In order to investigate the joint effect of history of diabetes and blood transfusion on ischemic heart disease mortality, we analyzed data for 7,759 subjects enrolled in a cohort study in Fukuoka Prefecture, Japan. All deaths due to ischemic heart disease were recorded. The Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) of ischemic heart disease with history of diabetes and blood transfusion. We also tested the null hypothesis of the multiplicative model to assess the potential joint effect of these two factors. During 102,800 person-years of follow-up, we observed 66 deaths due to ischemic heart disease. Adjusted HRs of diabetes only as well as transfusion only showed no statistical association, with HRs of 0.93 and 1.18, respectively. In contrast, an increased HR of 9.49 (95% CI: 2.82-32.00) was observed in subjects having both diabetes and blood transfusion, suggesting a positive interaction between them on the risk of death from ischemic heart disease (p=0.02). To conclude: We identified a multiplicative effect of history of diabetes and blood transfusion on the risk of death from ischemic heart disease.

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Breast cancer is one of the leading causes of death among women in Japan. Its mortality rate has been increased in recent years. However, there has been no study examining the changes in premature mortality in Japanese women. In the present study, using two health indicators, years of life lost (YLL) and average of years of life lost (AYLL), we estimated the premature mortality due to breast cancer in Japan during the period from 1995 to 2006. YLL indicates how many years that life of a patient was shortened with the presence of cancer, and AYLL provides an average loss of expected years of life among these deceased persons. Results showed an increase in total YLL due to this condition from 204,840.6 years in 1995 to 255,046.9 years in 2006. In each calendar year, YLL remained the highest in the group aged 50-59 years, accounting for 32%-36% of annual YLL. In contrast, we found a decrease in AYLL of breast cancer from 26.4 years in 1995 to 22.8 years in 2006; namely, breast cancer patients who died in 2006 lived an average 3.6 years longer than those who died in 1995. In conclusion, we show the decrease in AYLL of breast cancer deaths, despite the increase in total numbers of annual YLL during the study period. Thus, women with breast cancer have benefited from postponement of the deaths in 2006, compared to those in 1995, which may be related to the improvements in medical health care or appropriate prevention.

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The aim of the present paper is to summarize the history of the Yusho incidence that occurred in the western part of Japan in 1968. A strange disease was reported in October 1968. This strange disease was characterized by acne-like eruptions, pigmentation of the skin, and eye discharge, and it was named Yusho (oil disease). Through systematic epidemiological studies based on observation of initial case series, and extensive efforts to clarify causal agents by the Study Group for Yusho, it was concluded that Yusho was caused by ingestion of rice oil contaminated with PCBs and PCDFs. As of now, more than 1, 800 patients, have been registered as having Yusho and around 300 are deceased. Clinical observation showed that typical symptoms of Yusho have decreased, even general fatigue, headache and numbness of extremities have still been complained by patients. No effective treatment has been found so far. Careful and systematic observation for Yusho patients and medical care services should be continued for a further understanding of Yusho.

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We studied treatment satisfaction in 1,903 subjects with Japanese cedar pollinosis, seen in Gifu Prefecture institutions in 2009, a mass scattering year. Institution physicians determined the choice of therapeutic drugs. We evaluated subject satisfaction and symptoms by questionnaire using nasal and eye symptom scores evaluated by the visual analog scale (VAS) in the pretreatment stage, in the stage with the severest symptoms, and in the posttreatment stage. Antihistamines were most widely used, followed by topical nasal steroids, and leukotriene antagonists, in this order. More subjects were treated with 2 types of drug combined than with a single drug alone. Satisfaction (very good plus good) was found in 68.8% of 747 subjects. The most frequent cause of dissatisfaction was insufficient therapeutic effect. Higher nasal symptom VAS was significantly related to satisfaction.

