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研究者総覧

詳細

石川 鎮清 (ｲｼｶﾜ ｼｽﾞｷﾖ)

  • 情報センター　教授
Last Updated :2021/12/07

研究者情報

学位

  • 医学博士

ホームページURL

J-Global ID

研究キーワード

  • 医学教育   臨床疫学   地域医療学   Clinical epidemiology   community and family credicine   

研究分野

  • ライフサイエンス / 医療管理学、医療系社会学
  • ライフサイエンス / 衛生学、公衆衛生学分野：実験系を含まない
  • ライフサイエンス / 衛生学、公衆衛生学分野：実験系を含む
  • ライフサイエンス / 衛生学、公衆衛生学分野：実験系を含まない
  • ライフサイエンス / 衛生学、公衆衛生学分野：実験系を含む
  • ライフサイエンス / 医療管理学、医療系社会学
  • ライフサイエンス / 医療管理学、医療系社会学

経歴

  • 2013年04月 - 現在  自治医科大学医学教育センター教授
  • 2008年04月 - 2013年03月  自治医科大学地域医療学准教授
  • 2003年04月 - 2008年03月  自治医科大学 講師地域医療学
  • 1998年06月 - 2003年03月  自治医科大学 助手地域医療学
  • 自治医科大学（JMU）教授

学歴

  •         - 1989年   自治医科大学(JMU)   医学部   医学科
  •         - 1989年   自治医科大学   Faculty of Medicine

所属学協会

  • 日本プライマリケア学会   日本家庭医学会   日本高血圧学会   日本総合医学会   The International Epidemiological Association   日本行動医学会   日本老年医学会   日本循環器学会   日本公衆衛生学会   日本疫学会   

研究活動情報

論文

  • Masatoshi Matsumoto, Yasushi Matsuyama, Saori Kashima, Soichi Koike, Yuji Okazaki, Kazuhiko Kotani, Tetsuhiro Owaki, Shizukiyo Ishikawa, Seitaro Iguchi, Hitoaki Okazaki, Takahiro Maeda
    Human Resources for Health 19 1 2021年12月 
    Abstract Background Japan has established comprehensive education-scholarship programs to supply physicians in rural areas. Their entrants now comprise 16% of all medical students, and graduates must work in rural areas for a designated number of years. These programs are now being adopted outside Japan, but their medium-term outcomes and inter-program differences are unknown. Methods A nationwide prospective cohort study of newly licensed physicians 2014–2018 (n = 2454) of the four major types of the programs—Jichi Medical University (Jichi); regional quota with scholarship; non-quota with scholarship (scholarship alone); and quota without scholarship (quota alone)—and all Japanese physicians in the same postgraduate year (n = 40,293) was conducted with follow-up workplace information from the Physician Census 2018, Ministry of Health, Labour and Welfare. In addition, annual cross-sectional survey for prefectural governments and medical schools 2014–2019 was conducted to obtain information on the results of National Physician License Examination and retention status for contractual workforce. Results Passing rate of the National Physician License Examination was highest in Jichi, followed in descending order by quota with scholarship, the other two programs, and all medical graduates. The retention rate for contractual rural service of Jichi graduates 5 years after graduation (n = 683; 98%) was higher than that of quota with scholarship (2868; 90%; P < 0.001) and scholarship alone (2220; 81% < 0.001). Relative risks of working in municipalities with the least population density quintile in Jichi, quota with scholarship, scholarship alone, and quota alone in postgraduate year 5 were 4.0 (95% CI 3.7–4.4; P < 0.001), 3.1 (2.6–3.7; < 0.001), 2.5 (2.1–3.0; < 0.001), and 2.5 (1.9–3.3; < 0.001) as compared with all Japanese physicians. There was no significant difference between each program and all physicians in the proportion of those who specialized in internal medicine or general practice in postgraduate years 3 to 5 Conclusions Japan’s education policies to produce rural physicians are effective but the degree of effectiveness varies among the programs. Policymakers and medical educators should plan their future rural workforce policies with reference to the effectiveness and variations of these programs.
  • Yasushi Matsuyama, Motoyuki Nakaya, Jimmie Leppink, Cees van der Vleuten, Yoshikazu Asada, Adam Jon Lebowitz, Teppei Sasahara, Yu Yamamoto, Masami Matsumura, Akira Gomi, Shizukiyo Ishikawa, Hitoaki Okazaki
    BMC Medical Education 21 1 2021年12月 
    Abstract Background Developing self-regulated learning in preclinical settings is important for future lifelong learning. Previous studies indicate professional identity formation, i.e., formation of self-identity with internalized values and norms of professionalism, might promote self-regulated learning. We designed a professional identity formation-oriented reflection and learning plan format, then tested effectiveness on raising self-regulated learning in a preclinical year curriculum. Methods A randomized controlled crossover trial was conducted using 112 students at Jichi Medical University. In six one-day problem-based learning sessions in a 7-month pre-clinical year curriculum, Groups A (n = 56, female 18, mean age 21.5y ± 0.7) and B (n = 56, female 11, mean age 21.7y ± 1.0) experienced professional identity formation-oriented format: Group A had three sessions with the intervention format in the first half, B in the second half. Between-group identity stages and self-regulated learning levels were compared using professional identity essays and the Motivated Strategies for Learning Questionnaire. Results Two-level regression analyses showed no improvement in questionnaire categories but moderate improvement of professional identity stages over time (R2 = 0.069), regardless of timing of intervention. Conclusions Professional identity moderately forms during the pre-clinical year curriculum. However, neither identity nor self-regulated learning is raised significantly by limited intervention.
  • Yasushi Matsuyama, Hitoaki Okazaki, Kazuhiko Kotani, Yoshikazu Asada, Shizukiyo Ishikawa, Adam Jon Lebowitz, Jimmie Leppink, Cees van der Vleuten
    The Asia Pacific Scholar 6 4 49 - 64 2021年10月 
    Introduction: Previous studies indicate that professional identity formation (PIF), the formation of a self-identity with the internalised values and norms of professionalism, may influence self-regulated learning (SRL). However, it remains unclear whether a PIF-oriented intervention can improve SRL in clinical education. The aim of this study was to explore whether a PIF-oriented mentoring platform improves SRL in a clinical clerkship. Methods: A mixed-methods study was conducted. Forty-one students in a community-based clinical clerkship (CBCC) used a PIF-oriented mentoring platform. They articulated the values and norms of professionalism in a professional identity essay, elaborated on future professional self-image, and reflected on their current compared to future selves. They made a study plan while referring to PIF-based self-reflection and completed it. The control group of 41 students completed CBCC without the PIF-oriented mentoring platform. Changes in SRL between the two groups were quantitatively compared using the Motivated Strategies for Learning Questionnaire. We explore how PIF elements in the platform affected SRL by qualitative analysis of questionnaire and interview data. Results: A moderate improvement in intrinsic goal orientation (p = 0.005, ε2 = 0.096) and a mild improvement in critical thinking (p = 0.041, ε2 = 0.051) were observed in the PIF-oriented platform group. Qualitative analysis revealed that the PIF-oriented platform fostered professional responsibility as a key to expanding learning goals. Gaining authentic knowledge professionally fostered critical thinking, and students began to elaborate knowledge in line with professional task processes. Conclusion: A PIF-oriented mentoring platform helped students improve SRL during a clinical clerkship.
  • Yukiko Imai, Takumi Hirata, Shigeyuki Saitoh, Toshiharu Ninomiya, Yoshihiro Miyamoto, Hirofumi Ohnishi, Yoshitaka Murakami, Hiroyasu Iso, Sachiko Tanaka, Katsuyuki Miura, Akiko Tamakoshi, Michiko Yamada, Masahiko Kiyama, Hirotsugu Ueshima, Shizukiyo Ishikawa, Tomonori Okamura
    Hypertension Research 43 12 1437 - 1444 2020年12月
  • 色素性乾皮症全国疫学調査
    石川 鎮清, 小佐見 光樹, 松原 優里, 阿江 竜介, 青山 泰子, 牧野 伸子, 錦織 千佳子, 中村 好一
    日本公衆衛生学会総会抄録集 79回 411 - 411 日本公衆衛生学会 2020年10月
  • 血圧、糖尿病、喫煙、高脂血症と心血管疾患死亡の生涯リスクの関連 EPOCH-JAPAN
    今井 由希子, 村上 義孝, 二宮 利治, 宮本 恵宏, 石川 鎮清, 坂田 清美, 磯 博康, 中川 秀昭, 大久保 孝義, 玉腰 暁子, 斎藤 重幸, 三浦 克之, 上島 弘嗣, 岡村 智教
    日本公衆衛生学会総会抄録集 79回 239 - 239 日本公衆衛生学会 2020年10月
  • 血圧、糖尿病、喫煙、高脂血症と心血管疾患死亡の生涯リスクの関連 EPOCH-JAPAN
    今井 由希子, 村上 義孝, 二宮 利治, 宮本 恵宏, 石川 鎮清, 坂田 清美, 磯 博康, 中川 秀昭, 大久保 孝義, 玉腰 暁子, 斎藤 重幸, 三浦 克之, 上島 弘嗣, 岡村 智教
    日本公衆衛生学会総会抄録集 79回 239 - 239 日本公衆衛生学会 2020年10月
  • 松原 優里, 青山 泰子, 小佐見 光樹, 阿江 竜介, 牧野 伸子, 石川 鎮清, 中村 好一
    日本小児科学会雑誌 124 8 1224 - 1233 (公社)日本小児科学会 2020年08月 
    栃木県の調査データを二次利用し、在宅医療的ケア児の生活状況について分析した。医療的ケア児は県内に約300人、20歳未満人口1000人対0.91みられ、年齢分布では6歳未満が50%を占め、寝たきりや座位の児が50%、歩行や走ることが可能な児が31%であった。サービスについては人工呼吸器使用者で「送迎がない」「利用できるサービスの量が不足」「費用負担が大きい」などの項目が有意に高かった。また、介護者で睡眠5時間未満の者は児に経管栄養がある場合において有意に高かった。以上、これらの結果からも、在宅医療的ケア児の運動・知的機能には個人差があり、個々に応じたサービスの提供が必要であると考えられた。
  • 鈴木 真紀, 松山 泰, 淺田 義和, 三重野 牧子, 川平 洋, 武藤 弘行, 石川 鎮清, 岡崎 仁昭
    医学教育 51 Suppl. 215 - 215 (一社)日本医学教育学会 2020年07月
  • Jun Watanabe, Daeho Park, Eiichi Kakehi, Kazuoki Inoue, Shizukiyo Ishikawa, Yuki Kataoka
    Endoscopy international open 8 7 E848-E860  2020年07月 
    Background and study aims  We aimed to assess the efficacy and safety of the starting position during colonoscopy. Patients and methods  We searched CENTRAL, MEDLINE, EMBASE, and the WHO International Clinical Trials Registry Platform through February 2019 to identify studies reporting the comparison between the right/supine/prone/tilt-down and left lateral starting position during colonoscopy. The primary outcomes were mean cecal insertion time and adverse events requiring medication. Two reviewers performed study selection and risk of bias assessment. We determined the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation method. This study was registered in PROSPERO (CRD42019124360). Results  We identified 10 randomized controlled trials (RCTs) (2083 participants), including three trials on right/tilt-down versus left, two trials on supine/prone versus left, respectively. Mean difference in mean cecal insertion time in supine versus left was -41.0 s (95 % confidence interval [CI] -57.3 to -24.7) in one study and in tilt-down versus left was - 37.3 s (95 % CI -72.1 to -2.4; I 2  = 58 %) in three studies; however, there were no statistically significant differences in prone/right versus left position (very low certainty of evidence). Four of eight studies noted adverse effects requiring medication (moderate certainty of evidence). One RCT applying the tilt-down position was terminated because of increased occurrence of oxygen desaturation. Conclusion  We could not conclusively determine the efficacy and safety of the starting position during colonoscopy because of low certainty of evidence. Further studies are needed to confirm the efficacy and safety of the starting potion during colonoscopy.
  • 自治医大マルチメディア形式総合判定試験の11年の解析 医療面接・臨床推論連問の導入
    鈴木 真紀, 松山 泰, 淺田 義和, 三重野 牧子, 川平 洋, 武藤 弘行, 石川 鎮清, 岡崎 仁昭
    医学教育 51 Suppl. 215 - 215 (一社)日本医学教育学会 2020年07月
  • Jun Watanabe, Yusuke Ikegami, Ayumi Tsuda, Eiichi Kakehi, Takeshi Kanno, Shizukiyo Ishikawa, Yuki Kataoka
    Digestive Endoscopy 2020年06月 [査読有り][通常論文]
  • Michihiro Satoh, Takayoshi Ohkubo, Kei Asayama, Yoshitaka Murakami, Daisuke Sugiyama, Takashi Waki, Sachiko Tanaka-Mizuno, Michiko Yamada, Shigeyuki Saitoh, Kiyomi Sakata, Fujiko Irie, Toshimi Sairenchi, Shizukiyo Ishikawa, Masahiko Kiyama, Akira Okayama, Katsuyuki Miura, Yutaka Imai, Hirotsugu Ueshima, Tomonori Okamura
    Journal of atherosclerosis and thrombosis 2020年04月 [査読有り][通常論文]
     
    AIM: Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual's lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk. METHODS: We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined "normal BP" as systolic/diastolic BP ＜130/＜80 mmHg and "high BP" as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death. RESULTS: During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women. CONCLUSIONS: High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.
  • Jun Watanabe, Eiichi Kakehi, Kazuhiko Kotani, Kazunori Kayaba, Yosikazu Nakamura, Shizukiyo Ishikawa
    Journal of clinical laboratory analysis 34 3 e23087  2020年03月 
    BACKGROUND: The cardiovascular relevance of isolated low levels of high-density lipoprotein cholesterol (HDL-C) is yet to be determined. Stroke often leads to long-term disability, and thus, not only stroke mortality but also stroke incidence is a topic of research. Although isolated low HDL-C level has been found to be a predictor for stroke mortality previously, whether it can predict stroke incidence is unknown. METHODS: In the Jichi Medical School cohort study, 11 025 community-living residents without a history of stroke were examined. Hazard ratios (HRs) for isolated and non-isolated low HDL-C levels were calculated relative to those for normal HDL-C levels in stroke patients using Cox's regression models. RESULTS: During the mean follow-up period of 10.7 years, 412 residents had their first-ever stroke. The multivariable-adjusted HRs for the levels of isolated and non-isolated low HDL-C were 1.11 (95% confidence interval, 0.85-1.44) and 1.35 (1.01-1.81), respectively, when compared to that for normal HDL-C. CONCLUSION: Low HDL-C levels with other dyslipidemias may contribute to the incidence of stroke, not isolated low HDL-C.
  • Jun Watanabe, Eiichi Kakehi, Kazuhiko Kotani, Kazunori Kayaba, Yosikazu Nakamura, Shizukiyo Ishikawa
    Asia-Pacific journal of public health 32 1 27 - 34 2020年01月 
    We aimed to investigate the relationship between high-density lipoprotein cholesterol (HDL-C) concentration and the incident stroke subtypes. We enrolled 11 027 participants between the ages of 18 and 90 years without a history of stroke in 12 Japanese communities. Cox's regression models were used for stroke subtypes, adjusted for traditional risk factors, according to the categories based on HDL-C concentrations: 1.04 to 1.55 mmol/L, ≥1.56 mmol/L, and <1.03 mmol/L (as the reference). During a mean follow-up of 10.7 years, 412 stroke events had occurred. However, HDL-C was not significantly associated with the incidence of cerebral infarction and subarachnoid hemorrhage. High HDL-C concentration was associated with a decreased incidence of intracerebral hemorrhage in women (hazard ratio = 0.23; 95% confidence interval = 0.06-0.89), but not in men (hazard ratio = 0.73; 95% confidence interval = 0.27-1.97). Therefore, high HDL-C concentration might have a protective effect on the incidence of intracerebral hemorrhage, particularly in women.
  • Lesley A. Inker, Morgan E. Grams, Andrew S. Levey, Josef Coresh, Massimo Cirillo, John F. Collins, Ron T. Gansevoort, Orlando M. Gutierrez, Takayuki Hamano, Gunnar H. Heine, Shizukiyo Ishikawa, Sun Ha Jee, Florian Kronenberg, Martin J. Landray, Katsuyuki Miura, Girish N. Nadkarni, Carmen A. Peralta, Dietrich Rothenbacher, Elke Schaeffner, Sanaz Sedaghat, Michael G. Shlipak, Luxia Zhang, Arjan D. van Zuilen, Stein I. Hallan, Csaba P. Kovesdy, Mark Woodward, Adeera Levin, Brad Astor, Larry Appel, Tom Greene, Teresa Chen, John Chalmers, Hisatomi Arima, Vlado Perkovic, Hiroshi Yatsuya, Koji Tamakoshi, Yuanying Li, Yoshihisa Hirakawa, Kunihiro Matsushita, Yingying Sang, Kevan Polkinghorne, Steven Chadban, Robert Atkins, Ognjenka Djurdjev, Lisheng Liu, Minghui Zhao, Fang Wang, Jinwei Wang, Natalie Ebert, Peter Martus, Mila Tang, Insa Emrich, Sarah Seiler, Adam Zawada, Joseph Nally, Sankar Navaneethan, Jesse Schold, Mark Sarnak, Ronit Katz, Jade Hiramoto, Hiroyasu Iso, Kazumasa Yamagishi, Mitsumasa Umesawa, Isao Muraki, Masafumi Fukagawa, Shoichi Maruyama, Takeshi Hasegawa, Naohiko Fujii, David Wheeler, John Emberson, John Townend, Hermann Brenner, Ben Schöttker, Kai Uwe Saum, Caroline Fox, Shih Jen Hwang, Anna Köttgen, Markus P. Schneider, Kai Uwe Eckardt, Jamie Green, H. Lester Kirchner, Alex R. Chang, Kevin Ho, Sadayoshi Ito, Mariko Miyazaki, Masaaki Nakayama, Gen Yamada, Fujiko Irie, Toshimi Sairenchi, Yuichiro Yano, Kazuhiko Kotani, Takeshi Nakamura, Heejin Kimm, Yejin Mok, Gabriel Chodick, Varda Shalev, Jack F.M. Wetzels, Peter J. Blankestijn, Jan van den Brand, Barbara Kollerits
    American Journal of Kidney Diseases 73 2 206 - 217 2019年02月 
    © 2018 National Kidney Foundation, Inc. Rationale & Objective: Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework. Study Design: Cross-sectional individual participant-level analyses in a global consortium. Setting & Study Populations: 17 CKD and 38 general population and high-risk cohorts. Selection Criteria for Studies: Cohorts in the CKD Prognosis Consortium with data for eGFR and albuminuria, as well as a measurement of hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, or calcium, or hypertension. Data Extraction: Data were obtained and analyzed between July 2015 and January 2018. Analytical Approach: We modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, and calcium values using linear regression and with hypertension and categorical definitions of each abnormality using logistic regression. Results were pooled using random-effects meta-analyses. Results: The CKD cohorts (n = 254,666 participants) were 27% women and 10% black, with a mean age of 69 (SD, 12) years. The general population/high-risk cohorts (n = 1,758,334) were 50% women and 2% black, with a mean age of 50 (16) years. There was a strong graded association between lower eGFR and all laboratory result abnormalities (ORs ranging from 3.27 [95% CI, 2.68-3.97] to 8.91 [95% CI, 7.22-10.99] comparing eGFRs of 15 to 29 with eGFRs of 45 to 59 mL/min/1.73 m2), whereas albuminuria had equivocal or weak associations with abnormalities (ORs ranging from 0.77 [95% CI, 0.60-0.99] to 1.92 [95% CI, 1.65-2.24] comparing urinary albumin-creatinine ratio > 300 vs < 30 mg/g). Limitations: Variations in study era, health care delivery system, typical diet, and laboratory assays. Conclusions: Lower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.
  • Watanabe J, Kakehi E, Kotani K, Kayaba K, Nakamura Y, Ishikawa S
    Diabetology & metabolic syndrome 11 3  2019年 [査読有り][通常論文]
  • Kakehi E, Kotani K, Gotoh T, Kayaba K, Ishikawa S
    SAGE open medicine 7 2050312119860398  2019年 [査読有り][通常論文]
  • Satoh Michihiro, Ohkubo Takayoshi, Asayama Kei, Murakami Yoshitaka, Sugiyama Daisuke, Yamada Michiko, Saitoh Shigeyuki, Sakata Kiyomi, Irie Fujiko, Sairenchi Toshimi, Ishikawa Shizukiyo, Kiyama Masahiko, Ohnishi Hirofumi, Miura Katsuyuki, Imai Yutaka, Ueshima Hirotsugu, Okamura Tomonori, Iso Hiroyasu, Kitamura Akihiko, Ninomiya Toshiharu, Kiyohara Yutaka, Nakagawa Hideaki, Nakayama Takeo, Okayama Akira, Sairenchi Toshimi, Tamakoshi Akiko, Tsuji Ichiro, Miyamoto Yoshihiro, Ishikawa Shizukiyo, Yatsuya Hiroshi, Okamura Tomonori
    HYPERTENSION 73 1 52 - 59 2019年01月 [査読無し][通常論文]
  • LIFETIME RISK OF STROKE AND CORONARY HEART DISEASE DEATH ACCORDING TO BLOOD PRESSURE LEVEL: EVIDENCE FOR CARDIOVASCULAR PREVENTION FROM OBSERVATIONAL COHORTS IN JAPAN
    Satoh Michihiro, Ohkubo Takayoshi, Asayama Kei, Murakami Yoshitaka, Sugiyama Daisuke, Yamada Michiko, Saitoh Shigeyuki, Sakata Kiyomi, Irie Fujiko, Sairenchi Toshimi, Ishikawa Shizukiyo, Kiyama Masahiko, Ohnishi Hirofumi, Miura Katsuyuki, Imai Yutaka, Ueshima Hirotsugu, Okamura Tomonori
    JOURNAL OF HYPERTENSION 36 E92 - E93 2018年10月 [査読無し][通常論文]
  • Matsubara Shigeki, Takahashi Hironori, Ohkuchi Akihide, Kumagai Hideki, Ishikawa Shizukiyo
    PEDIATRIC ALLERGY AND IMMUNOLOGY 29 3 332 - 333 2018年05月 [査読有り][通常論文]
  • 中村好一, 松原優里, 笹原鉄平, 古城隆雄, 阿江竜介, 青山泰子, 牧野伸子, 小池創一, 石川鎮清
    日本公衆衛生雑誌 65 2 72 - 82 2018年02月 [査読有り][通常論文]
  • 地方紙に掲載された自己申告型死亡記事
    中村 好一, 松原 優里, 笹原 鉄平, 古城 隆雄, 阿江 竜介, 青山 泰子, 牧野 伸子, 小池 創一, 石川 鎮清
    日本公衆衛生雑誌 65 2 72 - 82 日本公衆衛生学会 2018年02月 [査読無し][通常論文]
     
    目的 地方紙における遺族の自己申告型死亡記事の記載事項を集計し、その地域での死亡やそれに伴う儀式の実態を明らかにするとともに、死亡記事のデータベースとしての利点と問題点を明らかにする。方法 栃木の地方紙である下野新聞の自己申告型死亡記事「おくやみ」欄に掲載された2011〜2015年の栃木県内の死亡者全員のデータを集計解析し、一部の結果は人口動態統計と比較した。観察項目は掲載年月日、市町村、住所の表示(市町村名のみ、町名・字まで、番地まで含めた詳細な住所)、氏名、性別、死亡年月日、死因、死亡時年齢、通夜・告別式などの名称、通夜などの年月日、告別式などの年月日、喪主と喪主の死亡者との続柄の情報である。結果 観察期間中の掲載死亡者数は69,793人で、同時期の人口動態統計による死亡者数の67.6%であった。人口動態統計と比較した掲載割合は男女で差がなく、小児期には掲載割合が低く、10歳代で高く、20歳代で低下し、以降は年齢とともに上昇していた。市町別の掲載割合は宇都宮市や小山市など都市化が進んだ地域では低く、県東部や北部で高い市町がみられた。最も掲載割合が高かったのは茂木町(88.0%)、低かったのは野木町(38.0%)であった。死亡日から通夜や告別式などの日数から、東京などで起こっている火葬場の供給不足に起因する火葬待ち現象は起こっていないことが判明した。六曜の友引の日の告別式はほとんどなく、今後、高齢者の増加に伴う死者の増加によって火葬場の供給不足が起こった場合には、告別式と火葬を切り離して友引に火葬を行うことも解決策の1つと考えられた。死亡者の子供、死亡者の両親、死亡者の子供の配偶者が喪主の場合には、喪主は男の方が多いことが判明した。老衰、自殺、他殺の解析から、掲載された死因の妥当性は低いことが示された。結論 栃木県の地方紙である下野新聞の自己申告型死亡記事「おくやみ」欄の5年分の観察を行い、実態を明らかにした。約3分の2に死亡が掲載されており、データベースとしての使用に一定の価値があると考えられたが、記載された死因の妥当性は低いことが判明した。(著者抄録)
  • Joji Ishikawa, Hideo Hirose, Joseph E. Schwartz, Shizukiyo Ishikawa
    Circulation Journal 82 7 1797 - 1804 2018年 [査読有り][通常論文]
     
    Background: Minor ST-T changes are frequently observed on the electrocardiogram (ECG), but the risk of stroke associated with such changes is unclear. Methods and Results: In 10,642 subjects from the Japanese general population, we evaluated minor and major ST-T changes (major ST depression ≥0.1 mV) on ECGs obtained at annual health examinations. At baseline, minor ST-T changes were found in 10.7% of the subjects and 0.5% had major ST-T changes. Minor ST-T changes were associated with older age, female gender, higher systolic blood pressure, presence of hyperlipidemia, and use of antihypertensive medication. There were 375 stroke events during the follow-up period (128.7±28.1 months). In all subjects, minor ST-T changes (HR, 2.10 95% CI: 1.57–2.81) and major ST-T changes (HR, 8.64 95% CI: 4.44–16.82) were associated with an increased risk of stroke, but the stroke risk associated with minor ST-T changes had borderline significance after adjustment for conventional risk factors (P=0.055). In subgroup analysis, the risk of stroke was significantly associated with minor ST-T changes in subjects who had hyperlipidemia (HR, 1.75 95% CI: 1.15–2.67) compared to those without hyperlipidemia (HR, 1.01 95% CI: 0.64–1.59 P for interaction=0.016), even after adjustment for ECG-diagnosed left ventricular hypertrophy. Conclusions: Minor ST-T changes were particularly associated with a higher risk of stroke in subjects with hyperlipidemia and this association was independent of electrocardiographic left ventricular hypertrophy.
  • Nakamura Y, Matsubara Y, Sasahara T, Kojo T, Ae R, Aoyama Y, Makino N, Koike S, Ishikawa S
    [Nihon koshu eisei zasshi] Japanese journal of public health 65 2 72 - 82 2018年 [査読有り][通常論文]
  • Takuya Shiraishi, Shizukiyo Ishikawa, Kazuomi Kario, Kazunori Kayaba, Eiji Kajii
    JOURNAL OF CLINICAL LABORATORY ANALYSIS 31 6 2017年11月 [査読有り][通常論文]
     
    BackgroundThe role of factor VII (FVII) as a risk factor in myocardial infarction (MI) has been the subject of numerous studies. However, it remains uncertain whether the FVII levels are associated with development of MI. MethodsThe subjects were 4142 men and women whose activated FVII (FVIIa) and FVII coagulant (FVIIc) levels were measured in the Jichi Medical School Cohort Study. Subjects were divided into tertiles by FVIIa and FVIIc levels, and Cox's proportional hazard model was used to calculate hazard ratios (HRs) for MI. ResultsThe multivariate-adjusted HRs (95% confidential interval [CI]) for FVIIa in men were 0.67 (0.67-1.78) in tertile 2 (T2), and 0.52 (0.17-1.60) in T3. In women, the multivariate-adjusted HRs (95% CI) were 0.18 (0.02-1.60) in T2, and 0.39 (0.07-2.20) in T3. The multivariate-adjusted HRs (95% CI) for FVIIc in men were 0.54 (0.21-1.36) in T2, and 0.20 (0.04-0.91) in T3. In women, the multivariate-adjusted HRs (95% CI) were 0.44 (0.07-2.85) in T2, and 0.35 (0.06-2.22) in T3. We used T1 as a reference for all measures. ConclusionOur findings revealed a significant association between low FVIIc level and incidence of MI in men. The FVIIa and FVIIc levels were inversely related to increased MI risk, but did not reach statistical significance. Future studies are needed to confirm this association.
  • Ryo Yoshinaga, Yasufumi Doi, Katsuhiko Ayukawa, Shizukiyo Ishikawa
    BMJ Open 7 10 2017年10月 [査読有り][通常論文]
     
    Objective We investigated whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are associated with inhospital mortality in patients with cardiovascular disease (CVD). Design A retrospective cohort study. Setting ED of a teaching hospital in Japan. Participants 12 211 patients with CVD aged ≥18 years who presented to the ED by an ambulance between 1 February 2006 and 30 September 2014 were evaluated. Main outcome measures Inhospital mortality. Results 1156 patients had died. The inhospital mortality increased significantly with the hs-CRP levels (< 3.0 mg/L: 7.0%, 95% CI 6.4 to 7.6 3.1-5.4 mg/L: 9.6%, 95% CI 7.9 to 11.3: 5.5-11.5 mg/L: 11.2%, 95% CI 9.4 to 13.0 11.6-33.2 mg/L: 12.3%, 95% CI 10.5 to 14.1 and ≥33.3 mg/L: 19.9%, 95% CI 17.6 to 22.2). The age-adjusted and sex-adjusted HR for total mortality was increased significantly in the three ≥5.5 mg/L groups compared with the < 3.0 mg/L group (5.5-11.5 mg/L: HR=1.32, 95% CI 1.09 to 1.60, p=0.005 11.6-33.2 mg/L: HR=1.38, 95% CI 1.14 to 1.65, p=0.001 and ≥33.3 mg/L: HR=2.15, 95% CI 1.84 to 2.51, p< 0.001). Similar findings were observed for the CVD subtypes of acute myocardial infarction, heart failure, cerebral infarction and intracerebral haemorrhage. This association remained unchanged even after adjustment for age, sex and white cell count and withstood Bonferroni adjustment for multiple testing. When the causes of death were divided into primary CVD and non-CVD deaths, the association between initial hs-CRP levels and mortality remained significant, but the influence of hs-CRP levels was greater in non-CVD deaths than CVD deaths. The percentage of non-CVD deaths increased with hs-CRP levels among the patients with hs-CRP levels ≥33.3 mg/L, non-CVD deaths accounted for 37.5% of total deaths. Conclusion Our findings suggest that increased hs-CRP is a significant risk factor for inhospital mortality among patients with CVD in an ED. Particular attention should be given to our finding that non-CVD death is a major cause of death among patients with CVD with higher hs-CRP levels.
  • Nami Kawate, Kazunori Kayaba, Motohiko Hara, Toyohiro Hamaguchi, Kazuhiko Kotani, Shizukiyo Ishikawa
    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 26 8 1683 - 1688 2017年08月 [査読有り][通常論文]
     
    Background: Whereas high body mass index (BMI) is reportedly a risk factor for cardiovascular events in Western countries, low BMI has been reported as a risk factor for cardiovascular death in Asia, including Japan. Although subarachnoid hemorrhage (SAH) is a highly fatal disease and common cause of disability, few cohort studies have examined the associations between BMI and SAH in Japan. This study investigated the associations between BMI and incidence of SAH using prospective data from Japanese community residents. Methods: Data were analyzed from 12,490 participants in the Jichi Medical School Cohort Study. Participants were categorized into 5 BMI groups: <= 18.5, 18.6-21.9, 22.0-24.9, 25.0-29.9, and >= 30.0 kg/m(2). Multivariate-adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard model with BMI of 22.0-24.9 kg/m(2) as the reference category. Results: During the mean follow-up period of 10.8 years, 55 participants (13 men, 42 women) experienced SAH. BMI >= 30.0 kg/m(2) was associated with significantly higher risk for SAH (HR, 5.98; 95% CI, 2.25-15.87). BMI <= 18.5 kg/m(2) showed a nonsignificant tendency toward high risk of SAH (HR, 2.51; 95% CI,.81-7.79). Conclusions: High BMI was a significant risk factor for SAH. Lower BMI showed a nonsignificant tendency toward higher risk of SAH. Our results suggest a J-shaped association between BMI and risk of SAH incidence.
  • Takuma Tsuda, Mikito Takefuji, Nina Wettschureck, Kazuhiko Kotani, Ryota Morimoto, Takahiro Okumura, Harmandeep Kaur, Shunsuke Eguchi, Teruhiro Sakaguchi, Sohta Ishihama, Ryosuke Kikuchi, Kazumasa Unno, Kunihiro Matsushita, Shizukiyo Ishikawa, Stefan Offermanns, Toyoaki Murohara
    Journal of Experimental Medicine 214 7 1877 - 1888 2017年07月 [査読有り][通常論文]
     
    Heart failure occurs when the heart is unable to effectively pump blood and maintain tissue perfusion. Despite numerous therapeutic advancements over previous decades, the prognosis of patients with chronic heart failure remains poor, emphasizing the need to identify additional pathophysiological factors. Here, we show that corticotropin releasing hormone receptor 2 (Crhr2) is a G protein-coupled receptor highly expressed in cardiomyocytes and continuous infusion of the Crhr2 agonist, urocortin 2 (Ucn2), reduced left ventricular ejection fraction in mice. Moreover, plasma Ucn2 levels were 7.5-fold higher in patients with heart failure compared to those in healthy controls. Additionally, cardiomyocyte-specific deletion of Crhr2 protected mice from pressure overload-induced cardiac dysfunction. Mice treated with a Crhr2 antagonist lost maladaptive 3'-5'-cyclic adenosine monophosphate (cAMP)-dependent signaling and did not develop heart failure in response to overload. Collectively, our results indicate that constitutive Crhr2 activation causes cardiac dysfunction and suggests that Crhr2 blockade is a promising therapeutic strategy for patients with chronic heart failure.
  • Nami Kawate, Kazunori Kayaba, Motohiko Hara, Kazuhiko Kotani, Shizukiyo Ishikawa
    JOURNAL OF EPIDEMIOLOGY 27 7 325 - 330 2017年07月 [査読有り][通常論文]
     
    Background: High body mass index (BMI) has been reported as a risk factor for cardiovascular events in Western countries, while low BMI has been reported as a risk factor for cardiovascular death in Asian countries, including Japan. Although stroke is a major cause of death and disability in Japan, few cohort studies have examined the association between BMI and stroke incidence in Japan. This study aimed to examine the association between BMI and stroke incidence using prospective data from Japanese community residents. Methods: Data were analyzed from 12,490 participants in the Jichi Medical School Cohort Study. Participants were categorized into five BMI groups: <= 18.5, 18.6-21.9, 22.0-24.9, 25.0-29.9, and >= 30.0 kg/m(2). Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazard model. The group with a BMI of 22.0-24.9 kg/m(2) was used as the reference category. Results: During mean follow-up of 10.8 years, 395 participants (207 men and 188 women) experienced stroke, including 249 cerebral infarctions and 92 cerebral hemorrhages. Men with a BMI <= 18.5 kg/m(2) (HR 2.11; 95% CI, 1.17-3.82) and women with a BMI >= 30.0 kg/m(2) (HR 2.25; 95% CI, 1.28-5.08) were at significantly higher risk for all-stroke. Men with a BMI <= 18.5 kg/m(2) were at significantly higher risk for cerebral infarction (HR 2.15; 95% CI, 1.07-4.33). Conclusions: The association between BMI and stroke incidence observed in this population was different than those previously reported: low BMI was a risk factor for all-stroke and cerebral infarction in men, while high BMI was a risk factor for all-stroke in women. (C) 2017 The Authors. Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association.
  • Ishikawa Yukiko, Ishikawa Joji, Ishikawa Shizukiyo, Kario Kazuomi, Kajii Eiji, the Jichi Medical School Cohort, Investigators Group
    Journal of Epidemiology 27 1-2 8  日本疫学会 2017年02月 [査読無し][通常論文]
  • Akiteru Takamura, Masatoshi Matsumoto, Shizukiyo Ishikawa
    Rural and Remote Health 17 4 2017年 [査読有り][通常論文]
  • Yoichiro Hirakawa, the Evidence for Cardiovascular Prevention From Observational Cohorts in Japan Research Group (EPOCH-JAPAN), Toshiharu Ninomiya, Yutaka Kiyohara, Yoshitaka Murakami, Shigeyuki Saitoh, Hideaki Nakagawa, Akira Okayama, Akiko Tamakoshi, Kiyomi Sakata, Katsuyuki Miura, Hirotsugu Ueshima, Tomonori Okamura, Yutaka Imai, Takayoshi Ohkubo, Fujiko Irie, Hiroyasu Iso, Akihiko Kitamura, Takeo Nakayama, Toshimi Sairenchi, Ichiro Tsuji, Michiko Yamada, Masahiko Kiyama, Yoshihiro Miyamoto, Shizukiyo Ishikawa, Hiroshi Yatsuya
    Journal of Epidemiology 27 3 123 - 129 2017年 [査読有り][通常論文]
     
    Background: Diabetes mellitus is a strong risk factor for cardiovascular disease. However, the age-specific association of diabetes with cardiovascular risk, especially in the elderly, remains unclear in non-Western populations. Methods: A pooled analysis was conducted using 8 cohort studies (mean follow-up period, 10.3 years) in Japan, combining the data from 38,854 individual participants without history of cardiovascular disease. In all, 1867 of the participants had diabetes, defined based on the 1998 World Health Organization criteria. The association between diabetes and the risk of death from cardiovascular disease, coronary heart disease (CHD), and stroke was estimated using a stratified Cox model, accounting for variability of baseline hazard functions among cohorts. Results: During the follow-up, 1376 subjects died of cardiovascular disease (including 268 of coronary heart disease and 621 of stroke). Diabetes was associated with an increased risk of cardiovascular death after multivariable adjustment (hazard ratio [HR] 1.62 95% confidence interval [CI], 1.35-1.94). Similarly, diabetes was a risk factor for CHD (HR 2.13 95% CI, 1.47-3.09) and stroke (HR 1.40 95% CI, 1.05-1.85). In the age-stratified analysis of the risk of cardiovascular death, the relative effects of diabetes were consistent across age groups (p for heterogeneity = 0.18), whereas the excess absolute risks of diabetes were greater in participants in their 70s and 80s than in younger subjects. Conclusions: The management of diabetes is important to reduce the risk of death from cardiovascular disease, not only in midlife but also in late life, in the Japanese population.
  • Kazuo Eguchi, Tomoyuki Kabutoya, Satoshi Hoshide, Shizukiyo Ishikawa, Kazuomi Kario
    JOURNAL OF CLINICAL HYPERTENSION 18 12 1250 - 1257 2016年12月 [査読有り][通常論文]
     
