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Biomedical subjects

K Tatara

Publications and source records attributed to K Tatara.

At least 109 records · Page 6Linked to original sources
PubMed1992

Relationships of site of infarction and history of previous infarction with short- and long-term prognosis after acute myocardial infarction in Japan.

We studied the outcome in 308 patients with acute myocardial infarction (MI) admitted to the coronary care unit of Kobe General Hospital. Short-term outcome (within 28 days after MI) and long-term outcome (more than 28 days) were examined with survival curves to find any relationship with a history of previous MI and with the site of the MI. In the short term, 38 of the 308 patients died of cardiac causes. The group with anterior MI tended to have higher mortality than the group of patients with inferior MI, and among patients without a previous MI, patients with anterior MI had significantly higher mortality (p = 0.01). In multivariate analysis by the logistic regression model, the site of the MI was found to be independently associated with the short-term outcome. In the long term, with a mean follow-up of 3.4 years, 23 of the 308 patients died of cardiac causes. Different sites of the MI did not result in different outcomes in patients with or without a previous MI. Of patients with anterior or inferior MI, those with a previous MI tended to have higher mortality, and of patients with an inferior MI, the difference was significant (p = 0.001). In multivariate analysis by the proportional hazards model, a history of MI was more predictive than the site of the MI. In conclusion, the site of the MI was associated more with the short-term outcome than with the long-term outcome, and a history of MI was associated more closely with the long-term outcome.

Aged↗
PubMed1992

Factors related to long-term stay in hospital by elderly people in a Japanese city.

The characteristics and social backgrounds of 61 elderly patients with long hospital stays and those of 179 incapacitated elderly people living at home in a Japanese city were compared. Discriminant function analysis was performed to clarify the factors associated with long-term use of hospital beds by elderly people. In addition to this analysis, the elderly patients with long hospital stays were divided into two subgroups according to the likelihood of discharge, and these subgroups were compared in the same way. The elderly patients with long hospital stays were more likely to be women, persons with low ADL, living alone and not living with a spouse or a second generation, compared with incapacitated elderly people living at home. Analysis of the subgroups of the elderly subjects with long hospital stays showed that use of a urethral catheter and not undergoing rehabilitation were the medical factors related to difficulty of discharge, while being women, of advanced age and not having their own room at home were the non-medical factors associated with long-term occupation of hospital beds.

Activities of Daily Living↗
PubMed1992

Effect of physical exercise on mortality in patients with Parkinson's disease.

Public health nurses visited and followed up for more than one year 438 patients with Parkinson's disease living in Osaka. The follow-up period averaged 4.1 years, during which 71 deaths were observed. The patients were classified according to the degree of physical exercise they performed, and the ratios of observed to expected deaths were calculated. The exercising group showed the lowest ratio of 1.68 (1.45 for patients able to walk independently, and 1.89 for those could not) while all patients exhibited a ratio of 2.47. Multivariate analysis using Cox's proportional hazard model, adjusted for age, sex, walking ability and duration of disease at study entry, showed that, compared with the exercising group, the non-exercising patients had a hazard ratio of 1.83.

Exercise↗
PubMed1992

[Factors influencing prolonged hospital stays by elderly patients: problems in medical management including use of urethral catheters].

Fifty-nine elderly patients who had been hospitalized more than six months in five hospitals in the city of Mino in Osaka Prefecture, were studied to clarify the factors influencing prolonged hospital stays by the elderly. Their mean age was 82.2 years, and women accounted for 86% of the patients. One-third had suffered a stroke. As for ADL, 44% were completely dependent when walking, eating, bathing and dressing. Moreover, 36% had severe dementia, 19% suffered from decubitus ulcers, 66% were undergoing rehabilitation, 58% were receiving venous infusion therapy, 36% used a urethral catheter, and 10% were receiving tube feeding. The subjects were divided into two groups according to the likelihood of discharge assessed by the doctors in charge: one group consisted of 27 patients who might be discharged and the other of 32 patients with an ongoing need for inpatient care. Multivariate analyses using Hayashi's quantification method II indicated that use of a urethral catheter and not undergoing rehabilitation were the main factors associated with the need for inpatient care, while being a woman, being of advanced age and not having one's own room at home were the non-medical factors which made it difficult for the patients to be discharged from the hospital. As use of a urethral catheter was the factor most strongly related to prolonged hospital stay, multivariate analyses were applied to the 45 patients with urinary incontinence, who were divided into one group of 21 patients with, and one of 24 without a urethral catheter. The factors associated with use of a urethral catheter were then investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[A comparative study of the characteristics and social backgrounds of frail and elderly persons at home, long-stay elderly hospital patients, and residents of welfare homes for the frail elderly].