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This study prospectively examined the association between employment status (employed or self-employed) and the risk of death from circulatory diseases among Japanese workers. A baseline survey was conducted between 1988 and 1990 among 110,792 inhabitants of 45 areas. Follow-up surveys were conducted annually and causes of death were identified from death certificates. Analysis was restricted to 25,945 individuals (15,434 male and 10,511 female) with ages ranging from 40 to 59 years. These subjects were employed or self-employed at the time of recruitment. The risks of self-employment for death due to circulatory system disease, ischemic heart disease and cerebrovascular disease were estimated using the Cox proportional hazards model. During the 10-year follow-up period (151,817 and 104,870 person-years for males and females, respectively), 720 male and 193 female deaths were recorded. No significant differences were detected between the employed and self-employed workers in the total death risk, or the risk of death from ischemic heart disease. However, self-employed men showed a significantly lower risk of death from cerebrovascular disease compared with employed men (relative risk=0.58; 95% confidence interval=0.35, 0.97). Our findings suggest that employed men are at increased risk of death from cerebrovascular disease compared with self-employed men.

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To explore the association between dietary habits and risk of hepatocellular carcinoma (HCC) mortality in Japan, univariate analyses was performed using data from the JACC Study. A cohort of 46, 465 males and 64, 327 females aged 40 to 79 in 19 prefectures in Japan completed the baseline survey during 1988-1990 and were followed up until the end of 1999. The hazard ratio (HR) of HCC mortality for each food item by gender, age group (40-59 and 60-79 years) and history of liver diseases was obtained by Cox proportional hazards model. Some categories, such as boiled rice, ham and sausage, chicken, fish and pickles among men without history of liver diseases and those of miso-soup, fish, carrots and squash, and potatoes among women without history of liver diseases showed a significant inverse association with HCC mortality. Frequent intake of eggs was significantly associated with increased HCC mortality in men without history of liver diseases. Potatoes and foods boiled down in soy sauce (tsukudani) showed a significant positive association, and pickles had a significant inverse association with HCC mortality in men with history of liver diseases. Frequent intake of coffee showed a significant inverse association with HCC mortality both in men and women with history of liver diseases. It is considered that further analysis using a multivariate Cox proportional hazards model including other confounding factors will be required for a more meaningful interpretation of the data.

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Hazard ratios (HR) of death due to hepatocellular carcinoma (HCC) were analyzed by gender and age strata (40-59 and 60-79) among smokers and ex-smokers in 65, 528 eligible subjects from a large cohort of males and females aged 40-79 years, based on information about several smoking-related characteristics. Both current smokers and ex-smokers among total older males had hazard ratios (HR) for dying from HCC that were 2 to 4 times higher than those who had never smoked at the baseline survey. When subjects were restricted to those without history of liver disease (LD), older male (60-79) ex-smokers presented a statistically significant HR of 5.0. Earlier age at start of smoking (15 to 19) showed a significantly increased HR of 4 to 8 for both current and ex-smokers. Moderate number of cigarettes smoked per day showed an increased HR, and later age at cessation of smoking had a higher HR compared to earlier cessation. Larger cumulative amount of smoking resulted in an elevated HR of 11 times than in those who had never smoked. Cigarette smoking was suggested to be an important risk factor for death from HCC regardless of whether the smoking habit was in the past or was continuing at present. To eliminate confounding effects and interaction with other risk factors of HCC and to clarify the net association between smoking habits and HOC, farther careful analysis using multivariate models is needed.

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Hazard ratios (HR) of death due to hepatocellular carcinoma (HOC) were analyzed by gender and age strata (40-59 and 60-79) among drinkers and ex-drinkers in 66, 974 eligible subjects from a a large cohort of male and female subjects aged 40-79 years, based on information about several drinking related characteristics. The HR of dying from HOC for ex-drinkers was 4 to 8 times higher than for those who had never consumed alcohol at the baseline survey. When the subjects were restricted to those without history of liver disease (LD), the HR was still high for ex-drinkers among younger males, though the difference was not statistically significant. It appeared that the earlier drinking habits were established, the higher the HR, especially for younger males without LD. Among total current drinkers, the amount ingested per occasion and the cumulative amount ingested at the baseline did not show significantly increased HRs. Among subjects without LD, larger amounts ingested per occasion and larger cumulative amount seemed to have higher HRs in older male current drinkers. Frequent drinking and later age (50 to 79) at cessation of drinking were associated with higher HRs among both genders and both age strata. After restricting the analysis to subjects without LD, many of these increased HRs remained among males. The results suggested that the association between alcohol drinking history and HR of HOC differs depending on the presence of LD. Major confounders other than age and gender associated with both drinking and HCC, e.g. smoking, hepatitis virus infection, or history of diabetes, were not considered in this analysis, and the observed associations might be confounded by any of these factors. To clarify the net association between alcohol drinking and HOC, further analysis is needed to control potential confounders, including past history of liver disease, and to consider probable effect modifiers.

