinants are closely related to the health status of a population and individual determinants interact with each other. Simultaneous analysis of the interrelations among health determinants and health status would contribute to widen integration oriented perspective in policy interventions based on collaboration between different sectors of society.

Consumption of animal source foods and dietary diversity reduce stunting in children in Cambodia

Background Malnutrition in children is a major public health concern. This study aimed to determine the association between dietary diversity and stunting, underweight, wasting, and diarrhea and that between consumption of each specific food group and these nutritional and health outcomes among children. Methods A nationally representative household survey of 6209 children aged 12 to 59 months was conducted in Cambodia. We examined the consumption of food in the 24 hours before the survey and stunting, underweight, wasting, and diarrhea that had occurred in the preceding 2 weeks. A food variety score (ranging from 0 to 9) was calculated to represent dietary diversity. Results Stunting was negatively associated with dietary diversity (adjusted odd ratios [ORadj] 0.95, 95% confident interval [CI] 0.91-0.99, P = 0.01) after adjusting for socioeconomic and geographical factors. Consumption of animal source foods was associated with reduced risk of stunting (ORadj 0.69, 95% CI 0.54-0.89, P < 0.01) and underweight (ORadj 0.74, 95% CI 0.57-0.96, P = 0.03). On the other hand, the higher risk of diarrhea was significantly associated with consumption of milk products (ORadj 1.46, 95% CI 1.10-1.92, P = 0.02) and it was significantly pronounced among children from the poorer households (ORadj 1.85, 95% CI 1.17-2.93, P < 0.01). Conclusions Consumption of a diverse diet was associated with a reduction in stunting. In addition to dietary diversity, animal source food was a protective factor of stunting and underweight. Consumption of milk products was associated with an increase in the risk of diarrhea, particularly among the poorer households. Both dietary diversity and specific food types are important considerations of dietary recommendation.

Health Levels Influenced by Urban Residential Conditions in a Megacity—Tokyo

Influences of residential conditions in a megacity on the health levels of residents were investigated. Correlations between mortalities and specified residential-condition indicators in study areas randomly selected from the megacity Tokyo were examined. Indicators representing housing and city planning were significantly correlated with mortalities after adjusting for socio-economic differences between the communities. Urbanisation to a certain level seems to have been associated with good health; however, the most densely developed artificial urban environment seems to be associated with negative health outcomes. Coping skills with regard to health problems are discussed in relation to health levels. A survey elucidated that the coping attitude of the elderly is related with their educational level, family structure, frequency of receiving health information and contact with a family doctor.

Variations in societal characteristics of spatial disease clusters: examples of colon, lung and breast cancer in Japan

BackgroundSpatial analyses and ecological studies are essential for epidemiology and public health. The present study combining these two methods was performed to identify spatial clusters of selected types of cancer in Japan and to determine their societal characteristics focusing on homogeneity among clusters.ResultsSpatial clusters of high mortality rates of male colon and lung cancer and of female breast cancer were identified by the spatial scan statistic using Japanese municipal data (N = 3360) from 1993 to 1998 and also municipalities were divided into four societal clusters based on socioeconomic indicators and population density (urban-rich, suburban, rural-poor, and clutter). Five, seven, and four mortality clusters were identified for lung, colon and breast cancer, respectively. For colon and breast cancer, most municipalities of all except one cluster were included in a single societal cluster (urban-rich). The municipalities associated with mortality clusters for lung cancer belonged to various societal clusters.ConclusionIncreased mortality rates of colon and breast cancer can be explained by homogenous societal characteristics related to urbanisation, although there were exceptional areas with higher mortality rates. The regional variation in lung cancer mortality rate appeared to be due to heterogeneous factors. These findings and the analysis performed in the present study will contribute to both nationwide and region-specific cancer prevention strategies.

Factors associated with the health and nutritional status of children under 5 years of age in Afghanistan: family behaviour related to women and past experience of war-related hardships

BackgroundThe present study was performed to assess, beyond socio-economic factors, independent associations between the health and nutritional status of children under 5 years old and (1) family behavioural factors related to women with regard to child care and (2) war-related experience by the household of hardships in Afghanistan.MethodsThe subjects were all children born during the previous 5 years from 1400 households in Kabul Province, Afghanistan and were selected by multistage sampling in March 2006. Height and weight measurements of the children and culturally sensitive interviews with their mothers were conducted by household visits. Child mortality, morbidity and nutritional status were evaluated. Four areas were assessed as variables for family behavioural factors related to women: education of mothers, child marriage of the mothers, maternal autonomy in obtaining healthcare for children and preference for a female physician. Hardships experienced by the family were examined by determining their satisfaction of basic material needs and by any experience of being forced to leave a preferred residence.ResultsA total of 2474 children from 1327 households completed the examinations and interviews; among them, 101 children were deceased by the time of the interview visits. Diarrhoea (32.5%) and acute respiratory infection (41.0%) were common child health problems and both emaciation (12.4%) and linear growth retardation (39.9%) were prevalent. Regardless of the influence of economic, demographic, family behavioural or hardships experience factors, a lack of maternal autonomy (79.1%) was associated with the occurrence of acute respiratory infection (odds-ratio = 1.72; 95% confidence interval = 1.23, 2.40), and linear growth retardation of children (odds-ratio = 1.38; 95% confidence interval = 1.01, 1.90); a lack of education of the mother (71.7%) and child marriage of the mothers (18.3%) were associated with diarrhoea (odds-ratio = 1.84; 95% confidence interval = 1.40, 2.41; odds-ratio = 1.46; 95% confidence interval = 1.08, 1.96, respectively); a shortage of basic material needs (59.1%) was associated with diarrhoea (odds-ratio = 1.35; 95% confidence interval = 1.08, 1.68); and migration inside the country (52.9%) was associated with underweight children (odds-ratio = 2.48; 95% confidence interval = 1.13, 5.44).ConclusionA lack of education of the mothers, child marriage, lack of maternal autonomy, shortage of basic material needs and internal displacement showed independent and significant negative associations with child health and nutritional variables in this country that has experienced a long period of conflict.

Green tea consumption in everyday life and mental health

OBJECTIVE Green tea has been widely acknowledged in Japan to induce a pleasurable mental feeling. Recent laboratory studies have suggested positive psychological effects as a result of consuming green tea. The present study examined whether green tea consumption in everyday life in Japan is associated with positive mental health. DESIGN A cross-sectional study was performed in February-March 2002. SETTING AND SUBJECTS The subjects of the study consisted of a general population of 600 Japanese aged 20-69 years. Responses of 380 subjects, obtained by home-visit interview, were analysed. The questionnaire inquired about consumption of brewed green tea and other beverages, perceived mental health status, lifestyle and others. The 12-item General Health Questionnaire (GHQ 12) was used for the assessment of mental ill-health (GHQ score >or=4). RESULTS After adjustments for age, area, perceived mental stress, lifestyle and daily caffeine intake, the consumption of brewed green tea was not statistically associated with any decrease in risk of mental ill-health among either males or females (odds ratio (OR)=0.78, 95% confidence interval (CI)=0.47-1.29 for males; OR=0.77, 95% CI=0.51-1.14 for females). Daily caffeine intake (100 mg) inclusive of green tea, black tea, coffee and other caffeine-containing beverages was associated with a higher risk of mental ill-health among females (OR=1.26, 95% CI=1.01-1.56). CONCLUSIONS The results provide population-based evidence on the consumption of brewed green tea in everyday life and mental health, together with information on consumption patterns of various beverages and lifestyles.