    The authors aimed to investigate the blood pressure (BP)-lowering ability of eplerenone in drug-resistant hypertensive patients. A total of 57 drug-resistant hypertensive patients whose home BP was 135/85 mm Hg were investigated. The patients were randomized to either an eplerenone group or a control group and followed for 12 weeks. The efficacy was evaluated by clinic, home, and ambulatory BP monitoring. Urinary albumin, pulse wave velocity, and flow-mediated vasodilation (FMD) were also evaluated. Home morning systolic BP (148 +/- 15 vs 140 +/- 15 mm Hg) and evening systolic BP (137 +/- 16 vs 130 +/- 16 mm Hg) were significantly lowered in the eplerenone group (n=35) compared with baseline (both P<.05), while unchanged in the control group (n=22). BP reductions in the eplerenone group were most pronounced for ambulatory awake systolic BP (P=.04), awake diastolic BP (P=.004), and 24-hour diastolic BP (P=.02). FMD was significantly improved in the eplerenone group. In patients with drug-resistant hypertension, add-on use of eplerenone was effective in lowering BP, especially home and ambulatory awake BP.
  • Teruyuki Sugiyama, Shizukiyo Ishikawa, Kazuhiko Kotani, Tadao Gotoh, Yoshihisa Itoh, Kazunori Kayaba, Eiji Kajii
    JOURNAL OF CLINICAL LABORATORY ANALYSIS 30 6 999 - 1002 2016年11月 [査読有り][通常論文]
     
    BackgroundDue to ethic differences in its serum levels, clinical applicability of high-sensitivity C-reactive protein (hsCRP) to the primary prevention of atherosclerotic events has not completely been established in Japanese people whose hsCRP levels are lower than in Western people. This study investigated the relationship between hsCRP and myocardial infarction (MI) in general Japanese people. MethodsIn relation to hsCRP, the incidence of MI was determined in a multiregional population-based prospective cohort study (n = 6,637; mean age 54.9 years; 2,513 men/4,124 women). ResultsFifty-six cases of MI were confirmed during a follow-up period of 10.7 years. The cut-off levels of hsCRP between the highest quartile (fourth quartile) and the other quartiles combined were 0.368 mg/l in men and 0.279 mg/l in women. The hazard ratio (HR) of the highest quartile for MI was significantly greater than that of the other quartiles combined (multivariate-adjusted HR: 2.07, 95% confidence interval: 1.03-4.15) in men, but not in women (1.03, 0.35-2.21). ConclusionsIn this population, serum hsCRP measurement predicted MI in men, but not in women. Under the low hsCRP level, a method of applicability of hsCRP to a risk assessment for preventing MI among Japanese people should be further explored.
  • Yasushi Matsuyama, Arno M. M. Muijtjens, Makoto Kikukawa, Renee Stalmeijer, Reiko Murakami, Shizukiyo Ishikawa, Hitoaki Okazaki
    BMC MEDICAL EDUCATION 16 245  2016年09月 [査読有り][通常論文]
     
    Background: Progress testing (PT) is used in Western countries to evaluate students' level of functional knowledge, and to enhance meaning-oriented and self-directed learning. However, the use of PT has not been investigated in East Asia, where reproduction-oriented and teacher-centered learning styles prevail. Here, we explored the applicability of PT by focusing on student perceptions. Methods: Twenty-four students from Years 2, 3, and 5 at Jichi Medical University in Japan attended a pilot PT session preceded by a brief introduction of its concept and procedures. Variations in obtained test scores were analyzed by year, and student perceptions of PT were explored using focus groups. Results: Formula scores (mean +/- standard deviation) in Years 2, 3, and 5 were 12.63 +/- 3.53, 35.88 +/- 14.53, and 71.00 +/- 18.31, respectively. Qualitative descriptive analysis of focus group data showed that students disfavored testing of medical knowledge without tangible goals, but instead favored repetitive assessment of knowledge that had been learned and was tested on a unit basis in the past in order to achieve deep learning. Further, students of all school years considered that post-test explanatory lectures by teachers were necessary. Conclusions: East Asian students' perceptions indicated that, in addition to their intensive memorization within narrow test domains compartmentalized by end-of-unit tests, the concept of PT was suitable for repetitive memorization, as it helped them to integrate their knowledge and to increase their understanding. Post-test explanatory lectures might lessen their dislike of the intangible goals of PT, but at the expense of delaying the development of self-directed learning. Key issues for the optimization of PT in East Asia may include administration of PT after completed end-of-unit tests and a gradual change in feedback methodology over school years from test-oriented post-test lectures to the provision of literature references only, as a means of enhancing test self-review and self-directed learning.
  • Makiko Naka Mieno, Noriko Tanaka, Tomio Arai, Takuya Kawahara, Aya Kuchiba, Shizukiyo Ishikawa, Motoji Sawabe
    JOURNAL OF EPIDEMIOLOGY 26 4 191 - 198 2016年04月 [査読有り][通常論文]
     
    Background: Cause of death (COD) information taken from death certificates is often inaccurate and incomplete. However, the accuracy of Underlying CODs (UCODs) recorded on death certificates has not been comprehensively described when multiple diseases are present. Methods: A total of 450 consecutive autopsies performed at a geriatric hospital in Japan between February 2000 and August 2002 were studied. We evaluated the concordance rate, sensitivity, and specificity of major UCODs (cancer, heart disease, and pneumonia) reported on death certificates compared with a reference standard of pathologist assessment based on autopsy data and clinical records. Logistic regression analysis was performed to assess the effect of sex, age, comorbidity, and UCODs on misclassification. Results: The concordance rate was relatively high for cancer (81%) but low for heart disease (55%) and pneumonia (9%). The overall concordance rate was 48%. Sex and comorbidity did not affect UCOD misclassification rates, which tended to increase with patient age, although the association with age was also not significant. The strongest factor for misclassification was UCODs (P < 0.0001). Sensitivity and specificity for cancer were very high (80% and 96%, respectively), but sensitivity for heart disease and pneumonia was 60% and 46%, respectively. Specificity for each UCOD was more than 85%. Conclusions: Researchers should be aware of the accuracy of COD data from death certificates used as research resources, especially for cases of elderly patients with pneumonia.
  • Michikazu Nakai, Yoshihiro Miyamoto, Aya Higashiyama, Yoshitaka Murakami, Kunihiro Nishimura, Hiroshi Yatsuya, Shigeyuki Saitoh, Kiyomi Sakata, Hiroyasu Iso, Katsuyuki Miura, Hirotsugu Ueshima, Tomonori Okamura, The EPOCH-JAPAN Research Group, Hirotsugu Ueshima, Tomonori Okamura, Hirotsugu Ueshima, Yutaka Imai, Takayoshi Ohkubo, Fujiko Irie, Hiroyasu Iso, Akihiko Kitamura, Yutaka Kiyohara, Katsuyuki Miura, Yoshitaka Murakami, Hideaki Nakagawa, Takeo Nakayama, Akira Okayama, Toshimi Sairenchi, Shigeyuki Saitoh, Kiyomi Sakata, Akiko Tamakoshi, Ichiro Tsuji, Michiko Yamada, Masahiko Kiyama, Yoshihiro Miyamoto, Shizukiyo Ishikawa, Tomonori Okamura
    Journal of Atherosclerosis and Thrombosis 23 2 176 - 195 2016年02月 [査読有り][通常論文]
     
    Aim: In Japan Atherosclerosis Society guidelines for the prevention of atherosclerotic cardiovascular diseases 2012 (JAS2012), NIPPON DATA80 risk assessment chart (ND80RAC) was adopted to estimate the 10-year probability of coronary artery disease (CAD) mortality. However, there was no comparison between the estimated mortality calculated by ND80RAC and actual mortality in external populations. Accordingly, we used the large pooled database of cohorts in Japan, EPOCH-JAPAN, as an external population.Methods:The participants of EPOCH-JAPAN without a history of cardiovascular disease (15,091 men and 18,589 women aged 40–74 years) were analyzed based on sex. The probability of a 10-year risk of CAD/stroke mortality was estimated by ND80RAC. The participants were divided into both decile of their estimated mortality and three categories according to JAS2012. The calibration between the mean estimated mortality and the actual mortality was performed by the Hosmer and Lemeshow (H-L) test.Results: In both sexes, the estimated CAD mortality was higher than the actual mortality, particularly in higher deciles of estimated mortality, and the estimated stroke mortality was almost concordant with the actual mortality in low/moderate deciles of estimated mortality. As for the categories according to JAS2012, the estimated CAD mortality was higher than the actual mortality in both sexes actual mortality in Category III was lower than that in Category II in women. However, it increased in the ascending order of category when we excluded the presence of diabetes from Category III.Conclusions: The estimated CAD mortality by ND80RAC tended to be higher than the actual mortality in the population in which the baseline survey was more recently performed.
  • Tsuyako Sakamaki, Motohiko Hara, Kazunori Kayaba, Kazuhiko Kotani, Shizukiyo Ishikawa
    JOURNAL OF EPIDEMIOLOGY 26 2 71 - 75 2016年02月 [査読有り][通常論文]
     
    Background: Previous studies on the association between coffee consumption and subarachnoid hemorrhage (SAH) have provided inconsistent results. We examine the risk of SAH from coffee consumption in a Japanese population. Methods: Our analyses were based on the Jichi Medical School Cohort Study, a large-scale population-based prospective cohort study. A total of 9941 participants (3868 men and 6073 women; mean age 55 years) with no history of cardiovascular disease or carcinoma were examined. Participants were asked to choose one of five options to indicate their daily coffee consumption: none, less than 1 cup a day, 1-2 cups a day, 3-4 cups a day, or 5 or more cups a day. The incidence of SAH was assessed independently by a diagnostic committee. Cox proportional hazards models were used to calculate hazard ratios (HRs) and their 95% confidence intervals (CI) after adjustment for age and sex (HR1) and for additional potential confounders (HR2). Results: During 10.7 years of follow-up, SAH occurred in 47 participants. When compared with the participants who consumed less than 1 cup of coffee a day, the HR of SAH was significantly higher in the group who consumed 5 or more cups a day in both models (HR1 4.49; 95% CI, 1.44-14.00; HR2 3.79; 95% CI, 1.19-12.05). Conclusions: The present community-based cohort study showed that heavy coffee consumption was associated with an increased incidence of SAH after adjusting for age, sex, and multiple potential cardiovascular confounders.
  • Tadenuma Saki, Kanda Hideyuki, Ishikawa Shizukiyo, Kayaba Kazunori, Gotoh Tadao, Nakamura Yosikazu, Kajii Eiji
    Health 8 1 105 - 115 Scientific Research Publishing 2016年01月 
    Dietary salt intake has been reported to be associated with cardiovascular disease (CVD). However, there were few studies that assessed the relationship of salt preference with CVD. We examined the association between salt preference and the incidence of CVD and its subtypes in a Japanese general population. Based on the prospective Jichi Medical School Cohort Study, data were analyzed from 11,394 eligible participants. A baseline survey of the preference for salt was obtained by questionnaire and health examinations from April 1992 through July 1995 in 12 communities in Japan. The participants were followed up until December 2005 (mean follow-up period, 10.7 ± 2.4 years). Subjects were divided into three categories according to their preference for salt: favor, so-so, and disfavor. A Cox proportional hazards model was used to calculate hazard ratios (HRs) of the incidence of CVD according to the preference categories. We observed 485 cardiovascular events (258 in men and 227 in women). Among the men, the multivariable adjusted HRs for incidence of myocardial infarction and subarachnoid hemorrhage for favor versus so-so salt preference were 0.34 (95% confidence interval, 0.17 - 0.71) and 7.10 (0.88 - 56.84), respectively. Among the women, age-adjusted HRs for the incidence of CVD, total stroke, cerebral hemorrhage, and cerebral infarction for the favor preference were 1.41 (1.02 - 1.95), 1.36 (0.97 - 1.91), 1.79 (0.87 - 3.71), and 1.40 (0.89 - 2.19), respectively. The data indicated that preference for salt may be associated with an increase in the incidence of CVD in women.
  • Yuanying Li, The EPOCH-JAPAN Research Group, Hiroyasu Iso, Renzhe Cui, Yoshitaka Murakami, Hiroshi Yatsuya, Katsuyuki Miura, Shin-Ya Nagasawa, Hirotsugu Ueshima, Tomonori Okamura, Yutaka Imai, Takayoshi Ohkubo, Fujiko Irie, Akihiko Kitamura, Yutaka Kiyohara, Hideaki Nakagawa, Takeo Nakayama, Akira Okayama, Toshimi Sairenchi, Shigeyuki Saitoh, Kiyomi Sakata, Akiko Tamakoshi, Ichiro Tsuji, Michiko Yamada, Masahiko Kiyama, Yoshihiro Miyamoto, Shizukiyo Ishikawa
    Journal of Atherosclerosis and Thrombosis 23 7 792 - 799 2016年 [査読有り][通常論文]
     
    Aim: Whether the association between serum γ-glutamyltransferase (γ-GTP) levels and total cardiovascular disease (CVD) mortality is independent of alcohol drinking in East Asian populations is not well known. We conducted a pooled analysis of Japanese men and women that enabled an analysis restricted to never-drinkers. Methods: A total of 15,987 men and 25,053 women aged 40-79 years, pooled from seven cohort studies throughout Japan, were followed-up to examine sex-specific relationship between serum γ -GTP levels and total CVD mortality. Cox regression model was used that was adjusted for age, smoking status, body mass index, and systolic blood pressure and serum triglyceride, total cholesterol, aspartate aminotransferase, and alanine aminotransferase levels. Results: During an average follow-up of 8.7 years, we documented 361 and 340 deaths from total CVD, 146 and 168 from stroke, and 101 and 53 from coronary heart disease (CHD) for men and women, respectively. Among the never-drinkers, hazard ratios (HRs) for mortality for one standard deviation of log-γ-GTP for men were 1.89 (1.00-3.58) for stroke, 1.04 (0.57-1.90) for CHD, and 1.43 (1.04-1.96) for total CVD. For women, HRs were 1.28 (1.06-1.54), 1.81 (1.34-2.44), and 1.30 (1.14-1.49), respectively. Conclusion: γ-GTP may be a risk factor for total CVD mortality independent of alcohol drinking status in Japanese men and women.
  • Wen Zhang, Hiroyasu Iso, Yoshitaka Murakami, Katsuyuki Miura, Masato Nagai, Daisuke Sugiyama, Hirotsugu Ueshima, Tomonori Okamura, Hirotsugu Ueshima, Yutaka Imai, Takayoshi Ohkubo, Fujiko Irie, Akihiko Kitamura, Yutaka Kiyohara, Hideaki Nakagawa, Takeo Nakayama, Akira Okayama, Toshimi Sairenchi, Shigeyuki Saitoh, Kiyomi Sakata, Akiko Tamakoshi, Ichiro Tsuji, Michiko Yamada, Masahiko Kiyama, Yoshihiro Miyamoto, Shizukiyo Ishikawa, Hiroshi Yatsuya, EPOCH-JAPAN GROUP
    Journal of Atherosclerosis and Thrombosis 23 6 692 - 703 2016年 [査読有り][通常論文]
     
    Aim: To investigate the relationship between serum uric acid levels and cardiovascular disease in Asians. Methods: We examined the above relationship using the data of Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH-JAPAN Study). The data of 36,313 subjects (15,628 men and 20,685 women aged 35 –89 years without histories of stroke, coronary heart disease, or cancer at baseline) were used for the analyses. Sex-specific hazard ratios (HRs) of mortality from cardiovascular disease were estimated according to the quintiles of serum uric acid using Cox hazard models stratified by cohorts. Results: During 441,771 person-years of follow-up, we documented 1,288 cardiovascular deaths. A J-or U-shaped relationship between serum uric acid level and cardiovascular disease mortality was observed. Compared with the lowest quintile of serum uric acid levels, the highest quintile was associated with an increased cardiovascular disease mortality in men [HR: 1.28 95% confidence interval (CI): 1.01– 1.63] and women (HR: 1.51 95% CI: 1.14–1.99). However, there was no significant association with mortality from stroke, coronary heart disease or heart failure in both men and women. Conclusion: This large pooled analysis in Japan suggested a J-or U-shaped relationship between serum uric acid levels and cardiovascular mortality. The highest quintile of serum uric acid levels was associated with increased cardiovascular disease mortality in both Japanese men and women.
  • Yukiko Ishikawa, Taro Takeshima, Junichi Mise, Shizukiyo Ishikawa, Masami Matsumura
    International Journal of General Medicine 8 261 - 266 2015年08月 [査読有り][通常論文]
     
    Purpose: General practitioners have an important role in diagnosing a variety of patients, including psychiatric patients with complicated symptoms. We evaluated the relationship between physical symptoms and psychiatric disorders in general internal medicine (GIM) outpatients in a Japanese university hospital. Materials and methods: We coded the symptoms and diagnoses of outpatients from medical documents using the International Classification of Primary Care, second edition (ICPC-2). The participants were new outpatients who consulted the GIM outpatient division at Jichi Medical University Hospital in Tochigi, Japan from January–June, 2012. We reviewed all medical documents and noted symptoms and diagnoses. These were coded using ICPC-2. Results: A total of 1,194 participants were evaluated, 148 (12.4%) of whom were diagnosed as having psychiatric disorders. The prevalence of depression, anxiety disorder, and somatization was 19.6% (number [n] =29), 14.9% (n=22), and 14.2% (n=21), respectively, among the participants with psychiatric disorders. The presence of several particular symptoms was associated with having a psychiatric disorder as compared with the absence of these symptoms after adjusting for sex, age, and the presence of multiple symptoms (odds ratio [OR] =4.98 [95% confidence interval {CI}: 1.66–14.89] for palpitation OR =4.36 [95% CI: 2.05–9.39] for dyspnea OR =3.46 [95% CI: 1.43–8.36] for tiredness and OR =2.99 [95% CI: 1.75–5.13] for headache). Conclusion: Not only the psychiatric symptoms, but also some physical symptoms, were associated with psychiatric disorders in GIM outpatients at our university hospital. These results may be of help to general practitioners in appropriately approaching and managing patients with psychiatric disorders.
  • Kyoko Yamasaki, Kazunori Kayaba, Shizukiyo Ishikawa
    ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH 27 5 531 - 541 2015年07月 [査読有り][通常論文]
     
    Soy and soy products are popular ingredients in the Japanese diet. This study aimed to determine whether soy or soy products intake was associated with all-cause mortality in a community-based cohort in Japan. A total of 11 066 participants were obtained from an annual community-based health examination program. A self-administered questionnaire was used to collect information concerning soy and soy products intake and potential confounding factors. Associations between soy and soy products intake and all-cause mortality were assessed using hazard ratios (HRs). After adjusting for all factors, morality was significantly higher in men with infrequent soy intake (HR = 1.53; 95% confidence interval [CI] = 1.13-2.07) and with almost daily intake (HR = 1.55; 95% CI = 1.19-2.03) compared with intake 1 to 2 times per week. Cancer mortality was higher among men who reported rarely eating soy (HR = 1.74; 95% CI = 1.08-2.79). Soy products intake was not statistically significantly associated with all-cause mortality in both sexes.
  • Kazuomi Kario, Satoshi Hoshide, Hajime Haimoto, Kayo Yamagiwa, Kiyoshi Uchiba, Shoichiro Nagasaka, Yuichiro Yano, Kazuo Eguchi, Yoshio Matsui, Motohiro Shimizu, Joji Ishikawa, Shizukiyo Ishikawa
    Journal of Clinical Hypertension 17 5 340 - 348 2015年05月 [査読有り][通常論文]
     
    To study whether sleep blood pressure (BP) self-measured at home is associated with organ damage, the authors analyzed the data of 2562 participants in the J-HOP study who self-measured sleep BP using a home BP monitoring (HBPM) device, three times during sleep (2am, 3am, 4am), as well as the home morning and evening BPs. The mean sleep home systolic BPs (SBPs) were all correlated with urinary albumin/creatinine ratio (UACR), left ventricular mass index (LVMI), brachial-ankle pulse wave velocity (baPWV), maximum carotid intima-media thickness, and plasma N-terminal pro-hormone pro-brain-type natriuretic peptide (NTproBNP) (all P<.001). After controlling for clinic SBP and home morning and evening SBPs, associations of home sleep SBP with UACR, LVMI, and baPWV remained significant (all P<.008). Even in patients with home morning BP <135/85mmHg, 27% exhibited masked nocturnal hypertension with home sleep SBP 120mmHg and had higher UACR and NTproBNP. Masked nocturnal hypertension, which is associated with advanced organ damage, remains unrecognized by conventional HBPM.
  • Eiichi Kakehi, Kazuhiko Kotani, Shizukiyo Ishikawa, Tadao Gotoh, Kazunori Kayaba, Yosikazu Nakamura, Eiji Kajii
    ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH 27 2 NP535 - NP543 2015年03月 [査読有り][通常論文]
     
    The predictive value of serum non-high-density lipoprotein cholesterol (non-HDL-C) levels for the incidence of ischemic stroke and its subtypes has not yet been established. The present cohort study investigated their relationships in a Japanese population. The first incidence of ischemic stroke and its subtypes was documented as the primary outcome. A total of 249 ischemic stroke patients (men/women = 145/104) were identified during a follow-up period of 10.7 years among 10 760 community-dwelling subjects (men/women = 4212/6548). Cox proportional hazard model analyses revealed that when compared with the lowest tertile of non-HDL-C, multivariate-adjusted hazard ratios for the highest tertile were 0.55 (95% confidence interval = 0.32-0.95, P =.03) on ischemic stroke and 0.29 (95% confidence interval = 0.08-1.05, P =.06) on cardioembolic infarction in women. Men did not show such significant relationships. Low serum non-HDL-C levels may be a predictive marker associated with an increase in the incidence of ischemic stroke and possibly of cardioembolic infarction in Japanese women.
  • Yuji Kaneda, Shizukiyo Ishikawa, Atsuko Sadakane, Tadao Gotoh, Kazunori Kayaba, Yoshikazu Yasuda, Eiji Kajii
    ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH 27 2 NP572 - NP579 2015年03月 [査読有り][通常論文]
     
    The aim of the study was to investigate the relation between insulin resistance and risk of cerebral infarction in a Japanese general population. The subjects were 2610 men and women without past history of stroke or myocardial infarction and who were under treatment for diabetes. Subjects were divided into quartiles by the homeostasis model assessment of insulin resistance (HOMA-IR), and Cox's proportional hazard model was used to calculate hazard ratios (HRs) for cerebral infarction. In men, the multivariate-adjusted HRs were 2.51 (95% confidence interval [CI] = 0.98-6.42) in quartile 1 (Q1), 1.43 (95% CI = 0.54-3.82) in Q2, and 2.13 (95% CI = 0.82-5.51) in Q4, using Q3 as the reference. In women, the multivariate-adjusted HRs were 2.12 (95% CI = 0.72-6.31) in Q1, 2.96 (95% CI = 1.06-8.26) in Q3, and 2.31 (95% CI = 0.80-6.69) in Q4, using Q2 as the reference. The association between risk of cerebral infarction and HOMA-IR was not dose dependent.
  • Joji Ishikawa, Shizukiyo Ishikawa, Kazuomi Kario
    JOURNAL OF CARDIOLOGY 65 3-4 237 - 242 2015年03月 [査読有り][通常論文]
     
    Background: We attempted to evaluate whether the relationship between the QTc interval and mortality (including sudden cardiac death) is linear or J-shaped in the general Japanese population, who tend to be at greater risk of strokes than cardiac events. Methods: we classified 10,804 subjects according to their Bazett QTc interval quartiles (determined by electrocardiography) at the baseline and followed them up for a mean period of 141.9 +/- 28.3 months (127,712 person-years). Results: In total, 878 subjects died during the study period. including 104 from cardiovascular events, 100 from stroke, and 46 from sudden cardiac death. In a Cox proportional hazards regression model adjusted for conventional cardiovascular risk factors, the risk of cardiovascular mortality increased progressively with the QTc interval quartile [Q2, hazard ratio (HR) = 0.94 (0.43-2.03); Q3, HR = 1.11 (0.53-2.34); Q4, HR = 2.21 (1.12-4.36); HR are vs. Q1]. A parallel analysis found that the risk of stroke mortality was marginally increased in the highest Bazett QTc interval quartile [HR = 1.93 (0.97-3.85)]. On the other hand, the risk of sudden cardiac death exhibited a J-shaped relationship with the Bazett QTc interval quartile [Q1, HR = 8.58(1.07-69.05); Q3, HR = 7.17(0.88-58.73); Q4, HR 13.18(1.72-101.03); HR are vs. Q2]. Conclusion: In the general Japanese population, cardiovascular and stroke mortality increase progressively with the Bazett QTc interval quartile, while the risk of sudden cardiac death exhibits a j-shaped relationship with the latter variable. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Joji Ishikawa, Shizukiyo Ishikawa, Kazuomi Kario
    HYPERTENSION 65 3 554 - U137 2015年03月 [査読有り][通常論文]
     
    We attempted to evaluate whether subjects who exhibit prolonged corrected QT (QTc) interval (>= 440 ms in men and >= 460 ms in women) on ECG, with and without ECG-diagnosed left ventricular hypertrophy (ECG-LVH; Cornell product, >= 244 mVxms), are at increased risk of stroke. Among the 10 643 subjects, there were a total of 375 stroke events during the follow-up period (128.7 +/- 28.1 months; 114 142 person-years). The subjects with prolonged QTc interval (hazard ratio, 2.13; 95% confidence interval, 1.22-3.73) had an increased risk of stroke even after adjustment for ECG-LVH (hazard ratio, 1.71; 95% confidence interval, 1.22-2.40). When we stratified the subjects into those with neither a prolonged QTc interval nor ECG-LVH, those with a prolonged QTc interval but without ECG-LVH, and those with ECG-LVH, multivariate-adjusted Cox proportional hazards analysis demonstrated that the subjects with prolonged QTc intervals but not ECG-LVH (1.2% of all subjects; incidence, 10.7%; hazard ratio, 2.70, 95% confidence interval, 1.48-4.94) and those with ECG-LVH (incidence, 7.9%; hazard ratio, 1.83; 95% confidence interval, 1.31-2.57) had an increased risk of stroke events, compared with those with neither a prolonged QTc interval nor ECG-LVH. In conclusion, prolonged QTc interval was associated with stroke risk even among patients without ECG-LVH in the general population.
  • Kentaro Ushijima, Hajime Nakashima, Tsuyoshi Shiga, Kazuhiro Harada, Shizukiyo Ishikawa, Takashi Ioka, Hitoshi Ando, Akio Fujimura
    JOURNAL OF PHARMACOLOGICAL SCIENCES 127 1 62 - 68 2015年01月 [査読有り][通常論文]
     
    This study was undertaken to evaluate the differences in chronotherapeutic effects of angiotensin-II receptor blockers, valsartan and olmesartan in hypertensive patients with non-dipper blood pressure (BP) pattern during valsartan at morning. Ninety four patients were enrolled, and 40 patients were judged to be non-dippers. In these patients, same dose of valsartan was changed to evening (Val-E, n = 12), or olmesartan (equivalent dose of valsartan) was given at morning (Olm-M, n = 13) or evening (Olm-E, n = 15) for 4 months. BP decreased during sleep and increased during waking hours in Val-E group. In Olm-M and Olm-E groups, BP decreased during sleep and waking hours. Percent reduction in BP at night-time compared to BP at waking hours significantly increased after changing the dose regimen in each group. Serum creatinine decreased and estimated glomerular filtration rate (eGFR) elevated in Olm-M and Olm-E, but not Val-E groups. Positive correlation between systolic BP (SBP) during sleep and serum creatinine, and negative correlation between SBP during sleep and eGFR were detected. These data suggest that dipper BP pattern could be obtained by chronotherapeutic approach using valsartan and olmesartan in non-dipper patients with valsartan at morning. Morning and evening olmesartan, but not evening valsartan improved renal function in these patients. (C) 2014 Japanese Pharmacological Society. Production and hosting by Elsevier B.V.
  • Eiichi Kakehi, Kazuhiko Kotani, Shizukiyo Ishikawa, Tadao Gotoh, Kazunori Kayaba, Yosikazu Nakamura, Eiji Kajii
    Journal of Public Health (Germany) 22 6 505 - 511 2014年12月 [査読有り][通常論文]
     
    Aim: Whether plasma glucose concentrations at the screening level in the public health care setting can predict mortality remains to be determined in Japanese people. The aim of this study was to investigate the relationships between screening plasma glucose concentrations and cause- and all-cause mortality in a general Japanese cohort. Subjects and methods: The current study investigated 11,998 community-dwelling participants from 12 Japanese communities who had been registered in the Jichi Medical School Cohort Study (a population-based prospective cohort study) between 1992 and 1995. Mortality was documented as the primary outcome. The relationships between screening plasma glucose concentrations and outcomes were analyzed using Cox proportional hazard models. Results: In all, 1,050 deaths (men/women = 631/419) were identified during a follow-up period of 10.7 years. Compared with the lowest glucose concentration (< 5.22 mmol/L), multivariate-adjusted hazard ratios for the highest glucose concentration (≥6.11 mmol/L) were 1.52 (95 % confidence interval [CI], 1.25–1.85) for all-cause mortality and 1.76 (95 % CI, 1.29–2.41) for cancer-cause mortality in men and 4.65 (95 % CI, 1.69–12.78) for myocardial infarction mortality in women. Conclusions: The current Japanese population-based cohort study suggests that high screening plasma glucose concentrations can predict cancer- and all-cause mortality, particularly in men.
  • Joji Ishikawa, Shizukiyo Ishikawa, Kazuomi Kario
    CIRCULATION JOURNAL 78 2 465 - 475 2014年02月 [査読有り][通常論文]
     
    Background: ECG-diagnosed left ventricular hypertrophy (LVH), the Cornell voltage (CV: >= 2.8 mV in males and mV in females) or Cornell product (CP: >= 244.0 mVxms), were selected in Western countries for their ability to diagnose anatomical LVH. Methods and Results: We aimed to elucidate the CV and CF values that were associated with a significantly increased risk of cardiovascular or stroke mortality and morbidity in a Japanese general population (n=10,172). In the receiver-operating curves analysis of CV and CP for predicting the risks, the area under the curve in females was greater than in males. In a quintile-based multivariate analysis that was performed separately for females and males, the mortality and morbidity risks of CV were significantly increased at the highest quintile of CV (>1.71 mV) in females. In males, the mortality risk was significantly increased at the highest quintile of CV (>2.04 mV). Additionally, in the parallel analysis of CP that included both males and females, the morbidity risk was significantly elevated in subjects with CF belonging to the 4th (158.7-193.4 mVxms; hazard ratio=1.387) or 5th quintiles (>= 193.5 mVxms; hazard ratio=1.507), compared with those with CP values within the lowest quintile (<101.9 mVxms). Conclusions: Cardiovascular and stroke risks may be elevated at lower levels of CV and CP in Japanese subjects, especially females.
  • Yuji Kaneda, Shizukiyo Ishikawa, Atsuko Sadakane, Tadao Goto, Kazunori Kayaba, Yoshikazu Yasuda, Eiji Kajii
    NEUROLOGY ASIA 18 4 343 - 348 2013年12月 [査読有り][通常論文]
     
    Objective: We investigated the relation between fasting insulin (FI) and risk of cerebral infarction in a Japanese general population. Methods: The subjects were 2,610 men and women without past history of stroke or myocardial infarction and under treatment for diabetes, examined between 1992 and 1995 as part of the Jichi Medical School Cohort Study. The FI level was measured once at the baseline. Subjects were divided into quintiles by FI levels, and Cox's proportional hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cerebral infarction. Results: During an average of 11.1 years of follow-up, 87 participants developed cerebral infarction. Crude incidence rates of FI quintiles 1-5 were 4.69, 2.35, 1.85, 2.77 and 3.30 per 1,000 person-years, respectively. The multivariate-adjusted HRs for cerebral infarction were 2.33 (95% CI, 1.10 - 4.96) in quintile 1 (Q1), 1.25 (95% CI, 0.55 - 2.84) in Q2, 1.68 (95% CI, 0.76 - 3.70) in Q4 and 2.06 (95% CI, 0.94 - 4.47) in Q5, using Q3 as the reference. Conclusions: The lowest FI level was associated with increased risk of cerebral infarction and the association between FI and risk of cerebral infarction appeared to be a U-shaped relationship.
  • Satohiro Matsumoto, Shizukiyo Ishikawa, Yukio Yoshida
    AUSTRALIAN JOURNAL OF RURAL HEALTH 21 6 319 - 324 2013年12月 [査読有り][通常論文]
     
    ObjectiveTo evaluate the efficacy of endoscopic and radiographic screening for gastric cancer. DesignA retrospective cohort study. SettingCommunity in an isolated island. ParticipantsThe study involved 186 patients (131 men, 55 women) diagnosed with gastric cancer between 2000 and 2005. InterventionsEndoscopic and radiographic screening. Main outcome measurementsThe odds ratio of death from gastric cancer in participants versus non-participants of screening, the cumulative survival rate of the gastric cancer patients. ResultsThe odds ratio of death from gastric cancer in the participants versus non-participants of screening was 0.091 (95% confidence interval (CI) 0.027-0.308; P<0.0001). The cumulative survival rate of the gastric cancer patients in the screening group was higher than that in the non-screening group (P<0.0001). In the endoscopic screening district, the odds ratio of death from gastric cancer among the participants versus non-participants of endoscopic screening was 0.117 (95% CI 0.013-1.056; P=0.0525), while in the radiographic screening district, it was 0.086 (95% CI 0.020-0.376; P<0.0001). The cumulative survival rates were higher in both the screening groups as compared with the non-screening group (endoscopy, P=0.0302; radiography, P=0.0012). ConclusionThe results suggest that both radiographic and endoscopic screening may prevent gastric cancer deaths.
  • Yuichiro Yano, Kazuomi Kario, Shizukiyo Ishikawa, Toshiyuki Ojima, Tadao Gotoh, Kazunori Kayaba, Akizumi Tsutsumi, Kazuyuki Shimada, Yosikazu Nakamura, Eiji Kajii
    DIABETES CARE 36 5 1186 - 1192 2013年05月 [査読有り][通常論文]
     
    OBJECTIVE-To examine the BMI-stratified associations between diabetes and the risks of all-cause death, cardiovascular disease (CVD) death, and cancer death.RESEARCH DESIGN AND METHODS-Using a prospective study with 12 rural Japanese general populations (n = 3,641, mean age, 53.7 years; 33.5% men), we examined the associations between diabetes and the risk of all-cause death, CVD death, and cancer death. We also examined the effects of BMI and age on such associations.RESULTS-During an average duration of 10.2 years (37,278 person-years), 240 deaths occurred (54 deaths from CVD, 101 from cancer, and 85 from other causes). Cox regression analysis showed leanness (defined as the lowest quartile of entire BMI; mean, 19.5 kg/m(2)), but not obesity (BMI >= 25 kg/m(2)), and diabetes were independently associated with an increased risk of all-cause death (hazard ratio [HR] 1.70 and 1.65, respectively; both P < 0.01.). Stratification with cause-specific deaths showed that leanness and obesity were associated with CVD death (HR 3.77 and 2.94, respectively), whereas diabetes was associated with cancer death (HR 1.87; all P < 0.05). The increased risk of all-cause death in diabetes was substantially higher in lean subjects aged <65 years (HR 3.4) or those aged >= 65 years (HR 4.2), whereas the risk in obese diabetes patients was significant only in subjects aged <65 years (HR 2.32; all P < 0.05).CONCLUSIONS-Among the Japanese general population, diabetes confers an increased risk of all-cause death. Particular attention must be paid to the pronounced high mortality in diabetes accompanied with leanness, regardless of age.
  • Shizukiyo Ishikawa, Kazuhiko Kotani, Kazuomi Kario, Kazunori Kayaba, Tadao Gotoh, Yosikazu Nakamura, Eiji Kajii
    THROMBOSIS RESEARCH 131 2 E54 - E58 2013年02月 [査読有り][通常論文]
     
    Introduction: Although lipoprotein(a) (Lp(a)) is involved in cardiometabolic disease processes, the association between serum Lp(a) and stroke and/or its subtypes has not yet been elucidated among Japanese people. This study investigated the association between Lp(a) and the incidence of stroke and/or its subtypes in the general Japanese population. Materials and Methods: This population-based prospective cohort study included 10,494 community-dwelling participants (4,030 males/6,464 females). The incidence of stroke and its subtypes was the primary outcome. The subjects were divided into tertiles based on their Lp(a) levels, and the risk of all stroke and stroke subtypes was examined using Cox's proportional hazard model. Results: A total of 393 subjects (199 males and 194 females) with stroke were identified during a follow-up duration of 10.7 years. The multivariate-adjusted hazard ratios for all stroke events were 0.55 (95% confidence interval: 0.38-0.81) and 0.69 (0.49-0.99) in the 2nd (9-19 mg/dl) and 3rd tertiles (>= 20 mg/dl) of Lp(a) in reference to the 1st tertile (<9 mg/dl) in males, and 0.85 (0.59-1.24) and 0.76 (0.52-1.11) in 2nd (10-22 mg/dl) and 3rd tertiles (>= 23 mg/dl) of Lp(a) in reference to the 1st tertile (<10 mg/dl) in females. The multivariate-adjusted hazard ratios for cerebral hemorrhage were 0.26 (0.10-0.67) and 0.34 (0.15-0.76) in the 2nd and 3rd tertiles of Lp(a) in reference to the 1st tertile in males, and were 0.48 (0.23-1.04) and 0.44 (0.21-0.96) in the 2nd and 3rd tertiles of Lp(a) in females. Conclusions: Lp(a) was associated with the incidence of cerebral hemorrhage in the general Japanese population, particularly among males, while a similar trend was seen among females. A low Lp(a) level may be a marker of the risk of cerebral hemorrhage in this population. (c) 2012 Elsevier Ltd. All rights reserved.
  • Yayoi Takezako, Shizukiyo Ishikawa, Eiji Kajii
    JOURNAL OF PAIN AND SYMPTOM MANAGEMENT 45 1 63 - + 2013年01月 [査読有り][通常論文]
     
