Assessment of the zinc turbidity test and the use of risk factors in detecting asymptomatic hepatitis C virus carriers: population based study.
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Adult↗
Biomedical subjects
K Tatara
Publications and source records attributed to K Tatara.
Tendency toward atopy in Kawasaki disease.
UNLABELLED: To evaluate the possible trend towards developing allergic disease in children who had suffered from Kawasaki disease (KD), we evaluated data related to allergy that were collected by parental questionnaire on 1,165 children who had suffered from KD. Comparisons were made with 5,825 sex- and age-matched control children. The incidence of household pets and of cigarette smoking in the family were significantly lower in the children with a history of KD than in those of control children. A family history of allergy was significantly more common in the children with a history of KD (71%) versus the controls (56%) (P < 0.001). The incidence of atopic dermatitis and of allergic rhinitis was significantly higher (by approximately 1.7 times) in the KD children versus the control group (P < 0.01), even in subgroups with no family history of allergy. CONCLUSION: We suggest that a genetic predisposition to atopy may be associated with a susceptibility to KD. Patients with KD tended to develop atopic dermatitis and allergic rhinitis.
Case-Control Studies↗
Urinary and fecal incontinence in a community-residing older population in Japan.
OBJECTIVE: To estimate the prevalence and risk factors of urinary and fecal incontinence among a community-residing older population in Japan. DESIGN: Population-based cross-sectional study. SUBJECTS: A randomly selected sample of 1473 people aged 65 years and older living in the City of Settsu, Osaka, in 1992. MEASURES: Data collected via in-home visits were used to estimate the prevalence of urinary and fecal incontinence and to provide information regarding potential risk factors of urinary and fecal incontinence. RESULTS: Data were obtained from 1405 older adults, a response rate of 95.4%. The prevalence of any degree of urinary incontinence was 98/1000 in both sexes, and 87/ 1000 men and 66/1000 women admitted to some degree of fecal incontinence. Daily, 34/1000 and 20/1000 of the population were incontinent of urine and feces, respectively. There was an increasing prevalence of urinary and fecal incontinence with age in both sexes, but the expected greater prevalence in women was not found. By univariate analyses, age older than 75 years, poor general health as measured by Activities of Daily Living, stroke, dementia, no participation in social activities, and lack of life worth living (Ikigai) were associated significantly with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years, poor general health, and stroke were independent risk factors for any type of incontinence. Diabetes was an independent risk factor for isolated fecal incontinence, and dementia and no participation in social activities were independent risk factors for double incontinence. CONCLUSIONS: Incontinence of urine and feces is a prevalent condition among very old people living in the community in Japan and is associated highly with health and psychosocial conditions.
Age Factors↗
Effects of preventive health services on survival of the elderly living in a community in Osaka, Japan.
STUDY OBJECTIVE: To examine the relationships between the use of preventive health services--such as health checks, basic health examination/cancer screening, and daily preventive health practices--and survival of elderly people living in the community. DESIGN AND SETTING: A cohort of elderly people aged 65 years and over living in Settsu City, Osaka was followed for 38 months. Data on the history of health management, disability scores, and psychosocial conditions were collected in October 1992 by interview during home visits. SUBJECTS: Of the 1491 people randomly selected from the computerised sex-age register at enrollment, 1473 were contacted and responses were obtained from 1405 (95.4%). They constituted the study cohort. Follow up was completed for 1325 (94.3%) (154 decreased and 1171 alive). MEASUREMENTS AND MAIN RESULTS: From the analysis using the Kaplan-Meier method and the log-rank test, female sex, younger age group (65-74 years), use of health checks, use of basic health examination and/or cancer screening, use of daily preventive health practices, less disability, taking part in social activity, and finding life worth living were univariately statistically significantly related to survival. The estimated survival rates were highest in those with regular health checks or daily preventive health practices before 59 years of age or both basic health examination and cancer screening. From the Cox proportional hazards model, use of health checks and use of daily preventive health practices remained as statistically significant factors associated with survival, controlling for other factors such as sex, age group, medical treatment, disability scores, and psycho-social conditions, and these hazard ratios (not used v starting at 59 years) were 0.41 (95% CI, 0.25, 0.66) and 0.52 (95% CI, 0.30, 0.88), respectively. CONCLUSIONS: Health management efforts such as health checks and daily preventive health practices may increase survival in the elderly.
