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Biomedical subjects

A Gunji

Publications and source records attributed to A Gunji.

At least 73 records · Page 4Linked to original sources
PubMed1995

[The structural analysis of inpatient medical cost of the aged in 81 secondary medical areas of 12 Prefectures in Japan].

In order to understand the structure of the per capita medical care expenditure of inpatients aged 70 years and over, correlational and principal component analyses were performed using several medical cost indices for fiscal 1991 in 81 secondary medical areas of 12 prefectures. Requests were sent to all of 777 municipalities in the 12 prefectures, and there were 763 responses for the response rate of 98.2%. A total of 1,647,187 residents who had been inpatients based on receipts for inpatient medical care expenditure were surveyed. There were 389,456 who responded that they had been inpatients at least once in the preceding 12 months, in 1991. The main results were as follows: 1) Of the residents aged 70 and over, 32.0% of men and 29.7% of women surveyed had at least one episode of hospital admission in the preceding 12 months in 1991. 2) Large differences in the medical care expenditure per inpatient per year for those aged 70 years and over exist in the secondary medical areas in 12 prefectures. 3) In both sexes, per capita expenditures for inpatient care per year are positively correlated with the bed-days in hospitals per inpatient per year, the bed days per receipt, the medical care expenditure per receipt, and the number of receipts per inpatient per year. On the other hand, for women it is negatively correlated with per capita medical care expenditure per day, but it is not statistically significant. 4) The medical care expenditure per inpatient per day is significantly negatively correlated with bed-days in hospital per receipt, the number of receipts per inpatient per year, bed-days in hospital per inpatient per year for both sexes. On the other hand, it is significantly positively correlated with medical care expenditure per receipt for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Effects of daily mild supine exercise on physical performance after 20 days bed rest in young persons.

To investigate the effects of daily mild supine exercise on physical performance capacity identified as maximal oxygen uptake rate (VO2max) after 20 days bedrest, 3 male students performed a supine pedaling at 40% intensity of VO2max for one hour every day, while 6 male and 5 female students were control. Before and after the bedrest, muscle mass and strength of exercising leg and cardiovascular responses during -40mmHg lower body negative pressure (LBNP) and moderate upright cycling exercise were measured. Despite the exercise programme VO2max was similarly decreased to the control subjects after bed-rest. The delta VO2max was correlated to delta % left ventricular fractional shortening during LBNP, and also % delta VO2max to % delta stroke volume of the moderate exercise (both p<0.05). The exercise programme should be too weak to maintain cardiovascular functions and thus to present the decrease in VO2max against prolonged bedrest as well as weightlessness stress.

Adult↗
PubMed1994

The influence of system factors upon the macro-economic efficiency of health care: implications for the health policies of developing and developed countries.

This paper aims to clarify the global association of system factors with the attainment of health policy goals, through economic analyses of cross-country data. In the case of OECD (the Organization for Economic Co-operation and Development) data for 1990, the variation in total expenditure on health among 24 countries can be explained by various factors including Gross Domestic Product (GDP). Among these, the variables representing the level of public sector involvement through social protection or public-private mix within a health care system, such as the Public-to-Total Expenditure Ratio, Coverage Rate and Public Cost Sharing, are significantly negative when factors such as GDP are controlled. This suggests that countries attaining higher equity or accessibility are in a better position to gain higher cost-containment or macro-economic efficiency. The results of this study may be helpful for developing countries searching for a long-term health care system as well as for developed countries facing health care system reforms.

Costs and Cost Analysis↗
PubMed1994

[Baroreceptor reflex function in young normotensive men with a family history of hypertension].