    Context. Advance directives are poorly understood in Japanese nursing homes. In April 2006, additional funding for end-of-life care became available as the first support for terminal care at Japanese nursing homes. Objectives. The objectives of this study were to investigate the adoption of advance directives by Japanese nursing homes, the effect of additional funding for end-of-life care in nursing homes from long-term care insurance on the use of advance directives, and the types of directives used. Methods. A nationwide questionnaire survey of nursing homes was performed in Japan. The participants were 913 nursing homes. We investigated the prevalence of advance directives, details of the directives, and demographic data of the responders. Results. Advance directives were used in 58.4% of nursing homes. The timing of introduction of the directives and the results of multivariate analysis at the facility level suggested a relation between the availability of additional funding for end-of-life care and the adoption of advance directives. Most nursing homes used instructional directives, especially directives providing an explanation and informed consent for end-of-life care in the nursing home. Conclusion. More than half of Japanese nursing homes have introduced advance directives, and additional funding for end-of-life care is related to their introduction. Most nursing homes have adopted instructional directives, especially those providing an explanation and informed consent regarding end-of-life care at the nursing home. J Pain Symptom Manage 2013;45:63-70. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
  • Kazuhiko Kotani, Yoshitaka Sekine, Shizukiyo Ishikawa, Imoh Z. Ikpot, Kazuhiro Suzuki, Alan T. Remaley
    Journal of Epidemiology 23 5 313 - 319 2013年 [査読有り][通常論文]
     
    Prostate cancer is a common disease in modern, developed societies and has a high incidence and mortality. Highdensity lipoprotein cholesterol (HDL-C) has recently received much attention as a possible risk marker of prostate cancer development and prognosis. In the present article, we summarized findings from epidemiologic studies of the association between HDL-C and prostate cancer. Low HDL-C level was found to be a risk and prognostic factor of prostate cancer in several epidemiologic studies, although the overall linkage between HDL and prostate cancer has not been definitively established. The mechanisms for this association remain uncertain however, limited data from experimental studies imply a possible role of HDL in the pathophysiology of prostate cancer. More epidemiologic research, in combination with experimental studies, is needed in this field. © 2013 Kazuhiko Kotani et al.
  • Kazuo Eguchi, Satoshi Hoshide, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    DIABETES RESEARCH AND CLINICAL PRACTICE 98 3 518 - 523 2012年12月 [査読有り][通常論文]
     
    Aims: We tested the hypothesis that short sleep duration is not only a risk factor for diabetes, but that the two conditions in combination would be associated with the risk of incident cardiovascular disease (CVD). Methods: We analyzed 1255 hypertensive patients (mean age: 70.4 +/- 9.9 years) with (N = 299) and without diabetes (N = 956). Short sleep duration was defined as a sleep time <7.5 h. A Hard CVD event was defined as either myocardial infarction, stroke, or sudden cardiac death; and All CVD events as Hard CVD events plus angina, heart failure and end-stage renal disease. Results: When the patients were divided into 4 categories by diabetes (present or absent) and sleep duration (short or long), the diabetes + short sleep group had a significantly higher incidence of both Hard CVD events (HR = 2.27, 95% CI = 1.17-4.42, P = 0.015) and All CVD events (HR = 2.47, 95% CI = 1.37-4.43, P = 0.003) compared with the non-diabetes + long sleep group, independent of significant covariates. There were significant interactions between sleep duration and glycemic control on CVD events. Conclusions: The combination of both diabetes and short duration of sleep was associated with higher risk of incident CVD compared with those with only one or neither condition. Altered glycemic control and short sleep duration could act synergistically to pose a risk for future CVD. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
  • Yuichiro Yano, Shizukiyo Ishikawa, Kazuomi Kario
    JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 308 20 2079 - 2080 2012年11月 [査読有り][通常論文]
  • Joji Ishikawa, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    HYPERTENSION 60 4 921 - + 2012年10月 [査読有り][通常論文]
     
    In ambulatory blood pressure (BP) monitoring, nighttime BP has a superior ability to predict hypertensive target organ damage than awake BP. We evaluated whether nighttime BP, assessed by a home BP monitor, was associated with hypertensive target organ damage. We measured clinic BP, out-of-clinic BP including nighttime home BP, and the urinary albumin: creatinine ratio (UACR) in 854 patients who had cardiovascular risk factors. Nighttime home BP was measured at 2: 00, 3: 00, and 4: 00 am, in addition to clinic, awake ambulatory, nighttime ambulatory, and awake home BP. Nighttime home systolic BP (SBP) was slightly higher than nighttime ambulatory SBP (difference, 2.6 mm Hg; P<0.001). Clinic (r=0.186), awake ambulatory (r=0.173), nighttime ambulatory (r=0.194), awake home (r=0.298), and nighttime home (r=0.311) SBPs were all associated with log-transformed UACR (all P<0.001). The correlation coefficient for the relationship between nighttime home SBP and log-transformed UACR was significantly greater than that for the relationship between nighttime ambulatory SBP and log-transformed UACR (P<0.001). The goodness of fit of the association between SBP and UACR was improved by adding nighttime home SBP to the other SBPs (P<0.001). Nighttime home diastolic BP also improved the goodness-of-fit of the association between diastolic BP and UACR (P=0.001). Similar findings were observed for the left ventricular mass index in the subgroup (N=594). In conclusion, nighttime home BP is slightly different from (but comparable to) nighttime ambulatory BP. The addition of nighttime home BP to other BP measures improves the association of BP with hypertensive target organ damage. (Hypertension. 2012; 60: 921-928.) center dot Online Data Supplement
  • Y. Tateno, S. Ishikawa
    RURAL AND REMOTE HEALTH 12 4 1992  2012年10月 [査読有り][通常論文]
     
    Introduction: Recent studies show that a clinical pathway (CP) optimizes pain management in palliative care; however, studies on CPs in home palliative care, especially in remote locations, are scarce. Physicians performing palliative care in remote areas frequently face characteristic difficulties. The CP is an effective tool to overcome these difficulties. This study evaluates the effectiveness of the CP in home palliative care on a remote island. Methods: This study reviewed 24 patients (17 in a pre-CP group and seven in a post-CP group) who received home palliative care on Kozu Island in south-eastern Japan from April 2006 to December 2011. To evaluate CP effectiveness, the authors compared patients in whom a rescue opioid was set, and nonsteroidal anti-inflammatory drugs (NSAIDs), antiemetics, and laxatives drug were used with opioids in the post-CP group compared with those in the pre-CP group. To assess pain management quality, authors compared Pain Management Index (PMI) scores on day 1 (baseline); day 8 following CP initiation; and within 3 days before death. Results: The proportion of patients in whom a rescue dose was set was 100% in the post-CP group versus 46% in the pre-CP group (p=0.04). The proportion of patients in whom NSAIDs were used with opioids was 100% in the post-CP group versus 18% in the pre-CP group (p=0.002). The proportion of patients in whom antiemetics and laxatives were used with opioids was 100% in the post-CP group versus 27% in the pre-CP group (p=0.009). Baseline PMI scores were not significantly different between groups (-1 in post-CP group versus 0 in pre-CP group, p=0.1); however, PMI scores at day 8 and within 3 days before death were significantly higher in the post-CP group (1.9 and 2.9) than in the pre-CP group (0.2 and -0.4) (p=0.007 and p=0.0005, respectively). Conclusion: Implementation of a CP for pain management in home palliative care in remote locations could improve compliance with the WHO pain management guidelines and the quality of pain management.
  • Reiko Yamamoto, Shizukiyo Ishikawa, Masafumi Mizooka, Eiji Kajii
    NEUROLOGY ASIA 17 3 183 - 192 2012年09月 [査読有り][通常論文]
     
    Background: Chronic infections, such as Helicobacter pylori (H. pylori) and Chlamydophila pneumoniae (C. pneumoniae), are known to contribute to atherosclerosis. However, the relationship of the infections to cerebral infarction is still controversial. Methods: The Jichi Medical School (JMS) Cohort Study, a prospective population-based study, investigated the risk factors of cardiovascular disease in Japanese community-dwelling populations. In 1999, we measured serum H. pylori IgG, C. pneumoniae IgG and IgA levels in 2,632 subjects. Logistic regressions were used to analyze associations between H. pylori and C. pneumoniae seropositivities and cerebral infarction. Results: A total of 2,243 subjects were followed up and, during 10.7-years, 64 developed cerebral infarctions, whose prevalence of H. pylori IgG, C. pneumoniae IgG and IgA seropositivities were 51.6%, 71.9%, and 67.2%, respectively. Among seropositive subjects, adjusted odds ratios (ORs) for cerebral infarctions were 1.04 (95% confi dence interval (CI), 0.58-1.87, P=0.89), 2.02 (1.03-3.95, P=0.04), and 1.35 (0.73-2.49, P=0.34) respectively, after adjusting for sex, age, body mass index, total cholesterol, high-density lipoprotein cholesterol, fasting blood sugar, smoking, alcohol, and fibrinogen. C. pneumoniae IgG seropositivities in subjects aged >= 65 years were associated with cerebral infarctions, whereas those in subjects aged < 65 years, were not. Conclusions: C. pneumoniae IgG was associated with cerebral infarction, C. pneumoniae IgA and H. pylori IgG were not.
  • Kazuo Eguchi, Satoshi Hoshide, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    JOURNAL OF CLINICAL HYPERTENSION 14 7 422 - 428 2012年07月 [査読有り][通常論文]
     
    J Clin Hypertens (Greenwich). 2012; 14:422428. (c) 2012 Wiley Periodicals, Inc. The authors tested the hypothesis that an aggressive antihypertensive treatment is beneficial in protecting against target organ damage (TOD) in patients with type 2 diabetes/prediabetes. The authors enrolled 60 patients with uncontrolled hypertension and diabetes/prediabetes and performed clinic, home, and ambulatory blood pressure (BP) monitoring. Irbesartan, amlodipine, and indapamide were used according to a titration schedule from step 1 to 5 for target home BP level =125/75 mm Hg. The flow-mediated vasodilation (FMD), radial augmentation index (AI), pulse wave velocity (PWV), and urinary albumin excretion ratio (UACR), as a surrogate marker of TOD, were measured at baseline and 6 months. Compared with baseline, clinic, home, and ambulatory BP measures were significantly lower in the sixth month. FMD was increased significantly and AI, PWV, and UACR were reduced by the treatment. The extent of the changes in PWV and UACR were associated with the changes in all BP measures, but only the change in home morning BP was associated with the change in FMD. The change in AI was not associated with the change in BP levels, but was associated with the change in PWV. A very aggressive antihypertensive therapy guided by home morning BP was effective for surrogate end points in patients with diabetes/prediabetes.
  • Tomoyuki Kabutoya, Shizukiyo Ishikawa, Joji Ishikawa, Satoshi Hoshide, Kazuomi Kario
    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY 17 3 252 - 259 2012年07月 [査読有り][通常論文]
     
    Background: There have been few reports on the relationship between P-wave characteristics and long-term cardiovascular events. Methods: A nested case-control study was conducted as part of the Jichi Medical School cohort study, which enrolled 12,490 subjects in a community-dwelling population. The mean follow-up period was 10.7 years. The P-wave characteristics of 526 patients who suffered cardiovascular events (fatal/nonfatal stroke, fatal/nonfatal myocardial infarction, and sudden death) within the follow-up period (case group) were compared with those of 1578 matched controls (control group). The P-wave morphology was classified as normal, deflected, and notched type in precordial leads. A broad P wave was defined as a maximum P-wave duration of more than 120 ms in any of the 12 leads. Results: The mean age was 64 +/- 8 years and the percentage of males was 54% in both groups. A notched P wave at baseline was observed in 10.1% of the case group and 6.0% of the control group (P = 0.001). A notched P wave was a significant predictor of cardiovascular events after adjustment for covariates (odds ratio = 1.59; 95% confidence interval = 1.082.33). Among the patients with left ventricular hypertrophy as evaluated by the SokolowLyon criteria or Cornell product criteria, there was no significant difference in cardiovascular events between those with and those without a notched P wave, but in the absence of left ventricular hypertrophy, patients with a notched P wave suffered more cardiovascular events than those without a notched P wave by each criteria. Conclusion: P-wave morphologic characteristics were effective for predicting cardiovascular events.
  • Motohiro Shimizu, Joji Ishikawa, Yuichiro Yano, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    JOURNAL OF HYPERTENSION 30 5 1015 - 1021 2012年05月 [査読有り][通常論文]
     
    Background: Asleep blood pressure (BP) has been shown to better reflect cardiovascular risk than awake BP in hypertensive patients. This study investigated the correlation of brain natriuretic peptide (BNP) to asleep BP during antihypertensive treatment. Methods: In the Japan Morning Surge-Target Organ Protection (J-TOP) study, which was an open-label multicenter trial to compare bedtime or awakening dosing of candesartan (+ diuretics as needed) among individuals with home SBP higher than 135 mmHg, we evaluated 254 hypertensive patients who underwent ambulatory BP monitoring, and measured their BNP at baseline and after 6th month of treatment. Results: At follow-up, the decrease in log-transformed BNP was significantly related to the decrease in asleep SBP (r = 0.27, P < 0.001); the relationship remained significant (beta = 0.20, P = 0.002) even after adjusting for the decrease in the awake SBP (beta = 0.001, P = 0.991). When we divided participants by their time of candesartan administration, the relationship between the decrease in log-transformed BNP and asleep SBP was still significant in both the awakening-dosing group (beta = 0.21, P = 0.028) and the bedtime-dosing group (beta = 0.21, P = 0.029). Furthermore, this relationship was strong in the participants who were receiving diuretics. Conclusion: The decrease in BNP is associated with asleep BP reduction by candesartan (R diuretics as needed) over and above the awake BP reduction, regardless of the time of administration.
  • Motoji Sawabe, Noriko Tanaka, Makiko Naka Mieno, Shizukiyo Ishikawa, Kazunori Kayaba, Ken-ichi Nakahara, Satoru Matsushita
    PLOS ONE 7 4 e31954  2012年04月 [査読有り][通常論文]
     
    Background: Experimental studies support the anti-neoplastic effect of apo(a), but several clinical studies have reported contradictory results. The purpose of this study was to determine whether a low lipoprotein(a) [Lp(a)] concentration is related to mortality from major causes of death, especially cancer. Methods: The subjects were 10,413 participants (4,005 men and 6,408 women) from a multi-center population-based cohort study in Japan (The Jichi Medical School cohort study). The average age at registration was 55.0 years, and the median observation period was 4,559 days. As the estimated hazard ratio was high for both the low and very high Lp(a) levels, we defined two Lp(a) groups: a low Lp(a) group [Lp(a)<80 mg/L] and an intermediate-to-high Lp(a) group [Lp(a)>= 80]. Participants who died from malignant neoplasms (n=316), cardiovascular disease (202), or other causes (312) during the observation period were examined. Results: Cumulative incidence plots showed higher cumulative death rates for the low Lp(a) group than for the intermediate-to-high Lp(a) group for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p=0.03, and p=0.03, respectively). Cox proportional hazards analyses with the sex and age of the participants, body mass index, and smoking and drinking histories as covariates showed that a low Lp(a) level was a significant risk for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p=0.003, and p=0.01, respectively). The hazard ratio (95% CI) [1.48, 1.15-1.92] of a low Lp(a) level for cancer deaths was almost the same as that for a male sex (1.46, 1.00-2.13). Conclusions: This is the first report to describe the association between a low Lp(a) level and all-cause or cancer death, supporting the anti-neoplastic effect of Lp(a). Further epidemiological studies are needed to confirm the present results.
  • Yuichirou Yano, Satoshi Hoshide, Motohiro Shimizu, Kazuo Eguchi, Joji Ishikawa, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN JOURNAL OF HYPERTENSION 25 3 306 - 312 2012年03月 [査読有り][通常論文]
     
    BACKGROUND Our aim was to assess whether home blood pressure (HBP) and ambulatory BP monitoring measurement (ABPM), in addition to office BP (OBP) predict changes of cardiovascular biomarkers during antihypertensive treatment. METHODS Two hundred and fifty-two hypertensive patients (mean age, 68 years; men: 41%) underwent measurements of OBP, HBP, ABPM, and cardiovascular biomarkers (urinary albumin excretion (UAE) and brain natriuretic peptide (BNP)) before and after 6 months of treatment with candesartan (+/- thiazide-diuretics). RESULTS During the intervention, the OBP, HBP, daytime and night-time BP, and UAE levels were all significantly reduced (all P < 0.01). BNP was reduced only in the patients using diuretics (P = 0.003). For predicting the treatment-induced change in UAE, each of home systolic BP (SBP) and night-time SBP changes, but not daytime SBP change, had independent and significant value beyond OBP measurement (both P < 0.05). In contrast, for predicting the treatment-induced change in BNP, night-time SBP changes, but not home or daytime SBP changes, had significant value beyond OBP measurement (both P < 0.05). Patients who achieved a reduction in all three SBP parameters (office, home, and night-time SBP; n = 122) showed a more significant reduction of UAE compared with those who did not (-52.6 vs. 32.5%; P = 0.001), and patients who achieved a reduction in both office and night-time SBP (n = 134) showed a more significant reductions of BNP than those who did not (-12.9 vs. +12.8%; P < 0.05). CONCLUSIONS HBP and ABPM measurements, particularly night-time SBP values provide additional information for predicting treatment-induced changes of cardiovascular biomarkers when used in conjunction with office SBP measurement during antihypertensive treatment.
  • Yosuke Shibata, Shinya Hayasaka, Tomoyo Yamada, Toshiyuki Ojima, Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Yosikazu Nakamura
    CIRCULATION JOURNAL 75 6 1368 - 1372 2011年06月 [査読有り][通常論文]
     
    Background: Although many population-based studies have reported an association between physical activity and cardiovascular disease (CVD) among healthy populations, the association among CVD survivors has been less reported. We examined the relationship between physical activity and CVD risk among survivors. Methods and Results: This was a prospective cohort study of 12,490 Japanese participants, including 754 individual CVD survivors. Between April 1992 and July 1995, a baseline survey was conducted in 12 communities in Japan. The mean follow-up period was 11.9 years, during which time 74 individuals had non-fatal CVD and 51 cases were fatal CVD. Among CVD survivors, analysis was performed after exclusion of participants with a history of cancer and those who died within the first 2 years of follow-up. Physical activity was analyzed in tertiles (low, moderate and heavy), and the hazard ratios (HRs) were calculated for non-fatal or fatal CVD among CVD survivors. After setting the low group as the reference, the HRs for non-fatal CVD in the moderate and heavy groups were 0.61 (95% confidence interval: 0.30-1.24) and 0.50 (0.20-1.25) (P for trend=0.059), respectively, and the HRs for fatal CVD were 0.75 (0.33-1.69) and 0.18 (0.04-0.83) (P for trend=0.026), respectively. Conclusions: Physical activity reduced the risk of CVD, both fatal and non-fatal events, among CVD survivors. (Circ J 2011; 75: 1368 1372)
  • Tomoyo Yamada, Shinya Hayasaka, Yosuke Shibata, Toshiyuki Ojima, Tomohiro Saegusa, Tadao Gotoh, Shizukiyo Ishikawa, Yosikazu Nakamura, Kazunori Kayaba
    JOURNAL OF EPIDEMIOLOGY 21 3 169 - 175 2011年05月 [査読有り][通常論文]
     
    Background: It has been reported that fruit intake protects against cardiovascular disease (CVD). However, most of the relevant studies were conducted in Western countries, and only a few investigated Japanese populations. The present cohort study assessed the effect of citrus fruit intake on the incidence of CVD and its subtypes in a Japanese population. Methods: A baseline examination consisting of physical and blood examinations and a self-administered questionnaire was conducted during the period from April 1992 through July 1995. Dietary habits were assessed using a food frequency questionnaire that was divided into 5 categories. Citrus fruit was examined separately due to its frequent consumption by the general Japanese population. Using the Cox proportional hazards model, data from 10 623 participants (4147 men, 6476 women) who had no history of CVD or carcinoma were analyzed to assess the association between frequency of citrus fruit intake and CVD incidence. Results: Frequent intake of citrus fruit was associated with a lower incidence of CVD: the hazard ratio for almost daily intake versus infrequent intake of citrus fruit was 0.57 (95% confidence interval: 0.33-1.01, P for trend = 0.04) in men and 0.51 (0.29-0.88, P for trend = 0.02) in women. Frequent intake of citrus fruit was also associated with lower incidences of both all stroke and cerebral infarction, but not hemorrhagic stroke or myocardial infarction. Conclusions: Frequent intake of citrus fruit may reduce the incidence of CVD, especially cerebral infarction, in men and women.
  • Akizumi Tsutsumi, Kazunori Kayaba, Shizukiyo Ishikawa
    SOCIAL SCIENCE & MEDICINE 72 10 1652 - 1658 2011年05月 [査読有り][通常論文]
     
    The aims of the present study were to analyze the association between incident stroke, occupational class and stress and to examine whether the association is found in both men and women in a prospective study of Japanese male and female workers. A total of 3190 male and 3363 female Japanese community-dwelling workers aged 65 or under with no history of cardiovascular disease were followed. Occupational stress was evaluated using a demand-control questionnaire. The impact on stroke was examined in stratified analyses of occupational classes. We identified 147 incident strokes (91 in men and 56 in women) during the 11-year follow-up period. Men with high strain jobs (combination of high job demand and low job control) were nearly three times more likely to suffer from a stroke than men with low strain jobs (combination of low job demand and high job control). Among male workers in low occupational classes (blue-collar and non-managerial work), job strain was associated with a higher risk of stroke. In contrast, there was no association between job strain and incident stroke among male workers in high occupational classes (white-collar and managerial work). No statistically significant differences were found for stroke incidence among the job characteristic categories in all the female participants. However, significant, over five-fold excess risks were found among white-collar and managerial female workers exposed to high job strain, compared with their counterparts with low strain jobs. Our study of Japanese workers provided supportive evidence for vulnerability to occupational stress among lower occupational class workers in males but not in females. (C) 2011 Elsevier Ltd. All rights reserved.
  • Hiroyuki Iwahana, Shizukiyo Ishikawa, Joji Ishikawa, Tomoyuki Kabutoya, Kazunori Kayaba, Tadao Gotoh, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 21 2 95 - 101 2011年03月 [査読有り][通常論文]
     
    Background: Only a few population-based cohort studies have investigated the impact of atrial fibrillation (AF) on stroke in Japan. Methods: A total of 10 929 participants (4147 men and 6782 women) were included in this population-based prospective cohort study. Baseline data, including electrocardiograms (ECGs) to ascertain AF status, were obtained from April 1992 through July 1995 in 12 areas in Japan. Cox proportional hazards models were used to analyze the association of AF with stroke. Results: A total of 54 participants had AF (0.49%). The mean follow-up period was 10.7 years, during which 405 strokes were identified; 12 of these occurred in participants with AF. The crude incidence of stroke in participants with and without AF was 14.9 and 4.5 per 1000 person-years in men, respectively, and 39.3 and 2.7 per 1000 person-years in women. After adjusting for geographical area, sex, age, smoking status, drinking status, obesity, hypertension, dyslipidemia, and diabetes mellitus, the hazard ratios (95% confidence interval) of AF in all participants and in male and female participants were 4.11 (2.28-7.41), 2.12 (0.77-5.84), and 10.6 (5.01-22.4), respectively. The population attributable fraction (PAF) of stroke caused by AF was 2.2%; the PAFs were 1.0% and 3.6% in men and women, respectively. Conclusions: The present Japanese population-based prospective cohort study showed that AF is a major risk factor for stroke, especially in women.
  • Yosuke Baba, Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Eiji Kajii
    BLOOD PRESSURE 20 1 10 - 14 2011年02月 [査読有り][通常論文]
     
    Background. The relationship between pulse pressure (PP) and stroke has been described in populations outside Japan. Here, we investigated the relationship between PP and stroke incidence in Japan. Methods. Study subjects were 11,097 people (4315 men and 6782 women) in 12 rural areas of Japan enrolled in the Jichi Medical School Cohort Study, a population-based prospective study. The subjects were divided into quintiles of PP. Baseline data were obtained by questionnaire and health checkups between April 1992 and July 1995, and the incidence of all strokes and stroke subtypes was monitored. Results. A total of 412 strokes were observed during a mean follow-up period of 10.7 years. After adjusting for age, smoking status, drinking status, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, body mass index and diabetes mellitus, hazard ratios [HRs] in the second to fifth quintiles of PP for all strokes were 1.06 (95% confidence interval [CI] 0.69-1.64), 1.53 (CI 1.02-2.28), 2.02 (CI 1.38-2.96) and 2.22 (CI 1.53-3.20) compared with the first quintile using Cox's proportional hazard model, respectively. Conclusion. Our findings suggest high PP is at an increased risk of stroke.
  • Naoki Nago, Shizukiyo Ishikawa, Tadao Goto, Kazunori Kayaba
    JOURNAL OF EPIDEMIOLOGY 21 1 67 - 74 2011年01月 [査読有り][通常論文]
     
    Background: We investigated the relationship between low cholesterol and mortality and examined whether that relationship differs with respect to cause of death. Methods: A community-based prospective cohort study was conducted in 12 rural areas in Japan. The study subjects were 12 334 healthy adults aged 40 to 69 years who underwent a mass screening examination. Serum total cholesterol was measured by an enzymatic method. The outcome was total mortality, by sex and cause of death. Information regarding cause of death was obtained from death certificates, and the average follow-up period was 11.9 years. Results: As compared with a moderate cholesterol level (4.14-5.17 mmol/L), the age-adjusted hazard ratio (FIR) of low cholesterol (<4.14 mmol/L) for mortality was 1.49 (95% confidence interval [CI]: 1.23-1.79) in men and 1.50 (1.10-2.04) in women. High cholesterol (>= 6.21 mmol/L) was not a risk factor. This association was unchanged in analyses that excluded deaths due to liver disease, which yielded age-adjusted HRs of 1.38 (95% CI, 1.13-1.67) in men and 1.49 (1.09-2.04) in women. The multivariate-adjusted HRs and 95% CIs of the lowest cholesterol group for hemorrhagic stroke, heart failure (excluding myocardial infarction), and cancer mortality significantly higher than those of the moderate cholesterol group, for each cause of death. Conclusions: Low cholesterol was related to high mortality even after excluding deaths due to liver disease from the analysis. High cholesterol was not a risk factor for mortality.
  • Kazuo Eguchi, Satoshi Hoshide, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION 4 5 255 - 262 2010年09月 [査読有り][通常論文]
     
    Data relating habitual sleep duration to the risk of silent or overt stroke are sparse. We tested the hypothesis that short duration of sleep is associated with increased risk of silent cerebral infarct (SCI) and stroke events in hypertensive patients. We performed ambulatory BP monitoring in 1268 hypertensives (mean age: 70.4 years) and followed them for 50 months. Brain MRI was performed in 932 of these subjects for the assessment of SCI, and these subjects were analyzed in this study. Cox proportional hazard models were used to calculate the hazard ratios (HR) of sleep-duration-associated risk for cardiovascular events while controlling for significant covariates. In multivariable Cox regression analysis, a sleep duration <7.5 h was independently associated with the risk of stroke (HR = 2.21; P = 0.003). The presence of SCI was also associated with stroke events (HR = 2.60; P = 0.005). When the subjects were divided into an SCI(+) group and SCI(-) group, the short sleep duration was a significant predictor for incident stroke only in the SCI(+) group (HR = 2.52; P = 0.001). Shorter sleep duration was an independent risk for future incidence of stroke events in hypertensive patients, especially those with SCIs. J Am Soc Hypertens 2010;4(5):255-262. (C) 2010 American Society of Hypertension. All rights reserved.
  • Yukiko Ishikawa, Joji Ishikawa, Shizukiyo Ishikawa, Eiji Kajii, Joseph E. Schwartz, Thomas G. Pickering, Kazuomi Kario
    JOURNAL OF HYPERTENSION 28 8 1630 - 1637 2010年08月 [査読有り][通常論文]
     
    Background Prehypertension is associated with an increased risk of the development of hypertension and subsequent cardiovascular disease. However, it is unclear whether the increased risk of cardiovascular disease associated with prehypertension varies by duration of follow-up (i.e., the first 5 years vs. second 5 years) or varies between nonelderly and elderly individuals. Methods We enrolled 11 000 community dwelling persons (6739 women and 4261 men, aged 18-90 years) from the Japanese general population, followed them for an average of 10.7 +/- 2.4 years (117 517 person-years) and evaluated the incidence of cardiovascular events (including both stroke and myocardial infarction). Results In the full cohort, prehypertension was associated with a 45% higher risk of cardiovascular events than normal blood pressure after adjusting for traditional cardiovascular risk factors (hazard ratio = 1.45, P = 0.03). The risk of cardiovascular events with prehypertension during the second 5-year period was elevated in the nonelderly subgroup (<65 years) (hazard ratio = 2.13, P = 0.01), but not in the elderly subgroup (>= 65 years) (hazard ratio = 0.93, P = 0.82) (P = 0.054 for the difference in hazard ratio). The elevated risk with prehypertension during the first 5-year period was not significant in either the nonelderly (hazard ratio = 1.60, P = 0.36) or elderly (hazard ratio = 1.19, P = 0.63) group. However, the risks with prehypertension were not statistically different between the first and second 5-year period. Conclusion Prehypertension is associated with an increased 10-year risk of cardiovascular disease; the provocative finding that this risk may be especially elevated during the second 5-year period in the nonelderly requires confirmation in a larger cohort. J Hypertens 28: 1630-1637 (c) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
  • Hideo Hirose, Shizukiyo Ishikawa, Tadao Gotoh, Tomoyuki Kabutoya, Kazunori Kayaba, Eiji Kajii
    JOURNAL OF CARDIOLOGY 56 1 23 - 26 2010年07月 [査読有り][通常論文]
     
    Background and purpose: Premature ventricular complexes (PVCs) are frequently encountered in healthy people. But the association between PVCs and cardiac events is not well established in Japan. We investigated the association of PVCs and cardiac deaths in people without cardiovascular disease in the Jichi Medical School (JMS) Cohort study. Methods and subjects: We conducted a prospective cohort study in 12 districts in Japan as part of the JMS cohort study. Baseline data were obtained between April 1992 and July 1995. We excluded subjects who had myocardial infarction and stroke and those who had not received 12-lead electrocardiograms. Cox's proportional hazard model was used to calculate the hazard ratios (HRs) of cardiovascular mortality of subjects with PVCs, using subjects without PVCs as reference. Results: A total of 11,158 participants (4333 males and 6825 females) were analyzed. Participants were followed for an average of 11.9 years. PVCs were present in 1.4% of men and 1.1% of women. There were 92 cardiac deaths (47 males and 45 females) during the follow-up period. In crude cardiovascular mortality, HRs (95% confidence interval [CI]) were 5.29 (1.64-17.0) in males and 2.14 (0.29-15.5) in females. Age-adjusted HRs were 3.73 (1.16-12.0) and 0.98 (0.13-7.21), respectively. After further adjustment for body mass index, systolic blood pressure, total cholesterol level, high-density lipoprotein-cholesterol, and blood glucose, HRs were 3.98 (1.21-13.0) and 0.95 (0.13-7.11), respectively. Conclusions: We conclude that PVCs are a predictive factor for cardiac death in men without structural heart disease. (c) 2010 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.
  • Kazuomi Kario, Satoshi Hoshide, Motohiro Shimizu, Yuichiro Yano, Kazuo Eguchi, Joji Ishikawa, Shizukiyo Ishikawa, Kazuyuki Shimada
    JOURNAL OF HYPERTENSION 28 7 1574 - 1583 2010年07月 [査読有り][通常論文]
     
    Objectives To study the impact of the dosing time of an angiotensin II receptor blocker (ARB) titrated by self-measured home blood pressure (HBP) on cardiorenal damage in hypertensives. Methods We conducted an open-label multicenter trial, the J-TOP study, that enrolled 450 hypertensives with self-measured systolic HBP more than 135 mm Hg. The study patients were stratified into three groups according to the difference between their morning and evening SBPs difference: a morning hypertension group (morning and evening difference at least 15 mm Hg; n=170), a morning and evening hypertension group (0 mm Hg <= morning and evening difference <15 mm Hg; n=198), and an evening hypertension group (morning and evening difference <0 mm Hg; n=82). Individuals were then randomly allocated to receive bedtime dosing or awakening dosing of candesartan (+/-diuretic as needed) titrated to achieve a target systolic HBP less than 135 mm Hg. The 6-month change in the urinary albumin/creatinine ratio (UACR) was assessed. Results In total patients, the UACR was more markedly reduced in the bedtime-dosing group than in the awakening-dosing group (-45.7 vs. -34.5%, P=0.02), whereas there were no differences in the reduction of any of the HBPs including the sleep blood pressures (BPs) between the two groups. Among the three subgroups stratified by the morning and evening difference, the difference in the UACR reduction between the bedtime-dosing and awakening-dosing groups was only significant in the morning hypertension group (-50.6 vs. -31.3%, P=0.02). Conclusion In HBP-guided antihypertensive treatment in hypertensives, bedtime dosing of an ARB may be superior to awakening dosing for reducing microalbuminuria. J Hypertens 28: 1574-1583 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
  • M. Matsumoto, S. Ishikawa, E. Kajii
    RURAL AND REMOTE HEALTH 10 3 1493  2010年07月 [査読有り][通常論文]
     
    Introduction: An urban-rural gap in stroke incidence or mortality has been reported. However, whether the effect of rurality on stroke is independent of the distribution of conventional individual-level risk factors and other community-level risk factors is inconclusive. Methods: A cohort study was conducted involving 4849 men and 7529 women residing in 12 communities throughout Japan. Baseline data were obtained between April 1992 and July 1995. Follow up was conducted annually to capture first-ever-in-life stroke events. During that period, geographic, demographic and weather information was obtained for each community. Multi-level logistic regression analysis was conducted to evaluate the association between stroke incidence and each geographic/demographic factor adjusted for meteorological parameters (temperature and rainfall), in addition to individual-level risk factors (age, body mass index, smoking, total cholesterol, hypertension, and diabetes). Results: Throughout an average of 10.7 years' follow up, 229 men and 221 women with stroke events were identified. In women, low population (odds ratio [OR] per 1000 persons 0.97; 95% confidence interval 0.94-1.00), low population density (OR per 1/km(2) 0.85; 0.74-0.97) and high altitude (OR per 100 m 1.18; 1.09-1.28) increased the risk of stroke independently of individual-level risk factors; however, significance was absent for all three associations when further adjusted for weather parameters. Conversely, the association between each meteorological parameter and stroke in women was significant, even after adjustment for each of the three geographic/demographic factors. Similar results were obtained for cerebral infarction. Conclusion: The association between living in rural communities and stroke may be caused by the confounding effect of weather conditions in the communities studied.
  • Yosuke Baba, Shizukiyo Ishikawa, Yoko Amagi, Kazunori Kayaba, Tadao Gotoh, Eiji Kajii
    MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY 17 3 506 - 510 2010年05月 [査読有り][通常論文]
     
    Objective: Few epidemiological studies have examined the relationship between age at menopause and stroke incidence, and none have done so in Japanese women. Here, we investigated the relationship between age at menopause and stroke incidence in a large group of Japanese women. Methods: The study participants were 4,790 postmenopausal women aged 36 to 89 years enrolled in the Jichi Medical School Cohort Study, a population-based prospective study. Baseline data were obtained by questionnaire and health checkups between April 1992 and July 1995 in 12 rural areas in Japan. The incidence of all strokes and stroke subtypes was monitored. Results: Mean (SD) participant age was 61.0 (6.7) years, and mean (SD) age at menopause was 48.3 (4.8) years. A total of 185 strokes were observed during a mean follow-up of 10.8 years. On adjustment for age, systolic blood pressure, total cholesterol, body mass index, smoking habits, and alcohol drinking habits, hazard ratios (95% CIs) of stroke for women who underwent menopause before age 40 years, at 40 to 44 years, at 45 to 49 years, and at 55 years or after relative to those who underwent menopause at age 50 to 54 years were 1.56 (0.78-3.12), 1.59 (1.00-2.51), 1.28 (0.92-1.78), and 0.83 (0.38-1.81), respectively. However, hazard ratios (95% CI) of cerebral infarction for women who underwent menopause before age 40 years, at 40 to 44 years, at 45 to 49 years, and at 55 years or after relative to those who underwent menopause at age 50 to 54 years were 2.57 (1.20-5.49), 1.49 (0.80-2.78), 1.06 (0.67-1.68), and 1.08 (0.43-2.74), respectively. Conclusions: Our data suggest that Japanese women who undergo menopause before age 40 years are at an increased risk of cerebral infarction. Premature menopause should be considered an indicator of the need for more aggressive medical intervention aimed at the prevention of cerebral infarction.
  • Kazuo Eguchi, Yoshio Matsui, Seiichi Shibasaki, Satoshi Hoshide, Tomoyuki Kabutoya, Joji Ishikawa, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN JOURNAL OF HYPERTENSION 23 5 522 - 527 2010年05月 [査読有り][通常論文]
     
    BACKGROUND The significance of home blood pressure (BP) measurement in type 2 diabetes (T2DM) has not been well investigated. We aimed to test the hypotheses that home BP is more closely associated with target-organ damage than clinic BP, and that the presence of prediabetes/T2DM enhances the impact of home BP measurement. METHODS We studied 551 hypertensives (99 diabetics and 452 nondiabetics) whose self-measured systolic BP (SBP) was >135 mm Hg while on medication. The subjects were followed for 6 months after allocation to either a control group or an active treatment group. The changes in clinic BP and home BP were analyzed in relation to the changes in the spot urine albumin-creatinine ratio (UAR). RESULTS The extent of clinic and home BP reduction was similar between the diabetic and nondiabetic groups. The change in UAR in nondiabetics was significantly associated with the extent of SBP reduction in the clinic (r = 0.19), morning (r = 0.33), and evening (r = 0.22, all P < 0.01). In contrast, in the diabetic group, the change in UAR was significantly associated with the changes in morning SBP (r = 0.23, P = 0.02) and evening SBP (r = 0.39, P < 0.001), but not with clinic BP. The correlation with evening SBP in the diabetic group tended to be stronger than the nondiabetic group. CONCLUSIONS In hypertensives with prediabetes/T2DM, changes in home BP were better than changes in clinic BP to predict changes in UAR. In particular, this suggests the hypothesis that aggressive control of evening home BP might be equally or more important to morning BP in hypertensives with prediabetes/T2DM.
  • Yosuke Shibata, Shinya Hayasaka, Tomoyo Yamada, Yasuaki Goto, Toshiyuki Ojima, Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Yosikazu Nakamura
    JOURNAL OF EPIDEMIOLOGY 20 3 225 - 230 2010年05月 [査読有り][通常論文]
     