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The relationship between the past history of selected diseases and the risk of dying from hepatocellular carcinoma (HCC) was analyzed using 110, 792 cohort members (46, 465 males and 64, 327 females) recruited between 1988 and 1990 by the JACC Study (the Japan Collaborative Cohort Study for Evaluation of Cancer Risk). Significantly elevated hazard ratios (HRs) were observed in both genders for the past history of kidney diseases, liver diseases, gallstones or cholecystitis, diabetes mellitus, and blood transfusion. Further, when analyzed by age group (those 40-59 years of age were “younger” and those 60-79 years of age were “older”), although the significant associations were generally maintained, the magnitude of the HRs for liver diseases and diabetes mellitus seemed to be considerably different between the younger and older age groups for male cohort members. When the analyses were limited to cohort members without the past history of liver diseases, the past histories which had significantly elevated HRs were hypertension (HR=3.14, 95% confidence interval (Cl):1.25-7.89), diabetes mellitus (HR=4.17, 95% Cl: 1.22-14.25), and blood transfusion (HR=7.69, 95% Cl: 3.09-19.15) in the younger male age group and gallstone or cholecystitis (HR=2.58, 95% Cl: 1.11-5.98) in the older male age group. On the other hand, for females, the significantly elevated HRs were gastric or duodenal ulcer (HR=4.33, 95% Cl: 1.09-17.25) in the younger age group and diabetes mellitus (HR=6.16, 95% Cl: 2.25-16.90) and blood transfusion (HR=3.86, 95% Cl: 1.58-9.41) in the older age group. However, since the evidence from our univariate analyses might not be decisive, multivariate Cox proportional hazards models controlling for potential confounders and effect modifiers will be required to obtain more valid or unbiased hazard ratios.

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BACKGROUND: Physical activity is thought to play an important role in the maintenance and promotion of health, and practical questionnaires assessing levels of physical activity are currently a widely used method in epidemiological research.
METHODS: As a part of the Japan Collaborative Cohort Study (JACC Study) for Evaluation of Cancer Risk sponsored by the Ministry of Education, Science, Sports and Culture of Japan (Monbusho), we investigated the status of physical activity of cohort participants aged 40-79. A total of 110,792 participants (46,465 men and 64,327 women) completed the baseline survey from 1988-1990. Questionnaires concerning physical activity contained the following questions: 1) How much time per week on average do you spend engaging in sports or physical exercise? (at least 5 hours, 3-4 hours, 1-2 hours, little); 2) How much time per day on average do you spend walking either indoors or outdoors? (longer than 1 hour, 30 min-1 hour, about 30 min, little).
RESULTS: In total, 68.7% of men and 76.2% of women responded with "little" to the amount of time spent engaged in sports or physical exercise. The proportion of time spent on habitual physical exercise (sports and physical exercise of one hour or more per week) was lowest in the 50-59 years age group and increased with age among participants aged 50-79. In addition, 49.4% of men and 50.7% of women responded with "more than 1 hour per day" to the amount of time spent walking.
CONCLUSION: These results show that the proportion of habitual physical exercise was relatively low in the JACC Study and increased with age among participants aged 50-79, whereas almost half walked for more than one hour a day.
J Epidemiol 2005; 15: S43-S47.

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BACKGROUND: In Japan, green tea has been drunk for a long time. Because it can be drunk casually, many people love drinking it. If such green tea has an effect to prevent stomach cancer, it will be a very convenient way to prevent the disease.
METHODS: To examine the association between green tea consumption and the risk of stomach cancer, past epidemiologic studies including JACC Study were reviewed.
RESULTS: Among eight case-control studies, five showed risk reduction with a statistically significant difference, and two studies showed risk reduction without a statistically significant difference. The remaining study showed the opposite result. Among six prospective studies regarding stomach cancer, no study showed risk reduction with a statistically significant difference. Four of the six studies showed no relation. In terms of study design, prospective studies, which are considered to be more reliable than case-controlled studies, tend to show no risk reduction. The results of case-control studies and prospective studies present considerably different impressions.
CONCLUSIONS: Prospective studies showed no inverse association between the consumption of green tea and the risk of stomach cancer.
J Epidemiol 2005; 15: S109-S112.