The purpose of this study is to evaluate the baroreflex function using lower body negative pressure (LBNP) and neck suction in young normotensive men with or without a family history of hypertension. Twenty-two young normotensive men with a family history of hypertension (FH+) and eight young normotensive men who had no family history of hypertension (FH-) were studied. FH(+) consisted of men who had a family history of hypertension within second degree relatives. We studied cardiopulmonary baroreflex function using LBNP and carotid sinus baroreflex function using neck suction and evaluated the reflex function under stimulated conditions using both LBNP and neck suction at the same time. Systolic arterial pressure (SAP)(F = 5.42, p < 0.0001) and pulse pressure (PP)(F = 15.57, p < 0.0001) decreased similarly in both groups in response to LBNP. SAP and PP responses to LBNP were not significantly affected by the family history of hypertension. Diastolic arterial pressure (DAP) increased (F = 2.89, p < 0.005) in both groups. There was a relationship between the LBNP level and family history of hypertension (F = 2.53, p < 0.013), and the increment in DAP during LBNP -30, -40 mmHg was larger in the FH(+) group. Through mean arterial pressure (MAP) was not effected by LBNP, there LBNP level was related to the family history of hypertension (F = 2.23, p < 0.02). Heart rate increased progressively (F = 25.7, p < 0.0001) with increasing levels of LBNP; however, these changes did not differ significantly in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Exercise-induced ST segment change and coronary risk factors in apparently healthy men].

Exercise stress test is useful for the early detection of coronary artery disease and is recommended as a medical clearance test before the initiation of exercise training. However, when applied to apparently healthy people, there are many false positive results. It is therefore necessary to determine indications for stress testing, but few data are available in Japan. In this study, we performed exercise stress test in apparently healthy men to investigate the incidence of exercise-induced ST segment changes and their relationship to coronary risk factors. The subjects were 2,187 men who underwent symptom-limited exercise stress test at a health-promotion center in Tokyo. Those with a history of cardiovascular disease were excluded. They underwent symptom-limited exercise stress test on a treadmill with a modified Bruce protocol or on a cycle ergometer with a ramp protocol (20 watts per minute). Twelve-lead electrocardiogram was recorded every 3 min. Cardiologists evaluated the exercise ECG responses, and advised those with abnormal ST segment changes (Group A) to undergo further examinations at a cardiovascular hospital. The results of further examination such as exercise scintigraphy and/or coronary angiography were obtained. Twice the number of subjects with normal exercise responses were selected as age-matched controls (Group N) to compare the coronary risk factors between the two groups. Twenty-nine subjects had abnormal ST segment changes (1.33% of the total subjects) (Group A). Their mean age was 57 years (38 to 76). Among these, 27 had ST segment depression and 2 had ST elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Capillary filtration rate, venous compliance, and blood flow in arms and legs do not change during bed rest for 20 days.

It has been generally accepted that pooling of the blood in the legs is one reason for the orthostatic intolerance experienced after space flights. This is also the reasoning behind the application of anti-G suits during reentry after space flights. Fighter pilots also use the anti-G suit, the hypothesis being that this prevents the pooling of blood in the legs. In order to investigate if immobilization during bed rest would induce peripheral cardiovascular deconditioning we measured capillary filtration rate, venous compliance, and blood flow in arms and legs during bed rest.

Adult↗
PubMed1994

Regional changes in muscle mass and strength following 20 days of bed rest, and the effects on orthostatic tolerance capacity in young subjects.

To this day, many studies have suggested that prolonged bed rest (BR) affects on muscle mass and strength not only in gravity muscles but also in ungravity muscles. However, it is still unclear whether the decrease in regional muscle strength after BR is due to the alterations in the corresponding muscle mass, or not. On the other hand, if BR decreases the mass of antigravity muscles (UGM) as well as muscle strength and then increases tissue compliance of the antigravity muscles, orthostatic tolerance capacity will be decreased by the reduction in cardiac output (CO) in spite of the increase in myocardial contractility because the more decrease in venous return due to the more increase in blood pooling within the compliant tissues of the lower body. However, this is also unclear. To make these questions clear, the present study investigated the regional muscle mass and strength and orthostatic tolerance capacity before and after 20 days of bed rest in young subjects.

Adult↗
PubMed1994

[Personnel requirements for health examination of infants under 5 months in municipalities in Japan].

Municipalities offer health education, health counseling, health examinations, and home visitation service for infants and their mothers. In order to determine what the personnel staffing requirements were for health examination of infants under 5 months for municipalities in Japan in 1989, a questionnaire survey was conducted in 1990. Questionnaires were sent to all municipalities and 3,198 responses were received for a response rate of 97.9%. Responses from 912 municipalities were considered invalid, leaving a total of 2,286 responses that were analysed. Results showed that 79.2% of the 2,286 municipalities were able to perform health examinations for infants under 5 months independently, while in 6.5% of the municipalities these examinations were performed by the clinical hospitals. Analysis by size of municipalities showed that 85.7% of the cities with populations of 500,000 or more were able to perform health examinations independently. In the large cities designated by the Government, the health personnel system adequately supported these health examinations. However in rural towns and villages with small populations, it was necessary for public health nurses to be assisted by other staff, most of whom were public health nurses from prefectural health centers. For example, in areas with populations of less than 3,000, about 60% of the total volume of the work required to be performed by public health nurses during the health examinations had to be covered by assistance from prefectural public health nurses.