    Background: Many studies have reported an association between physical activity and cardiovascular disease (CVD); however, the effect of physical activity remains controversial. Few such studies have been conducted in Japan. Therefore, we examined the relationship between physical activity and death from CVD using prospective data from a Japanese population. Methods: From a prospective cohort study that comprised 12 490 participants, data from 9810 were analyzed. From April 1992 through July 1995, a baseline survey was conducted in 12 communities in Japan. The participants were Followed up until December 2005. Physical activity was assessed using the physical activity index (PAI). PAI scores were grouped in quartiles: Q1 was the lowest PAI quartile and Q4 was the highest. Hazard ratios (HRs) for death from CVD, stroke, and myocardial infarction (MI) were calculated for all PAI quartiles. Results: The mean follow-up period was 11.9 years, during which time 194 participants died of CVD. With Q1 as the reference, the HRs for death from CVD in Q2, Q3, and Q4, were 0.62 (95% confidence interval, 0.40-0.98), 0.53 (0.31-0.88), and 0.40 (0.22-0.73), respectively, in men, and 0.71(0.38-1.32). 0.52 (0.26-1.04), and 0.48 (0.22-1.05), respectively, in women. The HRs for death from CVD subtypes were similar but not statistically significant. Conclusions: Among a Japanese population, physical activity was associated with a decreased risk of death from CVD. However, more evidence is needed to elucidate the relationships between physical activity and CVD subtypes.
  • Kazuo Eguchi, Satoshi Hoshide, Yoko Hoshide, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    JOURNAL OF HYPERTENSION 28 5 918 - 924 2010年05月 [査読有り][通常論文]
     
    Objective We tested the reproducibility of ambulatory blood pressure (ABP), BP variability, and BP reduction in hypertensive patients. Methods Forty-two hypertensive patients were enrolled, and ABP monitoring (ABPM) was performed four times in each patient: twice before and twice after the treatment. Morning BP was defined as the average of 2 h after waking, and morning BP surge (MBPS) was defined by four ways: sleep-trough, preawake, morning-evening and morning-after-bed surge. The BP variability was evaluated by standard deviation, weighted standard deviation, coefficient of variation and average real variability. The reproducibility was compared using the repeatability coefficient and the Bland-Altman's method. Results The awake, sleep, 24-h and morning BP were well corresponded in the first and the second ABPM values in each period. The four measures of BP variability also corresponded well between the first and the second ABPM values in each period. MBPS did not correspond well in each period when it was defined by diaries, but the extent of correlation was improved when it was defined by actigraphy. The reproducibility of BP-lowering effect was fair when it was defined by a single parameter, but not very good when it was defined by two parameters (e.g. MBPS). Conclusion The reproducibility of ABP levels and BP variability was fairly good and that of MBPS was moderate when defined by actigraphy. The good reproducibility of BP reduction means that each single ABPM, before and after the treatment, is acceptable for the assessment of drug efficacy. J Hypertens 28:918-924 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
  • Yoko Amagai, Shizukiyo Ishikawa, Tadao Gotoh, Kazunori Kayaba, Yosikazu Nakamura, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 20 2 106 - 110 2010年03月 [査読有り][通常論文]
     
    Background: Although sleep is one of the most important health-related factors, the relationship between sleep duration and the incidence of cardiovascular events has not been fully described. Methods: The present Study comprised the 11 367 Study Subjects (4413 men and 6954 women) of the Jichi Medical School Cohort Study, a population-based prospective Study. Baseline data were obtained by questionnaire and health examinations between April 1992 and July 1995 in 12 rural areas in Japan, and the main outcome measures were the incidence of cardiovascular diseases (stroke and myocardial infarction [MI]). Cox proportional hazards models were used to analyze the association between sleep duration and the incidence of cardiovascular events. Results: A total of 481 cardiovascular events (255 men and 226 women) were observed during all average follow-Lip period of 10.7 years. After ad Listing for age, systolic blood pressure, serum total cholesterol, body mass index, smoking habits, and alcohol drinking habits, the hazard ratios (95% confidence intervals) for the incidence of cardiovascular diseases for individuals sleeping less than 6 hours and 9 hours or longer were 2.14 (1.11-4.13) and 1.33 (0.93-1.92) in men, and 1.46 (0.70-3.04) and 1.28 (0.88-1.87) in women, respectively, relative to those who reported sleeping 7 to 7.9 hours per day. Conclusions: Our data indicate that men who sleep less than 6 hours a day have a higher risk of cardiovascular events than those sleeping 7 to 7.9 hours.
  • Masatoshi Matsumoto, Shizukiyo Ishikawa, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 20 2 136 - 142 2010年03月 [査読有り][通常論文]
     
    Background: Although seasonal variation in stroke incidence has been reported, it is not known whether yearlong exposure to particular meteorological conditions affects the risk of stroke independently of conventional cardiovascular risk factors. Methods: We conducted a cohort study involving 4849 men and 7529 women residing in 12 communities dispersed throughout Japan. Baseline data were obtained from April 1992 through July 1995. Follow-Lip was conducted annually to capture first-ever-in-life stroke events. Weather information during the period was also obtained for each community. Multilevel logistic regression analysis was conducted to evaluate the association between stroke incidence and each meteorological parameter adjusted for age, obesity, smoking status, total cholesterol, systolic blood pressure, diabetes, and other meteorological parameters. Results: Over an average of 10.7 years of follow-up, 229 men and 221 women had stroke events. Among women, high annual rainfall (OR per 1000 mm, 1.46; 95% confidence interval, 1.05-2.03). low average ambient temperature (OR per 1 degrees C, 0.79; 0.66-0.94), and number of cold days per year (OR per 10 days, 3.37; 1.43-7.97) were associated with increased risk of stroke incidence, independent of conventional risk factors. Among men, number of cold days (OR per 10 days, 1.07; 1.02-1.12) was associated with all increased risk of stroke incidence, but the association became non-significant after adjustment for other risk factors. Similar results were obtained for cerebral infarction and cerebral hemorrhage. Conclusions: Long-term exposure to some meteorological conditions inlay affect the risk of stroke, particularly in women, independent of conventional risk factors.
  • Yasunori Niwa, Shizukiyo Ishikawa, Tadao Gotoh, Kazunori Kayaba, Yosikazu Nakamura, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 20 1 62 - 69 2010年01月 [査読有り][通常論文]
     
    Background: Metabolic syndrome increases the morbidity and mortality of cardiovascular diseases. However, few studies have examined the association between the incidence of stroke and metabolic syndrome, as defined by Japanese criteria. The aim of this study was to identify the association between stroke and metabolic syndrome, as defined by criteria used in Japan. Methods: A total of 2205 subjects (920 men and 1285 women) were examined between 1992 and 1995 as part of the Jichi Medical School Cohort Study. Metabolic syndrome was defined using the Japanese criteria. Medical records, computed tomography, and magnetic resonance imaging were used to diagnose stroke. The Cox proportional-hazards model was used to analyze the association between metabolic syndrome and incident stroke. Results: The prevalence of metabolic syndrome at baseline was 9.0% in men and 1.7% in women. There were 96 incident strokes during an 11.2-year follow-up period, 14 of which Occurred in Subjects with metabolic syndrome. Among Subjects with metabolic syndrome, the age-adjusted hazard ratio (95% confidence interval) for stroke was 1.93 (0.94-3.96) in men and 6.85 (2.68-17.47) in women. After adjusting for age, smoking status, and alcohol drinking status, the hazard ratio was 1.89 (0.88-4.08) in men and 7.24 (2.82-18.58) in women. Age-adjusted hazard ratios associated with having 2 or more components of metabolic syndrome, with and without central obesity, were 2.93 (1.21-7.08) and 3.20 (1.23-8.31) in men and 1.75 (0.69-4.44) and 8.64 (2.82-28.03) in women, respectively, Conclusions: The presence of metabolic syndrome, as defined by Japanese criteria, increases the risk of stroke; this effect was highly significant among women.
  • Shizukiyo Ishikawa, Kazuomi Kario
    HYPERTENSION RESEARCH 32 11 934 - 935 2009年11月 [査読有り][通常論文]
  • Seiichi Shibasaki, Kazuo Eguchi, Yoshio Matsui, Joji Ishikawa, Satoshi Hoshide, Shizukiyo Ishikawa, Tomoyuki Kabutoya, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    JOURNAL OF HYPERTENSION 27 6 1252 - 1257 2009年06月 [査読有り][通常論文]
     
    Background It has been demonstrated that insulin resistance is associated with morning hypertension. We investigated the hypothesis that the lowering of morning blood pressure (BP) can improve insulin resistance in patients with morning hypertension. Methods In the present study, 611 treated hypertensive patients with morning hypertension were randomized into either a doxazosin group, for whom a once-daily bedtime dose of doxazosin was added to the current medication regimen, or a control group, who continued their current medication. The homeostasis model assessment of the insulin resistance index (HOMA-IR) was performed at baseline and the 6th month of treatment. The associations between change in HOMA-IR and changes in systolic BP (SBP) measures were assessed by multiple regression analyses with adjustment for covariates. Results HOMA-IR was significantly decreased in the doxazosin group (2.1 +/- 3.0 to 1.8 +/- 2.6, P = 0.04) but not in the control group. The change in HOMA-IR was significantly associated with the change in morning SBP (r = 0.10, P = 0.02) but not with evening SBP. In multiple regression analysis, the change in HOMA-IR was independently and significantly associated with the change in morning SBP (beta = 0.15, P = 0.016) but not with the change in evening SBP. Conclusion In patients with morning hypertension, specific treatment for morning hypertension with an adrenergic blockade has a beneficial effect on insulin resistance. J Hypertens 27:1252-1257 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
  • Atsuko Sadakane, Tadao Gotoh, Shizukiyo Ishikawa, Yosikazu Nakamura, Kazunori Kayaba
    JOURNAL OF EPIDEMIOLOGY 19 3 107 - 115 2009年05月 [査読有り][通常論文]
     
    Background: Lower mortality has been reported in light-to-moderate alcohol drinkers. We examined the association between the amount and frequency of alcohol consumption and all-cause mortality in a Japanese population. Methods: We conducted a prospective cohort study among 8934 Japanese people (3444 men and 5490 women) who completed a baseline survey between 1992 and 1995. We confirmed the date and cause of death by referring to death certificates. The Cox proportional hazards model was used to evaluate the effect of alcohol consumption on risk for all-cause mortality, after adjustment for potential confounding factors. Results: We identified 637 (397 men and 240 women) deaths during the 12.0 years of mean follow-up. Among men, as compared with non-drinkers, the relative risk was higher in ex-drinkers (hazard ratio [HR], 1.18), lower in light drinkers (HR, 0.95) and moderate drinkers (HR, 0.91), and significantly higher in heavy drinkers (HR, 1.67; 95% confidence interval, 1.10-2.55). Among women, light, moderate, and heavy drinkers were grouped into current drinkers. The relative risk was slightly higher in current drinkers (HR, 1.23), and that in ex-drinkers was near 1.0 (HR, 0.97). In stratified analysis, the harmful effects of heavy drinking were more severe among male smokers and younger men. In terms of frequency, men who drank only on special occasions had the highest mortality (HR, 1.28), regardless of alcohol intake per drinking session. Conclusions: In men, a near J-shaped association was identified between alcohol consumption and all-cause mortality. Both the amount and frequency of alcohol consumption were related to mortality.
  • Shizukiyo Ishikawa, Masatoshi Matsumoto, Kazunori Kayaba, Tadao Gotoh, Naoki Nago, Akizumi Tsutsumi, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 19 2 101 - 106 2009年03月 [査読有り][通常論文]
     
    Background: Risk charts are used to estimate the risk of cardiovascular diseases; however, most have been developed in Western Countries. In Japan, currently available risk charts are based on mortality data. Using data on cardiovascular disease incidence from the JMS Cohort Study, we developed charts that illustrated the risk of stroke.Methods and Results: The JMS Cohort Study is a community-based cohort study of cardiovascular disease. Baseline data were obtained between 1992 and 1995, In the present analysis, the participants were 12 276 subjects without a history of stroke; the follow-up period was 10.7 years. Color-coded risk charts were created by using Cox's proportional hazards models to calculate 10-year absolute risks associated with sex, age, smoking status, diabetes status, and systolic blood pressure. The risks of stroke and cerebral infarction rose as age and systolic blood pressure increased. Although the risk of cerebral hemorrhage were generally lower than that of cerebral infarction, the patterns of association with risk factors were similar.Conclusion: These risk charts should prove useful for clinicians and other health professionals who are required to estimate an individual's risk for stroke.
  • Masatoshi Matsumoto, Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Naoki Nago, Akizumi Tsutsumi, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 19 2 94 - 100 2009年03月 [査読有り][通常論文]
     
    Background: Risk charts that depict the absolute risk of myocardial infarction (MI) for each combination of risk factors in individuals are convenient and beneficial tools for primary prevention of ischemic heart disease. Although risk charts have been developed using data from North American and European cardiovascular cohort studies, there is no such chart derived from cardiovascular incidence data obtained from the Japanese population.Methods and Results: We calculated and constructed risk charts that estimate the 10-year absolute risk of MI by using data from the Jichi Medical School (JMS) Cohort Study-a prospective cohort study which followed 12490 participants in 12 Japanese rural communities for an average of 10.9 years. We identified 92 cases of a clinically-certified MI event. Color-coded risk charts were created by calculating the absolute risk associated with the following conventional cardiovascular risk factors: age, sex, smoking status, diabetes status, systolic blood pressure, and serum total cholesterol.Conclusions: In health education and clinical practice, particularly in rural communities, these charts should prove useful in understanding the risks of MI, without the need for cumbersome calculations. In addition, they can be expected to provide benefits by improving existing risk factors in individuals.
  • Yu Hatano, Masatoshi Matsumoto, Shizukiyo Ishikawa, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 19 2 49 - 55 2009年03月 [査読有り][通常論文]
     
    Background: Adiponectin is associated with many cardiovascular risk factors. Thus, a relation between adiponectin and subsequent coronary heart disease has been hypothesized. However, the results of prospective studies have been conflicting. Methods: In this nested case-control study, blood samples were collected from 5243 of 12 490 community residents enrolled in the Jichi Medical School Cohort Study. The samples were taken between 1992 and 1995 and stored until 2007, at which point the plasma adiponectin level was measured. Results: During an average of 9.4 years of follow-up, 38 patients with myocardial infarction and 89 controls matched for age, sex, and community were identified. Plasma adiponectin concentration did not significantly differ between cases and controls (geometric mean 7.6 [interquartile range, 5.0-12.2] versus 7.4 [5.4-11.0] mg/L, respectively, P = 0.57). The odds of myocardial infarction in the lowest tertile of adiponectin concentration was not significantly different from that in the highest tertile, after adjustment for age and sex (OR 1.33; 95% CI, 0.50-3.55) or after further adjustment for other cardiovascular risk factors (OR 1.69; 95% CI, 0.45-6.25). Similarly, there was no significant difference in odds of myocardial infarction between the lowest and highest quartiles of adiponectin concentration. Conclusion: The results do not support an association between hypoadiponectinemia and myocardial infarction.
  • Tomoyuki Kabutoya, Joji Ishikawa, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN JOURNAL OF HYPERTENSION 22 1 35 - 40 2009年01月 [査読有り][通常論文]
     
    BACKGROUND The negative white-coat effect (WCE), a phenomenon in which out-of-office blood pressure (BP) is higher than clinic BP, has not been well examined, unlike the WCE. METHODS As part of the Jichi Morning Hypertension Research study, in which clinic and home BP were measured in 969 hypertensive outpatients, 405 patients with normal clinic BP were separately analyzed, Clinic BP was measured on two different occasions, and home BP was measured twice in the morning and twice in the evening for three consecutive days. Clinic and home BP were each averaged from all readings, and negative WCE was defined as clinic systolic BP (SBP) lower than home SBP. RESULTS Negative WCE was observed in 324 (33%) of the patients overall and in 173 (42%) of the patients with controlled BP (clinic BP < 140/90 mm Hg). In multiple logistic regression analysis adjusting for covariates including home SBP and pulse rate, negative WCE was correlated with older age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.06) and male gender (OR 1.08, 95% CI 1.01-1.14) in overall subjects. Among patients with well-controlled clinic BP, negative WCE was significantly correlated with the presence of ischemic heart disease (OR 1.17, 95% CI 1.04-1.31). The association of negative WCE with age and male gender remained significant under stringent criteria (negative WCE < -10.2 mm Hg (the mean -1 s.d.)). CONCLUSIONS Negative WCE remaining even after clinic BP is controlled may be related to cardiovascular risk factors such as older age, male gender, and a history of ischemic heart disease.
  • Joji Ishikawa, Shizukiyo Ishikawa, Tomoyuki Kabutoya, Tadao Gotoh, Kazunori Kayaba, Joseph E. Schwartz, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    HYPERTENSION 53 1 28 - U52 2009年01月 [査読有り][通常論文]
     
    Left ventricular hypertrophy (LVH), assessed by ECG, is associated with an increased risk for cardiovascular events among hypertensive subjects. We evaluated the risks of LVH in a Japanese general population including normotensive and prehypertensive subjects. We measured ECG and blood pressure in 10 755 subjects at baseline. The Cornell product (CP) and Sokolow-Lyon (SL) voltage were calculated as markers of LVH (CP >= 2440 mm x ms and SL voltage >= 38 mm). Follow-up was performed for 10 years, and the incidence of stroke and myocardial infarction was evaluated. The prevalence of CP-LVH was 2.7% for normotensives, 5.2% for prehypertensives, and 11.0% for hypertensives, and the prevalence of SL-LVH was 5.0%, 8.2%, and 15.2%, respectively. In all of the subjects, CP-LVH and SL-LVH were both predictors of stroke (CP-LVH: hazard risk: 1.62, 95% CI: 1.19 to 2.20, P = 0.002; SL-LVH: hazard risk: 1.29, 95% CI: 0.98 to 1.71, P = 0.07) after adjustment for confounding factors but were not predictors of myocardial infarction. The adjusted hazard ratio of CP-LVH predicting stroke was especially high in the normotensives (hazard risk: 7.53; 95% CI: 3.39 to 16.77). In the normotensives, diabetes mellitus and hyperlipidemia were significant determinants of CP-LVH but not of SL-LVH. In all of the hypertensive subgroups (normotensives, prehypertensives, and hypertensives), the c-statistic for the equation predicting stroke increased when CP-LVH was added to the model but not when SL-LVH was added. In conclusion, both CP-LVH and SL-LVH are risk factors for stroke in the Japanese general population. CP-LVH is related to glucose abnormality, and its predictive value for stroke is seen even in normotensives and prehypertensives. (Hypertension. 2009; 53: 28-34.)
  • Akizumi Tsutsumi, Kazunori Kayaba, Kazuomi Kario, Shizukiyo Ishikawa
    ARCHIVES OF INTERNAL MEDICINE 169 1 56 - 61 2009年01月 [査読有り][通常論文]
     
    Background: No prospective studies have examined the association between occupational stress according to the job demand-control model and the risk of stroke in Asian populations.Methods: We conducted a multicenter community-based prospective study of 6553 Japanese male and female workers. Occupational stress was evaluated using a Japanese version of the job demand-control model questionnaire. We used the Cox proportional hazards model to evaluate the association between occupational stress and stroke.Results: During a mean follow-up of 11 years, we identified 147 incident strokes. Multivariable analysis revealed a more than 2-fold increase in the risk of total stroke among men with job strain (combination of high job demand and low job control) (hazard ratio, 2.73; 95% confidence interval, 1.17-6.38) compared with counterpart men with low strain (combination of low job demand and high job control) after adjustment for age, educational attainment, occupation, smoking status, alcohol consumption, physical activity, and study area. Additional adjustments for biologic risk factors attenuated the hazard ratio, but there continued to be statistical significance (hazard ratio, 2.53; 95% confidence interval, 1.08-5.94). In women, no statistically significant differences were found for any stroke incidence among the job characteristic categories.Conclusion: Occupational stress related to job strain was associated with incident strokes among Japanese men.
  • Shinya Hayasaka, Yosuke Shibata, Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Tatsuya Noda, Chiyoe Murata, Tomoyo Yamada, Yasuaki Goto, Yosikazu Nakamura, Toshiyuki Ojima
    JOURNAL OF EPIDEMIOLOGY 19 1 24 - 27 2009年01月 [査読有り][通常論文]
     
    Background: In April 2008, a new health check-up and health guidance system was introduced by the Japanese Government to promote increased physical activity. However, few studies have documented the health benefits of physical activity in Asian populations. We examined the association between all-cause mortality and level of physical activity in a Japanese multicommunity population-based study. Methods: The Jichi Medical School Cohort Study is a multicommunity, population-based study based in 12 districts in Japan. Baseline data from 4222 men and 6609 women (mean age, 54.8 and 55.0 years, respectively) were collected between April 1992 and July 1995. The participants were followed for a mean duration of 11.9 years. To determine the association between all-cause mortality and level of physical activity, crude mortality rates per 1000 person-years and hazard ratios (HRs) with 95% confidence intervals (CI) were determined using the Cox proportional hazards model. Physical activity was categorized by using physical activity index (PAI) quartiles. The lowest (first) PAI quartile was defined as the HR reference. Results: In men, the lowest mortality rate was observed in the third quartile, with 95 deaths and a crude mortality rate of 7.6; the age- and area-adjusted HR was 0.59 (95% CI, 0.45-0.76), and the mortality curve had a reverse J shape. In women, the lowest mortality rate was observed in the highest PAI quartile, with 69 deaths and a crude mortality rate of 3.5; the HR was 0.81 (95% CI, 0.58-1.12). Conclusion: Our results suggest that increased physical activity lowers the risk for all-cause death in Japanese.
  • Kazuo Eguchi, Thomas G. Pickering, Joseph E. Schwartz, Satoshi Hoshide, Joji Ishikawa, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    ARCHIVES OF INTERNAL MEDICINE 168 20 2225 - 2231 2008年11月 [査読有り][通常論文]
     
    Background: It is not known whether short duration of sleep is a predictor of future cardiovascular events in patients with hypertension. Methods: To test the hypothesis that short duration of sleep is independently associated with incident cardiovascular diseases (CVD), we performed ambulatory blood pressure (BP) monitoring in 1255 subjects with hypertension (mean [SD] age, 70.4 [9.9] years) and followed them for a mean period of 50 (23) months. Short sleep duration was defined as less than 7.5 hours (20th percentile). Multivariable Cox hazard models predicting CVD events were used to estimate the adjusted hazard ratio and 95% confidence interval (CI) for short sleep duration. A riser pattern was defined when mean nighttime systolic BP exceeded daytime systolic BP. The end point was a cardiovascular event: stroke, fatal or nonfatal myocardial infarction (MI), and sudden cardiac death. Results: In multivariable analyses, short duration of sleep (<7.5 hours) was associated with incident CVD (hazard ratio [HR], 1.68; 95% CI, 1.06-2.66; P = .03). A synergistic interaction was observed between short sleep duration and the riser pattern (P = .09). When subjects were classified according to their sleep time and a riser vs non-riser pattern, the group with shorter sleep duration-plus the riser pattern had a substantially and significantly higher incidence of CVD than the group with predominant normal sleep duration plus the nonriser pattern (HR, 4.43; 95% CI, 2.09-9.39; P < .001), independent of covariates. Conclusions: Short duration of sleep is associated with incident CVD risk and the combination of the riser pattern and short duration of sleep that is most strongly predictive of future CVD, independent of ambulatory BP levels. Physicians should inquire about sleep duration in the risk assessment of patients with hypertension.
  • Joji Ishikawa, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    HYPERTENSION RESEARCH 31 11 2045 - 2051 2008年11月 [査読有り][通常論文]
     
    Non-dipping (nocturnal blood pressure [BP] decrease<10%) is related to accelerated urinary salt excretion (u-NaCl), and increased risk of left ventricular hypertrophy (LVH) and cardiovascular events. We evaluated whether non-dippers exhibit an advanced extracellular matrix fibrosis, in relation to increased u-NaCl, among normotensive subjects. We measured plasma tissue inhibitor of matrix metal loproteinase-1 (TIMP-), a marker of collagen fibrosis in extracellular matrix, to evaluate the relationship between non-dipping and u-NaCl In 73 normotensive subjects (no anti hypertensive medications, clinic BP<140/90 mmHg and/or 24-h ambulatory BP <125/80 mmHg). Non-dippers had a significantly higher percentage of subjects with Impaired fasting glucose (IFG) or diabetes mellitus (DM), and had a greater left ventricular mass index (LVMI), plasma TIMP-1 level and u-NaCl than dippers (IFG or DM: 24.0 vs. 6.3%, p=0.029; LVMI: 118 +/- 31 vs. 103 +/- 26 g/m(2), p=0.039; TIMP-1: 168 +/- 35 vs. 151 +/- 30 pg/mL, p=0.035; u-NaCl: 5.1 +/- 1.7 vs. 3.9 +/- 1.7 g/12 h, p=0.005). In logistic regression analysis, non-dipping was independently associated with u-NaCl and TIMP-1. u-NaCl was correlated with non-dipping (r=0.35, p=0.003) and serum glucose level (r=0.26, p=0.027). On the other hand, TIMP-1 level was significantly correlated with the presence of IFG or DM (r=0.23, p=0.046), but not with uNaCl. In conclusion, plasma TIMP-1 level, a measure of cardiovascular fibrosis in extracellular matrix, Is greater in normotensive non-dippers than in dippers; however, the Increased TIMP-1 level may be related to impaired glucose metabolism, and non-dipping may be related to increased u-NaCl associated with high serum glucose levels in normotensive subjects. (Hypertens Res 2008; 31: 2045-2051)
  • Satoshi Hoshide, Yoshio Matsui, Seiichi Shibasaki, Kazuo Eguchi, Joji Ishikawa, Shizukiyo Ishikawa, Tomoyuki Kabutoya, Joseph E. Schwartz, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    HYPERTENSION RESEARCH 31 8 1509 - 1516 2008年08月 [査読有り][通常論文]
     
    Orthostatic blood pressure (BP) dysregulation is a risk factor for both falls and cardiovascular events. Self-measured BP, carried out at home, is both highly reproducible and useful for evaluating anti hypertensive treatment. However, there have been a few reports on the clinical implications of orthostatic BP changes in home BP monitoring (HBPM). In the baseline examination for the Japan Morning Surge-1 Study, a multi-center randomized control trial, we evaluated 605 hypertensive outpatients who had a morning systolic BP above 135 mmHg. The plasma brain natriuretic peptide (BNP) level and urinary albumin excretion were measured. When the patients were divided into 10 groups, according to orthostatic BP change evaluated by HBPM, after adjusting for age, gender, body mass index and sitting home BP level, those in the top decile (n=60, orthostatic BP increase >7.8 mmHg) had a higher urinary albumin/creatinine ratio (UAR) than the lowest decile group (geometric mean [SEM range]: 209.1 [134.7-318.7] vs. 34.1 [20.1-56.2] mg/g creatinine [Cr], p=0.003) and the pooled second to ninth decile groups (n=485, 209.1 [134.7-318.7] vs. 39.7 [33.2-47.3] mg/g Cr, p<0.02). Additionally, patients in the top decile had a higher BNP level than the second to ninth decile groups (75.7 [55.0-103.1] vs. 23.6 [20.8-26.6] pg/mL, p=0.003). Evaluation of orthostatic hypertension at home might be a high-risk factor for cardiovascular events in hypertensive subjects with increased levels of BNP and a higher UAR, independent of the home sitting BP level. (Hypertens Res 2008; 31: 1509-1516)
  • Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Naoki Nago, Yosikazu Nakamura, Akizumi Tsutsumi, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 18 4 144 - 150 2008年07月 [査読有り][通常論文]
     
    Background: Previous reports indicated that the incidence rate of stroke was higher in Japan than in Western countries, but the converse was true in the case of myocardial infarction (MI). However, few population-based studies on the incidence rates of stroke and MI have been conducted in Japan.Methods: The Jichi Medical School (JMS) Cohort Study is a multicenter population-based cohort study that was conducted in 12 districts in Japan. Baseline data were collected between April 1992 and July 1995. We examined samples from 4,869 men and 7,519 women, whose mean ages were 55.2 and 55.3 years, respectively. The incidence of stroke, stroke subtypes, and MI were monitored.Results: The mean follow-up duration was 10.7 years. A total of 229 strokes and 64 MIs occurred in men, and 221 strokes and 28 MIs occurred in women. The age-adjusted incidence rates (per 100,000 person-years) of stroke were 332 and 221 and those of MI were 84 and 31 in men and women, respectively. In the case of both sexes, the incidence rates of stroke and MI were the highest in the group of subjects aged > 70 years.Conclusion: We reported current data on the incidence rates of stroke and MI in Japan. usionThe incidence rate of stroke remains high, considerably higher than that of MI, in both men and women. The incidence rates of both stroke and MI were higher in men than in women.
  • Yukiko Ishikawa, Joji Ishikawa, Shizukiyo Ishikawa, Kazunori Kayaba, Yosikazu Nakamura, Kazuyuki Shimada, Eiji Kajii, Thomas G. Pickering, Kazuomi Kario
    HYPERTENSION RESEARCH 31 7 1323 - 1330 2008年07月 [査読有り][通常論文]
     
    It has been reported that subjects with prehypertension (pre-HT) (systolic blood pressure [SBP] 120-139 mmHg and/or diastolic blood pressure [DBP] 80-89 mmHg) have an increased risk of cardiovascular disease (CVD). We evaluated the prevalence and determinants of pre-HT in a Japanese general population. We enrolled 4,706 males and 7,342 females aged 18 to 90 years whose BPs were measured at baseline. The subjects' BPs were classified as follows: normotension (NT: SPB/DBP<120/80 mmHg), pre-HT (120/80-139/89 mmHg), and hypertension (HT: >= 140/90 mmHg or treated hypertension). The prevalence of pre-HT was 34.8% (males), and 31.8% (females). Body mass index (BMI) of more than 23.0 kg/m(2) was the strongest determinant of pre-HT (Males-BMI: 23.0-24.9 kg/m(2), odds ratio [OR]=1.47, 95% confidence interval [Cl]=1.21-1.79; BMI: 25.0-26.9 kg/m(2), OR=2.20,95% CI=1.68-2.87; BMI: 27.0-29.9 kg/m(2), OR=2.75, 95% CI=1.80-4.19; BMI: >= 30.0 kg/m(2), OR=3.39, 95% CI=1.21-9.46. Females-BMI: 23.0-24.9 kg/m(2), OR=1.67, 95% CI=1.421.95; BMI: 25.0-26.9 kg/m(2), OR=1.79,95% CI=1.46-2.19; BMI: 27.0-29.9 kg/m(2), OR=3.65, 95% CI=2.73-4.89; BMI: >= 30.0 kg/m(2), OR=4.23, 95% CI=2.33-7.70). The other determinants of pre-HT were hyperlipidemia (Males: OR=1.25; Females: OR=1.43), and aging (by 10 years; Males: OR=1.12; Females: OR=1.48). Determinants of pre-HT in females were impaired glucose tolerance (OR=1.41, 95% CI=1.03-1.94), diabetes (OR=2.01, 95% CI=1.16-3.47) and a family history of HT in both parents (OR=1.90, 95% CI=1.38-2.62), whereas in males the only other predictor was alcohol drinking (OR = 1.45, 95% CI = 1.23-1.70). In conclusion, even subjects with a mild increase of BMI (23.0-24.9 kg/m2) had an increased risk of pre-HT in a Japanese population, and the level of BMI associated with pre-HT was lower than that in Western countries. Additionally, there were gender differences in the determinants of pre-HT. (Hypertens Res 2008; 31: 1323-1330)
  • Joji Ishikawa, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    JOURNAL OF HYPERTENSION 26 6 1181 - 1187 2008年06月 [査読有り][通常論文]
     
    Objective Patients with sleep apnea syndrome have an increased risk of cardiovascular events and frequently show a nondipper pattern (blunted nocturnal decline < 10%) of systolic blood pressure. We investigated neurohumoral activation and risk factors in relation to nocturnal blood pressure dipping pattern and sleep apnea syndrome. Methods We conducted sleep polysomnography and ambulatory blood pressure monitoring and measured high-sensitivity C-reactive protein, tissue-type plasminogen activator inhibitor-1, and neurohumoral factors in 121 outpatients with suspected sleep apnea syndrome who were classified into four groups on the basis of the presence or the absence of dipping/nondipping and sleep apnea syndrome. Results Nondippers with sleep apnea syndrome had higher high-sensitivity C-reactive protein (overall P < 0.001), plasminogen activator inhibitor-1 (overall P=0.004), and aldosterone levels (overall P=0.010) than any of the other three groups. After adjustment for significant covariates such as age, sex, body mass index, waist circumference, smoking, alcohol drinking, aspirin use, presence of diabetes, and insulin, nondippers with sleep apnea syndrome still had a higher high-sensitivity C-reactive protein level than nondippers without sleep apnea syndrome (geometric mean: 1.47 vs. 0.37 mg/l, P=0.001). In multiple linear regression analysis controlling for confounding factors related with sleep apnea syndrome, high-sensitivity C-reactive protein was significantly correlated with 3% oxygen desaturation index (P=0.047). Plasminogen activator inhibitor-1 level was also highest in the nondippers with sleep apnea syndrome but not independent of obesity. Plasminogen activator inhibitor-1 level correlated with insulin (r=0.32, P=0.002) and high-sensitivity C-reactive protein levels (r=0.26, P=0.005). Conclusion Nondipper status was associated with an increased high-sensitivity C-reactive protein level in patients who also had sleep apnea syndrome but not in those who did not. High-sensitivity C-reactive protein level was closely affected by the desaturation level. Plasminogen activator inhibitor-1 level is also increased in nondippers with sleep apnea syndrome and is related to insulin and high-sensitivity C-reactive protein levels.
  • Kazuomi Kario, Yoshio Matsui, Seiichi Shibasaki, Kazuo Eguchi, Joji Ishikawa, Satoshi Hoshide, Shizukiyo Ishikawa, Tomoyuki Kabutoya, Joseph E. Schwartz, Thomas G. Pickering, Kazuyuki Shimada
    JOURNAL OF HYPERTENSION 26 6 1257 - 1265 2008年06月 [査読有り][通常論文]
     
    Background The impact on microalbuminuria of strict treatment aimed at lowering of self-measured morning blood pressure using an adrenergic blockade is unclear. Methods We conducted an open-label multicenter trial, the Japan Morning Surge-1 Study, that enrolled 611 hypertensive patients, whose self-measured morning systolic blood pressure levels were more than 135 mmHg while taking antihypertensive drugs. These were randomly allocated to an experimental group, whose members received bedtime administration of 1-4 mg doxazosin (doxazosin group) or a control group whose members continued without any add-on medication (control group). The urinary albumin/creatinine ratio was investigated at the baseline and 6 months after the randomization. Results Both the morning and evening blood pressures and urinary albumin/creatinine ratio (-3.4 vs. 0.0 mg/gCr for urinary albumin/creatinine ratio; P<0.001) were more markedly reduced in the doxazosin group than in the control group. This difference in the urinary albumin/creatinine ratio between the two groups was more marked in the patients with microalbuminuria (n=238, -27.9 vs. -8.1 mg/gCr, P<0.001). The reduction of urinary albumin/creatinine ratio was significantly associated with the use of doxazosin, and the change in all self-measured blood pressures (morning, evening, the average morning-evening), and these associations were independent of each other (P<0.001). Conclusion Adding a bedtime dose of an a-adrenergic blocker titrated by self-measured morning blood pressure in treated hypertensive patients with uncontrolled morning hypertension significantly reduced blood pressure and urinary albumin excretion rate, particularly in those with microalbuminuria.
  • Masatoshi Matsumoto, Shizukiyo Ishikawa, Eiji Kajii
    METABOLISM-CLINICAL AND EXPERIMENTAL 57 6 811 - 818 2008年06月 [査読有り][通常論文]
     
    This study is to evaluate the associations between adiponectin level and non cardiovascular death and to test a hypothesis that adiponectin level reflects the degree of systemic wasting that precedes death. A nested case-control study was conducted involving 5243 subjects, drawn from 12490 subjects of the Jichi Medical School Cohort Study, whose blood samples had been drawn between 1992 and 1995. Over an average of 10.8 years of follow-up, 103 cases with noncardiovascular death and 565 controls without history/event/death of any cardiovascular disease were identified. Odds ratios (ORs) were estimated relative to the lowest quintile of adiponectin level. The risks for noncardiovascular death of the second lowest quintile and the highest quintile of adiponectin level were significantly higher than that of the lowest quintile when adjusted for age and sex (model 1) (OR, 2.38 [95% confidence interval (CI), 1.12-5.06] and 2.16 [1.01-4.80]). All the statistical significances disappeared when adjusted further for body mass index and C-reactive protein level (model 2). When excluding cases with cancer death, the odds for death in the highest 2 quintiles were significantly higher than those in the lowest quintile in model 1 (OR, 2.80 [95% CI, 1.04-7.59] and 3.74 [1.38-10.18]). The significant difference between the highest vs the lowest quintile remained significant in model 2 and even after adjusting further for smoking, diabetes, and total cholesterol level (model 3) (OR, 3.28 [95% CI, 1.02-10.51] and 3.98 [1.21-13.13]). Adiponectin levels had linear associations with the risks of noncardiovascular noncancer death in models 1, 2, and 3 (OR per 1 SD increase in log-adiponectin, 1.72 [95% CI, 1.23-2.40], 1.89 [1.23-2.91], and 2.01 [1.29-3.15]). Adiponectin is an independent indicator of noncardiovascular mortality that may relate with systemic wasting. (C) 2008 Elsevier Inc. All rights reserved.
  • Shizukiyo Ishikawa, Kazuomi Kario, Kazunori Kayaba, Tadao Gotoh, Naoki Nago, Yosikazu Nakamura, Akizumi Tsutsumi, Eiji Kajii
    HYPERTENSION RESEARCH 31 6 1125 - 1133 2008年06月 [査読有り][通常論文]
     
    Although it is confirmed that anti hypertensive treatment for hypertension (HT) reduces stroke, it is uncertain whether the risk of stroke in controlled hypertensives is as low as that in normotensives. To address this question, we examined the risk of stroke in hypertensives with or without anti hypertensive treatment in the general population. A total of 11,103 men and women were enrolled in for this multi-center, population-based cohort study. Subjects were divided into three categories: normotensives (blood pressure < 140/90 mmHg), treated hypertensives, and non-treated hypertensives (blood pressure >= 140/90 mmHg without antihypertensive treatment). The treated hypertensives were divided into controlled and uncontrolled HT groups. The non-treated hypertensives were also divided into two groups: mild HT, and moderate or severe HT. The mean follow-up duration was 10.7 years. Risk of all stroke was significantly higher in the hypertensives than in the normotensives (treated HT: hazard ratio=3.00 in men and 3.34 in women, 95% confidence interval =2.00-4.51 in men and 2.29-4.87 in women; non-treated HT: 2.56, 1.83-3.57 in men and 1.93, 1.35-2.76 in women). Risk of stroke in controlled treated hypertensives was about three times as high as that in normotensives (2.96, 1.66-5.26 in men and 3.69, 2.20-6.17 in women). Risk of stroke was about 2.5 times higher in individuals with hyperglycemia than in those with normoglycemia among both treated hypertensive men and women. In conclusion, compared with normotensives, hypertensives of all categories had a significantly higher risk of stroke. Residual confounding might have affected the result that risk of stroke was higher in controlled treated HT than in non-treated mild HT. Moreover, it is important to control blood pressure and blood glucose in hypertensives in order to reduce the risk of stroke.
  • Hideyuki Uno, Joji Ishikawa, Satoshi Hoshide, Tomoyuki Kabutoya, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    HYPERTENSION RESEARCH 31 5 887 - 896 2008年05月 [査読有り][通常論文]
     