Aged↗
[Mortality in relation to disabilities, health, management and psycho-social conditions among the community-residing elderly people].
To examine the predictive factors for the survival among community-residing elderly people, a cohort of 1405 randomly selected elderly people, aged 65 years and over, living in S City, Osaka, was investigated in October 1992 and followed for 38 months. Follow-up was completed for 1,325 (94.3%) (154 deceased and 1,171 alive). The main results were as follows: 1. From the Cox proportional hazards model analysis of survival, controlling for age and sex, hazard ratios for disabilities of communication, intellectual functioning, behaviour, locomotion, locomotion, personal care, and urinary and fecal incontinence were significantly higher than 1 (1.50-3.14). On the other hand, hazard ratios for participation in health examinations, daily preventive health practices, participation in social activity, and having a sense of life worth living were significantly lower than 1 (0.43, 0.37, 0.44 and 0.52, respectively). 2. From the Cox proportional hazards model using the likelihood-ratio forward method, disability scores of communication and locomotion showed significant hazard ratios (1.08 and 1.14, respectively), and for these hazard ratios were 1.47 (95% confidence interval (CI); 1.13-1.91) and 1.92 (95% CI; 1.52-2.44), respectively when comparing a score of 5 to a score of 0. Hazard ratios for participating in health examinations and daily preventive health practices were 0.44 (95% CI; 0.31-0.63) and 0.58 (95% CI; 0.38-0.88), respectively, and remained as statistically significant factors associated with survival. 3. Health management efforts such as health examinations and daily preventive health practices can be assumed to be able to enhance the prognosis of the elderly.
Aged↗
[Urinary and fecal incontinence in a community-residing elderly population: prevalence, correlates and prognosis].
To estimate the prevalence and risk factors of urinary and fecal incontinence and examine its prognosis among a community-residing elderly population, a randomly selected sample of 1473 elderly people, aged 65 years and over, living in the City of Settsu, Osaka, was investigated in October 1992. Data was obtained from 1405 for a response rate of 95.4%. The cohort of 1405 was followed for 38 months and follow-up was completed for 1325 (94.3%). The main results were as follows: 1) The prevalence of urinary incontinence of any degree was 9.8% in both sexes, and 8.7% men and 6.6% women admitted to some degree of fecal incontinence. 3.4% and 2.0% of the elderly were daily incontinent in urine and feces, respectively. There was an increasing prevalence of urinary and fecal incontinence with age in both sexes. 2) By univariate analyses, age older than 75 years, low activities of daily living (ADL), stroke, dementia, no participation in social activities, and lack of a perception of having a life worth living were significantly associated with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years and low ADL were significantly associated with any type of incontinence. Stroke was associated with incontinence less than once a day, while dementia was associated with incontinence more than once a day. 3) From analysis by Kaplan-Meier method and log-rank test, the estimated survival rates were higher among the elderly without incontinence than among those with incontinence, and tended to become low with the increased frequency of incontinence in both urine and feces. 4) From Cox proportional hazards model analysis, less than once daily fecal incontinence and once or more fecal and urinary incontinence daily remained as statistically significant factors associated with survival, controlling for other factors.
Activities of Daily Living↗
Oral health habits and the number of teeth present in Japanese aged 50-80 years.
OBJECTIVE: To suggest appropriate oral health habits for daily practice in order to prevent tooth loss. DESIGN: Cross sectional study correlating mean number of teeth and oral health habits. SETTING: All 97 dental clinics in an urban area (population 256,000) in Osaka Prefecture, Japan. SUBJECTS: 1,248 persons aged 50-80 who received dental treatment at any of the dental clinics between 10 January and 7 February, 1992. OUTCOME MEASURES: The number of teeth present was recorded by the dentists in their clinics. The subjects were asked to complete questionnaires on oral health habits, prior dental attendance patterns and the perceived general health status. RESULTS: Mean number of teeth present had a significant relationship with perceived health status. Implementation of particular oral health habits, such as using a toothbrush with nylon tufts and hard tufts, changing the toothbrush within three months, receiving tooth brushing instruction, scaling, and prompt dental treatment were related positively to the number of teeth present. Furthermore, the frequency of dental visits in the past showed an inverse relationship with the mean number of teeth present. This result does not necessarily mean, however, that regular dental visits are undesirable. From multiple regression, the mean number of teeth was calculated to be from 27.9 to 16.9 at 50 years of age and from 12.2 to 3.0 at 80 years of age in relation to oral health habits. CONCLUSIONS: To keep more teeth in the later years, it is evident that prevention of dental disease in earlier life is essential, and that individuals should receive prophylactic treatment, and maintain proper tooth brushing habits throughout life.