Child Welfare↗
PubMed1994

[Differences in inpatient medical costs for the aged within one prefecture].

The rapid increase in the proportion of the elderly population has made the problem of medical costs increasingly important. This problem, however, is not uniform over all regions in Japan. In order to determine what factors are associated with per capita medical care expenditure of inpatients aged 70 years and over, in fiscal 1991, correlation analyses were performed using several indices of medical services, socioeconomic factors and medical supplies among 208 municipalities in one prefecture. Data from a survey in 1992 conducted by the Ministry of Health and Welfare was used in the analysis. Requests were sent to all 218 municipalities in one prefecture, and 208 responses were received a response rate of 95.4%. The main findings were as follows: 1) There were large differences in per capita medical care expenditure for those aged 70 years and over among the secondary medical areas in the prefecture. 2) Both the inpatient expenditures per person per year and bed-days in hospitals per person per year were positively correlated with number of hospital beds per 1,000, the aging population rate and death rate of those aged 70 years and over; but correlated negatively with the primary industry population rate for both sexes. 3) Inpatient expenditure per person per day was negatively correlated with the aging population rate, especially for men. 4) Three major factors that correlated significantly and positively with per capita medical care expenditure for those aged 70 years and over were bed days of inpatients per receipt, the total receipts per inpatient per year, and the number of the admission days of inpatients per year. These three major factors were negatively correlated but not significantly, with the per capita medical care expenditure per day. 5) Multiple regression analyses indicate that the aging population rate, the number of hospital beds per 1,000 of those aged 70 years and over, and death rate of those aged 70 years and over were independently correlated with the inpatient expenditure per person per year for both sexes. 6) Results of this analysis indicate that data from secondary medical regions within the prefecture rather than the municipalities yield a stronger possibility of clarifying those factors contributing to differences in per capita medical care expenditure.

Aged↗
PubMed1994

Effects of mild supine exercise during 20 days bed rest on maximal oxygen uptake rate in young humans.

Fourteen sedentary young volunteers performed a maximal exercise test on a bicycle ergometer before, after and eight or nine weeks after 20 days bed rest. They were divided into four groups. They all went through 20 days bed rest; 5 females and 6 males as controls while 3 males performed mild pedaling supine exercise for 30 minutes twice a day. Three other males from the control group started a retraining programme after bed rest performing mild pedaling exercise in the sitting position for an hour a day, 3-4 days a week for eight weeks. VO2max was reduced after bed rest in all groups. In the control group the 6 males decreased VO2max from 2.82 +/- 0.09 1.min-1 before bed rest to 2.42 +/- 0.14 1.min-1 after. The female controls decreased from 2.55 +/- 0.24 1.min-1 to 2.22 +/- 0.23 1.min-1. The exercise regime performed by the three males during bed rest did not prevent a fall in VO2max in that group from 2.76 +/- 0.06 to 2.57 +/- 0.09 1.min-1. The three males who performed bicycle exercise in the recovery period did not attain higher recovery values at 8-9 weeks than the other males. However the 5 female controls did not recover their > 13% loss in VO2max after 8-9 weeks of recovery. Calculation of peak oxygen pulse from VO2max divided by heart rate indicated that these changes in VO2max were caused exclusively by a reduction in stroke volume of the heart, a finding supported by resting echocardiography of left ventricular end-diastolic diameter and stroke volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Bone turnover and calcium metabolism during 20 days bed rest in young healthy males and females.