    Strong adherence to antihypertensive therapy has been shown to reduce the frequency of cardiovascular events by strictly controlling blood pressure. Although calcium channel blockers (CCBs) are among the most popular antihypertensive drugs in Japan, few trials have been conducted using high CCB doses in Japanese patients. In this study, we administered amlodipine 5 mg or 10 mg to patients with hypertension in order to compare the efficacy and tolerability of low and high doses, and measured two surrogate markers of hypertensive target organ damage, i.e., brain natriuretic peptide (BNP) as a risk marker of cardiac overload and microalbuminuria as a measure of renal damage. Seventy-two patients were randomly assigned to either amlodipine 5 mg (n = 35) or 10 mg (n = 37) dose groups. The latter group achieved greater reductions in clinic as well as both morning and evening home BP levels without an increase in pulse rate (the differences between the two groups in clinic/morning/evening systolic BP were 4.7/4.7/5.4 mmHg, and for diastolic BP they were 4.2/3.6/3.8 mmHg). Reductions in BNP and urinary albumin/creatinine ratio (UAR) levels were significantly correlated with the reductions in systolic BP levels (BNP, clinic/morning BP: r = 0.256, p = 0.030/r = 0.330, p = 0.005; UAR, clinic BP: r = 0.316, p = 0.007). In conclusion, the higher dose (10 mg) of amlodipine induced greater reductions in all BP levels than did the lower dose, without increasing the pulse rate. These additional reductions were significantly correlated with reductions in hypertensive cardiac overload, as evaluated by BNP levels, and a reduction in renal damage, as evaluated by microalbuminuria levels. Moreover, a reduction in the microalbuminuria may have occurred concomitant with a reduction in clinic systolic BP level.
  • Kazuo Eguchi, Thomas G. Pickering, Satoshi Hoshide, Joji Ishikawa, Shizukiyo Ishikawa, Joseph E. Schwartz, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN JOURNAL OF HYPERTENSION 21 4 443 - 450 2008年04月 [査読有り][通常論文]
     
    BACKGROUND The prognostic significance of ambulatory blood pressure (ABP) has not been established in patients with type 2 diabetes (T2DM). METHODS In order to clarify the impact of ABP on cardiovascular prognosis in patients with or without T2DM, we performed ABP monitoring (ABPM) in 1,268 subjects recruited from nine sites in Japan, who were being evaluated for hypertension. The mean age of the patients was 70.4 +/- 9.9 years, and 301 of them had diabetes. The patients were followed up for 50 23 months. We investigated the relation between incidence of cardiovascular diseases (CVDs) and different measures of ABP, including three categories of awake systolic blood pressure (SBP < 135,135-150, and > 150 mm Hg), sleep SBP (< 120,120-135, and > 135 mm Hg), and dipping trends in nocturnal blood pressure (BP) (dippers, nondippers, and risers). Cox regression models were used in order to control for classic risk factors. RESULTS Higher awake and sleep SBPs predicted higher incidence of CVD in patients with and without diabetes. In multivariable analyses, elevated SBPs while awake and asleep predicted increased risk of CVD more accurately than clinic 1313 did, in both groups of patients. The relationships between ABP level and CVD were similar in both groups. In Kaplan-Meier analyses, the incidence of CVD in nondippers was similar to that in dippers, but risers experienced the highest risk of CVD in both groups (P < 0.01). The riser pattern was associated with a similar to 150% increase in risk of CVD, in both groups. CONCLUSIONS These findings suggest that ABPM is a better predictor of cardiovascular risk than clinic BP, and that this holds true for patients with or without T2DM.
  • Atsuko Sadakane, Akizumi Tsutsumi, Tadao Gotoh, Shizukiyo Ishikawa, Toshiyuki Ojima, Kazuomi Kario, Yosikazu Nakamura, Kazunori Kayaba
    JOURNAL OF EPIDEMIOLOGY 18 2 58 - 67 2008年03月 [査読有り][通常論文]
     
    Background: Associations between dietary patterns and cardiovascular disease risk factors remain unclear. The objective of this study was to evaluate the association between dietary patterns derived from factor analysis and the levels of blood pressure and serum lipids in a Japanese population.Methods: We conducted a cross-sectional analysis among 6886 (in the analysis on blood pressure) and 7641 (in the analysis on serum lipids) Japanese subjects aged 40-69 years. Dietary patterns were identified from a food frequency questionnaire by factor analysis. Associations between dietary patterns and blood pressure and serum lipids were examined after taking potential confounders into account.Results: Three dietary patterns were identified: vegetable, meat, and Western. In men, the meat pattern was associated with higher total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol. The Western pattern was associated with higher total and LDL cholesterol. In women, the vegetable pattern was associated with lower systolic and diastolic blood pressure and pulse pressure, and higher HDL cholesterol. The meat pattern was associated with higher total and HDL cholesterol. The Western pattern was associated with higher total, HDL, and LDL cholesterol, and the least intake pattern of Western diet was associated with higher systolic and diastolic blood pressures.Conclusions: Dietary patterns of a Japanese population were related to cardiovascular disease risk factors, especially in women.
  • Masatoshi Matsumoto, Shizukiyo Ishikawa, Eiji Kajii
    Stroke 39 2 323 - 328 2008年02月 [査読有り][通常論文]
     
    BACKGROUND AND PURPOSE - Even though adiponectin is associated with many traditional cardiovascular risk factors, studies assessing the association between adiponectin and cerebrovascular disease (CVD) are scarce. We assessed the odds of CVD at different plasma levels of adiponectin. METHODS - A nested case-control study was conducted involving 5243 subjects, drawn from 12 490 subjects of the Jichi Medical School Cohort Study, whose blood samples had been drawn between 1992 and 1995. Over an average of 9.7 years of follow-up, through 2005, 179 patients with cerebrovascular events were identified, in addition to 630 controls matched for age, sex, and community (total n=809). Odds ratios were estimated relative to the highest quartile of adiponectin level. RESULTS - There was neither a significant difference in the odds of stroke between the lowest and highest adiponectin quartiles, nor a significant linear trend toward a reduced risk of stroke at higher adiponectin levels. These results did not change after excluding participants with diabetes, impaired glucose metabolism, or metabolic syndrome. The odds of ischemic stroke in the lowest quartile were significantly higher than in the highest quartile, when adjusted for age and sex (OR 2.04 [95% CI, 1.09 to 3.80]). However, the odds failed to achieve statistical significance when adjusted further for other cardiovascular risk factors. Again exclusion of subjects with diabetes, impaired glucose metabolism, or metabolic syndrome did not alter results. CONCLUSIONS - Adiponectin levels are not independently associated with stroke or brain infarction. The use of adiponectin as a cerebrovascular disease predictor may be premature. © 2008 American Heart Association, Inc.
  • Kazuo Eguchi, Satoshi Hoshide, Joji Ishikawa, Shizukiyo Ishikawa, Thomas G. Pickering, William Gerin, Gbenga Ogedegbe, Joseph E. Schwartz, Kazuyuki Shimada, Kazuomi Kario
    BLOOD PRESSURE MONITORING 13 1 15 - 20 2008年02月 [査読有り][通常論文]
     
    Objective Cardiovascular prognosis in diabetic white-coat hypertension (WCH) has not yet been described. We designed this study to investigate the impact of WCH on cardiovascular events in patients with type 2 diabetes, compared with those having type 2 diabetes along with sustained hypertension (SH), and with nondiabetic hypertensive individuals. Methods We performed ambulatory blood pressure (BP) monitoring in 1207 consecutive hypertensive patients at baseline, and they were followed up for 49 +/- 22 months. The mean age was 70.7 +/- 9.8 years; 262 had type 2 diabetes; and 945 did not. They were classified as having SH with diabetes (n = 210); diabetic WCH (n = 52); SH alone (n = 719); or WCH alone (n = 226), using awake BP of 135/85 mmHg as the cutoff value. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals of the risk for cardiovascular events, after controlling for age, sex, body mass index, current smoking, serum creatinine, and clinical systolic BP. Results During the follow-up period, 97 cardiovascular events occurred. The incidence of cardiovascular events in the diabetic SH group was significantly higher than in the diabetic WCH, nondiabetic SH, and nondiabetic WCH (P<0.05; log-rank test) groups. In Cox regression analysis, the diabetic SH group had significantly higher risk of cardiovascular events compared with the diabetic WCH group (HR: 8.2; 95% confidence intervals: 1.09-61.8; P = 0.04). Although nonsignificant, the HRs in the SH and WCH groups, relative to diabetic WCH, exceeded 3.0. Conclusions The cardiovascular prognosis for diabetic WCH was better than that for diabetic SH during 4 years of follow-up.
  • Joji Ishikawa, Satoshi Hoshide, Seiichi Shibasaki, Yoshio Matsui, Tomoyuki Kabutoya, Kazuo Eguchi, Shizukiyo Ishikawa, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    JOURNAL OF CLINICAL HYPERTENSION 10 1 34 - 42 2008年01月 [査読有り][通常論文]
     
    We evaluated whether morning minus evening systolic blood pressure (SBP) difference (MEdif) in home blood pressure measurements can be a marker for hypertensive target organ damage. The authors analyzed 611 hypertensive patients who had high morning SBP levels (>= 135 mm Hg) The patients with morning hypertension (MEdif >= 15 mm Hg, average of morning and evening SBP [MEave] >= 135 mm Hg) were older (P<.001) and bad a longer duration of hypertension and antihypertensive medication use, a higher prevalence of left ventricular hypertrophy (LVH) on electrocardiograph),, a lower glomerular filtration rate by the Cockcroft-Gault equation (P=.002), and a higher brain natriuretic peptide (BNP) level (P<.001) than those with well-controlled blood pressure (MEdif <15 mm Hg, Wave <135 mm Hg). The patients with morning hypertension had a higher BNP level than those with well-controlled blood pressure after adjustment for the confounding factors (28.7 pg/mL vs 20.0 pg/mL; P=.033). In conclusion, nlorning hypertension is more likely seen among patients with older age and longer duration of hypertension and anti-hypertensive medication use, and it may be associated with a higher prevalence of LVH and a higher BNP level. (J Clin Hypertens (Greenwich). 2008;10:34-42) (C) 2008 Le Jacq
  • Tomoyuki Kabutoya, Joji Ishikawa, Satoshi Hoshide, Kazuo Eguchi, Seiichi Shibasaki, Yoshio Matsui, Shizukiyo Ishikawa, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    CLINICAL AND EXPERIMENTAL HYPERTENSION 30 3-4 255 - 265 2008年 [査読有り][通常論文]
     
    Background. Recently, it was reported that high pulse rate (PR), which was measured using by self-measured blood pressure (BP) monitoring at home, was associated with cardiovascular risk. However, the predictor of high PR at home in treated hypertensives is unknown. In this study, we studied the predictor of high PR and evaluated pulse rate variability (PRV). Methods. In the JMS-1 study, 611 hypertensive outpatients were recruited. Self-measured BP monitoring was conducted consecutively twice in the morning and evening for three days. PR analysis was conducted using the average of these two measurements for three days (six readings in total). We defined home PR as the mean of these six readings. Home PRV was defined as the standard deviation of these six readings. Results. Multivariate linear regression analysis demonstrated that current smoking (beta = 0.12, p = 0.002), diabetes (beta = 0.16, p < 0.001), lack of angiotensin-converting enzyme (ACE) inhibitor use (beta = 0.10, p = 0.008), decreased brain-type natriuretic peptide (BNP; beta = 0.17, p < 0.001), and elevated home diastolic blood pressure (beta = 0.14, p = 0.009) were determinants of high PR. Determinants of decreased home PRV were female gender (beta = 0.10, p < 0.03) and increased hemoglobin A1c (HbA1c; beta = 0.15, p < 0.001). When we divided the patients into four groups according to home PR and its variability, hypertensives whose home PR was high and variability was low were found to have high HbA1c (ANOVA, p > 0.05). Conclusions. Smoking habit, diabetes, lack of ACE inhibitor use, and low BNP value were determinants of home PR, and female gender and higher HbA1c were significantly associated with its low variability. Home PR and its variability may be useful for detecting high-risk hypertensive patients, particularly with autonomic neuropathy.
  • Kazuo Eguchi, Yoshio Matsui, Seiichi Shibasaki, Joji Ishikawa, Satoshi Hoshide, Shizukiyo Ishikawa, Tomoyuki Kabutoya, Joseph E. Schwartz, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN JOURNAL OF HYPERTENSION 20 12 1268 - 1275 2007年12月 [査読有り][通常論文]
     
    Background: Pulse pressure (PP) is an independent marker of cardiovascular risk, even in treated hypertensive subjects, but is often little changed by antihypertensive treatment. We assessed the hypothesis that changes in PP during antihypertensive therapy correlate with changes in surrogate markers of target-organ damage. Methods: We studied 540 treated hypertensive subjects whose home systolic blood pressure (SBP) was >= 135 mm Hg. They were followed for 6 months after allocation to either a control group or an added treatment group (doxazosin, 1 to 4 mg plus beta-blocker when needed). The changes in PP and various blood pressure (BP) measures, including mean BP (MP), SBP, and diastolic BP (DBP) during follow-up, were related to changes in plasma B-type natriuretic peptide (BNP) and the urine albumin-creatinine ratio (UAR). Results: Although self-measured MP was significantly lowered in the added treatment group, PP was not changed overall, although some patients showed a decrease, and others showed an increase. In multivariable analyses, changes in both clinic and home PP were positively associated with changes in log BNP, such that increases in clinic and home PP were paralleled by corresponding increases in BNP. However, no such corresponding relationships were observed when home PP decreased. The change in home PP, but not clinic PP, was positively and linearly associated with the change in UAR. Conclusions: Changes in PP during antihypertensive treatment are important because PP may increase in some patients, in whom there are adverse changes in surrogate markers of target-organ damage. These changes of PP are best evaluated by home monitoring. Am J Hypertens 2007;20:1268-1275 (c) 2007 American Journal of Hypertension, Ltd.
  • Yasunori Niwa, Shizukiyo Ishikawa, Tadao Gotoh, Kazunori Kayaba, Yosikazu Nakamura, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 17 6 203 - 209 2007年11月 [査読有り][通常論文]
     
    BACKGROUND: Metabolic syndrome is known to increase morbidity and mortality of cardiovascular disease. The National Cholesterol Education Program Adult Treatment Expert Panel III in 2001 (revised in 2005) and the Japanese definition of metabolic syndrome were launched in 2005. No study regarding the association between metabolic syndrome by Japanese definition and mortality has been Performed. The aim of this study was to clarify the prevalence of metabolic syndrome and its effects to mortality in a population-based cohort study. METHODS: A total of 2176 subjects who satisfied the necessary criteria for metabolic syndrome were examined between 1992 and 1995 as a part of Jichi Medical School Cohort Study by Japanese definition. Cox's proportional hazard models were used to analyze the association of metabolic syndrome with mortality. RESULTS: The prevalence of metabolic syndrome was 9.0% in males and 1.7% in females. There were 17 deaths (14 males), including 6 cardiovascular deaths (5 males), during a 12.5-year follow-up period among metabolic syndrome subjects. After adjusting for age, smoking status, and alcohol drinking status, the hazard ratio (95% confidence interval) for all-cause mortality was 1.13 (0.64-1.98) in males and 1.31 (0.41-4.18) in females, and HR for cardiovascular mortality was 1.84 (0.68-4.96) in males, and 1.31 (0.17-9.96) in females. CONCLUSION: No statistical significant relationship between metabolic syndrome by Japanese defini tion and all-cause mortality was observed in a population-based cohort study.
  • 上部消化管内視鏡検査を契機にして診断されたMRSAによる椎間板炎の一例
    白石 守, 石川 鎭清, 神山 英彦, 楡木 恵実子, 津本 順史, 丹羽 康則, 岡山 雅信, 三瀬 順一, 梶井 英治
    地域医療 第46回特集号 823 - 825 (公社)全国国民健康保険診療施設協議会 2007年10月
  • Ishikawa S, Kazuomi K, Kayaba K, Gotoh T, Nago N, Nakamura Y, Tsutsumi A, Kajii E, Jichi Medical School, JMS) Cohort, Study Group
    Journal of clinical hypertension (Greenwich, Conn.) 9 9 677 - 683 2007年09月 [査読有り][通常論文]
  • Kazuo Eguchi, Joji Ishikawa, Satoshi Hoshide, Shizukiyo Ishikawa, Tomas G. Pickering, Joseph E. Schwartz, Shunichi Homma, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN HEART JOURNAL 154 1 79.e9 - 15 2007年07月 [査読有り][通常論文]
     
    Background Cardiovascular prognostic significance of relative wall thickness (RWT) in patients with diabetes has not been reported although concentric hypertrophy is common in diabetic patients. Purpose This study was conducted to test the hypothesis that the prognostic significance of different measures of left ventricular (LV) geometric change, principally IV mass index (LVMI) and RWT, would be different in diabetic patients compared with nondiabetic individuals among Japanese hypertensive subjects. Methods Ambulatory blood pressure monitoring and echocardiography were performed in 400 uncomplicated hypertensive individuals at baseline, of whom 379 (157 with diabetes and 222 without diabetes, mean age 67.8.8.8 years) were successfully followed up for 63 +/- 26 months to document cardiovascular events. We dichotomized LVMI and RWT to the highest quartile vs other 3 quartiles for further categoric analyses in diabetic and nondiabetic patients. Results Fifty-three cardiovascular events occurred during the follow-up period. With Kaplan-Meier analysis, both diabetic and nondiabetic patients with the highest quartile of LVMI showed a significantly higher incidence of cardiovascular vents. However, the highest quartile of RWT was associated with cardiovascular events only in diabetic subjects. With Cox regression analyses controlling for age, sex, body mass index, serum creatinine, triglycerides, and clinic systolic blood pressure, RWT (per 0.01 change), but not LVMI, was associated with cardiovascular events in diabetic patients (relative risk: 1.06, 95% confidence interval 1.02-1.11; P =.008), whereas LVMI (9/m(2)), but not RWT, was associated with cardiovascular events in nondiabetic patients (relative risk: 1.02, 95% confidence interval 1.01 -1.03; P =.005). Conclusion In hypertensive subjects with type 2 diabetes mellitus, echocardiographic LV RWT is a predictor of cardiovascular events independent of LV mass and other confounders.
  • Eguchi K, Matsui Y, Shibasaki S, Ishikawa J, Hoshide S, Ishikawa S, Kabutoya T, Schwartz JE, Pickering TG, Shimada K, Kario K, Japan Morning Surge, JMS, Study Group
    Journal of clinical hypertension (Greenwich, Conn.) 9 7 522 - 529 2007年07月 [査読有り][通常論文]
  • Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Yosikazu Nakamura, Kazuomi Kario, Yoshihisa Ito, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 17 4 120 - 124 2007年07月 [査読有り][通常論文]
     
    Background: C-reactive protein (CRP) is an acute phase reactant, and has been reported as a predictor of cardiovascular diseases. Measurements of high sensitive CRP in thawed samples are possible and the values are thought to remain stable even after frozen storage. However, the long-term stability of CRP values has not been documented. We measured the values of CRP before and after long-term storage, and examined the difference in determined values. Methods: High sensitive CRP was measured before and after long-term storage of samples from 99 men and women among the JMS Cohort Study subjects. We selected subjects who underwent measurement of high sensitive CRP at the baseline by stratified sampling methods using baseline CRP values. CRP was measured in serum samples at the baseline and in thawed plasma samples after an average storage period of 13.8 years. Results: Geometric means of CRP were 0.25 mg/L and 0.59 mg/L before and after storage, respectively. The CRP values were significantly higher after long-term frozen storage than at the baseline (p<0.0001). The both values of logarithm CRP were significantly correlated using Pearson's correlation (r = 0.920, 95% confidence interval: 0.883-0.945). Conclusion: CRP values increased after long-term frozen storage. The CRP values showed a high correlation between before and after long-term storage.
  • Shizukiyo Ishikawa, Yoshihiro Shibano, Yasuhiro Asai, Kazuomi Kario, Kazunori Kayaba, Eiji Kajii
    HYPERTENSION RESEARCH 30 7 643 - 649 2007年07月 [査読有り][通常論文]
     
    Few studies have reported on risk factors by blood pressure categories based on antihypertensive treatment in the general population. We examined the associations between blood pressure categories and other risk factors in Japan. Cross-sectional study, multicenter population-based study was designed. A total of 11,302 men and women were eligible. Data were obtained from April 1992 to July 1995 in 12 rural districts in Japan. Subjects were divided into three categories: normotensives (with blood pressure < 140/90 mmHg), treated hypertensives (antihypertensive treatment regardless of current blood pressure), and nontreated hypertensives (blood pressure >= 140/90 mmHg without hypertensive treatment). The proportions of normotensives, treated hypertensives, and nontreated hypertensives were 63%, 10%, and 27% among men, and 67%, 13%, and 20% among women, respectively. Total cholesterol, triglyceride, blood glucose, and body mass index were higher in treated or nontreated hypertensives than in normotensives. Fibrinogen, factor VIIc, and physical activity index were higher in treated hypertensives than in normotensives. High-density lipoprotein (HDL) cholesterol was higher in normotensives than in treated or nontreated hypertensives in women; but no tendency was shown in men. The proportions of dyslipidemia, impaired glucose tolerance, and metabolic syndrome were significantly higher in treated and nontreated hypertensives than in normotensive men and women. In conclusion, cardiovascular risk factors were higher in hypertensives with or without treatment than in normotensives in a general population in Japan.
  • 臨床講師医学研修会の地域医療臨床実習への効果
    岡山 雅信, 石川 鎮清, 三瀬 順一, 梶井 英治
    医学教育 38 Suppl. 23 - 23 (一社)日本医学教育学会 2007年06月
  • 臨床講師(地域担当)医学教育研修会のあり方と問題点
    石川 鎮清, 三瀬 順一, 岡山 雅信, 梶井 英治
    医学教育 38 Suppl. 26 - 26 (一社)日本医学教育学会 2007年06月
  • 地域保健福祉実習で医学生が得たもの
    三瀬 順一, 長嶺 伸彦, 石川 鎮清, 岡山 雅信, 梶井 英治
    医学教育 38 Suppl. 60 - 60 (一社)日本医学教育学会 2007年06月
  • Yuichiro Yano, Satoshi Hoshide, Joji Ishikawa, Chishio Noguchi, Daisuke Tukui, Hidaka Takanori, Masashi Tada, Yoshimasa Kanemaru, Ayako Yano, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN JOURNAL OF HYPERTENSION 20 5 565 - 572 2007年05月 [査読有り][通常論文]
     
    Background: A dual angiotensin type 1 receptor blocker (ARB)/peroxisome proliferator-activated receptor-gamma (PPAR gamma) agonist telmisartan may be more useful for microalbuminuria reduction than ARBs with no PPAR gamma agonistic action. We investigated whether there is a difference between the effects of telmisartan and valsartan with respect to microalbuminuria reduction, and the association with improvement of metabolic features or suppression of the inflammatory state. Methods: Fifty-three patients who had metabolic syndrome and had been taking valsartan were recruited. All of these patients were randomly assigned to replace valsartan by telmisartan (telmisartan group; n = 30) or to keep taking valsartan (control group; n = 21). Various parameters were measured at baseline and 12 weeks after randomization. Results: There were no significant changes in blood pressure (BP), glucose, and lipid parameters between baseline and 12 weeks after randomization in either group. There was a significant increase in high molecular weight adiponectin in the telmisartan group (4.6 v 5.0 mu g/mL, P =.024), whereas there was no significant change in the control group. The reductions of microalbuminuria and high-sensitivity C-reactive protein (hs-CRP) were significant in the telmisartan group (28.1 v 18.9 mg/g center dot Cr and 0.77 v 0.60 mg/L, respectively, P =.001 and P =.022), whereas there was no significant change in the control group. The reductions of microalbuminuria and hs-CRP were significantly correlated with each other (gamma = 0.413, P =.003). Conclusions: The dual ARB/PPAR gamma agonist telmisartan achieved more microalbuminuria reduction than an ARB with no PPAR gamma agonistic action, possibly through suppression of the inflammatory state in metabolic hypertensive patients.
  • Joji Ishikawa, Yurie Tamura, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario
    STROKE 38 3 911 - 917 2007年03月 [査読有り][通常論文]
     
    Background and Purpose - High-sensitivity C-reactive protein (hsCRP), a marker of inflammation, is associated with atherosclerosis, hypertensive target organ damage, and cardiovascular events. In the general Japanese population, the level of hsCRP is reported to be lower than that in Western countries, and the relationships among hsCRP, silent cerebral infarcts (SCIs), and clinical stroke events in older Japanese hypertensives remain unclear. Methods - We conducted brain MRI and measured hsCRP at baseline in 514 older Japanese hypertensives ( clinic blood pressure >= 140/90 mm Hg, age >= 50 years old) who were enrolled in the Jichi Medical School ABPM Study, wave 1. They were followed up for an average of 41 months ( range: 1 to 68 months, 1751 person-years) and the incidence of subsequent clinical stroke events was evaluated. Results - The subjects with SCIs at baseline (n = 257) had a higher hsCRP level than those without SCIs ( geometric mean hsCRP [SD range];0.19 [0.18 to 0.21] versus 0.14 [0.13 to 0.16] mg/L, P = 0.007) after adjustment for confounding factors, and the OR for the presence of SCIs was increased with the quartile of hsCRP levels. In Cox regression analysis, the patients with above median hsCRP level (>= 0.21 mg/L) (hazard ratio [HR]: 2.50, 95% CI: 1.24 to 5.00, P = 0.01) and those with SCIs ( HR: 4.60, 95% CI: 1.91 to 11.03, P = 0.001) at baseline had independently higher risks for clinical stroke events after adjustment for age, smoking status, antihypertensive medication use, and 24-hour systolic blood pressure level. Compared with the patients with below median hsCRP level without SCIs, those with above median hsCRP level and SCIs at baseline had a higher risk for clinical stroke events ( HR: 7.32, 95% CI: 2.17 to 24.76, P = 0.001), although those with below median hsCRP level and SCIs ( HR: 2.46, 95% CI: 0.64 to 9.47, P = 0.19) and those with above median hsCRP level without SCIs ( HR: 1.11, 95% CI: 0.22 to 5.55, P = 0.90) did not have significant risks. Conclusion - High-sensitivity C-reactive protein is a risk factor for clinical stroke events in addition to silent cerebral infarcts in Japanese older hypertensives, indicating that the risk for clinical stroke events increases with preexisting hypertensive target organ damage in the brain and additionally with ongoing low-grade inflammation.
  • Masatoshi Matsumoto, Shizukiyo Ishikawa, Yosikazu Nakamura, Kazunori Kayaba, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 17 2 38 - 44 2007年03月 [査読有り][通常論文]
     
    BACKGROUND: Relationships between consumption of dairy products and death from various types of cancer are largely unknown. METHODS: Between April 1992 and July 1995, a baseline survey was conducted for 11,349 residents in 12 communities in Japan, which included collection of demographic data and a self-administered food-frequency questionnaire inquiring about three dairy products: milk, butter and yogurt. The subjects were followed prospectively until 2002. Causes of death were identified using death certificates. Hazard ratios (HRs) and their 95% confidence intervals (Cls) for each dairy product were calculated using Cox's proportional hazard models. RESULTS: Among eight common cancers, only deaths from hernatopoietic neoplasm (n=14) were significantly associated with consumption of butter (HR=5.11, 95% Cl: 1.40-18.62), though they exhibited a nearly-significant association with milk consumption (HR=3.17, 95% Cl: 0.99-10.17), independent of age and sex. Consumption of milk and butter was significantly associated with non-lymphoma deaths 7 (n=9) when adjusted for age and sex (HR=9.86, 95% Cl: 1.23-, 9.19 for milk; and HR=1 0.04, 95% Cl: 2.39-42.18 for butter). CONCLUSION: The frequencies of butter consumption, and probably that of milk, were correlated with death from hematopoietic neoplasm, particularly from non-lymphomas.
  • 医師以外の職種による実践型医学生教育
    伊東 剛, 川原田 恒, 土井 和博, 石川 鎮清, 三瀬 順一, 岡山 雅信, 長嶺 伸彦, 黒木 茂広, 梶井 英治
    総合診療医学 12 1 85 - 85 日本総合診療医学会 2007年02月
  • Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Yosikazu Nakamura, Eiji Kajii
    CIRCULATION JOURNAL 71 1 26 - 31 2007年01月 [査読有り][通常論文]
     
    Background In recent years some studies have shown that metabolic syndrome (MS) is associated with inflammation, indicated by high-sensitivity C-reactive protein (hsCRP), but there have been few population-based studies, especially in Japan. Methods and Results The study subjects were 2,191 men and women examined between 1992 and 1995 with the necessary data to ascertain MS as part of the Jichi Medical School Cohort Study. CRP was measured by nephelometry. There were 109 subjects defined as having MS (5.0%), and the proportion of MS cases was higher in men (9.4%) than in women (1.8%). Geometric mean and median CRP in the NIS group was higher than that in the non-MS (geometric mean; p < 0.001, median: 0.312 mg/L in MS and 0.122 mg/L). Proportion of MS increased with CRP, after the subjects were divided by tertile of CRP (odds ratio, 95% confidence interval 1(st) tertile as a reference; 2(nd) tertile: 2.9, 1.5-5.9, 3(rd) tertile: 5.7, 3. 1-11.1). Conclusion Inflammation, measured by the concentration of hsCRP, was elevated in cases of MS in the general Japanese population. Longitudinal data should be examined in the future.
  • Akizumi Tsutsumi, Kazunori Kayaba, Toshiyuki Ojima, Shizukiyo Ishikawa, Norito Kawakami
    PSYCHOTHERAPY AND PSYCHOSOMATICS 76 3 177 - 185 2007年 [査読有り][通常論文]
     
    Background: Although adverse psychosocial job characteristics are suspected predictors of suicide death, prospective studies based on established stress instruments are limited. Methods: In a multicenter community-based Japanese cohort study, we prospectively investigated the association between psychosocial job characteristics and the risk of death from suicide among male workers. Baseline examination was conducted from 1992 to 1995 to determine the socioeconomic, behavioural and biological variables in addition to the psychosocial job characteristics of 3,125 male workers aged 65 and under and free from major illness. Low job control and high job demands were measured as adverse psychosocial job characteristics according to a job demand-control model questionnaire. Suicide deaths were identified using the Cause-of-Death Register. Results: During the 9-year follow-up, 14 suicides were identified. The suicide death rate was 48.1 per 100,000 person years. Multivariate analysis revealed a more than fourfold increase in the risk of suicide among men with low control at work ( relative risk: 4.10; 95% confidence interval: 1.31-12.83) compared with counterpart men after adjustment for age, marital status, educational attainment, occupation, smoking status, alcohol consumption, total cholesterol level, and study area. Job demands were not associated with risk of death from suicide. Conclusions: By using a job demand-control model questionnaire, low control at work was revealed as a predictor of suicide death among Japanese male workers. The finding implies that job redesign aimed at increased worker control could be a worthwhile strategy in preventing, or at least reducing, the risk of suicide death. Copyright (c) 2007 S. Karger AG, Basel.
  • 自治医科大学21世紀COEプログラム大規模地域ゲノムバンク推進事業の紹介
    岡山 雅信, 亀崎 豊実, 石川 鎮清, 熊田 真樹, 岩本 禎彦, 香山 不二雄, 小林 英司, 中村 好一, 梶井 英治
    地域医療 第45回特集号 797 - 799 (公社)全国国民健康保険診療施設協議会 2006年12月
  • Akizumi Tsutsumi, Kazunori Kayaba, Kurni Hirokawa, Shizukiyo Ishikawa
    SOCIAL SCIENCE & MEDICINE 63 5 1276 - 1288 2006年09月 [査読有り][通常論文]
     
    We prospectively investigated the association between psychosocial job characteristics according to the job demand-control model and the risk of mortality in a Japanese community-based working population. A baseline examination conducted from 1992 to 1995 determined the socioeconomic, behavioural, and biological risks in addition to the psychosocial job characteristics of 3178 male and 3331 female workers aged 65 and under and free from cancer and cardiovascular diseases. During the 9-year follow-up study, 157 men and 64 women died. In the follow-up, the results of Cox proportional hazards regression analysis revealed that men with concurrent high job demands and high job control (an active job) had the lowest risk of mortality from all causes. Compared with the low demand and high control job category, the multivariate relative risk of an active job was 0.53 (95% confidence interval: 0.31, 0.89). This finding appeared largely attributable to a reduction in cancer mortality. Job characteristics were not associated with cardiovascular diseases or external causes of mortality. For women, no significant associations were observed. The findings suggest that an active job has a beneficial effect on the health of Japanese male workers. Investigating of the effect of psychosocial job characteristics on cancer might therefore provide valuable insights into the health of workers. (c) 2006 Elsevier Ltd. All rights reserved.
  • Joji Ishikawa, Kazuomi Kario, Kazuo Eguchi, Masato Morinari, Satoshi Hoshide, Shizukiyo Ishikawa, Kazuyuki Shimada
    HYPERTENSION RESEARCH 29 9 679 - 686 2006年09月 [査読有り][通常論文]
     
    Morning blood pressure (BP) level may play an important role in the pathogenesis of cardiovascular events; however, morning BP detected by home BP monitoring may remain uncontrolled in medicated hypertensive patients even when clinic BP is well controlled (masked morning hypertension: MMHT). We studied the determinants of MMHT in stably medicated hypertensive outpatients. In the Jichi Morning Hypertension Research (J-MORE) study, 969 consecutive hypertensive outpatients were recruited by 43 doctors in 32 different institutes. They had been under stable antihypertensive medication status at least for 3 months. Clinic BP was measured on 2 different days and self-measured BP monitoring was conducted twice consecutively in the morning and evening for 3 days. Four-hundred and five patients had well-controlled clinic 1313 (systolic BP [SBP]<140 mmHg and diastolic BP [DBP]<90 mmHg). Among them., 246 patients (60.7%) had MMHT (morning SBP >= 135 mmHg and/or DBP >= 85 mmHg). Compared with the patients with normal clinic BP and morning BID, the patients with MMHT had a significantly higher prevalence of regular alcohol drinkers (35.0% vs. 23.3%, p=0.012), a significantly higher number of antihypertensive drug classes (1.83 +/- 0.82 vs. 1.66 +/- 0.84, p=0.04) and a significantly higher clinic BP level (SBP: 130.4 +/- 7.6 mmHg vs. 127.8 +/- 8.4 mmHg, p=0.001; DBP: 75.5 +/- 7.6 mmHg vs. 73.6 +/- 7.6 mmHg, p=0.013). In logistic regression analysis, independent determinants for MMHT were regular alcohol drinking (odds ratio [OR]: 1.76; 95% confidence interval [CI]: 0.99-3.12; p=0.05) and higher-normal clinic BP (130/85 mmHg<clinic SBP/DBP<140/90 mmHg) (OR: 1.60; 95% CI: 1.05-2.44; p=0.03) after adjustment for confounding factors. The patients who both drank alcohol regularly and had a higher-normal clinic BP had 2.71 times higher risk for MMHT than those who did not drink alcohol regularly and had a relatively lower-normal clinic BP (<130/85 mmHg) (p<0.01). In conclusion, regular alcohol drinking is an independent determinant for MMHT detected by home BP monitoring in medicated hypertensive patients with well-controlled clinic BP.
  • Ishikawa S, Nakamura Y, Kajii E, Kayaba K
    Nihon rinsho. Japanese journal of clinical medicine 64 Suppl 6 121 - 125 2006年08月 [査読有り][通常論文]
  • Yoko Amagai, Shizukiyo Ishikawa, Tadao Gotoh, Kazunori Kayaba, Yosikazu Nakamura, Eiji Kajii
    JOURNAL OF EPIDEMIOLOGY 16 4 161 - 166 2006年07月 [査読有り][通常論文]
     
    BACKGROUND: Although several studies have reported increased mortality risk with early menopause, there were no studies examining the relationship between age at menopause and mortality in Japan. The goal of this analysis is to investigate the relationship between age at menopause and all-cause mortality among the Japanese. METHODS: Study subjects were 4,683 postmenopausal females in the Jichi Medical School Cohort Study, a population-based prospective study. Baseline data were obtained by questionnaire and health checkups between April 1992 and July 1995 in 12 rural areas in Japan. Main outcome measures were all-cause mortality derived from death certificates up to December 31, 2002. Cox's proportional hazard models were used to analyze the association of age at menopause with mortality. RESULTS: A total of 215 deaths were observed during the average of 9.2 year follow-up period. After adjusting for age, systolic blood pressure, serum total cholesterol level, serum high density lipoprotein cholesterol level, history of diabetes mellitus, body mass index, smoking habits, alcohol drinking habits, marital status, study area, and types of menopause, the hazard ratios (95% confidence intervals) of all-cause mortality were 2.10 (1.07-4.11), 0.68 (0.36-1.26), 0.94 (0.68-1.30), and 1.17 (0.63-2.20) for females with a menopause at ages younger than 40 years, 40-44, 50-54, and 55 or older, respectively, relative to those with menopause at age 45-49 years. CONCLUSIONS: Our data suggest that menopause aged younger than 40 years increases the risk of death from all causes among the Japanese.
  • Eguchi K, Ishikawa J, Hoshide S, Ishikawa S, Shimada K, Kario K
    Journal of clinical hypertension (Greenwich, Conn.) 8 6 404 - 410 2006年06月 [査読有り][通常論文]
  • Joji Ishikawa, Satoshi Hoshide, Seiichi Shibasaki, Yoshio Matsui, Tomoyuki Kabutoya, Kazuo Eguchi, Shizukiyo Ishikawa, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario
    HYPERTENSION RESEARCH 29 3 153 - 159 2006年03月 [査読有り][通常論文]
     