Three studies were carried out in Mino City, Osaka Prefecture, on 188 frail and elderly persons living at home (the home group), 61 elderly patients who had been hospitalized more than six months (the inpatient group), and 72 residents of welfare homes for the frail elderly (the resident group). The characteristics and social backgrounds of the three groups were compared. About 30% of each group had suffered a stroke. As for ADL score, moderate disability was dominant in the home group, severe disability in the inpatient group, and slight disability in the resident group. The proportions of those who had been living alone and those who had no spouse were significantly higher in the inpatient group and in the resident group than in the home group. Significantly fewer subjects in the resident group had been living with their offspring than in the home group or in the inpatient group. The percentage of those who did not have their own home was the highest for the resident group. Multivariate analyses using Hayashi's quantification method II were conducted for a comparison between cases belonging to the home group and the inpatient group, and between the home group and the resident group. The analysis of the home group and the inpatient group revealed a relationship of the inpatient group to severe disability in ADL, and living alone. Differences between these two groups were related to such variables as ADL, sex, living or not living alone, living or not living with offspring, and having or not having a spouse.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Relation between use of health check ups starting in middle age and demand for inpatient care by elderly people in Japan.

OBJECTIVE: To find out whether there is any correlation between the use of general health check ups (provided for by the Health Services for the Elderly Act 1982) by insured Japanese residents aged 40 or older and demand by the elderly for inpatient care. DESIGN: A questionnaire was posted in 1988 to municipal offices of Japanese cities. All questionnaires were returned with data for 1983 and 1986. SETTING: All 509 Japanese cities with a population of 30,000-199,999. SUBJECTS: All people aged 40 or older who hold a resident card and are not offered health examinations at work are eligible for general health check ups. The questionnaire also inquired about use of inpatient care by elderly residents (aged 70 or older) who were covered by national health insurance. MAIN OUTCOME MEASURES: Correlation coefficients between the rates of use of general health check ups and mean annual bed days for the elderly. Comparison of relative changes by analysis of correlation between improvement indices in mean bed days and mean inpatient fee. RESULTS: In cities with relatively high rates of use of health check ups both the mean annual bed days and the mean inpatient fee for the elderly tended to be low. Correlation coefficients between the logarithmic rates of use of check ups and mean bed days by sizes of cities and number of beds were all negative values. There tended to be more correlation between improvement indices for rate of use of check ups and both mean bed days and mean inpatient fee with higher rates of use in 1983, and the correlation was significant for rates of 60% or more. CONCLUSIONS: Strong health service programmes that start in middle age decrease the demand for inpatient care of the elderly. It was estimated that in a single year from 1985 to 1986, when there was an increase in the rate of use of check ups from 25.5% to 27.6%, the reduction in the number of bed days for the total of 8.5 million elderly insured people was 2.21 million bed days.

Age Factors↗
PubMed1991

Collateral circulation in Kawasaki disease with coronary occlusion or severe stenosis.

Forty patients with Kawasaki disease with severe coronary sequelae were investigated. All had at least a 90% reduction in the diameter of the major coronary artery. Collateral vessels were seen in 32 of 33 (97%) patients with total occlusion. All patients with severe stenosis but not total occlusion had no or poorly developed collateral vessels. Analysis according to the presence or absence of collateral vessels showed no significant differences in the results of treadmill stress testing and myocardial imaging between these two groups. In patients treated surgically, the abnormalities recognized by these tests were normalized or improved when the bypass was patent. These data indicate that collateral circulation in patients with Kawasaki disease cannot be seen angiographically unless there is total occlusion and the presence of collateral circulation cannot provide protection against stress-induced myocardial ischemia.

Arterial Occlusive Diseases↗
PubMed1991

[An evaluation of the attitudes and productivity of public health nurses in mental health service programs for the elderly].

The relationship between productivity of public health nurses (PHN) employed in mental health programs including home visit service for elderly people with dementia, and their attitudes toward mental health services was studied by surveying PHN at 31 health centers (HC) in Osaka Prefecture. A review of the services provided for 382 clients with dementia visited during a one-year period showed that PHN had provided the following services: home health care education: family education to promote understanding of the disease; management of interpersonal relations in the family; intervention to reduce the burden placed on the family members; medical facility referral; social service resource referral. For each of these PHN-provided services, the service had been provided to more than 60% of the clients. The percentage of clients who had been visited by a PHN accompanying a psychiatrist or a social worker was significantly higher at the 13 HC where PHN attach importance to counseling programs for the elderly, the 8 HC which provide group work services, and the 13 HC which hold case conferences more than six times a year than at other HC. In addition, the service provision rates for many PHN-provided services were significantly higher for these HC than for other HC. Analysis on the basis of whether PHN did or did not attach importance to the counseling program, showed that in either group, clients who had been visited by a PHN accompanying a psychiatrist or a social worker were more likely to have received PHN-provided services than other clients. Furthermore, at HC where PHN actively participated in mental health programs, PHN attitudes toward mental health care were more enthusiastic than at other HC. These results indicate that increased productivity of PHN employed in mental health programs and promotion of a multidisciplinary approach in client services are correlated with each other, and that both factors contribute to improving the quality of home visit services provided by PHN.