Age Factors↗
[Correlates and prognosis in relation to intellectual dysfunction in a community-residing elderly population].
To estimate the risk factors for intellectual dysfunction and examine its prognosis in a community-residing (non-institutionalized) elderly population, a randomly selected sample of 1,473 elderly people aged 65 years and over living in S city, Osaka Prefecture, was studied in October 1992, and data were obtained from 1,383, a response rate of 93.9%. A cohort of 1,383 was followed for 42 months and follow-up was completed for 1,300 (94.0%). The main results were as follows: 1) The prevalence of intellectual dysfunction did not differ significantly between sexes, and there was an increasing prevalence of intellectual dysfunction with age in both sexes. The prevalence of severe intellectual dysfunction was found to increase highly at age 85 and over. 2) By univariate analysis, odds ratios for age older than 75 years, low Activities of Daily Living (ADL), urinary and fecal incontinence, and no participation in social activities were significantly higher than 1 in any level of mild, moderate, and severe intellectual dysfunction. In the multivariate analysis using logistic regression, age older than 75 years and urinary and fecal incontinence showed significant higher odds ratios than 1 for severe intellectual dysfunction, and low ADL and treatment for hypertension also showed significant higher odds ratios than 1 for moderate intellectual dysfunction. 3) From analysis using the Kaplan-Meier method, the cumulative survival rates decreased with a decline in intellectual functioning in both age groups of 65-74 and 75 years and older. 4) Application of the Cox proportional hazards model resulted in adjusted hazard ratio for severe intellectual dysfunction of 1.79 (95% confidence interval, 1.02-3.12), controlling for other factors such as sex, age, general health status, incontinence and social activities.
Activities of Daily Living↗
[Indicators of social functioning and social participation in mentally ill participants in a public health rehabilitation programme: a one year follow-up study].
In order to investigate social functioning, a self-administered questionnaire was distributed to 66 participants (30 men and 36 women) in a group rehabilitation programme for the mentally ill at public health centers, and followed for 1 year to investigate their employability as an indicator of social participation. The survey included 20 items related to 5 aspects of daily life: diurnal routine, basic personal management, social activities, personal relationships, and management of illness. The major findings were as follows: 1. The group who had become employed showed significantly higher positive responses to questions concerning self-management such as conversation with others, consultation with others and when condition worsened than the unemployed group. Also the employed showed a tendency for higher positive responses to such items as cooking, keeping appointments, taking medicine, taking an active role in managing medications. 2. According to discriminant analysis by Hayashi's quantification method II, factors distinguishing 17 participants who had become employed within the year and those who remained unemployed included the following: ability to converse with others, taking an active role in managing medications, and ability to cook, male gender, co-residence with family, and a period of 3 years or less since hospital discharge. These results suggest that a public health rehabilitation program aimed at improving interpersonal skills, self-management of illness and other skills of daily living may be useful in helping the mentally ill participate socially.
Adult↗
Do preventive health services reduce eventual demand for medical care?