    Morning blood pressure is reported to be more closely related to hypertensive organ damages such as left ventricular mass index, microalbuminuria and silent cerebral infarcts, than blood pressure at other times of the day. Morning blood pressure may play an important role in the pathogenesis of hypertensive target organ damage. Increased sympathetic nerve activity is reported to be one of the mechanisms of morning hypertension; however, there are no available data that show whether strict home blood pressure control, especially in the morning period, can reduce target organ damage. The Japan Morning Surge-1 (JMS-1) study includes hypertensive outpatients with elevated morning systolic blood pressure (2:135 mmHg) as assessed by self-measured blood pressure monitoring at home. All enrolled patients are under stable antihypertensive medication status. Exclusion criteria are arrhythmia, chronic inflammatory disease, and taking alpha-blockers or beta-blockers. The target number of patients to be enrolled in the JMS-1 study is 600, and the aim is to evaluate differences in the markers of hypertensive target organ damage, such as brain natriuretic peptide and the urinary albumin excretion/creatinine ratio. All of the patients are randomized to an experimental group or a control group, with randomization to be carried out by telephone interviews with the patients' physicians. In the experimental group, patients begin taking additional anti hypertensive medication just before going to bed. This consists of doxazosin 1 mg/day, which then is increased to 2 mg1day and 4 mg/day, with a beta-blocker added after a 1-month interval until the morning systolic blood pressure is controlled to less than 135 mmHg. Patients in the control group continue the treatment they are receiving at the enrollment for 6 months. Blood pressure levels, adverse effects, and hypertensive target organ damage before and after the study are evaluated. In the JMS-1 study, we will evaluate whether strict morning blood pressure control by sympathetic nervous system blockade using an alpha-blocker, doxazosin, and with the addition of a beta-blocker if needed, can reduce hypertensive target organ damage.
  • K Kayaba, A Tsutsumi, T Gotoh, S Ishikawa, Y Miura
    JOURNAL OF EPIDEMIOLOGY 15 6 228 - 234 2005年11月 [査読有り][通常論文]
     
    BACKGROUND: The job characteristics scale of job strain, which combines high job demands and low decision latitude based on Karasek's model, has been applied to studies on health care and cardiovascular disease. However, little is known about the long-term stability of this scale with exposure of workers to job. We investigated the 5-year intraindividual variation in job characteristics scores among healthy community workers. METHODS: Subjects of the study were 458 community dwelling persons forming part of the Jichi Medical School Cohort Study at Yamato (currently, Minami-Uonuma city), Niigata prefecture. The Japanese version of the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (WHO-MONICA) Psychosocial Study Questionnaire was implemented twice (from 1992 through 1995, and in 1999) to measure job demands and decision latitude levels. Intraclass correlation coefficients were computed to evaluate stability of scores of the questionnaire. RESULTS: Intraclass correlation coefficient of the decision latitude scores was 0.629 (95% confidence interval: 0.564 - 0.686) and that of the job demands scores was 0.551 (0.476 - 0.617). Subgroup analyses by age, sex, education level, years since first employment, number of co-workers, and job category and status at baseline revealed similar results. In contrast, subjects who experienced position changes within the same enterprise or changed jobs showed lower correlation coefficients of both decision latitude and job demands scores compared to those who experienced no change in job contents. CONCLUSION: The Japanese version of the WHO-MONICA Psychosocial Study Questionnaire showed statistically significant long-term stability and could be to some extent responsive to change in job strain levels.
  • F Uno, S Ishikawa, Y Nakamura, T Gotoh, N Nago, K Kayaba, E Kajii
    JOURNAL OF EPIDEMIOLOGY 15 5 173 - 179 2005年09月 [査読有り][通常論文]
     
    BACKGROUND: There have been comparatively few large-scale cohort studies analyzing all-cause mortality due to cigarette smoking. The goal of this analysis is to investigate the relationship between smoking status and all-cause mortality, and to evaluate the effect of smoking in the Japanese. METHODS: The baseline data were collected between 1992 and 1995. Ultimately, 10,873 Japanese (4,280 males and 6,593 females) aged 19 years or older from 12 rural communities located across Japan participated in the study. This analysis is based on the results, including the information on those who died and moved out of the communities, obtained by December 31, 2001. The Cox's proportional hazards model was used to calculate the hazard ratio (HR) of mortality for smoking with adjustment for age, systolic blood pressure, total cholesterol, body mass index, alcohol drinking habit and education. RESULTS: The mean follow-up period was 8.2 years, during which time, 284 males and 192 females died. The multivariate-adjusted HRs for total mortality among former and current smokers compared with never smokers were 1.09 (95% confidence interval [Cl]: 0.73-1.61) and 1.65 (95% Cl: 1.16-2.35) in males, and 0.98 (95% Cl: 0.40-2.42) and 0.91 (95% Cl: 0.42-1.95) in females, respectively. Those for the consumption of 1-14, 15-24, and 25+ cigarettes per day among male smokers were 1.62, 1.57, and 1.89, respectively. In females, there was no great difference in all-cause mortality between smokers and never smokers. CONCLUSIONS: The results of our study confirm an increased risk in males of premature death from all causes among Japanese with a smoking habit.
  • 地域の男性就業者における心理社会的仕事の特徴と自殺死亡との関係 JMSコホート研究
    堤 明純, 萱場 一則, 尾島 俊之, 石川 鎮清
    日本公衆衛生学会総会抄録集 64回 892 - 892 日本公衆衛生学会 2005年08月 [査読有り][通常論文]
  • J Ishikawa, K Kario, S Hoshide, K Eguchi, M Morinari, R Kaneda, Y Umeda, S Ishikawa, T Kuroda, Y Hojo, K Shimada
    AMERICAN JOURNAL OF HYPERTENSION 18 7 958 - 965 2005年07月 [査読有り][通常論文]
     
    Background: Morning blood pressure (BP) surge in ambulatory BP monitoring was a risk factor for stroke in our previous study. We studied the determinants of the morning minus evening systolic BP difference (ME difference) in self-measured BP monitoring, as a possible risk factor for stroke in medicated hypertensive patients. Methods: Nine hundred sixty-nine hypertensive outpatients receiving stable antihypertensive drug treatment were studied using self-measured BP monitoring in the morning and evening. Results: The ME difference ranged from -37.3 to 53.3 mm Hg (mean 7.9 mm Hg). The highest quartile (Q4) of the ME difference group (> 15.0 mm Hg) had older age (68.0 +/- 9.8 years v 66.2 +/- 10.3 years, P =.01) and higher prevalence of men (48.3% v 39.9%, P =.02), regular alcohol drinkers (34.7% v 26.0%, P =.01) and beta-blocker use (26.9% v 19.9%, P =.03) than the other quartile groups (Q1 to Q3), whereas there was no significant difference in the average of morning and evening (ME average) BP. In logistic regression analysis controlling for ME average and other confounding factors, independent risks for Q4 of ME difference were older age (10 years older: odds ratio [OR] 1.21, P =.01, 95% confidence interval (CI) 1.04-1.42), regular alcohol drinker (OR 1.51, P =.04, 95% CI 1.01-2.26), and beta-blocker use (OR 1.50, P =.02, 95% CI 1.06-2.12). Conclusions: Older age, beta-blocker use, and regular alcohol drinking were significant determinants of the exaggerated ME difference in medicated hypertensive patients.
  • K Kario, J Ishikawa, S Hoshide, Y Matsui, M Morinari, K Eguchi, S Ishikawa, K Shimada
    HYPERTENSION 45 5 887 - 893 2005年05月 [査読有り][通常論文]
     
    Diabetes and hypertension are potent risk factors for cerebrovascular disease. We studied the effects of an angiotensin II type 1 receptor blockade (ARB) on brain damage in hypertensives in relation to diabetes. We studied cerebral metabolism ( by proton magnetic resonance spectroscopy) and hemodynamics (by phase-contrast magnetic resonance angiography) before and 3 to 4 months after candesartan therapy in 20 diabetic hypertensives (DHTs) and 20 matched nondiabetic hypertensives (HTs). Silent multiple cerebral infarcts detected by brain MRI were more common in DHTs than in HTs (50% versus 25%). Cerebral N-acetyl aspartate (NAA; an indicator of functional neuronal mass) was lower in DHTs than in HTs (8.35 versus 9.58 mmol/kg; P=0.007). Baseline quantitative volume flow in the internal carotid arteries (ICAs) and the middle cerebral arteries (MCAs) was comparable between the 2 groups, whereas cerebrovascular reserve (CVR) assessed using acetazolamide ( a cerebral arteriolar dilator) in ICAs (25% versus 35%; P=0.03) and MCAs (20% versus 31%; P=0.01) was lower in DHTs than in HTs. These baseline CVR and NAA values of DHT group were lower than those of 12 matched normotensives (CVR: 44% for ICA; 41% for MCA; NAA: 10.5 mmol/kg; all P<0.005). After candesartan therapy, CVR in ICAs and MCAs was significantly increased (P=0.001) independently of the reduction of the 24-hour blood pressure level, whereas the cerebral NAA level did not change. In conclusion, brain damage is advanced in DHTs. ARB partly improved the impaired cerebral microvascular function in DHTs.
  • 外島 正樹, 羽田 兼吾, 冨山 宗徳, 小松 憲一, 梶井 英治, 谷藤 正人, 石川 鎮清, 岡山 雅信, 黒木 茂広
    地域医学 19 3 110 - 117 (公社)地域医療振興協会 2005年03月
  • Mariko Naito, Takeo Nakayama, Toshiyuki Ojima, Gen Kobashi, Kaori Muto, Masakazu Washio, Shizukiyo Ishikawa, Eiji Maruyama, Michi Sakai, Keiko Sato, Hiroki Sugimori, Mika Suzuki, Futoshi Takahashi, Zentaro Yamagata, Akiko Tamakoshi
    Journal of epidemiology 14 5 174 - 6 2004年09月 [査読有り][通常論文]
  • Y Amagai, S Ishikawa, T Gotoh, Y Doi, K Kayaba, Y Nakamura, E Kajii
    JOURNAL OF EPIDEMIOLOGY 14 4 124 - 128 2004年07月 [査読有り][通常論文]
     
    BACKGROUND: Although sleep is one of the most important health-related factors, relationship between sleep duration and mortality has not been fully discussed. METHODS: Study subjects were 11,325 participants (4,419 males and 6,906 females) in the Jichi Medical School Cohort Study, a population-based prospective study. Baseline data were obtained by questionnaire and health checkups between April 1992 and July 1995 in 12 rural areas in Japan. Main outcome measures were all-cause and cause-specific mortality derived from death certificates up to December 31, 2001. Cox's proportional hazard models were applied to analyze the association of sleep duration with mortality. RESULTS: A total of 495 deaths (289 males and 206 females) were observed during the average of 8.2-year follow-up period. After adjusting for age, systolic blood pressure, serum total cholesterol, body mass index, smoking habits, alcohol drinking habits, education, and marital status, the hazard ratios (95% confidence intervals) of all-cause mortality for individuals sleeping shorter than 6 hours and 9 hours or longer were 2.4 (1.3-4.2) and 1.1 (0.8-1.6) in males, and 0.7 (0.2-2.3) and 1.5 (1.0-2.4) in females, respectively, relative to those with 7-7.9 hours sleep. CONCLUSION: Our data suggest that males with short sleep and females with long sleep were at an elevated risk of death.
  • K Kario, J Ishikawa, K Eguchi, M Morinari, S Hoshide, S Ishikawa, K Shimada
    AMERICAN JOURNAL OF HYPERTENSION 17 5 439 - 445 2004年05月 [査読有り][通常論文]
     
    Background: It remains uncertain which is the stronger predictor for stroke in older hypertensives, ambulatory pulse pressure (PP) or mean blood pressure (MBP). Methods: We studied the prognosis for stroke in 811 older hypertensives in whom ambulatory BP monitoring was performed. We also assessed silent cerebral infarct (SCI) by brain magnetic resonance imaging. Results: Silent cerebral infarcts were found in 50% of 515 subjects (64% of the total population) in whom we assessed SCI using brain magnetic resonance imaging. During a mean of a 42-month follow-up period, stroke events occurred in 59 subjects. After adjustment for covariates, for each 10 mm Hg increase in sleep PP, there was an independent 43% (95% confidence interval [CI]: 16%-75%, P = .001) increase in the stroke risk, and sleep MBP was not a significant factor after controlling for sleep PP. On the other hand, for each 10 mm Hg increase in awake MBP, there was an independent 48% (95% CI: 21%-81%, P = .0002) increase in the stroke risk, and awake PP was not a significant factor after controlling for awake MBP. After adjusting for SCI (a strong predictor, P < .0001) at baseline, the effects of awake MBP (38% risk increase for each 10 mm Hg, P = .007) and sleep PP (32% risk increase for each 10 mm Hg, P = .016) remained significant. Conclusions: In older hypertensives, the impacts of PP and MBP on stroke risk are different during sleep and awake periods. Sleep PP and awake MBP are both predictors of stroke events independently of SCI.
  • K Eguchi, K Kario, Y Hoshide, S Hoshide, J Ishikawa, M Morinari, S Ishikawa, K Shimada
    AMERICAN JOURNAL OF HYPERTENSION 17 2 112 - 117 2004年02月 [査読有り][通常論文]
     
    Background: Cardiovascular events occur most frequently in the morning. We aimed to study the effects of monotherapy with the long-acting angiotensin 11 receptor blocker valsartan compared with the long-acting calcium antagonist amlodipine on ambulatory and morning blood pressure (BP). Methods: We performed ambulatory BP monitoring before and after once-daily dose of valsartan (valsartan group, n = 38) and amlodipine (amlodipine group, n = 38) therapy in 76 hypertensive patients. To achieve the target BP of less than or equal to 140/90 mm Hg, valsartan was titrated from 40 mg/day to 160 mg/day (mean dose 124 mg/day) and amlodipine was titrated from 2.5 mg/day to 10 mg/day (mean dose 6.4 mg/day). Results: Both drugs significantly reduced clinic and 24-h systolic BP (SBP) and diastolic BP (DBP) (P < .002). However, the anti hypertensive effect of amlodipine was superior to that of valsartan in clinical SBP (-26 mm Hg v - 13 mm Hg, P = .001) and 24-h SBP (- 14 mm Hg v -7 mm Hg, P = .008). In addition, morning SBP was significantly reduced by amlodipine from 156 to 142 mm Hg (P < .001) but not by valsartan. Both agents reduced lowest night SBP to a similar extent (amlodipine 121 to 112 mm Hg, P < .001; valsartan 123 to 114 mm Hg, P < .002). Reduction in morning SBP surge (morning SBP minus lowest night SBP) was significantly greater in patients treated with amlodipine compared with those treated with valsartan (-6.1 mm Hg v +4.5 mm Hg, P < .02). Conclusions: Amlodipine monotherapy was more effective than valsartan monotherapy in controlling 24-h ambulatory BP and morning BP in hypertensive patients. (C) 2004 American Journal of Hypertension, Ltd.
  • M Mizooka, S Ishikawa
    INTERNAL MEDICINE 42 10 960 - 966 2003年10月 [査読有り][通常論文]
     
    Objective We conducted a large-scale cross-sectional study to assess the prevalence of Chlamydia pneumoniae and clarify the association between seropositivity and risk factors, such as smoking status, physical activity and body mass index in Japanese rural districts. Methods A total of 1,063 men and 1,573 women aged 18-94 years participated in 1999. Serum index values (ID) of IgA and IgG antibodies to C. pneumoniae were measured by ELISA. Index values were categorized as "negative" (IDless than or equal to1.10), "positive" (ID greater than or equal to 1.10) and "high positive" (ID greater than or equal to 3.00). Logistic regression analysis was performed to estimate the crude and adjusted odds ratios for C. pneumoniae seropositivity. Results The overall prevalence of C. pneumoniae IgA seropositivity was 52.5%, and that of IgG was 55.2%. Each seropositivity significantly increased with age. The prevalence among men was significantly higher than in women in C. pneumoniae IgG "high positive" subjects. Compared with never-smokers, the adjusted odds ratio of current smokers was 2.00 (95%CI: 1.45-2.77) for C. pneumoniae IgA seropositivity. The adjusted odds ratio of the higher tertiles of physical activity for C. pneumoniae IgG seropositivity was 1.42 (1.12-1.80) compared with the lower tertiles. In "high positive" subjects, smoking was associated with both immune complexes. Conclusion We confirmed a high prevalence of C. pneumoniae seropositivity among healthy Japanese adults. The results indicated that smoking and high physical activity were associated with C. pneumoniae infection.
  • 地域医療における公的医療機関の役割 保健福祉活動への関わりについて
    岡山 雅信, 高屋敷 明由美, 濱崎 圭三, 坂本 敦司, 尾島 俊之, 黒木 茂広, 長嶺 伸彦, 三瀬 順一, 石川 鎮清, 浅井 泰博, 中村 好一, 梶井 英治
    地域医療 第41回特集号 747 - 749 (公社)全国国民健康保険診療施設協議会 2003年03月
  • A Tsutsumi, K Kayaba, S Ishikawa, T Gotoh, N Nago, S Yamada, M Mizooka, K Sakai, S Hayasaka
    JOURNAL OF EPIDEMIOLOGY 13 2 63 - 71 2003年03月 [査読有り][通常論文]
     
    To observe the association between adverse psychosocial job characteristics, measured by the Karasek job demand-control questionnaire, and a lipid profile, cross-sectional analyses were performed for a Japanese rural working population. The study population comprised 3,333 male and 3,596 female actively employed workers, aged 65 years and under. Among men, higher psychological demands were associated with high total cholesterol levels, with an adjusted difference from the top to bottom tertiles of 3.3 mg/dl (F = 3.03; p = 0.048). High demands were also positively associated with the total/HDL cholesterol ratio (F = 3.94; p = 0.020). Neither job control nor job strain (the ratio of demands to control) was associated with any of the lipid levels in either gender. A psychologically demanding job may be associated with an unfavorable lipid profile, but the impact of job strain on atherogenic lipids is negligible.
  • A Tsutsumi, K Kayaba, M Yoshimura, M Sawada, S Ishikawa, K Sakai, T Gotoh, N Nago
    INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE 10 2 125 - 142 2003年 [査読有り][通常論文]
     
    Associations between job characteristics defined by the Karasek's job demand-control model and health behaviors were, investigated in a cross-sectional analysis of 6,759 Japanese rural workers. High psychological demands were associated with heavy smoking, exaggerated prevalence of alcohol drinking, and high work-related physical activity. Low job control was associated with lower consumption of vegetables, a smaller quantity number of cigarettes smoked, and a low level of work-related physical activity. Job strain, a combined-measure obtained from the ratio of demands to control, was associated with lower vegetable consumption, low prevalence of smoking, and high prevalence of current alcohol drinking. Stratified analyses by occupations and gender provided some but not all of the explanations for the unexpected findings. The results indicate a possible association between psychosocial job characteristics and health behaviors. A few unexpected findings prevent complete support to one of the hypothetical pathways that the job characteristics lead to cardiovascular disease through behaviors.
  • 石川 鎮清, 萱場 一則, 後藤 忠雄, 名郷 直樹, 梶井 英治
    Journal of epidemiology 12 1 2002年01月 [査読無し][通常論文]
  • Shizukiyo Ishikawa, Tadao Gotoh, Naoki Nago, Kazunori Kayaba
    Journal of Epidemiology 12 6 408 - 417 2002年 [査読有り][通常論文]
     
    We have been conducting a cohort study titled the Jichi Medical School Cohort Study (The JMS Cohort Study) since 1992, which is aiming to clarify the risk factors of cardiovascular and cerebrovascu-lar diseases in the Japanese. The baseline data were gathered from April 1992 through July 1995 in 12 rural districts using a legal mass screening system. The total samples were 12,490 males and females, and the overall response rate for the total population was 63%. The mean ages were 55.2 years for males and 55.3 years for females, respectively. Smoking rates were 50.5% and 5.5%, and drinking rates were 75.1% and 25.0% for males and females, respectively. We also examined the Standardized mortality ratios (SMRs) of the cohort subjects for 7.6 year follow-up period. The SMRs were 0.68 [95% confidence interval (CI): 0.59-0.78] for males and 0.73 (95% CI: 0.62-0.85) for females for the cohort subjects, whereas the SMRs were 1.00 (95% CI 0.97-1.04) for males and 1.06 (95% CI: 1.02-1.10) for females for all residents. In this article, we outlined the cohort study and showed general characteristics of the baseline data, and the SMRs of the subjects. We have been following the eligible subjects, and are preparing to show some prospective data regarding cardiovascular and cerebrovascular risks in the near future.
  • 地域医療における公的医療機関の役割 保健福祉活動への関わりについて
    岡山 雅信, 高屋敷 明由美, 濱崎 圭三, 坂本 敦司, 尾島 俊之, 黒木 茂広, 長嶺 伸彦, 三瀬 順一, 石川 鎮清, 浅井 泰博
    全国国保地域医療学会抄録集 41回 208 - 208 全国国保地域医療学会事務局 2001年09月
  • 玉腰 暁子, 石川 鎮清, 尾島 俊之, 菊地 正悟, 小橋 元, 斎藤 有紀子, 杉森 裕樹, 中村 好一, 中山 健夫, 武藤 香織, 山縣 然太朗, 鷲尾 昌一
    医療と社会 9 2 55 - 68 公益財団法人 医療科学研究所 1999年 
    主に以下の3つの研究を行った。
    1.疫学研究におけるインフォームド・コンセント(以下IC)の実態調査
    日本における疫学研究のICの現状について明らかにした,初めての研究である。233名(70.6%)の研究者が何らかの説明を行っており,156名(47.3%)が研究参加の同意も確認したと回答した。
    2.一般住民に対する疫学研究の倫理的問題に関する意識調査
    本調査を通じて,どのような健康情報の提供を求められているかによって,対象者が研究に関する情報を必要とする程度が異っていることが明らかになった。
    3.諸外国における疫学研究の倫理的問題についての情報収集および整理
    イギリスとアメリカの医療記録に関するアクセスについての法的・倫理的な状況について検討した。さらに,ICを巡る法的側面についての課題についての検討を行った。
    疫学研究におけるICのための倫理的なガイドラインを策定するに向けて,より多くの議論の機会を持つことが重要である。
  • K Inoue, N Nago, H Matsuo, T Goto, T Miyamoto, T Saegusa, S Ishikawa, K Kario, Y Nakamura, M Igarashi
    DIABETES CARE 20 8 1242 - 1247 1997年08月 [査読有り][通常論文]
     
    OBJECTIVE - To examine the relationship between serum insulin and lipoprotein(a) [Lp(a)] concentrations in both sexes in a large population. RESEARCH DESIGN AND METHODS - The authors conducted a cross-sectional investigation of fasting serum concentrations of insulin and Lp(a), other blood tests, blood pressures, anthropological measurements, physical activity index, smoking habit, alcohol consumption, and menopause. The subjects were 1,121 men and 1,480 women, ranging between 30 and 90 years of age, who were voluntary participants in the Jichi Medical Cohort Study and who resided in one of five rural communities in Japan. RESULTS - In men, insulin, age, BMI, LDL cholesterol, triglycerides, glucose, and fibrinogen were significantly correlated with Lp(a). In women, insulin, age, IDL cholesterol, fibrinogen, and activated coagulation factor VII were significantly correlated with Lp(a). However, all correlations were weak in either sex. Insulin was inversely correlated with Lp(a) in both sexes. However, the coefficients were weak (r = -0.16 in men and r = -0.06 in women). In the partial correlation analyses, Lp(a) was not significantly associated with insulin in either sex. The result was not influenced by selecting the subjects on the basis of detectable values of insulin and Lp(a) and stratifying them by serum glucose level. CONCLUSIONS - There was no significant relationship found between serum insulin and Lp(a) concentrations in either sex of the cohort, which indicates that Lp(a) does not play a role in the increased risk of cardiovascular disease in hyperinsulinemic subjects.
  • K Kario, N Nago, K Kayaba, T Saegusa, H Matsuo, T Goto, A Tsutsumi, S Ishikawa, T Kuroda, T Miyamoto, T Matsuo, K Shimada
    ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY 16 2 269 - 274 1996年02月 [査読有り][通常論文]
     
    We investigated the relationships between hyperinsulinemia (a major indicator of the insulin resistance syndrome), blood pressure, dyslipidemia, and coagulation factors in 2606 community-dwelling Japanese individuals as part of the Jichi Medical School Cohort Study. An age-related decrease of the fasting insulin level was found in men but not in women. Body mass index, systolic and diastolic blood pressure, triglyceride and fasting glucose levels, and factor VII activity all increased in both sexes as the insulin level became higher, while the HDL cholesterol level decreased. In addition, total cholesterol and LDL cholesterol levels increased as the insulin level became higher and lipoprotein(a) levels decreased in the men. Fibrinogen levels were not related to the insulin level in either sex. Multiple logistic regression analysis revealed that fasting insulin levels were positively correlated with body mass index and fasting glucose and factor VII activity levels, whereas they were negatively correlated with HDL cholesterol in both sexes. In addition, fasting insulin levels were positively correlated with LDL cholesterol levels in men and with triglyceride levels in women. Our results indicate that hyperinsulinemia is associated with high factor VII activity in a general Japanese population as well as with high blood pressure and dyslipidemia. The accumulation of these cardiovascular risk factors in hyperinsulinemic subjects appears to contribute to cardiovascular events in the Japanese as well as in westerners.
  • 萱場 一則, 名郷 直樹, 五十嵐 正紘, 三枝 智宏, 後藤 忠雄, 松尾 仁司, 苅尾 七臣, 堤 明純, 石川 鎮清, 宮本 健史, 寺田 満和
    日本血栓止血学会誌 = The Journal of Japanese Society on Thrombosis and Hemostasis 6 6 477 - 484 1995年12月 [査読無し][通常論文]

書籍

  • 気負わず毎日使えるEBM超実践法「共著」
    ()
    金原出版 2002年
  • 看護のための最新医学講座28薬物療法．ハイリスク患者の薬物療法（高血圧患者）
    ()
    中山書店 2002年

MISC

  • 日本の大規模コホートによる糖尿病と高血圧が心血管疾患による死亡の生涯リスクに与える影響 The EPOCH-JAPAN study
    今井 由希子, 平田 匠, 斎藤 重幸, 二宮 利治, 宮本 恵宏, 大西 浩文, 磯 博康, 三浦 克之, 玉腰 暁子, 山田 美智子, 木山 昌彦, 石川 鎮清, 岡村 智教 日本動脈硬化学会総会プログラム・抄録集 51回 2 -5 2019年07月 [査読無し][通常論文]
  • 医療経済学系研究人材を取り巻く環境と課題
    石川 鎮清, 木村 哲也, 中村 好一, 近藤 克則, 尾島 俊之, 菅原 琢磨, 橋本 英樹 日本公衆衛生学会総会抄録集 77回 519 -519 2018年10月 [査読無し][通常論文]
  • 特定行為に関わる看護師の研修の受講ニーズ調査―施設規模による傾向の違いー
    八木(佐伯)街子, 村上礼子, 鈴木美津枝, 讃井將満, 石川鎮清, 春山早苗, 簑田清次 看護展望 43 (11) 1094 -1101 2018年08月 [査読無し][通常論文]
  • 全国9コホート43,407名の統合解析による超高値HDL-Cと動脈硬化性心血管疾患との関連 The EPOCH-JAPAN study
    平田 あや, 杉山 大典, 渡邉 至, 玉腰 暁子, 磯 博康, 小谷 和彦, 木山 昌彦, 山田 美智子, 石川 鎮清, 村上 義孝, 三浦 克之, 上嶋 弘嗣, 岡村 智教 日本動脈硬化学会総会プログラム・抄録集 50回 336 -336 2018年06月 [査読無し][通常論文]
  • 地方紙に掲載された自己申告型死亡記事
    中村 好一, 松原 優里, 笹原 鉄平, 古城 隆雄, 阿江 竜介, 青山 泰子, 牧野 伸子, 小池 創一, 石川 鎮清 日本公衆衛生雑誌 65 (2) 72 -82 2018年02月 [査読無し][通常論文]
     
    目的 地方紙における遺族の自己申告型死亡記事の記載事項を集計し、その地域での死亡やそれに伴う儀式の実態を明らかにするとともに、死亡記事のデータベースとしての利点と問題点を明らかにする。方法 栃木の地方紙である下野新聞の自己申告型死亡記事「おくやみ」欄に掲載された2011〜2015年の栃木県内の死亡者全員のデータを集計解析し、一部の結果は人口動態統計と比較した。観察項目は掲載年月日、市町村、住所の表示(市町村名のみ、町名・字まで、番地まで含めた詳細な住所)、氏名、性別、死亡年月日、死因、死亡時年齢、通夜・告別式などの名称、通夜などの年月日、告別式などの年月日、喪主と喪主の死亡者との続柄の情報である。結果 観察期間中の掲載死亡者数は69,793人で、同時期の人口動態統計による死亡者数の67.6%であった。人口動態統計と比較した掲載割合は男女で差がなく、小児期には掲載割合が低く、10歳代で高く、20歳代で低下し、以降は年齢とともに上昇していた。市町別の掲載割合は宇都宮市や小山市など都市化が進んだ地域では低く、県東部や北部で高い市町がみられた。最も掲載割合が高かったのは茂木町(88.0%)、低かったのは野木町(38.0%)であった。死亡日から通夜や告別式などの日数から、東京などで起こっている火葬場の供給不足に起因する火葬待ち現象は起こっていないことが判明した。六曜の友引の日の告別式はほとんどなく、今後、高齢者の増加に伴う死者の増加によって火葬場の供給不足が起こった場合には、告別式と火葬を切り離して友引に火葬を行うことも解決策の1つと考えられた。死亡者の子供、死亡者の両親、死亡者の子供の配偶者が喪主の場合には、喪主は男の方が多いことが判明した。老衰、自殺、他殺の解析から、掲載された死因の妥当性は低いことが示された。結論 栃木県の地方紙である下野新聞の自己申告型死亡記事「おくやみ」欄の5年分の観察を行い、実態を明らかにした。約3分の2に死亡が掲載されており、データベースとしての使用に一定の価値があると考えられたが、記載された死因の妥当性は低いことが判明した。(著者抄録)
  • 急性期病院における特定行為にかかわる看護師の研修制度の活用のための示唆―受講ニーズ調査の結果から―
    八木(佐伯)街子, 村上礼子, 鈴木美津枝, 渡辺芳江, 菅野一枝, 讃井將満, 石川鎮清, 春山早苗 看護展望 42 (13) 1253 -1259 2017年10月 [査読無し][通常論文]
  • Takumi Hirata, Daisuke Sugiyama, Shin-Ya Nagasawa, Yoshitaka Murakami, Shigeyuki Saitoh, Akira Okayama, Hiroyasu Iso, Fujiko Irie, Toshimi Sairenchi, Yoshihiro Miyamoto, Michiko Yamada, Shizukiyo Ishikawa, Katsuyuki Miura, Hirotsugu Ueshima, Tomonori Okamura European journal of epidemiology 32 (7) 547 -557 2017年07月 [査読無し][通常論文]
     
    Low levels of serum high-density lipoprotein cholesterol (HDL-C) have been shown to be associated with increased risk of coronary heart disease (CHD). However, because this is usually observed in the context of other lipid abnormalities, it is not known whether isolated low serum HDL-C levels are an independent risk factor for CHD. We performed a large pooled analysis in Japan using data from nine cohorts with 41,206 participants aged 40-89 years who were free of cardiovascular disease at baseline. We divided participants into three groups: isolated low HDL-C, non-isolated low HDL-C, and normal HDL-C. Cohort-stratified Cox proportional hazards models were used to estimate multivariate-adjusted hazard ratios (HRs) for death due to CHD, ischemic stroke, and intracranial cerebral hemorrhage; during a 12.9-year follow-up, we observed 355, 286, and 138 deaths, respectively, in these groups. Non-isolated low HDL-C was significantly associated with increased risk of CHD compared with normal HDL-C (HR 1.37, 95 % confidence interval (CI) 1.04-1.80); however, isolated low HDL-C was not. Although isolated low HDL-C was significantly associated with decreased risk of CHD (HR 0.51, 95 % CI 0.29-0.89) in women, it was significantly associated with increased risk of intracranial cerebral hemorrhage in all participants (HR 1.62, 95 % CI 1.04-2.53) and in men (HR 2.00, 95 % CI 1.04-3.83). In conclusion, isolated low HDL-C levels are not associated with increased risk of CHD in Japan. CHD risk may, therefore, be more strongly affected by serum total cholesterol levels in this population.
  • 医学生の臨床実習後の臨床能力自己評価と学習方略に関する9大学合同調査
    小松 弘幸, 石川 和信, 首藤 太一, 阿部 恵子, 藤崎 和彦, 吉田 素文, 大槻 眞嗣, 泉 美貴, 鈴木 敬一郎, 石川 鎮清, 廣橋 一裕 医学教育 47 (4) 271 -279 2016年08月 [査読無し][通常論文]
     
    臨床実習を終了した国内9医学部の6年生903名を対象として、臨床能力に関する自己評価と教育方略を調査した。医学教育モデル・コア・カリキュラムに準じた27項目のうち約4割が病院実習とシミュレーションの両方、もしくは、シミュレーションのみで学習されていた。また、いずれの方略でも、学習経験のない項目が少なくないことが判明した。シミュレーション教育の高利用大学4校が低利用大学5校よりも、多くの学習領域で有意に医学生の臨床能力自己評価が高かった。(著者抄録)
  • 淺田 義和, 細谷 好則, 鈴木 義彦, 石川 鎮清, 岡崎 仁昭 医学教育 46 (Suppl.) 117 -117 2015年07月 [査読無し][通常論文]
  • 小松 弘幸, 石川 和信, 首藤 太一, 阿部 恵子, 藤崎 和彦, 吉田 素文, 大槻 眞嗣, 泉 美貴, 鈴木 敬一郎, 石川 鎮清, 廣橋 一裕 医学教育 46 (Suppl.) 119 -119 2015年07月 [査読無し][通常論文]
  • 自治医科大学におけるマルチメディア形式総合判定試験の6年の解析
    松山 泰, 三重野 牧子, 武藤 弘行, 江口 和男, 石川 鎮清, 佐田 尚宏, 岡崎 仁昭 医学教育 46 (Suppl.) 133 -133 2015年07月 [査読無し][通常論文]
  • 東アジア地域初のプログレステストの試み
    松山 泰, 菊川 誠, 村上 礼子, Muijtjens Arno, Stalmeijer Renee, 石川 鎮清, 岡崎 仁昭 医学教育 46 (Suppl.) 189 -189 2015年07月 [査読無し][通常論文]
  • 都道府県拠点病院実習とそのファカルティ・ディベロプメント
    石川 鎮清, 江口 和男, 松山 泰, 武藤 弘行, 岡崎 仁昭 医学教育 46 (Suppl.) 204 -204 2015年07月 [査読無し][通常論文]
  • 森田 喜紀, 竹島 太郎, 古城 隆雄, 中村 剛史, 石川 鎮清, 梶井 英治 医学教育 46 (Suppl.) 211 -211 2015年07月 [査読無し][通常論文]
  • 中村 剛史, 岡山 雅信, 藍原 雅一, 古城 隆雄, 石川 鎮清, 中村 好一, 梶井 英治 日本プライマリ・ケア連合学会誌 38 (2) 127 -130 2015年06月 [査読無し][通常論文]
     
    目的:高齢者が糖尿病の診療を受けるために通院する医療機関の地理的分布を検証する。方法:茨城県で2010年5月の1ヵ月間に糖尿病を主病名として通院し後期高齢者医療制度により保険請求された診療データを用いて、市町村ごとにその中心地から医療機関までの距離を測定し、これらの医療機関の地理的分布を検討した。結果:対象は17,717件で、住所地から地図上の位置情報に変換できた17,144件(96.8%)を解析対象とした。医療機関までの距離の中央値[四分位範囲]は5.5[2.3-9.9]kmであった。これは、性・年齢によってわずかに違いを認めるものの、市町村の人口、高齢化率、市町村面積によって違いを認めなかった。結論:高齢者が糖尿病で通院する医療機関は市町村中心から概ね10km範囲に分布していた。いくつかの限界はあるものの、後期高齢者が増加する際の効率的医療資源の配置の資料になり得る。(著者抄録)
  • 2型糖尿病腎症の発症と進展に寄与する臨床的および栄養学的指標の検討 栄養指導による介入がこれらの諸指標に及ぼす効果に関する研究
    川畑 奈緒, 佐藤 敏子, 斎藤 修, 石川 鎮清, 長田 太助, 草野 英二, 石橋 俊 腎臓 37 37 -42 2015年03月 [査読無し][通常論文]
     
    2型糖尿病患者を、正常アルブミン尿(NA)群(30名)、微量アルブミン尿(MA)群(13名)、顕性蛋白尿(OP)群(15名)に分け、早期腎症、顕性腎症の発症・進展に関わる臨床的・栄養学的検討を行った。患者背景では、腹囲はNA群<MA群、足関節血圧/上腕血圧比はNA群>MA群、BUMはNA群<OP群、CrはNA群・MA群<OP群、TGはNA群<MA群・OP群、LDL-CはNA群>OP群といずれも有意差を認めた。薬物療法では、血糖降下薬でスルホニル尿素薬使用がNA群・MA群>OP群、降圧薬でACE阻害薬使用がNA群・MA群<OP群、カルシウム拮抗薬使用がNA群・OP群>MA群、脂質異常症治療薬でEPA製剤使用がNA群<OP群といずれも有意差を認めた。総エネルギー摂取量、各栄養素摂取量、各食品群摂取量は3群間で有意差はなかった。2型糖尿病患者では、早期腎症の発症・進展に腹囲、脂質異常症が、顕性腎症の発症・進展に脂質異常症が関連している可能性が示唆された。
  • 柴田 陽介, 尾島 俊之, 早坂 信哉, 石川 鎮清, 萱場 一則, 後藤 忠雄, 中村 好一 運動疫学研究: Research in Exercise Epidemiology 17 (1) 60 -60 2015年03月 [査読無し][通常論文]
  • 日常病をみる CKD(慢性腎臓病) CKDの疫学
    石川 鎮清 地域医学 28 (12) 1003 -1007 2014年12月 [査読無し][通常論文]
  • 一般住民における身体活動とメタボリック・シンドロームの関係
    石川 鎮清, 中村 好一, 梶井 英治 日本公衆衛生学会総会抄録集 73回 361 -361 2014年10月 [査読無し][通常論文]
  • 自治医科大学における国際的な地域医療教育の構築
    岡崎 仁昭, 淺田 善和, 石川 鎮清 医学教育 45 (Suppl.) 96 -96 2014年07月 [査読無し][通常論文]
  • 自治医科大学女子医学生への有効な卒前教育プログラム確立のための自記式調査
    石川 由紀子, 牧野 伸子, 山本 さやか, 石川 鎮清, 松村 正巳 医学教育 45 (Suppl.) 108 -108 2014年07月 [査読無し][通常論文]
  • 自治医科大学におけるマルチメディア形式の総合判定試験の導入
    松山 泰, 石川 鎮清, 岸 浩一郎, 矢野 晴美, 武藤 弘行, 佐田 尚宏, 岡崎 仁昭 医学教育 45 (Suppl.) 141 -141 2014年07月 [査読無し][通常論文]
  • 自治医科大学における学習支援体制の構築
    岡崎 仁昭, 武藤 弘行, 奥田 浩, 神田 健史, 石川 鎮清 医学教育 45 (Suppl.) 162 -162 2014年07月 [査読無し][通常論文]
  • Bedside learning(BSL)前の診断学実習の効果
    石川 鎮清, 淺田 義和, 岡崎 仁昭 医学教育 45 (Suppl.) 164 -164 2014年07月 [査読無し][通常論文]
  • 臨床推論教育 医学生の参加型臨床実習における症例の主訴解析
    望月 礼子, 矢野 晴美, 石川 鎮清 医学教育 45 (Suppl.) 165 -165 2014年07月 [査読無し][通常論文]
  • 初期臨床研修医に対するSignificant Event Analysis(SEA)を用いた振り返りの検討
    上田 祐樹, 見坂 恒明, 松村 正巳, 石川 鎮清 医学教育 45 (Suppl.) 181 -181 2014年07月 [査読無し][通常論文]
  • 地域医療臨床実習で用いた実習日誌に対する学生の評価
    岡山 雅信, 竹島 太郎, 小松 憲一, 神田 健史, 森田 喜紀, 古城 隆雄, 三瀬 順一, 石川 鎮清, 梶井 英治 医学教育 45 (Suppl.) 186 -186 2014年07月 [査読無し][通常論文]
  • 空腹時インスリン濃度と空腹時血糖による脳梗塞発症のリスク評価 JMSコホート研究より(Risk of Cerebral Infarction assessed by Fasting Insulin and Fasting Glucose in a Japanese General Population: The Jichi Medical School Cohort Study)
    兼田 裕司, 石川 鎮清, 後藤 忠雄, 萱場 一則, 安田 是和, 梶井 英治 自治医科大学紀要 36 33 -40 2014年03月 [査読無し][通常論文]
     