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BACKGROUND: A large-scale population-based cohort study would offer the best evidence of a relation between lifestyle and cancer.
METHODS: The Japan Collaborative Cohort Study (JACC Study) for Evaluation of Cancer Risk sponsored by the Ministry of Education, Science, Sports and Culture of Japan (Monbusho) was established and carried out from 1988 to 1990 in 45 areas in Japan. Epidemiological information, such as demographic information, past medical history, exercise/sports activities engaged in, frequency of food intake, smoking and alcohol drinking status and so on, was collected by a self-administered questionnaire. Blood samples were collected from each participant at screening in 37 out of 45 areas to investigate risk factors of cancer relating to biochemical substances in blood. Collected sera were divided into 3-5 tubes (100-500μL per tube) and stored at -80°C. Additionally, about 5 years after the baseline survey, an interim survey regarding lifestyle changes was conducted in 31 areas. We followed the study subjects for mortality, move-outs, and cancer incidence, if possible (in 24 areas).
RESULTS: There were 127,477 participants (54,032 men and 73,445 women) registered in the study. Of these, 110,792 subjects (46,465 men and 64,327 women), aged 40 to 79 years at baseline, were eligible for follow-up. Sera were stocked from 39,242 subjects, and interim survey was carried out on 46,650 subjects.
CONCLUSIONS: The JACC Study provides useful evidence for cancer prevention in Japan.
J Epidemiol 2005; 15: S4-S8.

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BACKGROUND: As endpoint of cohort studies on cancer, the incidence, rather than the mortality is preferable. Of 45 areas in the Japan Collaborative Cohort Study (JACC Study), surveys for incidence of cancer were conducted in 24.
METHODS: The proportion of the study subjects aged 40 to 79 years in areas of survey for the incidence of cancer (65,184 persons) was 58.2% of the total subjects of the JACC Study (110,792 persons). Among the 24 areas of survey for the incidence of cancer (ASI), 10 areas were combined because of similarity. Then, we present the incidence rate of cancer among 15 ASI unified from the 24 ASI by gender according to area. We also report the completeness of the survey for cancer incidence presenting the mortality-incidence ratio (MI ratio) among the ASI.
RESULTS: Where a population-based cancer registry was utilized, the MI ratio deviated from 0.31 to 0.61 in the male subjects and from 0.15 to 0.53 in the female subjects. However, where a populationbased cancer registry was not used, the MI ratio deviated from 0.25 to 0.72 in the male subjects and from 0.13 to 0.79 in the female subjects, and there was an area where the MI ratio exceeded 0.70 in both of the male and female subjects.
CONCLUSION: Establishment of population-based cancer registries is strongly desired throughout Japan to assess risk factors of cancer development for primary prevention of cancer.
J Epidemiol 2005; 15: S80-S85.

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The present study investigated the association between visual display terminal (VDT) work and sick building syndrome (SBS) and the role of psychosocial factors in the relationship. Subjects were 2,161 Japanese office workers who responded to a cross-sectional anonymous self-administered questionnaire survey. Questions included were derived from the Miljömedicin 040, a validated questionnaire on SBS symptoms. After exclusion of data with missing information, data for 1,881 subjects were used for analysis. Multivariate logistic regression was used to estimate the odds ratio for SBS with adjustment for potential confounding factors, including psychosocial work stress. In multivariate analysis, the odds ratio for SBS was significantly elevated for men engaged in VDT work for 4 or more hours a day (OR=2.5, 95%CI: 1.0, 5.9) compared with less than 1 hour a day, showing a significant trend association (P for trend=0.04). In women, although the odds ratio for SBS with VDT use of 4 or more hours a day was somewhat elevated with adjustment for non-psychosocial factors (OR=1.5, 95%CI: 0.5, 4.3), the increase was greatly attenuated after adjustment for psychosocial work distress (OR=1.1). In conclusion, our study suggests that extended hours of VDT use might be related to increased SBS symptoms. Moreover, psychosocial distress related to VDT work might mediate the relationship between VDT use and SBS symptoms in women.

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