Bone is a dynamic tissue that functions not only as a mechanical support, but also as a major component of the metabolic and endocrine systems maintaining mineral homeostasis. It has been shown that immobilization induces decalcification of bone. To evaluate the effect of immobilization on bone mineral density and calcium metabolism, we investigated 9 young healthy males and females during 20 days bed rest. Three methods for measuring bone mineral density were performed to quantify whole body and regional bone changes: 1) dual energy X-ray absorptiometry, 2) quantitative computed tomography, and 3) multiple scanning X-ray photodensitometry, respectively. Bone mineral density showed a rapid decreasing tendency, especially in both lumbar and metacarpal bones (mean +/- SE: 4.6 +/- 0.6% and 3.6 +/- 0.4%, respectively). Urinary daily excretion of deoxypyridinoline, a sensitive marker of bone matrix resorption, tended to increase by day 10, and to decline by day 20 (mean +/- SE: 42.2 +/- 1.4, 27.6 +/- 2.2 nmol day-1, respectively). However, neither alkaline phosphatase nor tartrate-resistant acid phosphatase, both markers of osteoclast and mature osteoblast function, changed. These results showed that in the early stage of immobilization, bone matrix might be resorbed without any activation of osteoclasts, resulting in rapid decalcification of vertebral and cortical bones without any discernible changes in anatomical structure.

Absorptiometry, Photon↗
PubMed1994

Metabolic turnover of bone and peripheral monocyte release of cytokines during short-term bed rest.

Immobilization induces abnormal bone metabolism and rapid decalcification. Measurements of bone mineral content disclosed rapid decalcification, especially in lumbar vertebral and metacarpal bones in our short-term 20-day bed rest study. Many factors could contribute to the marked demineralization. The activities of osteoclasts and osteoblasts were studied by following serum levels of tartrate-resistant acid phosphatase and alkaline phosphatase, biomarkers for osteocyte activity. There were no alterations in these enzymes during bed rest. However, urinary excretion of pyridinium cross-links, resorption markers of bone matrix itself, increased by day 10 with subsequent decrease at day 20. So decalcification was induced without any relation to osteoclast activity. As cytokines strongly modulate the function of osteoclasts, peripheral monocyte release of interleukin 1 alpha and tumor necrosis factor alpha were assayed to determine the contribution to this rapid demineralization. Cytokines were released transiently by day 7 and later rapidly decreased. However, there was no correlation between cytokine release and bone matrix resorption.

Acid Phosphatase↗
PubMed1994

Decremental reset in basal metabolism during 20-days bed rest.

Changes in basal metabolism during 20 days bed rest were measured in 9 young healthy males and 5 females. Food intake was unrestricted and supplementary meals were allowed. All food intake was monitored. A special sleeping pattern was not enforced, although an ordinary day-night diurnal rhythm was kept in the rooms. Body temperatures were measured daily every 2 hours from 7:00 to 22:00. Basal oxygen uptake decreased significantly during the first 10 days of bed rest and levelled off during the following 10 days. Body weight and composition remained substantially unchanged in spite of a decreased energy consumption during the bed rest. In conclusion, basal VO2 was reset at a decreased level during the first 10 days of bedrest with no relationship to the dietary energy intake or to the body temperature, while no more change took place during the following 10 days.

Adult↗
PubMed1994

Effects of 10 and 20 days bed rest on leg muscle mass and strength in young subjects.

Sedentary voluntary students were exposed to 10 (n = 8) and 20 (n = 14) days bed rest to study effects of prolonged bed rest on isometric strength of knee extension and flexion, total leg strength, right hand grip and elbow flexion using different dynamometers. Further, muscle mass of right leg and arm was measured by dual energy X-ray absorptiometry, and cross sectional area of right thigh by X-ray computed tomography before and after bed rest and after 4 or 8 weeks of recovery. After 10 days bed rest, these variables tended to decrease except for the muscle mass of right arm which increased. After 20 days of bed rest, a similar trend was observed, but at a statistically significant level of p < 0.05. However, no correlation was observed between the decrease in knee extensor strength and cross sectional area of the thigh. Nor was a correlation observed between the sum total of isometric strength of the leg and the total muscle mass measured. The 24h urinary excretion of N2 and creatinine was not changed through the experiments. During recovery, the variables measured had reached the initial levels after 4 or 8 weeks. These changes were not affected by mild supine exercise training. The results suggest that isometric muscle strength was decreased in non-antigravity muscles as well as antigravity muscles by prolonged bed rest, but the rate of changes did not correlate to the corresponding changes in muscle mass. The decreases in maximum voluntary strength are probably not only due to the decrease in muscle mass but also due to reductions of neuromuscular function.