    JMSコホート研究のデータを用いて、空腹時インスリン濃度(FI)、空腹時血糖(FG)と脳梗塞発症との関係について検討した。JMSコホート研究参加者の中で、FI、FGを測定しており、脳卒中、心筋梗塞の既往があるもの、糖尿病治療中のものを除外した2608例を対象とした。FI、FGをそれぞれ3分位に分け、FIが第1分位(T1)、FGがT1の群をGroup 1(G1)、FIがT2、FGがT1の群をG2、FIがT3、FGがT1の群をG3、FIがT1、FGがT2の群をG4、FIがT2、FGがT2の群をG5、FIがT3、FGがT2の群をG6、FIがT1、FGがT3の群をG7、FIがT2、FGがT3の群をG8、FIがT3、FGがT3の群をG9とした。統計学的手法としてCoxの比例ハザードモデルを用いた。G2を基準として脳梗塞発症のハザード比、95%信頼区間を計算したところ、G1、G3、G4、G5、G6、G7、G8、G9はそれぞれ3.93(1.13-13.72)、2.30(0.51-10.34)、2.19(0.58-8.19)、1.18(0.26-5.31)、2.96(0.81-10.88)、3.48(0.97-12.53)、2.39(0.66-8.62)、3.73(1.09-12.84)であった。脳梗塞発症とFIとの関係はFGの各レベルでU字型となっていた。(著者抄録)
  • 10年間死亡率をエンドポイントにした生活習慣によるリスクチャートの作成 和良地域におけるJMSコホート研究より(Lifestyle Risk Charts Illustrating the 10-year Risk of Death in a Japanese Small Community: The JMS Cohort Study at Wara)
    廣瀬 英生, 石川 鎮清, 後藤 忠雄, 萱場 一則, 梶井 英治 自治医科大学紀要 36 57 -62 2014年03月 [査読無し][通常論文]
     
    地域独自かつ生活習慣に根差したリスクチャートを作成することは患者教育に有用であると考えられる。1992年6月からJMSコホートの対象地区の一つとして岐阜県和良町において調査を開始した。参加者は、収縮期血圧、総コレステロール、HDLコレステロール、血糖値を測定し、既往歴、生活習慣をアンケートにて聴取した。1371人(男性615名、女性756名)に対して解析、総死亡は356例であった。男性において、physical activity indexは総死亡率と関連があった(Hazard ratio 0.92 95%信頼区間0.87-0.97)、女性においては、死亡率が少ない傾向であった(HR0.92 95% CI 0.82-1.01)。男女において、柑橘類の摂取は、死亡の低下と関連があった。(柑橘類低摂取群vs通常摂取群、低摂取群vs高摂取群:男性0.63 95% CI 0.35-1.14及び0.23 0.09-0.55、女性1.02、0.51-2.06及び0.39、0.19-0.90)。この有意であった2つの因子を基に10年間総死亡率に対するリスクチャートを作成した。この研究を通じて、日本のへき地である和良地域独自の生活習慣を基にしたリスクチャートを作成した。(著者抄録)
  • 竹迫 弥生, 石川 鎮清, 梶井 英治 Palliative Care Research 8 (2) 280 -285 2013年12月 [査読無し][通常論文]
     
    【目的】介護老人福祉施設,介護老人保健施設,介護療養型医療施設(以下,介護保険3施設)における胃瘻の医療処置を受けている利用者の割合と,その割合が2007年から2010年で増加したかを明らかにする.【方法】厚生労働省が2007年と2010年に行った全国調査の公表データをもとに,施設種別ごと,要介護度別ごとに,介護保険3施設内で行われた胃瘻の医療処置を受けた者の対在所者割合を算出した.【結果】胃瘻の利用者割合は,2007年,2010年おのおの,介護老人福祉施設で5.8%,8.1%,介護老人保健施設で3.9%,5.9%,介護療養型医療施設で18.4%,26.1%であった.介護保険3施設共に,要介護度3以上の利用者で胃瘻の利用者割合は増加した.【結論】2007年から2010年にかけて,介護保険施設内における胃瘻利用者は要介護度3以上で増加した.(著者抄録)
  • Kazuomi Kario, Hajime Haimoto, Kayo Yamagiwa, Kiyoshi Uchiba, Shouichirou Nagasaka, Yuichiro Yano, Kazuo Eguchi, Yoshio Matsui, Motohiro Shimizu, Joji Ishikawa, Shizukiyo Ishikawa, Satoshi Hoshide CIRCULATION 128 (22) 2013年11月 [査読無し][通常論文]
  • 【臨床研究の成果を実地臨床へ生かそう-産科編】 PubMedとUpToDateのうまい使い方 検索具体例 周産期編
    石川 鎮清 周産期医学 43 (10) 1211 -1216 2013年10月 [査読無し][通常論文]
  • 自治医科大学における国際的な地域医療教育の構築
    岡崎 仁昭, 淺田 義和, 石川 鎮清 医学教育 44 (Suppl.) 116 -116 2013年07月 [査読無し][通常論文]
  • 地域医療臨床実習での経験の共有の試み
    岡山 雅信, 小松 憲一, 竹島 太郎, 古城 隆雄, 神田 健史, 三瀬 順一, 石川 鎮清, 梶井 英治 医学教育 44 (Suppl.) 118 -118 2013年07月 [査読無し][通常論文]
  • 10ステーションでのAdvanced OSCEトライアルにおける学生アンケート結果
    石川 鎮清, 岡崎 仁昭 医学教育 44 (Suppl.) 187 -187 2013年07月 [査読無し][通常論文]
  • 自治医科大学におけるAdvanced OSCEの現状と課題
    上田 祐樹, 石川 鎮清, 岡崎 仁昭 医学教育 44 (Suppl.) 188 -188 2013年07月 [査読無し][通常論文]
  • 選択必修BSLにおける院外拠点病院実習ポストアンケート2年間の結果
    石川 鎮清, 佐田 尚宏, 岡崎 仁昭 医学教育 44 (Suppl.) 193 -193 2013年07月 [査読無し][通常論文]
  • 宮道 亮輔, 石川 鎮清, 尾身 茂 日本救急医学会雑誌 24 (6) 321 -328 2013年06月 [査読無し][通常論文]
     
    【目的】震災派遣医師のストレスマネジメントにおけるSignificant Event Analysis(SEA)の有効性を検討する。【対象と方法】自治医科大学同窓会東日本大震災支援プロジェクトにより被災地(東北地方)に派遣された医師67名である。SEA施行群(SEA群)と非施行群(対照群)に無作為に割り付け、SEA群には震災派遣から帰還4週間後に質問紙にてSEA調査を行った。【主要なアウトカム評価】改訂出来事インパクト尺度(IES-R)、K6質問票を用いて、帰還4週間後(SEA調査前)と8週間後の改善度を調査した。【結果】IES-Rの改善度は、SEA群:1.27±5.08[平均±標準偏差]、対照群:2.43±4.05であり、p=0.30と有意な差を認めなかった。K6質問票の改善度は、SEA群:1.83±2.68、対照群:0.76±3.01であり、p=0.13と有意な差を認めなかった。【結語】ボランティアで被災地支援に行った医師にSEAを行うことは、ストレスの軽減につながらない。(著者抄録)
  • 変形性膝関節症に対するヒアルロン酸ナトリウム架橋体製剤(商品名:サイビスク)の有効性・有害事象の検討
    西頭 知宏, 浅野 茂利, 石川 鎮清 JOSKAS 38 (2) 304 -305 2013年04月 [査読無し][通常論文]
     
    2011年3〜8月に来院した変形性膝関節症患者で、1年以上膝関節内に注射歴がなく、NSAID等の処方でも鎮痛効果が得られず、代わってヒアルロン酸架橋体製剤(本剤)の関節内注射(1週ごとに3回連続)を行ない、3ヵ月以上経過観察可能であった10例を対象に本剤の有効性・有害事象について検討した。その結果、Numerical Rating Scale、Western Ontario and McMaster Universities osteoarthritis index(WOMAC)、JOA scoreはそれぞれ投与前平均6.3±1.8、37.7±11.9、58.5±12.5が、6週後には2.4±1.6、23.8±17.9、71.0±19.0となり、全項目で有意に改善していた。12週後にはそれぞれ2.8±2.1、24.6±21.6、69.0±16.5となり、WOMAC以外は有意に改善がみられた。一方、疼痛緩和効果の持続期間は平均3.6ヵ月で、Kellgren-Lawrence分類別にgrade IIであった3例が平均4.3ヵ月、IIIであった5例が5.3ヵ月、IVであった2例が1.5ヵ月であった。尚、経過観察中に明らかな有害事象は認められなかった。
  • ヘリコバクター・ピロリ感染症と高血圧症 JMSコホート研究(The prevalence of Helicobacter pylori with hypertension: The Jichi Medical School Cohort Study)
    山本 令子, 石川 鎮清, 溝岡 雅文, 梶井 英治, 自治医科大学コホートグループ 自治医科大学紀要 35 13 -18 2013年03月 [査読無し][通常論文]
     
    ヘリコバクター・ピロリ感染症と心血管危険因子の関連性が指摘されている。高血圧症との関連性についても指摘されているが、一定の見解は得られていない。われわれは、日本の地域一般住民におけるヘリコバクター・ピロリ感染症と高血圧症との関連性を調べるため、自治医科大学(JMS)コホート研究の一環として、横断調査を行った。ヘリコバクター・ピロリ抗体陽性率は、高血圧症群では56.1%、非高血圧症群では52.4%であった。多重ロジスティック解析では、ヘリコバクター・ピロリ抗体陽性は、高血圧症と関連していなかった(一般的な心血管危険因子で調整したオッズ比:1.14、95%信頼区間:0.85-1.26、P=0.72)。65歳以上では、ヘリコバクター・ピロリ抗体陽性は高血圧症と関連があり(1.30、1.01-1.69、P=0.04)、65歳未満では、関連していなかった。われわれは、地域一般住民において、65歳以上ではヘリコバクター・ピロリ感染症が高血圧症と関連し、65歳未満では関連していないことを示した。(著者抄録)
  • 実習前の学生は地域医療臨床実習において地域社会活動の経験が必要と思っているのか?
    岡山 雅信, 小松 憲一, 山本 祐, 森田 喜紀, 見坂 恒明, 竹島 太郎, 神田 健史, 石川 鎮清, 三瀬 順一, 梶井 英治 地域医療 (第52回特集号) 1099 -1100 2013年03月 [査読無し][通常論文]
  • 内田 真一, 石川 鎮清, 熊田 真樹, 黒木 茂広, 梶井 英治 日本プライマリ・ケア連合学会誌 35 (4) 279 -285 2012年12月 [査読無し][通常論文]
     
    目的:自治医科大学附属病院総合診療部に入院した発熱患者の原因疾患の分布を調査した。方法:2003年4月から2004年3月までに当院総合診療部に入院したすべての患者を対象とした。病歴要約とカルテから発熱と不明熱が主訴に含まれる症例と入院時腋下体温が37.5℃以上であった全症例の原因疾患を調査した。結果:延べ464名の入院患者のうち発熱患者は221名(47.6%)であった。発熱の原因として最も多かったのは感染症で149名(67.4%)であった。以下悪性腫瘍9名(4.1%)、膠原病7名(3.2%)、その他23名(10.4%)となった。発熱患者のうち不明熱と診断されたものは26名(11.8%)であった。その原因として最も多かったのは膠原病の9名(34.6%)であった。原因不明は7名でその割合は26.9%と過去の報告と一致した。発熱の原因として悪性腫瘍と膠原病の割合は30歳代から50歳代までいずれも約16%を占め、このうち不明熱の基準を満たした症例は1例だけであった。結論:発熱の原因疾患は感染症が最も多かった。外来にて経過観察しても症状の改善が見られない場合には、入院での全身精査が必要と思われた。不明熱の原因疾患として非感染性炎症性疾患が重要と思われる。(著者抄録)
  • Kazuomi Kario, Satoshi Hoshide, Yuichiro Yano, Kazuo Eguchi, Yoshio Matsui, Motohiro Shimizu, Joji Ishikawa, Shizukiyo Ishikawa CIRCULATION 126 (21) 2012年11月 [査読無し][通常論文]
  • Joji Ishikawa, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Kazuomi Kario CIRCULATION 126 (21) 2012年11月 [査読無し][通常論文]
  • Satoshi Hoshide, Michiaki Nagai, Yuichiro Yano, Joji Ishikawa, Kazuo Eguchi, Shizukiyo Ishikawa, Kazuomi Kario CIRCULATION 126 (21) 2012年11月 [査読無し][通常論文]
  • Kazuo Eguchi, Satoshi Hoshide, Shizukiyo Ishikawa, Kazuomi Kario CIRCULATION 126 (21) 2012年11月 [査読無し][通常論文]
  • 震災支援者のストレスマネージメントおけるSignificant Event Analysisの有用性について 非盲検化ランダム化比較試験
    宮道 亮輔, 石川 鎮清, 尾身 茂 日本救急医学会雑誌 23 (10) 559 -559 2012年10月 [査読無し][通常論文]
  • S市における、2質問法による抑うつスクリーニングと健康指標に関する研究
    山本 令子, 石川 鎮清, 梶井 英治 日本公衆衛生学会総会抄録集 71回 218 -218 2012年10月 [査読無し][通常論文]
  • 一般住民における起立性低血圧および起立性高血圧の頻度と関連因子
    石川 鎮清, 中村 好一, 苅尾 七臣, 梶井 英治 日本高血圧学会総会プログラム・抄録集 35回 411 -411 2012年09月 [査読無し][通常論文]
  • 家庭血圧計による夜間血圧 自由行動下血圧計による夜間血圧の推定能について
    石川 譲治, 星出 聡, 江口 和男, 石川 鎮清, 島田 和幸, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 35回 415 -415 2012年09月 [査読無し][通常論文]
  • 慢性腎臓病患者における左室形態に対するBNPとNT-pro BNPを用いたスクリーニング J-HOP(Japan Morning Surge-Home Blood Pressure)研究
    信田 紗希, 星出 聡, 江口 和男, 石川 譲治, 石川 鎮清, 新保 昌久, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 35回 434 -434 2012年09月 [査読無し][通常論文]
  • 糖尿病/前糖尿病を合併した高血圧患者における積極的降圧療法は圧受容器反射感受性を改善させる
    江口 和男, 星出 聡, 石川 鎮清, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 35回 477 -477 2012年09月 [査読無し][通常論文]
  • 【答えが見つかる!慢性疾患への薬の使い方 専門医が伝授する高血圧、糖尿病、膠原病、腎疾患、慢性心不全、肺疾患診療のコツ】 (第1章)高血圧 外来通院時の注意点についての疑問 処方変更や紹介のタイミングは?
    石川 鎮清 レジデントノート 14 (8) 1447 -1451 2012年08月 [査読無し][通常論文]
     
    ＜point＞・外来での高血圧の薬の増減について学ぶ・高血圧専門医へ紹介するタイミングについて学ぶ(著者抄録)
  • コミュニケーション能力向上を目的とした振り返り学習を用いたロールプレイ実習の試み
    森田 喜紀, 黒木 茂広, 三瀬 順一, 石川 鎮清, 岡山 雅信, 梶井 英治 医学教育 43 (Suppl.) 129 -129 2012年07月 [査読無し][通常論文]
  • 選択必修BSLにおける院外拠点病院実習
    石川 鎮清, 黒木 茂広, 岡崎 仁昭 医学教育 43 (Suppl.) 137 -137 2012年07月 [査読無し][通常論文]
  • 患者コンテクストを意識した臨床推論能力獲得を目的とした参加型臨床実習の新たな試み
    山本 祐, 岡山 雅信, 見坂 恒明, 牧野 伸子, 三瀬 順一, 石川 鎮清, 黒木 茂広, 梶井 英治 医学教育 43 (Suppl.) 139 -139 2012年07月 [査読無し][通常論文]
  • 自治医科大学におけるAdvanced OSCEの試み
    見坂 恒明, 石川 鎮清, 黒木 茂広, 岡崎 仁昭 医学教育 43 (Suppl.) 163 -163 2012年07月 [査読無し][通常論文]
  • 変形性膝関節症に対するヒアルロン酸ナトリウム架橋体製剤(商品名:サイビスク)の有効性・有害事象の検討
    西頭 知宏, 浅野 茂利, 石川 鎮清 JOSKAS 37 (4) 168 -168 2012年06月 [査読無し][通常論文]
  • 介護老人福祉施設における事前指示書【全国調査】
    竹迫 弥生, 石川 鎮清, 梶井 英治 日本緩和医療学会学術大会プログラム・抄録集 17回 332 -332 2012年06月 [査読無し][通常論文]
  • 糖尿病・前糖尿病を合併した高血圧患者において積極的降圧療法により圧受容器反射感受性が改善する
    江口 和男, 星出 聡, 石川 鎮清, 苅尾 七臣 日本循環制御医学会総会プログラム・抄録集 33回 48 -48 2012年06月 [査読無し][通常論文]
  • 長期にわたる診察室血圧の平均値は24時間血圧と同等に脳卒中予後予測に有用である
    江口 和男, 星出 聡, 石川 鎮清, 島田 和幸, 苅尾 七臣 日本高血圧学会臨床高血圧フォーラムプログラム・抄録集 1回 129 -129 2012年04月 [査読無し][通常論文]
  • 稲熊 良仁, 岡山 雅信, 古城 隆雄, 原田 昌範, 高木 史江, 山本 令子, 今野 和典, 石川 鎮清, 三瀬 順一, 梶井 英治 日本プライマリ・ケア連合学会誌 35 (1) 12 -16 2012年03月 [査読無し][通常論文]
     
    目的:全国の総合診療科の初診時問診票を分析し、診察前に収集される医療情報を明らかにする。方法:日本総合診療医学会(現日本プライマリ・ケア連合学会)のホームページに掲載された総合診療科を標榜する302施設(2010年3月の時点)を対象とし、問診票の提出を依頼した。得られた問診票の形態と内容について分析を行った。結果:収集した初診時問診票には共通した書式は認めなかった。形態はA4版が58枚(68%)で最多であり、質問項目数は平均19.7項目であった。研究協力施設間で共通して記載されていた問診票の分野は、頻度が高い順に、既往歴に関する項目が28項目(31.8%)、生活歴に関する項目19項目(21.6%)、患者社会情報と生殖歴が共に7項目(8.0%)であった。結論:全国の総合診療科で使用されている問診票の質的評価を行い、医師が初診患者の診察前に求めている医療情報を推測することが出来た。(著者抄録)
  • 小松憲一, 岡山雅信, 森田喜紀, 山本祐, 見坂恒明, 竹島太郎, 神田健史, 中村剛史, 石川鎮清, 三瀬順一, 梶井英治 日本プライマリ・ケア連合学会学術大会抄録集 3rd 199 2012年 [査読無し][通常論文]
  • Kazuo Eguchi, Satoshi Hoshide, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario CIRCULATION 124 (21) 2011年11月 [査読無し][通常論文]
  • 【高血圧と糖尿病〜Clinical Up To Date〜】 疫学 Prehypertensionと肥満・糖尿病
    石川 鎮清 Diabetes Frontier 22 (5) 479 -483 2011年10月 [査読無し][通常論文]
  • ロサルタン/ヒドロクロロチアジド併用療法と高用量アムロジピンの血圧および微量アルブミン尿に対する効果の比較 the ALPHABET study(Effects of Losartan/Hydrochlorothiazide Combination versus High-dose Amlodipine on Blood Pressure and Microalubuminuria: the ALPHABET Study)
    福冨 基城, 星出 聡, 渡部 智紀, 甲谷 友幸, 石川 鎮清, 江口 和男, 島田 和幸, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 34回 324 -324 2011年10月 [査読無し][通常論文]
  • 糖尿病合併高血圧患者におけるARBベースの積極的降圧療法は降圧度とは独立して血管内皮機能、augmentation indexを改善する
    江口 和男, 星出 聡, 石川 鎮清, 島田 和幸, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 34回 467 -467 2011年10月 [査読無し][通常論文]
  • 降圧薬治療による、睡眠中血圧の低下と血漿BNP低下との相関関係 The Japan Morning Surge Target-Organ Protection(JMS-TOP) study
    志水 元洋, 石川 譲治, 矢野 裕一朗, 星出 聡, 江口 和男, 石川 鎮清, 島田 和幸, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 34回 477 -477 2011年10月 [査読無し][通常論文]
  • 本態性高血圧患者における外来血圧変動と24時間血圧変動の予後に及ぼす影響の比較
    江口 和男, 星出 聡, 石川 鎮清, 島田 和幸, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 34回 478 -478 2011年10月 [査読無し][通常論文]
  • 高血圧治療における高感度心筋トロポニンTの変化
    星出 聡, 福冨 基城, 江口 和男, 渡部 智紀, 甲谷 友幸, 石川 鎮清, 新保 昌久, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 34回 594 -594 2011年10月 [査読無し][通常論文]
  • 地域一般住民におけるHelicobacter pylori抗体陽性と高血圧症の関連 JMSコホート研究より
    山本 令子, 石川 鎮清, 溝岡 雅文, 梶井 英治 日本高血圧学会総会プログラム・抄録集 34回 604 -604 2011年10月 [査読無し][通常論文]
  • 【震災と地域医療】 自治医科大学医学部同窓会 東日本大震災支援プロジェクト 釜石地区における活動報告
    宮道 亮輔, 石川 鎮清, 尾身 茂 地域医学 25 (10) 909 -909 2011年10月 [査読無し][通常論文]
  • 職業階層間で職業性ストレスが日本人労働者の脳卒中罹患に及ぼす影響は性により異なる
    堤 明純, 萱場 一則, 石川 鎮清 日本公衆衛生学会総会抄録集 70回 342 -342 2011年10月 [査読無し][通常論文]
  • T. Toyotsuji, S. Ishikawa, K. Kayaba, Y. Nakamura, E. Kajii JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH 65 A383 -A383 2011年08月 [査読無し][通常論文]
  • S. Ishikawa, K. Kayaba, T. Gotoh, Y. Nakamura, E. Kajii JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH 65 A254 -A255 2011年08月 [査読無し][通常論文]
  • 低リポプロテイン(a)血症は生存期間の短縮と関連している 自治医科大学コホート研究
    沢辺 元司, 中原 賢一, 松下 哲, 石川 鎮清 日本老年医学会雑誌 48 (Suppl.) 52 -52 2011年05月 [査読無し][通常論文]
  • 我が国の大規模コホート研究のこれまでとこれから JMSコホート研究の経験とこれから
    石川 鎮清 日本循環器病予防学会誌 46 (2) 110 -111 2011年04月 [査読無し][通常論文]
  • 身長と脳卒中罹患の関連 JMSコホート研究
    定金 敦子, 石川 鎮清, 中村 好一 日本循環器病予防学会誌 46 (2) 144 -144 2011年04月 [査読無し][通常論文]
  • 外傷性脳出血を契機に診断し得たH.pylori陽性特発性血小板減少性紫斑病の1例
    山本 令子, 佐藤 元美, 石川 鎮清, 梶井 英治 日本内科学会関東地方会 579回 51 -51 2011年03月 [査読無し][通常論文]
  • 夜尿症治療における排便習慣聴取の重要性とその方法
    川合 志奈, 久保 太郎, 中村 繁, 中井 秀郎, 石川 鎮清 日本小児科学会雑誌 115 (3) 696 -696 2011年03月 [査読無し][通常論文]
  • 【大規模臨床試験のピットホール】 大規模臨床試験の意義と限界
    石川 鎮清, 島田 和幸 血圧 18 (1) 12 -15 2011年01月 [査読無し][通常論文]
     
    降圧薬を用いた大規模臨床試験では心血管イベント抑制を含め有用性が明確である。これらの試験成績は臨床判断の根拠として不可欠である。しかし、大規模臨床試験成績から治療後血圧について「低ければ低いほどよい」とはいえず、「至適降圧範囲」は確定していない。大規模臨床試験の内容は通常の診療と乖離した部分が少なくなく、試験期間が5年程度と短かったり、降圧薬間の比較試験では現在では使用頻度の低い薬剤の組み合わせが使われていたりしている。臨床試験の結果を日常臨床に活かすには、それぞれの研究の特徴を見極める必要がある。(著者抄録)
  • 社会医学実習での疫学調査と疫学調査を行なう際の倫理に関する教育の実態 衛生学公衆衛生学教育協議会加入講座の教育担当者へのアンケート調査より
    鷲尾 昌一, 尾島 俊之, 玉腰 暁子, 酒井 未知, 武藤 香織, 小橋 元, 石川 鎮清, 大神 英一, 太田 薫里, 佐藤 恵子, 鈴木 美香, 杉森 裕樹, 内藤 真理子, 中山 健夫, 丸山 英二, 山縣 然太朗 臨牀と研究 87 (10) 1473 -1481 2010年10月 [査読無し][通常論文]
     
    衛生学公衆衛生学教育協議会加入の衛生公衆衛生学204講座に対して社会医学実習における疫学調査と倫理に関するアンケート調査を行い、126講座より回答を得た。ヒトを対象とした疫学調査は61.9%で実施され、学生全員21.4%、一部40.5%であった。実習時間は1ヵ月未満31.7%、1〜3ヵ月31.0%で、6ヵ月以上は11.9%であった。疫学調査の倫理の講義は「1コマ以上行う」15.1%、「折に触れて」41.3%、「非社会学系の医療倫理で行う」23.8%、「別の社会医学系の講座が行う」10.3%、「行っていない」14.3%であった。実習で指導している項目は「守秘義務」52.4%、「資料の保管方法」34.1%、「資料の破棄」21.4%、「匿名化の方法」29.4%、「不必要な情報は集めない」27.0%であった。学生実習での倫理委員会への申請は、「必要ない」11.1%、「担当教員の判断」46.0%、「自主的に申請」2.4%、「申請が必要(通常審査)」4.8%であった。社会医学に関するProblem based learningを行っていたのは41.3%、倫理に関しては4.8%であった。
  • 柑橘類摂取と脳卒中発症との関連 JMSコホート研究
    山田 友世, 早坂 信哉, 尾島 俊之, 石川 鎮清, 萱場 一則 日本公衆衛生学会総会抄録集 69回 249 -249 2010年10月 [査読無し][通常論文]
  • 一般地域住民における脳卒中の発症とnon-HDLコレステロール JMS Cohort Study
    小谷 和彦, 石川 鎮清, 定金 敦子, 千原 泉, 坪井 聡, 上原 里程, 後藤 忠雄, 萱場 一則, 中村 好一 日本公衆衛生学会総会抄録集 69回 266 -266 2010年10月 [査読無し][通常論文]
  • 日本人地域一般住民の心血管イベントにおけるPrehypertension(前高血圧症)のリスク JMSコホート研究より
    石川 由紀子, 石川 譲治, 石川 鎮清, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 33回 282 -282 2010年10月 [査読無し][通常論文]
  • K. Kario, S. Hoshide, M. Shimizu, Y. Yano, K. Eguchi, J. Ishikawa, S. Ishikawa, K. Shimada JOURNAL OF HYPERTENSION 28 E83 -E84 2010年06月 [査読無し][通常論文]
  • 【高血圧のすべて】 なぜ高血圧になるのか ストレス・うつと高血圧
    石川 鎮清 からだの科学 (264) 58 -61 2010年02月 [査読無し][通常論文]
  • BABA Yosuke, ISHIKAWA Shizukiyo, AMAGI Yoko, KAYABA Kazunori, GOTOH Tadao, KAJII Eiji J Epidemiol 20 (Supplement 1) S107 2010年01月 [査読無し][通常論文]
  • 【高血圧(第4版) 日本における最新の研究動向】 臨床編 日本人の疫学研究の最新知見 JMSコホート研究
    石川 鎮清, 萱場 一則, 中村 好一, 梶井 英治 日本臨床 67 (増刊7 高血圧(下)) 596 -600 2009年11月 [査読無し][通常論文]
  • 地域で行う多機関による研究の特徴 JMSコホート研究 医師の視点から
    降籏 幹子, 石川 鎮清, 佐々木 美佐子 日本公衆衛生学会総会抄録集 68回 336 -336 2009年10月 [査読無し][通常論文]
  • 一般地域住民における心筋梗塞の発症とnon-HDLコレステロールの関連 JMSコホート研究
    小谷 和彦, 石川 鎮清, 後藤 忠雄, 萱場 一則, 定金 敦子, 上原 里程, 中村 好一 日本公衆衛生学会総会抄録集 68回 370 -370 2009年10月 [査読無し][通常論文]
  • 糖尿病合併高血圧では早朝血圧に加えて就寝前血圧のコントロールが重要である JMS-1研究サブ解析
    江口 和男, 松井 芳夫, 柴崎 誠一, 石川 譲治, 星出 聡, 石川 鎮清, 甲谷 友幸, 島田 和幸, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 32回 198 -198 2009年10月 [査読無し][通常論文]
  • K. Kotani, S. Ishikawa, T. Gotoh, K. Kayaba, Y. Nakamura, E. Kajii ATHEROSCLEROSIS SUPPLEMENTS 10 (2) 2009年06月 [査読無し][通常論文]
  • 腸腰筋巨大血腫に対して凝固因子補充療法ならびに外科的血腫除去術を施行した血友病Aの1例
    田中 裕一郎, 安納 靖美, 津本 順史, 石川 鎮清, 梶井 英治 地域医学 23 (6) 439 -443 2009年06月 [査読無し][通常論文]
     
    20歳男。10歳時、自転車で転倒時の膝関節腫脹を契機に血友病Aと診断された。2日に1度、第VIII因子製剤を自己注射していた。高校卒業後就職のため他県に転居した。第VIII因子製剤を処方されていたが自己中断していた。サッカーで転倒後右股関節に「肉離れ」のような疼痛が出現し、松葉杖を使用してのリハビリを行っていた。階段で転倒し、臀部を打撲し、その後から右側腹部の疼痛が出現し、右側腹部の疼痛が増強して動けなくなり、さらに右下肢の麻痺症状も出現した。腹部CTで巨大な右腸腰筋血腫を認めた。保存的治療を試みたが、自然吸収までには長時間を要し、神経障害や拘縮が不可逆となる可能性が高いと判断し、外科的血腫除去術施行となった。第VIII因子製剤補充療法、リハビリ療法を行い、右下肢の神経症状は改善に向かい、またCT上も血腫は縮小した。
  • 柴田 陽介, 山田 友世, 早坂 信哉, 尾島 俊之, 石川 鎮清, 萱場 一則, 後藤 忠雄, 中村 好一 日本循環器病予防学会誌 44 (2) 92 -92 2009年04月 [査読無し][通常論文]
  • 発熱・心嚢水貯留・胸水貯留を来し診断が困難だった1例
    岩下 ちひろ, 小松 憲一, 石川 鎮清, 梶井 英治 日本内科学会関東地方会 561回 27 -27 2009年03月 [査読無し][通常論文]
  • 【熟練医から"日常診療のさまざまなコツ"を伝授】 "患者マネジメント"のコツ 患者も人間、医者も人間
    石川 鎮清 治療 91 (臨増) 154 -155 2009年03月 [査読無し][通常論文]
  • 保健師が多機関と行う研究体制構築のプロセスの特性
    降籏 幹子, 佐々木 美佐子, 石川 鎮清, 萱場 一則 獨協医科大学看護学部紀要 2 1 -11 2009年03月 [査読無し][通常論文]
     
    本研究の目的は、保健師が多機関と行う研究体制の構築のプロセスの特性を明らかにすることである。研究対象は、JMSコホート研究(The Jichi Medical School Cohort Study)の対象地区市町村に属する保健師5名とした。対象条件としては、データベース調査、追跡調査を担当し、研究プロセスを12.8年間経験した保健師とした。半構造的インタビュー調査にて多機関と行う研究における保健師の役割と課題を聴取し、質的帰納的手法にて分析をした。その結果、多機関との関わりを特徴とした研究体制構築プロセスの5つの局面は、研究の動機づけ]、[研究の計画]、[研究の実施]、[研究の成果]、[研究の発展]に分類された。[研究の発展]は、地域活動への還元と保健師の専門性の発展に2つに分類された。以上のことから、多機関と行う地域の研究課題に対して、多機関との関わりのプロセスの特性を踏むことにより、研究の成果を地域活動に取り入れ、保健師の技術を向上、意識の変化をおこさせることができる。その結果、普遍性のある地域活動の展開がされて、更に多機関と行う研究課題と地域独自に行う研究課題に取り組めることができる特性を構造化した。(著者抄録)
  • 心房細動の死亡に与える影響について JMSコホート研究
    岩花 弘之, 石川 鎮清, 萱場 一則, 後藤 忠雄, 梶井 英治 日本内科学会雑誌 98 (Suppl.) 132 -132 2009年02月 [査読無し][通常論文]
  • K. Eguchi, T. G. Pickering, J. E. Schwartz, S. Hoshide, J. Ishikawa, S. Ishikawa, K. Shimada, K. Kario ARCHIVES OF INTERNAL MEDICINE 169 (2) 154 -154 2009年01月 [査読無し][通常論文]
  • 抗生剤単独での治療が奏功した脾膿瘍の2例
    瑞慶覧 元, 西谷 基子, 小松 憲一, 石川 鎮清, 亀崎 豊実, 梶井 英治 自治医科大学紀要 31 85 -90 2008年12月 [査読無し][通常論文]
     
    発熱や左上腹部痛などの症状があり画像診断等によって早期に脾膿瘍と診断され、抗菌薬単独で治療可能であった症例を経験した。従来、脾臓摘出術や経皮的ドレナージ術など侵襲的な治療法が選択されることが多かったが、脾膿瘍の原因や病態によっては保存的治療のみで治療を完遂できると考える。(著者抄録)
  • 睡眠時無呼吸症候群の患者における夜間血圧non-dippingと炎症およびPAI-1の上昇の関連について
    石川 譲治, 志水 元洋, 星出 聡, 江口 和男, 石川 鎮清, Pickering Thomas, 島田 和幸, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 31回 161 -161 2008年10月 [査読無し][通常論文]
  • 脳卒中発症推定のためのリスクチャート JMSコホート研究
    石川 鎮清, 苅尾 一臣, 梶井 英治 日本高血圧学会総会プログラム・抄録集 31回 286 -286 2008年10月 [査読無し][通常論文]
  • 日本人地域一般住民における心電図上の左室肥大の脳卒中および心筋梗塞のリスク 自治医大コホート研究
    石川 譲治, 甲谷 友幸, 三橋 武司, 石川 鎮清, 後藤 忠雄, 萱場 一則, 梶井 栄治, 島田 和幸, Pickering Thomas, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 31回 323 -323 2008年10月 [査読無し][通常論文]
  • 高血圧患者に対する高用量長時間作用型カルシウムチャンネル拮抗剤の降圧効果と臓器への作用
    宇野 秀之, 石川 譲治, 星出 聡, 甲谷 友幸, 石川 鎮清, 島田 和幸, 苅尾 七臣 日本高血圧学会総会プログラム・抄録集 31回 333 -333 2008年10月 [査読無し][通常論文]
  • 男性における日常の飲酒量および飲酒頻度と不慮の事故による死亡 JMSコホート研究
    定金 敦子, 堤 明純, 石川 鎮清, 中村 好一 日本公衆衛生学会総会抄録集 67回 236 -236 2008年10月 [査読無し][通常論文]
  • JMSコホート研究に果たした保健師の役割と地域活動への影響
    降籏 幹子, 石川 鎮清, 萱場 一則, 後藤 忠雄, 佐々木 美佐子 日本公衆衛生学会総会抄録集 67回 349 -349 2008年10月 [査読無し][通常論文]
  • 地域住民における脳卒中発症の危険因子に関する検討 JMSコホート研究
    柴田 陽介, 早坂 信哉, 村田 千代栄, 野田 龍也, 菊地 慶子, 長谷川 拓也, 船橋 香緒里, 安田 孝子, 山田 友世, 原岡 智子, 石川 鎮清, 萱場 一則, 尾島 俊之 日本公衆衛生学会総会抄録集 67回 403 -403 2008年10月 [査読無し][通常論文]
  • 市区町村福祉(介護)部門のがん対策に関する調査
    大木 いずみ, 渡辺 晃紀, 早坂 信哉, 石川 鎮清, 中村 好一 日本公衆衛生学会総会抄録集 67回 407 -407 2008年10月 [査読無し][通常論文]
  • 心理社会的仕事の特徴が脳卒中罹患に及ぼす影響の職位による相違
    堤 明純, 萱場 一則, 石川 鎮清 日本公衆衛生学会総会抄録集 67回 632 -632 2008年10月 [査読無し][通常論文]
  • かかりつけ医による生活習慣病予備軍への行動科学的個別支援の効果 東久留米市国保ヘルスアップモデル事業より
    石川 由紀子, 石川 鎮清, 竹迫 弥生, 石橋 幸滋, 中村 正和, 梶井 英治 プライマリ・ケア 31 (3) 134 -142 2008年09月 [査読無し][通常論文]
     