The aim of this study was to find out whether there is any relation between the use of preventive health services provided for by municipalities under the Japanese Health Services for the Elderly Act and the demands for in-patient and out-patient care by insured residents aged 40 or older who were covered by the National Health Insurance, eligible for preventive health services under the act, in nine cities within the same catchment area in Osaka Prefecture. Main outcome measures were correlation coefficients between the use of in-patient and out-patient care, and (1) the rate of use of health check-ups, and (2) the cost for preventive health services per resident. Hospital admission rate per 1000 insured persons had a strong negative correlation with the rate of use of health check-ups. The rate of long stay, 180 days or more, per 1000 insured persons was also negatively correlated with the rate of use of health check-ups. There were negative correlations between the rate of use of health check-ups and both the in-patient cost per insured person, and the rate of high in-patient cost, 600,000 Yen or more, per 1000 insured persons. On the other hand, out-patient utilization rate per 1000 insured persons had a positive correlation with the rate of use of health check-ups. However, there was a negative relation between the rate of use of health check-ups and the out-patient cost per insured person because of negative associations between the rate of use of health check-ups and the out-patient days, and cost per case. The rate of high out-patient cost, 60,000 Yen or more, was negatively correlated with out-patient utilization rate per 1000 insured persons. Negative relations were also shown between the cost for preventive health services per resident and the in-patient and out-patient cost per case and per insured person, except out-patient utilization rate per 1000 insured persons. The correlation coefficient between the cost for preventive health services per resident and the total medical cost per insured person was r = -0.779 (P = 0.007). Provision of preventive health services under the Health Services for the Elderly Act may possibly improve health management in the early stage of diseases by detecting abnormalities in health, and that investing in prevention might contribute to reducing the subsequent total demand for medical care.
Adult↗
Management of severe coronary sequelae of Kawasaki disease.
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Acute Disease↗
Usefulness of QRST isointegral maps for the diagnosis of right ventricular pressure overload in patients with surgically repaired tetralogy of Fallot complicated by right bundle block.
Right ventricular pressure overload was evaluated in 29 patients, 8-12 years old, with surgically repaired tetralogy of Fallot by using body surface QRST isointegral maps. In patients with right ventricular systolic pressure above 50 mmHg, the maxima of the isointegral maps tended to shift toward the lower right-hand region of the map. The maximum value was significantly correlated with right ventricular systolic pressure (r = .58; P < .01). There was a correlation between the right ventricular systolic pressure and the percentage +2SD and percentage +5SD departure areas, which are defined as the area (expressed as a percentage of the total chest area) in which the QRST integral values are greater than the normal mean +2SD or +5SD, respectively (r = .61 and .84, P < .01). The QRST isointegral map can be used to evaluate right ventricular pressure overload in postoperative patients with tetralogy of Fallot complicated by right bundle branch block. The percentage +5SD departure area is the most valuable parameter for the quantitative evaluation of the right ventricular systolic pressure.
Body Surface Potential Mapping↗
Percentage of elderly and the use of welfare services at city welfare offices in Japan.
Japan's population is aging rapidly. As in other developed countries, the establishment of a system of care for the elderly, especially for those suffering from dementia, has become an urgent issue. As the role of welfare offices, which is to directly serve the people, has become increasingly important, the need to assess their use in terms of demographic factors has risen. With respect to demographic factors, this study analyses the use of the welfare services by the demented elderly at city welfare offices in Japan from 1987 to 1989. In December 1991, questionnaires were mailed to 670 city welfare offices nationwide, excluding those located in designated large cities and special wards in Tokyo. Four-hundred and thirty-seven (65.2%) of the offices responded. Offices located in areas with a relatively high percentage of elderly reported giving fewer counselling sessions and reported fewer people registered for or utilizing domiciliary welfare services than offices in areas with a relatively low percentage of elderly. The differences between the two areas in the total amount of counselling, counselling cases at the welfare office, and respite-care for 1989 and day-care service registration were significant. The Pearson's correlation coefficients for the percentage of elderly and these activities all showed negative values, except for home-help utilization in 1987 and 1989. Welfare offices in which the number of activities increased significantly over the 3 years examined in this study were more common in the areas where a committee for communication between medical and welfare sectors (hereinafter "liaison-committee") existed. Discriminant analysis suggests a correlation between the existence of a liaison-committee and the following variables: the percentage of the elderly living alone, the number of home-helpers per elderly, the capacity of day-care service per elderly and the number of surgeries per elderly. From the results, it is apparent that the welfare offices in areas with a high elderly percentage tended to have less activity. Today, municipalities with a high percentage of elderly in its population are particularly required to draw up plans for their health and welfare. The establishment of a network like a liaison-committee will enable the municipalities to achieve their goals.
Aged↗
[The national health service in the United Kingdom-past, present and future].