Aged↗
PubMed1990

[Comparison of factors related to hospitalization versus home care of elderly].

This study was done to identify factors affecting present hospitalization versus home care in 4,578 elderly subjects representing 87.1% of the elderly population living in S. city near Osaka. Subjects or their families were asked by interviews regarding the age of the subjects, the kind of persons living together in the family unit, the kind of housing, the number of rooms in the family dwelling, and health conditions. Subjects were also asked whether he or she could walk unassisted and whether home care would be preferred in case of an illness. Among the 153 hospitalized subjects, ability to walk, age, and the number of rooms were all significant factors, in decreasing order. Among the 1,193 persons who preferred home care in case of an illness, the number of rooms, age, ability to walk, and the size of the family unit were all significant factors, in decreasing order. Among subjects who could not walk unassisted, the number of rooms was the main factor determining their admission and not preferring home care if their condition worsened. Thus, although the ability to walk is the major factor among the factors we investigated, housing conditions are also important if home care is to be possible.

Aged↗
PubMed1990

[A study of attitudes toward illness and its effect on mortality in patients with Parkinson's disease].

The standardized mortality ratio (SMR), i.e. the ratio of observed to expected deaths, was investigated among 433 patients with Parkinson's disease (172 males and 261 females), who had been visited by public health nurses for a period of more than one year between 1978 and 1987 in Osaka Prefecture. The mean age of the patients was 58.7, and the average duration of the disease was 6.1 years at study entry. The follow-up period averaged 4.1 years during which sixty eight deaths were observed. The SMR of the patients was 2.54 relative to the general population of Osaka Prefecture. The SMR of those who were able to walk without assistance at study entry was 1.73, while that of patients with severe gait disturbance was 3.81. Patients were divided into three groups according to the extent of daily physical exercise performed to maintain their remaining function. Among patients who had been able to walk, those doing daily physical exercise showed the lowest SMR of 1.46. Among those with severe gait disturbance, the SMR of the exercising group was also the lowest at 1.72. These results indicate that daily physical exercise affects the mortality of Parkinsonian patients independently of the grade of disability. Participation in daily exercise was strongly influenced by the patient's will to battle his illness, and was significantly related to the presence of a spouse, economic situation of household, and the number of rooms in their dwelling.

Adult↗
PubMed1990

[The effect of professional dental health care in the prevention of periodontal diseases in adults].

Dental health conditions of participants in adult general health examinations provided as a health service by a local government from 1983 to 1987, were analyzed to evaluate the effect of individual dental health instructions with prophylactic treatment (individual instructions) for preventing periodontal diseases. For this purpose, Periodontal Index (Russel) and Debris Index (Greene & Vermillion) of 557 dentate adults aged 40-59 were examined. In the group that received individual instructions, average PI showed a significantly greater decrease during the period from the first inspection in 1983-1986 to the last one in 1987, compared to the group that received no individual instructions. For those with PImax greater than or equal to 6 at the first examination in 1983-1986, the figures of average PI showed a significantly greater decrease in those receiving instruction than the group that received no individual instructions. Between 1983-1987, the proportion of persons with PImax greater than or equal to 6 decreased from 74.2% to 27.3% as a result of the individual instructions. The figures for average DI showed significant changes but, no significant difference was observed between the two groups.

Adult↗
PubMed1989

Long-term prognosis of Kawasaki disease patients with coronary artery obstruction.

The prognosis of coronary artery obstruction was studied in patients with Kawasaki disease. Between May 1973 and December 1987, coronary artery obstruction was diagnosed by coronary angiography in 30 patients (21 males, 9 females), of whom, only 8 (26.7%) had clinical symptoms. One patient died after 9 years of illness. Two complained of frequent chest pain, which disappeared after bypass surgery in one case and spontaneously in the other. Five had symptomatic myocardial infarction. Myocardial ischemia was diagnosed in 31.8% by treadmill stress testing, but was well demonstrated in 85.7% by thallium-201 myocardial tomography. Frequent ventricular premature beats, Wenckebach-type atrioventricular block, and ST-segment depression accompanied by chest pain were recognized by 24-h Holter monitoring. In the past, the methods used to determine the prognosis of Kawasaki disease patients with coronary artery obstruction were not adequate. However, the examinations used in this study revealed an improved ability to determine the prognosis in this disease. Myocardial tomography, in particular, provided a more accurate evaluation of myocardial damage. Ventricular arrhythmias seem to be a serious problem in these patients. Therefore, careful observation using these tests, especially myocardial tomography and Holter monitoring, should be done even if the patients are free of symptoms.