    目的:かかりつけ医による生活習慣病予備軍への行動科学的個別支援プログラムの効果をランダム化比較試験により評価する。方法:健康診査受診者のうち高血圧・高脂血症・糖尿病それぞれの予備軍を対象者とした(介入群199人、対照群145人)。1年後追跡した者(介入群124人、対照群97人)の健康診査および生活習慣に関する自記式調査により効果を検討した。成績:BMI増加の抑制(介入群22.9±3.2kg/m2→22.8±3.3kg/m2、対照群22.4±4.1kg/m2→22.8±3.4kg/m2,P<0.05)および「運動不足」に対する回答への改善を認めた(17.4%,7.3%OR=2.7,P<0.05)。「禁煙」の行動ステージの改善に対して効果がある可能性があった(38.1%,6.3%OR=9.2,P=0.05)。結論:本支援プログラムは運動不足であるという意識の改善および肥満の抑制への効果があった。(著者抄録)
  • S. Hoshide, Y. Matusi, S. Shimasaki, K. Eguchi, J. Ishikawa, S. Ishikawa, T. Pickering, K. Shimada, K. Kario JOURNAL OF HYPERTENSION 26 S489 -S490 2008年06月 [査読無し][通常論文]
  • S. Ishikawa, K. Kario, K. Kayaba, T. Gotoh, E. Kajii JOURNAL OF HYPERTENSION 26 S394 -S395 2008年06月 [査読無し][通常論文]
  • H. Uno, J. Ishikawa, S. Hoshide, T. Kabutoya, S. Ishikawa, K. Shimada, K. Kario JOURNAL OF HYPERTENSION 26 S477 -S477 2008年06月 [査読無し][通常論文]
  • 柴田 陽介, 早坂 信哉, 野田 龍也, 村田 千代栄, 尾島 俊之, 後藤 康彰, 石川 鎮清 心身医学 48 (6) 592 -592 2008年06月 [査読無し][通常論文]
  • 身体活動と死亡の関連について JMSコホート研究
    早坂 信哉, 柴田 陽介, 野田 龍也, 村田 千代栄, 尾島 俊之, 石川 鎮清, 梶井 英治, 中村 好一, 萱場 一則, 後藤 康彰 日本健康開発財団研究年報 (29) 21 -27 2008年06月 [査読無し][通常論文]
  • 2型糖尿病患者において24時間血圧測定は心血管予後の予測に有用である
    江口 和男, 星出 聡, 石川 譲治, 石川 鎮清, 島田 和幸, 苅尾 七臣 日本内科学会雑誌 97 (Suppl.) 224 -224 2008年02月 [査読無し][通常論文]
  • 心房細動の脳卒中に対する影響について JMSコホート研究
    岩花 弘之, 石川 鎮清, 萱場 一則, 後藤 忠雄, 梶井 英治 日本内科学会雑誌 97 (Suppl.) 226 -226 2008年02月 [査読無し][通常論文]
  • 早坂信哉, 柴田陽介, 野田龍也, 村田千代栄, 尾島俊之, 後藤康彰, 石川鎮清, 萓場一則 J Epidemiol 18 (1 Supplement) 140 2008年01月 [査読無し][通常論文]
  • Jol Ishikawa, Shizukiyo Ishikawa, Kazunori Kayaba, Kazuyuki Shimada, Kazuomi Kario CIRCULATION 116 (16) 417 -417 2007年10月 [査読無し][通常論文]
  • Kazuo Eguchi, Joji Ishikawa, Satoshi Hoshide, Shizukiyo Ishikawa, Thomas G. Pickering, Joseph E. Schwartz, Kazuyuki Shimada, Kazuomi Kario CIRCULATION 116 (16) 655 -655 2007年10月 [査読無し][通常論文]
  • 血圧と脳卒中の発症には直線的な関係がある JMSコホート研究
    石川 鎮清, 苅尾 七臣, 梶井 英治 日本高血圧学会総会プログラム・抄録集 30回 276 -276 2007年10月 [査読無し][通常論文]
  • 日本人における飲酒と脳卒中発症 JMSコホート研究
    定金 敦子, 後藤 忠雄, 石川 鎮清, 中村 好一, 萱場 一則 日本公衆衛生学会総会抄録集 66回 232 -232 2007年10月 [査読無し][通常論文]
  • 身体活動度と動脈硬化危険因子の関連 JMSコホート研究
    早坂 信哉, 柴田 陽介, 尾島 俊之, 村田 千代栄, 野田 龍也, 石川 鎮清, 萱場 一則 日本公衆衛生学会総会抄録集 66回 411 -412 2007年10月 [査読無し][通常論文]
  • 余暇による身体活動度と動脈硬化危険因子の関連 JMSコホート研究
    柴田 陽介, 早坂 信哉, 野田 龍也, 村田 千代栄, 尾島 俊之, 石川 鎮清, 萱場 一則 日本公衆衛生学会総会抄録集 66回 412 -412 2007年10月 [査読無し][通常論文]
  • 各自治体が行っているがん対策関連政策の調査に関する研究 中小医療機関を中心に
    石川 鎮清, 大木 いずみ, 宮森 正, 竹内 啓祐, 伊藤 達朗, 後藤 忠雄, 渡辺 晃紀, 藤原 真治 日本公衆衛生学会総会抄録集 66回 420 -420 2007年10月 [査読無し][通常論文]
  • 日本人地域就業者における心理社会的仕事の特徴と脳卒中罹患 職業階層による解析
    堤 明純, 萱場 一則, 石川 鎮清 日本公衆衛生学会総会抄録集 66回 641 -641 2007年10月 [査読無し][通常論文]
  • Shizukiyo Ishikawa CIRCULATION JOURNAL 71 (4) 621 -621 2007年04月 [査読無し][通常論文]
  • Joji Ishikawa, Kazuomi Kario, Kazuo Eguchi, Masato Morinari, Satoshi Hoshide, Shizukiyo Ishikawa, Kazuyuki Shimada HYPERTENSION RESEARCH 30 (2) 203 -203 2007年02月 [査読無し][通常論文]
  • Satoshi Hoshide, Yoshio Matsui, Seiichi Shibasaki, Kazuo Eguchi, Joji Ishikawa, Shizukiyo Ishikawa, Tomoyuki Kabutoya, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario JOURNAL OF HYPERTENSION 24 172 -172 2006年12月 [査読無し][通常論文]
  • Shizukiyo Ishikawa, Kazunori Kayaba, Tadao Gotoh, Kazuomi Kario, Eiji Kajii JOURNAL OF HYPERTENSION 24 351 -351 2006年12月 [査読無し][通常論文]
  • Tomoyuki Kabutoya, Joji Ishikawa, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Yoshio Matsui, Seiichi Shibasaki, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario JOURNAL OF HYPERTENSION 24 146 -146 2006年12月 [査読無し][通常論文]
  • Kazuomi Kario, Yoshio Matsui, Seiichi Shibasaki, Kazuo Eguchi, Joji Ishikawa, Satoshi Hoshide, Shizukiyo Ishikawa, Tomoyuki Kabutoya, Joseph E. Schwartz, Thomas G. Pickering, Kazuyuki Shimada JOURNAL OF HYPERTENSION 24 49 -49 2006年12月 [査読無し][通常論文]
  • Joji Ishikawa, Yoshio Matsui, Seiichi Shibasaki, Kazuo Eguchi, Satoshi Hoshide, Tomoyuki Kabutoya, Shizukiyo Ishikawa, Kazuyuki Shimada, Thomas G. Pickering, Kazuomi Kario JOURNAL OF HYPERTENSION 24 271 -271 2006年12月 [査読無し][通常論文]
  • Kazuo Eguchi, Yoshio Matsui, Seiichi Shibasaki, Joji Ishikawa, Satoshi Hoshide, Shizukiyo Ishikawa, Tomoyuki Kabutoya, Joseph E. Schwartz, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario JOURNAL OF HYPERTENSION 24 143 -144 2006年12月 [査読無し][通常論文]
  • Yuichiro Yano, Satoshi Hoshide, george Ishikawa, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario CIRCULATION 114 (18) 774 -774 2006年10月 [査読無し][通常論文]
  • Joji Ishikawa, Yoshio Matsui, Shibasaki Seiichi, Satoshi Hoshide, Kazuo Eguchi, Tomoyuki Kabutoya, Shizukiyo Ishikawa, Kazuyuki Shimada, Thomas G. Pickering, Kazuomi Kario CIRCULATION 114 (18) 630 -630 2006年10月 [査読無し][通常論文]
  • Kazuo Eguchi, Satoshi Hoshide, Joji Ishikawa, Shizukiyo Ishikawa, Shunichi Homma, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario CIRCULATION 114 (18) 493 -493 2006年10月 [査読無し][通常論文]
  • Satoshi Hoshide, Yoshio Matsui, Seiichi Shibasaki, Joji Ishikawa, Shizukiyo Ishikawa, Kazuo Eguchi, Tomoyuki Kabutoya, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario CIRCULATION 114 (18) 493 -493 2006年10月 [査読無し][通常論文]
  • Joji Ishikawa, Satoshi Hoshide, Kazuo Eguchi, Shizukiyo Ishikawa, Kazuyuki Shimada, Kazuomi Kario CIRCULATION 114 (18) 628 -629 2006年10月 [査読無し][通常論文]
  • Joji Ishikawa, Satoshi Hoshide, Seiichi Shibasaki, Yoshio Matsui, Tomoyuki Kabutoya, Kazuo Eguchi, Shizukiyo Ishikawa, Thomas G. Pickering, Kazuyuki Shimada, Kazuomi Kario HYPERTENSION RESEARCH 29 (9) 739 -739 2006年09月 [査読無し][通常論文]
  • K Kario, J Ishikawa, S Hoshide, K Eguchi, S Ishikawa, K Shimada HYPERTENSION 46 (4) 864 -864 2005年10月 [査読無し][通常論文]
  • F Uno, S Ishikawa, Y Nakamura, T Gotoh, N Nago, K Kayaba, E Kajii J Epidemiol 15 (5) 173 -179 2005年09月 [査読無し][通常論文]
     
    BACKGROUND: There have been comparatively few large-scale cohort studies analyzing all-cause mortality due to cigarette smoking. The goal of this analysis is to investigate the relationship between smoking status and all-cause mortality, and to evaluate the effect of smoking in the Japanese. METHODS: The baseline data were collected between 1992 and 1995. Ultimately, 10,873 Japanese (4,280 males and 6,593 females) aged 19 years or older from 12 rural communities located across Japan participated in the study. This analysis is based on the results, including the information on those who died and moved out of the communities, obtained by December 31, 2001. The Cox's proportional hazards model was used to calculate the hazard ratio (HR) of mortality for smoking with adjustment for age, systolic blood pressure, total cholesterol, body mass index, alcohol drinking habit and education. RESULTS: The mean follow-up period was 8.2 years, during which time, 284 males and 192 females died. The multivariate-adjusted HRs for total mortality among former and current smokers compared with never smokers were 1.09 (95% confidence interval [Cl]: 0.73-1.61) and 1.65 (95% Cl: 1.16-2.35) in males, and 0.98 (95% Cl: 0.40-2.42) and 0.91 (95% Cl: 0.42-1.95) in females, respectively. Those for the consumption of 1-14, 15-24, and 25+ cigarettes per day among male smokers were 1.62, 1.57, and 1.89, respectively. In females, there was no great difference in all-cause mortality between smokers and never smokers. CONCLUSIONS: The results of our study confirm an increased risk in males of premature death from all causes among Japanese with a smoking habit.
  • K Kario, J Ishikawa, Y Matsui, K Eguchi, S Shibazaki, S Hoshide, T Kabutoya, S Ishikawa, TG Pickering, K Shimada AMERICAN JOURNAL OF HYPERTENSION 18 (5) 254A -254A 2005年05月 [査読無し][通常論文]
  • K Kario, Y Matsui, K Eguchi, S Shibasaki, S Hoshide, J Ishikawa, S Ishikawa, K Shimada AMERICAN JOURNAL OF HYPERTENSION 18 (5) 65A -66A 2005年05月 [査読無し][通常論文]
  • S Ishikawa, K Kayaba, K Kario, J Ishikawa, E Kajii AMERICAN JOURNAL OF HYPERTENSION 18 (5) 261A -261A 2005年05月 [査読無し][通常論文]
  • J Ishikawa, K Kario, S Hoshide, M Morinari, K Eguchi, S Ishikawa, K Shimada AMERICAN JOURNAL OF HYPERTENSION 18 (5) 261A -261A 2005年05月 [査読無し][通常論文]
  • J Ishikawa, K Kario, M Morinari, S Hoshide, K Eguchi, S Ishikawa, K Shimada AMERICAN JOURNAL OF HYPERTENSION 18 (5) 264A -264A 2005年05月 [査読無し][通常論文]
  • Y Amagai, S Ishikawa, T Gotoh, Y Doi, K Kayaba, Y Nakamura, E Kajii J Epidemiol 14 (4) 124 -128 2004年07月 [査読無し][通常論文]
     
    BACKGROUND: Although sleep is one of the most important health-related factors, relationship between sleep duration and mortality has not been fully discussed. METHODS: Study subjects were 11,325 participants (4,419 males and 6,906 females) in the Jichi Medical School Cohort Study, a population-based prospective study. Baseline data were obtained by questionnaire and health checkups between April 1992 and July 1995 in 12 rural areas in Japan. Main outcome measures were all-cause and cause-specific mortality derived from death certificates up to December 31, 2001. Cox's proportional hazard models were applied to analyze the association of sleep duration with mortality. RESULTS: A total of 495 deaths (289 males and 206 females) were observed during the average of 8.2-year follow-up period. After adjusting for age, systolic blood pressure, serum total cholesterol, body mass index, smoking habits, alcohol drinking habits, education, and marital status, the hazard ratios (95% confidence intervals) of all-cause mortality for individuals sleeping shorter than 6 hours and 9 hours or longer were 2.4 (1.3-4.2) and 1.1 (0.8-1.6) in males, and 0.7 (0.2-2.3) and 1.5 (1.0-2.4) in females, respectively, relative to those with 7-7.9 hours sleep. CONCLUSION: Our data suggest that males with short sleep and females with long sleep were at an elevated risk of death.
  • J Ishikawa, K Kario, M Morinari, S Hoshide, K Eguchi, S Ishikawa, K Shimada AMERICAN JOURNAL OF HYPERTENSION 17 (5) 45A -46A 2004年05月 [査読無し][通常論文]
  • J Ishikawa, K Kazuomi, M Morinari, S Hoshide, K Eguchi, S Ishikawa, K Shimada AMERICAN JOURNAL OF HYPERTENSION 17 (5) 243A -243A 2004年05月 [査読無し][通常論文]
  • K Kario, TG Pickering, M Morinari, J Ishikawa, S Ishikawa, K Eguchi, S Hoshide, K Shimada AMERICAN JOURNAL OF HYPERTENSION 17 (5) 47A -47A 2004年05月 [査読無し][通常論文]
  • J Ishikawa, K Kario, M Morinari, S Hoshide, K Eguchi, S Ishikawa, K Shimoda AMERICAN JOURNAL OF HYPERTENSION 17 (5) 45A -45A 2004年05月 [査読無し][通常論文]
  • J Ishikawa, K Kario, M Morinari, S Hoshide, K Eguchi, S Ishikawa, K Shimada AMERICAN JOURNAL OF HYPERTENSION 17 (5) 46A -46A 2004年05月 [査読無し][通常論文]
  • S Ishikawa, K Kario, K Kayaba, K Shimada, E Kajii AMERICAN JOURNAL OF HYPERTENSION 17 (5) 61A -61A 2004年05月 [査読無し][通常論文]
  • J Ishikawa, K Kario, M Morinari, S Hoshide, K Eguchi, S Ishikawa, K Shimada AMERICAN JOURNAL OF HYPERTENSION 17 (5) 45A -45A 2004年05月 [査読無し][通常論文]
  • K Kario, K Eguchi, J Ishikawa, M Morinari, S Ishikawa, S Hoshide, K Shimada AMERICAN JOURNAL OF HYPERTENSION 17 (5) 155A -156A 2004年05月 [査読無し][通常論文]
  • S Ishikawa, Y Nakamura, K Kario, J Ishikawa, K Eguchi, E Kajii, K Shimada AMERICAN JOURNAL OF HYPERTENSION 17 (5) 199A -200A 2004年05月 [査読無し][通常論文]
  • 個人診療所での緊急医療 高血圧
    総合臨床 11(11):2866-2870 2004年 [査読無し][通常論文]
  • K Kario, S Hoshide, S Ishikawa, M Morinari, Y Hoshide, TG Pickering CIRCULATION 108 (17) 450 -451 2003年10月 [査読無し][通常論文]
  • K Kario, H Satoshi, K Eguchi, S Ishikawa, M Morinari, K Shimada CIRCULATION 108 (17) 630 -630 2003年10月 [査読無し][通常論文]
  • M Mizooka, S Ishikawa Internal Medicine 42 (10) 960 -966 2003年10月 [査読無し][通常論文]
     
    Objective We conducted a large-scale cross-sectional study to assess the prevalence of Chlamydia pneumoniae and clarify the association between seropositivity and risk factors, such as smoking status, physical activity and body mass index in Japanese rural districts. Methods A total of 1,063 men and 1,573 women aged 18-94 years participated in 1999. Serum index values (ID) of IgA and IgG antibodies to C. pneumoniae were measured by ELISA. Index values were categorized as "negative" (IDless than or equal to1.10), "positive" (ID greater than or equal to 1.10) and "high positive" (ID greater than or equal to 3.00). Logistic regression analysis was performed to estimate the crude and adjusted odds ratios for C. pneumoniae seropositivity. Results The overall prevalence of C. pneumoniae IgA seropositivity was 52.5%, and that of IgG was 55.2%. Each seropositivity significantly increased with age. The prevalence among men was significantly higher than in women in C. pneumoniae IgG "high positive" subjects. Compared with never-smokers, the adjusted odds ratio of current smokers was 2.00 (95%CI: 1.45-2.77) for C. pneumoniae IgA seropositivity. The adjusted odds ratio of the higher tertiles of physical activity for C. pneumoniae IgG seropositivity was 1.42 (1.12-1.80) compared with the lower tertiles. In "high positive" subjects, smoking was associated with both immune complexes. Conclusion We confirmed a high prevalence of C. pneumoniae seropositivity among healthy Japanese adults. The results indicated that smoking and high physical activity were associated with C. pneumoniae infection.
  • A Tsutsumi, K Kayaba, S Ishikawa, T Gotoh, N Nago, S Yamada, M Mizooka, K Sakai, S Hayasaka J Epidemiol 13 (2) 63 -71 2003年03月 [査読無し][通常論文]
     
    To observe the association between adverse psychosocial job characteristics, measured by the Karasek job demand-control questionnaire, and a lipid profile, cross-sectional analyses were performed for a Japanese rural working population. The study population comprised 3,333 male and 3,596 female actively employed workers, aged 65 years and under. Among men, higher psychological demands were associated with high total cholesterol levels, with an adjusted difference from the top to bottom tertiles of 3.3 mg/dl (F = 3.03; p = 0.048). High demands were also positively associated with the total/HDL cholesterol ratio (F = 3.94; p = 0.020). Neither job control nor job strain (the ratio of demands to control) was associated with any of the lipid levels in either gender. A psychologically demanding job may be associated with an unfavorable lipid profile, but the impact of job strain on atherogenic lipids is negligible.
  • 虚血性心疾患の一次・二次予防
    EBMジャーナル 4(1):70-74 2003年 [査読無し][通常論文]
  • A Tsutsumi, K Kayaba, M Yoshimura, M Sawada, S Ishikawa, K Sakai, T Gotoh, N Nago Int J Behav Med 10 (2) 125 -142 2003年 [査読無し][通常論文]
     
    Associations between job characteristics defined by the Karasek's job demand-control model and health behaviors were, investigated in a cross-sectional analysis of 6,759 Japanese rural workers. High psychological demands were associated with heavy smoking, exaggerated prevalence of alcohol drinking, and high work-related physical activity. Low job control was associated with lower consumption of vegetables, a smaller quantity number of cigarettes smoked, and a low level of work-related physical activity. Job strain, a combined-measure obtained from the ratio of demands to control, was associated with lower vegetable consumption, low prevalence of smoking, and high prevalence of current alcohol drinking. Stratified analyses by occupations and gender provided some but not all of the explanations for the unexpected findings. The results indicate a possible association between psychosocial job characteristics and health behaviors. A few unexpected findings prevent complete support to one of the hypothetical pathways that the job characteristics lead to cardiovascular disease through behaviors.
  • 日本心身医学会雑誌 42:119-127 2002年 [査読無し][通常論文]
  • 早坂 信哉, 岡山 雅信, 石川 鎮清, 中村 好一, 梶井 英治 厚生の指標 49:23-30 (11) 23 -30 2002年 [査読無し][通常論文]
     
    全国の市区町村社会福祉協議会(社協)が福祉サービスの一環として提供している高齢者入浴サービスの方法とその現状を明らかにする為,全国の市区町社協名簿より25%の系統抽出した828箇所の市区町村社協の高齢者入浴サービス担当者を対象に1999年に郵送自記式調査を行った.調査票の回収率は83%(回答数683)であった.入浴サービス担当者である回答者は平均41.6歳で女が56%であった.職種は事務職30%,看護師23%,ヘルパー18%であった.65%の社協で何らかの入浴サービスを実施しており,その1998年度1年間の延べ件数の平均は訪問入浴が570.8件,施設内入浴が2299.3件であった.入浴方法は90%が浴槽を使用しており,入浴時間は中央値8.0分,湯温は同40.0℃であった.入浴前の血圧測定は94%,体温測定は95%の社協で実施しており,入浴可否判断の基準値を設けている社協は血圧については35%,体温については44%であったが,顔色や全身状態などその他の項目も参考にして入浴可否判断を行っていた.入浴可否判断をしている者は看護師が53%と最も多く,次いで,介護福祉士が12%,ヘルパーが12%であった
  • 疫学研究におけるインフォームド・コンセントに関しての住民の意識に関する調査研究
    臨床と研究 79;1199-1204 2002年 [査読無し][通常論文]
  • 神経内科疾患とEBM
    Progress in Medicine 22(9):2142-2148 2002年 [査読無し][通常論文]
  • Shizukiyo Ishikawa, Tadao Gotoh, Naoki Nago, Kazunori Kayaba Journal of Epidemiology 12 (6) 408 -417 2002年 [査読無し][通常論文]
     
    We have been conducting a cohort study titled the Jichi Medical School Cohort Study (The JMS Cohort Study) since 1992, which is aiming to clarify the risk factors of cardiovascular and cerebrovascu-lar diseases in the Japanese. The baseline data were gathered from April 1992 through July 1995 in 12 rural districts using a legal mass screening system. The total samples were 12,490 males and females, and the overall response rate for the total population was 63%. The mean ages were 55.2 years for males and 55.3 years for females, respectively. Smoking rates were 50.5% and 5.5%, and drinking rates were 75.1% and 25.0% for males and females, respectively. We also examined the Standardized mortality ratios (SMRs) of the cohort subjects for 7.6 year follow-up period. The SMRs were 0.68 [95% confidence interval (CI): 0.59-0.78] for males and 0.73 (95% CI: 0.62-0.85) for females for the cohort subjects, whereas the SMRs were 1.00 (95% CI 0.97-1.04) for males and 1.06 (95% CI: 1.02-1.10) for females for all residents. In this article, we outlined the cohort study and showed general characteristics of the baseline data, and the SMRs of the subjects. We have been following the eligible subjects, and are preparing to show some prospective data regarding cardiovascular and cerebrovascular risks in the near future.
  • Shizukiyo Ishikawa, Tadao Gotoh, Naoki Nago, Kazunori Kayaba Journal of Epidemiology 12 (6) 408 -417 2002年 [査読無し][通常論文]
     
    We have been conducting a cohort study titled the Jichi Medical School Cohort Study (The JMS Cohort Study) since 1992, which is aiming to clarify the risk factors of cardiovascular and cerebrovascu-lar diseases in the Japanese. The baseline data were gathered from April 1992 through July 1995 in 12 rural districts using a legal mass screening system. The total samples were 12,490 males and females, and the overall response rate for the total population was 63%. The mean ages were 55.2 years for males and 55.3 years for females, respectively. Smoking rates were 50.5% and 5.5%, and drinking rates were 75.1% and 25.0% for males and females, respectively. We also examined the Standardized mortality ratios (SMRs) of the cohort subjects for 7.6 year follow-up period. The SMRs were 0.68 [95% confidence interval (CI): 0.59-0.78] for males and 0.73 (95% CI: 0.62-0.85) for females for the cohort subjects, whereas the SMRs were 1.00 (95% CI 0.97-1.04) for males and 1.06 (95% CI: 1.02-1.10) for females for all residents. In this article, we outlined the cohort study and showed general characteristics of the baseline data, and the SMRs of the subjects. We have been following the eligible subjects, and are preparing to show some prospective data regarding cardiovascular and cerebrovascular risks in the near future.
  • Active job is protective against all-cause mortality in Japanese male workers.「共著」
    International Journal of Behavioral Medicine 9 (Supple 1):275 2002年 [査読無し][通常論文]
  • Physical activity index and all cause mortality in Japanese.
    International Journal of Behavioral Medicine 9 (Supple 1):127 2002年 [査読無し][通常論文]
  • 高齢者における入浴介助必要者の背景因子 健康状態,寝たきり度について
    早坂 信哉, 石川 鎮清, 岡山 雅信, 梶井 英治 日本温泉気候物理医学会雑誌 65 (1) 52 -53 2001年11月 [査読無し][通常論文]
  • S Yamada, T Gotoh, Y Nakashima, K Kayaba, S Ishikawa, N Nago, Y Nakamura, Y Itoh, E Kajii American Journal of Epidemiology 153 (12) 1183 -1190 2001年06月 [査読無し][通常論文]
     
    The distribution of serum C-reactive protein (CRP) levels and their association with age, sex, and atherosclerotic risk factors were studied in a large Japanese population between 1992 and 1995, The subjects consisted of 2,275 males and 3,832 females aged 30 years and over. CRP was measured by nephelometry. The distribution of CRP was highly skewed toward a lower level than that of previous studies and seemed to be a combination of two separate distribution curves. The increase in CRP with age was statistically significant, and males had higher CRP levels than did females. Males who were current smokers had higher CRP levels than did nonsmokers. Age, systolic blood pressure, diastolic blood pressure, triglycerides, fibrinogen, and body mass index were all positively associated with CRP in both sexes, while total cholesterol and blood glucose were positively related in females only. High density lipoprotein cholesterol was inversely related in both sexes. Multiple logistic regression analysis showed that sex, age, systolic pressure, high density lipoprotein cholesterol, triglycerides, fibrinogen, and body mass index were significant independent variables. In conclusion, the distribution of CRP among the Japanese was quite different from that among Westerners, although CRP levels correlated with other atherosclerotic risk factors, similar to those in Westerners.
  • S Yamada, T Gotoh, Y Nakashima, K Kayaba, S Ishikawa, N Nago, Y Nakamura, Y Itoh, E Kajii AMERICAN JOURNAL OF EPIDEMIOLOGY 153 (12) 1183 -1190 2001年06月 [査読無し][通常論文]
     
    The distribution of serum C-reactive protein (CRP) levels and their association with age, sex, and atherosclerotic risk factors were studied in a large Japanese population between 1992 and 1995, The subjects consisted of 2,275 males and 3,832 females aged 30 years and over. CRP was measured by nephelometry. The distribution of CRP was highly skewed toward a lower level than that of previous studies and seemed to be a combination of two separate distribution curves. The increase in CRP with age was statistically significant, and males had higher CRP levels than did females. Males who were current smokers had higher CRP levels than did nonsmokers. Age, systolic blood pressure, diastolic blood pressure, triglycerides, fibrinogen, and body mass index were all positively associated with CRP in both sexes, while total cholesterol and blood glucose were positively related in females only. High density lipoprotein cholesterol was inversely related in both sexes. Multiple logistic regression analysis showed that sex, age, systolic pressure, high density lipoprotein cholesterol, triglycerides, fibrinogen, and body mass index were significant independent variables. In conclusion, the distribution of CRP among the Japanese was quite different from that among Westerners, although CRP levels correlated with other atherosclerotic risk factors, similar to those in Westerners.
  • 地域の一般住民における高血圧の認識・治療・コントロール「共著」
    日本公衆衛生雑誌 48(10):827-836 2001年 [査読無し][通常論文]
  • 早坂 信哉, 石川 鎮清, 岡山 雅信, 梶井 英治, 中村 好一, 小栗 重統, 岡山 明, 柳川 洋 日本温泉気候物理学会雑誌 64(4):173-181 (4) 173 -181 2001年 [査読無し][通常論文]
     
    健康・福祉関連サービス需要実態調査の回答者21723名において,入浴介助が必要な者は男478名(5.2%),女812名(6.4%)で,男女とも年代が上がるにしたがってその割合は高くなる傾向であった.入浴介助が必要な者の割合を背景因子ごとにみると,全く寝たきりでは男97.1%,女100%,殆ど寝たきりで男98.7%,女97.9%であった.在宅サービスの利用については,ホームヘルプサービス利用者では男77.6%,女73.3%,訪問看護サービス利用者では男87.1%,女87.6%,デイサービス利用者では男女とも81.1%,ショートステイ利用者では男92.5%,女88.5%であった.又,男を介護している介護者は57.4%が配偶者で70歳代,女は35.0%が子の配偶者で50歳代が多く,福祉による入浴サービスの提供が不可欠であることが示唆された
  • Journal of Epidemiology 11:139-142 2001年 [査読無し][通常論文]
  • HDLコレステロールと総死亡の関連―JMSコホート研究―
    第16回「健康医科学」研究助成論文集平成11年度 11-17 2001年 [査読無し][通常論文]
  • 地域の一般住民における高血圧の認識・治療・コントロール「共著」
    日本公衆衛生雑誌 48(10):827-836 2001年 [査読無し][通常論文]
  • Hayasaka S, Okayama M, Ishikawa S, Nakamura Y, Kajii E. Accidents associated with bathing in home care services for the aged in Japan.
    Journal of Epidemiology 11:139-142 2001年 [査読無し][通常論文]
  • 堤 明純, 萱場 一則, 石川 鎮清, 苅尾 七臣, 松尾 仁司, 詫摩 衆三 日本公衆衛生雑誌 47 (10) 866 -878 2000年10月 [査読無し][通常論文]
  • 堤 明純, 萱場 一則, 石川 鎮清, 苅尾 七臣, 松尾 仁司, 詫摩 衆三 日本公衆衛生雑誌 47 (10) 866 -878 2000年10月 [査読無し][通常論文]
  • K Kayaba, S Ishikawa, T Gotoh, N Nago, E Kajii, Y Nakamura, K Kario JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION 64 (4) 303 -308 2000年04月 [査読無し][通常論文]
     
    C-reactive protein (CRP) is an acute-phase reactant that is related to future cardiovascular events. However, little is known about the long-term intra-individual stability of CRP in community residents. The 5-year intra-individual correlation of CRP levels was examined in the Jichi Medical School Cohort Study in Japan. CRP measurements were obtained in 1993 and in 1998 from 388 presumptively healthy individuals aged 30-69 years at baseline. The Pearson's correlation coefficient of CRP between baseline and follow-up measurements was 0.43 (95% confidence interval (CI): 0.34-0.51). Additional analyses by sex and smoking status at baseline revealed similar coefficients. The correlation coefficient of CRP was lower than that of other classical risk factors, such as body-mass index (BMI), blood pressure, and total and high-density lipoprotein (HDL) cholesterol. A subgroup of individuals with higher levels of CRP at both baseline and follow-up measurements had higher BMI, hemoglobin Ale, and plasma fibrinogen, and lower levels of HDL-cholesterol than others, even after adjusting for age, sex, and smoking status in a multiple logistic model. In conclusion, the stability of CRP levels was statistically significant in a long-term population-based study. A subgroup with higher levels of CRP who had an aggregation of cardiovascular risk factors was identified by the 2 measurements.
  • JMSコホート研究の現状
    月刊地域医学 14 92 -97 2000年 [査読無し][通常論文]
  • 自治医科大学健診センターにおける人間ドック受診者の検査成績の現状とその検討.「共著」
    自治医科大学紀要 23 223 -230 2000年 [査読無し][通常論文]
  • 一般住民におけるHelicobacter pyloriとChlamydia pneumonia感染の検討-性年齢別の抗体陽性率と両者の関連について-「共著」
    自治医科大学紀要 23 157 -163 2000年 [査読無し][通常論文]
  • The JMS Cohort Study
    14 92 -97 2000年 [査読無し][通常論文]
  • The Jichi Medical School Cohort Study「共著」
    8 197 -203 2000年 [査読無し][通常論文]
  • Prevalence of antibodies to Helicobacter pylori and Chlamydia pneumoniae in population-based study and no correlation between seropositivities for Helicobacter pylori and Chlamydia pneumoniae.(共著)
    23 157 -163 2000年 [査読無し][通常論文]
  • A relationship between high level of HDL-choleslerol and atherosclevotic risk factors : The JMS Cohort Study
    Journal of Epidemiology 10 (1.Supple) 71 2000年 [査読無し][通常論文]
  • Standardized mortality ratios and cardiovascular risk factors in Japan. The JMS Cohort Study
    Journal of Epidemiology 10 (1.Supple) 67 2000年 [査読無し][通常論文]
  • 農漁村部中年男性の身体活動度と血圧,血清脂質,ヘモグロビンAlcとの関連-JMS(Jichi Medieal School)コホート研究-
    自治医科大学紀要 22 203 -210 1999年 [査読無し][通常論文]
  • A relation of physical activity to blood pressure, serum lipids and HbAlc : A cross-sectional population study in rural Japanese men-JMS Cohort Study-
    Jichi Medical School Journal 22 203 -210 1999年 [査読無し][通常論文]
  • Shizukiyo Ishikawa, Kazunori Kayaba, Masahiro Igarashi, Tomohiro Deguchi, Kazuo Hara, Shuzo Takuma, Akizumi Tsutsumi, Kazuomi Kario Journal of Epidemiology 9 (1) 32 -39 1999年 [査読無し][通常論文]
     
    Lipoprotein(a) Lp(a). has been considered to be a predictor of premature coronary heart disease and other cardiovascular diseases. Lp(a) levels are largely genetically determined, but the detailed mechanism of Lp(a) elevation is uncertain. We examined the association betw/een Lp(a) levels and apolipoprotein(a) apo(a). phenotypes as well as that of Lp(a) level and other various conditions. The subjects were 280 healthy Japanese (102 males and 178 females) aged 39 to 70 years who were living in a rural community in 1992. We obtained apo(a) phenotypes determined by SDS-PAGE as well as Lp(a) levels and other cardiovascular risk factors. We combined apo(a) phenotypes form 4 groups according to molecular weights (from high apo(a) molecular weight to low: I, II, III and IV). Lp(a) levels were associated with apo(a) phenotype-groups, that is, they were inversely associated with apo(a) molecular weight. Small apo(a) phenotypes were less frequent than large ones. The median Lp(a) level was higher in smoking (29.2 mg/dL) than in nonsmoking subjects (18.5 mg/dL) in phenotype-group III. Adjusted means of total cholesterol and fibrinogen levels in apo(a) phenotype-group IV were the highest of all phenotype-groups. Age, apo(a) phenotype, smoking status, total cholesterol and fibrinogen were positively correlated with Lp(a) levels by multiple regression analysis. Lp(a) levels were found to be mainly associated with apo(a) phenotype, but varied broadly within the same apo(a) phenotype at various conditions, such as smoking status and high total cholesterol. J Epidemiol, 1999 9: 32-39. © 1999, Japan Epidemiological Association. All rights reserved.
  • S Ishikawa, T Goto, N Nago BRITISH MEDICAL JOURNAL 316 (7145) 1675 -1676 1998年05月 [査読無し][通常論文]
  • S Ishikawa, K Kario, N Nago, K Kayaba, J Hiraoka, H Matsuo, T Goto, T Miyamoto, A Tsutsumi, Y Nakamura, K Shimada, K Inoue, M Igarashi THROMBOSIS AND HAEMOSTASIS 77 (5) 890 -893 1997年05月 [査読無し][通常論文]
     
    Factor VII coagulant activity (FVIIc) and fibrinogen (Fbg) levels have been investigated as cardiovascular risk factors. We studied these two factors with stratification for age, sex and blood pressure, and the relation with other atherosclerotic risk factors in a Japanese general population. The subjects were 3,139 Japanese (1,315 males and 1,824 females) aged 30 to 89 in 1992 and 1993. A linear increase with age was observed in the levels of Fbg in both men and women, but no differences were observed between men and women in each age group. A linear increase with age was also seen in the levels of FVIIc in women, but the levels of FVIIc in men were significantly higher for the age group 40-49 years than for any other age group. The levels of FVIIc in women were significantly higher than in men at age greater than or equal to 60 years. As concerning the effect of alcohol intake status, Fbg had a tendency to decrease with alcohol intake. Fbg and FVIIc levels were associated with an increase in smoking status in men, but no association was seen in women in either Fbg or FVIIc. FVIIc was positively correlated with age, body mass index, total cholesterol, triglycerides and fasting insulin level. Fbg was positively correlated with age, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL-cholesterol and triglycerides in women, but Fbg had few positive correlations with risk factors in men. A comparison with previous Western studies showed that the Fbg levels of our Japanese population were lower than those of the Caucasians studied, but the present FVIIc levels were nearly the same level or slightly higher than theirs. The association of Fbg and FVIIc and with other cardiovascular risk factors in Japanese was similar to those observed in Caucasians.

共同研究・競争的資金等の研究課題

  • 多地域一般住民でのCKDとsdLDL-Cの複合因子と認知機能の関連
    科学研究費補助金：
    研究期間 : 2016年 -2018年 
    代表者 : 石川 鎮清
  • 日本人における循環器疾患の発症要因に関する研究成果の還元方法に関する検討
    科学研究費補助金：
    研究期間 : 2006年 -2008年 
    代表者 : 石川 鎮清
  • 日本人における循環器疾患発症リスクの推定におけるリスクチャート作成の試み
    千代田生命健康開発事業団研究助成：
    研究期間 : 2008年 
    代表者 : 石川 鎮清
  • 日本人における循環器疾患の発症要因に関する研究成果の還元方法に関する検討
    がん臨床研究事業：
    研究期間 : 2006年 -2007年 
    代表者 : 石川 鎮清
  • 生活習慣病の日米間における健康障害とその問題に関する研究
    厚生労働科学研究費補助金
    研究期間 : 2005年 -2005年
  • 厚生労働行政施策の基盤となる疫学研究の適切な推進に関する研究
    厚生労働科学研究費補助金
    研究期間 : 2003年 -2005年
  • 日本人における循環器疾患の発症要因に関する大規模コホート研究
    科学研究費補助金
    研究期間 : 2003年 -2005年
  • Informed concent for the epidemiological studies
  • Examination of cardivrascular disease risk factors

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