Britain's National Health Service (NHS) came into existence in 1948. It was the first comprehensive health system in any Western society to be based on the national provision of services and to offer free medical care to the entire population. The NHS has gone through several developments since, in particular the reorganisations of 1974 and 1982 and the general management overhaul of 1984. Until 1991, however, the NHS kept to the following principles: health service for everyone; sharing of financial costs and free at the point of use; geographical equality; the same high standard of care for everyone; selection on the basis of need for health care; and encouragement of a non-exploitative ethos. Britain's achievement with respect to health care has generally received high praise. Nevertheless, Mrs. Thatcher's government was convinced that the NHS contained a number of serious weakness. This view sprang from the government's belief that, because the NHS did not have a competitive market structure, it lacked an incentive for efficient behaviour. The reforms that were introduced in 1991 were designed to overcome these perceived flaws by creating a limited or internal market in health care, in which multiple providers of services compete with each other for the custom of independent purchasers. Competitive pressures now focus greater attention on patient needs, and the separation of purchasing functions has placed resource allocation under greater scrutiny. Making hospitals financially dependent on general practitioner (GP) referrals has resulted in consultants establishing closer contact with GPs. More is being done in GP surgeries and this has the effect not only of widening the range of general practice but also of raising GP standards. However, there are also some internal problems. Administrative costs have increased steeply, and new inequalities are developing as a consequence of competition. To reduce management costs and to allocate as much of the NHS budget as possible to direct patient care, the government produced and made public its plans for the future structure of NHS management in 1993 and a simplified structure is expected to go into effect by 1996. The Labour Party's document on health and health services in Britain was made public in 1994. The plan rejects the use of competition in the NHS and promises to reverse recent developments, reasserting the importance of the original principles of the NHS. It is too early to reach a verdict on the British experiment. Given the direction of change in Labour's thinking and the fact that the current reforms by the Conservatives are becoming more and more firmly embedded, almost anything is possible.
Forecasting↗
[Mortality of SMON patients in relation to their disabilities].
The relationship between mortality and disability, was studied in SMON patients, who had participated in the questionnaire survey in 1980, by following them for 10 years through municipal resident registration information offices. Eighty deaths were observed among 409 subjects during the follow-up period. The effect of each disability on the mortality of SMON was estimated by applying the Cox proportional hazard model. The presence of severe gait disturbance and low levels of activities of daily living (ADL) were associated with significantly higher risk of death after adjustment for age and sex. The relative risk of visual disturbance was not significant after adjusting for age, sex and other kinds of disability. Those who complained of continuous dysesthesia at the time of the initial survey showed better prognosis than those without such dysesthesia. Among subjects who died during the follow-up period, those who had reported low levels of ADL at the time of the initial survey had a greater proportion of deaths attributable to heart failure and pneumonia than those who had reported high levels of ADL.
Activities of Daily Living↗
[Trends on results of health screening for residents in Y city, Osaka from 1986 to 1993].
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Adult↗
On putting life first.
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Attitude of Health Personnel↗
Echocardiographic evaluation of the development of aortic valve prolapse in supracristal ventricular septal defect.
UNLABELLED: The development and timing of aortic valve prolapse (AoVP) and aortic regurgitation (AR) was studied by two-dimensional echocardiography in 99 consecutive patients with supracristal ventricular septal defect (VSD). Thirty patients (30%) had aortic valve prolapse (VSD + AoVP group), and 31 patients (31%) had AoVP with AR (VSD + AoVP + AR group). In the VSD + AoVP group, AoVP was detected first by echocardiography at the age of 6.8 +/- 4.2 years (mean +/- SD). In the VSD + AoVP + AR group, the interval from detection of AoVP to the appearance of AR was 3.4 +/- 2.0 years. The configuration of the prolapsed aortic valve was echocardiographically classified into two types: tear-drop type (small) prolapse and box type (large) prolapse. The frequency of tear-drop type prolapse was not significantly different between VSD + AoVP and VSD + AoVP + AR groups (43% versus 32%, respectively), indicating that even minor AoVP can result in AR. Four infants (4%) had AoVP at the ages of 1, 5, 7, and 11 months, respectively. All infants had tear-drop type prolapse. Two infants developed AR by colour flow mapping at the ages of 3 and 11 months, and the interval from prolapse to AR was only 2 and 4 months, respectively. CONCLUSION: Aortic valce involvement can develop under the age of 1 year in supracristal VSD. Regular evaluation by two-dimensional echocardiography with colour flow mapping is important in the follow-up of children with supracristal VSD.
Age of Onset↗