Adolescent↗
PubMed1987

Declining trends in blood pressure level and the prevalence of hypertension, and changes in related factors in Japan, 1956-1980.

Trends in age-specific and age-adjusted blood pressure and the prevalence of hypertension were obtained from the National Nutrition Survey of Japan, 1956-1980. The national trends in the age-adjusted blood pressure of people (30-69 years old) in Japan during the 1956-1980 period show an increasing pattern reaching a peak around 1964 followed by a decreasing pattern. To explore the possible factors which have contributed to the change in blood pressure levels, we analyzed the relationship between the blood pressure and several possible factors, including the rate of treatment for cardiovascular diseases (CVD) for men and women, annual salt and alcohol consumption per captia and body mass index (MBI) for men and women. Only alcohol consumption was considered in the analysis of men because women in Japan still tend to drink relatively little alcohol. In simple descriptive analyses, the increasing trend in the treatment rates of CVD seemed to be related to the decrease in the blood pressure level and in the prevalence rate of hypertension for both men and women. The impact of treatment rate seemed to overcome the adverse influence of the increasing trends in BMI. Recent decrease in salt consumption may account in part for the later period of the decreasing trends in blood pressure level and the prevalence of hypertension. In multiple regression analysis using these time series data, CVD, BMI and alcohol consumption were significantly related to blood pressure level and the prevalence of hypertension, although salt was not significant in these analyses.

Adult↗
PubMed1987

Long-term prognosis of giant coronary aneurysm in Kawasaki disease: an angiographic study.

The incidence of coronary obstruction subsequent to giant coronary aneurysm in Kawasaki disease was studied. In 20 cases, aneurysms with a maximal diameter greater than 8 mm were identified by coronary angiography 2 to 120 months (mean 16.9 months) after onset. There were 25 giant aneurysms among these 20 patients, all of whom underwent coronary angiography between 12 and 134 months (mean 31.7 months) after initial examination. Coronary obstruction occurred in six cases (30.0%), all within 4 years of onset of disease. There were five obstructive aneurysms in the right coronary artery (5/12; 41.7%) and two in the left coronary artery (2/13; 15.4%). One of these patients developed symptomatic myocardial infarction. Two had abnormal electrocardiographic findings suggesting myocardial infarction. In five cases, persistent perfusion defects were found by myocardial imaging. On the other hand, in two patients giant aneurysms persisted without obstructive changes for greater than 10 years. In both cases the aneurysm was in the left coronary artery and obstruction of the right coronary artery was found at initial angiography. These results seem to indicate the limited efficacy of antiplatelet therapy for giant coronary aneurysms in Kawasaki disease and that giant aneurysms are likely to progress to become obstructive within a few years even if antiplatelet therapy is given. Other forms of treatment, including surgery, should therefore be considered in such patients.

Angiography↗
PubMed1987

Declining mortality from ischemic heart disease and changes in coronary risk factors in Japan, 1956-1980.

Mortality from ischemic heart disease has declined in Japan since 1970. This paper addresses the declining mortality from ischemic heart disease and the possible contributing factors for 1956-1980. Mortality figures were obtained from Vital Statistics reports by the Ministry of Health and Welfare in Japan. National trends in blood pressure levels, prevalence of hypertension, Keys' lipid factor phi instead of the serum cholesterol level, and body mass index were obtained from the National Nutrition Survey which is carried out annually from random samples in Japan. The smoking rate which was obtained from other national surveys was also reviewed for this purpose. The age-adjusted (30-69 years) mortality from ischemic heart disease declined by 24% and 37% for men and women, respectively, between 1968 and 1978. It seemed that the decline in blood pressure levels and in the prevalence of hypertension and the increasing treatment rate for cardiovascular disease might contribute to the declining mortality from ischemic heart disease. The decline in cigarette smoking may, in part, also play a role. On the other hand, the increase in intake of lipids which resulted in Keys' lipid factor phi was compatible with the increase in mortality from ischemic heart disease during 1956-1970. The experience in Japan shows that the treatment of hypertension or the lowering of blood pressure and the recommendation to stop smoking help to prevent ischemic heart disease.

Adult↗