Absorptiometry, Photon↗
PubMed1994

Carbohydrate and lipid metabolism after 20 days of bed rest.

To test the hypothesis that physical inactivity affects carbohydrate and lipid metabolism, we studied the influence of 20 days bed rest in 14 young subjects (9 men and 5 women). There were no changes in body weight or estimated per cent body fat after 20 days bed rest. Total cholesterol, triglyceride, high density lipoprotein cholesterol, and apolipoprotein B levels did not change statistically during bed rest. But apolipoprotein AI levels were significantly lower during and immediately after bed rest compared with control values (p < 0.05). On the 3rd day of bed rest a decrease was found in high density lipoprotein-2 cholesterol (p < 0.05) and an increase in high density lipoprotein-3 cholesterol (p < 0.01) compared with control level. To evaluate the carbohydrate metabolism, each subject underwent a 75 g oral glucose tolerance test. The glucose concentrations in response to glucose ingestion did not change during bed rest, but insulin concentrations increased. The insulin-response curve to glucose ingestion tended to shift to the right during bed rest. From the 3rd day of bed rest an increase (p < 0.05) of total insulin and a decrease (p < 0.05) in blood glucose/insulin ratio were found during the glucose tolerance test which suggested a decrease in insulin sensitivity. These results suggested that physical inactivity impaired carbohydrate- and lipid metabolism.

Adult↗
PubMed1994

Effect of 20 days bed rest upon peripheral capillary filtration rate, venous compliance and blood flow in arms and legs.

Capillary filtration rate, venous compliance and blood flow in arms and legs were measured during bed rest by strain gauge plethysmography using a liquid metal alloy in silastic tubes. Furthermore orthostatic tolerance to lower body suction was recorded. Six young healthy males and three young healthy females participated in the 20 days bed rest study. Neither arm nor leg blood flow was changed by bed rest. Arm blood flow varied between 2.18 +/- 0.30 and 3.03 +/- 0.35 vol%.min-1 and leg blood flow between 1.42 +/- 0.12 and 1.76 +/- 0.40 vol%.min-1. The capillary filtration rate tended to decrease in the arms from 0.27 +/- 0.07 vol%.min-1 at day 0 to 0.17 +/- 0.03 vol%.min-1 at day 3 and a tendency to an increase in filtration rate in the legs from 0.16 +/- 0.06 at day 0 to 0.56 +/- 0.21 vol%.min-1 at day 3 but both of these changes had recovered from day 10 on. There was a steady state in venous compliance of the forearm between 1.31 +/- 0.20 and 1.50 +/- 1.13 vol% during the first two weeks of the bed rest period but the values tended to increase to 1.75 +/- 0.16 and 1.89 +/- 0.22 vol% at days 16 and 19, respectively, while leg venous compliance showed a transient tendency to increase at day 3 (from 0.83 +/- 0.08 at day 0 to 1.30 +/- 0.32 vol% at day 3) to attain control values from day 5. Orthostatic intolerance measured during lower body suction decreased in the present subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Orthostatic tolerance and autonomous nervous functions before and after 20-days bed rest.

To determine the critical factor that induces tachycardia during orthostasis after bed rest, we tested some autonomous nervous functions and the reaction to lower body negative pressure before and after 20 days horizontal bed rest. Subjects were 5 young healthy males and one female. Carotid vagal baroreflex sensitivity was evaluated by cardiac response to a gradual increase in carotid distending pressure of 150 mmHg within 10 s by neck suction after neck positive pressure. Combined effects of cardiopulmonary and aortic baroreflexes were assessed by the cardiovascular responses during Valsalva manoeuvre. Sympathetic reactivity was evaluated by a cold pressor test. The carotid vagal baroreflex tended to be diminished after bed rest in supine rest, but unchanged in seated position. Cardiac responses to Valsalva manoeuvre did not change after bed rest, although blood pressures decreased more during the manoeuvre after bed rest. Cold pressor response did not change after bed rest. Heart rate response during lower body negative pressure was increased after bed rest. In conclusion, combining our results from several autonomous nervous functions suggested that the exaggerated orthostatic tachycardia after bed rest could not be explained by the changes in sensitivity of carotid, aortic, and cardiopulmonary reflexes and sympathetic reactivity to cold stress.

Adult↗