Biomedical subjects

Y Komachi

Publications and source records attributed to Y Komachi.

At least 37 records · Page 2Linked to original sources

PubMed1998

[Survival and disability in stroke by stroke subtype based on computed tomographic findings in three rural Japanese communities].

PURPOSE: We conducted an epidemiological study of survival and disability in stroke in three Japanese communities to seek community strategies for improvement in survival and disability. METHODS: A total of 297 first-ever strokes were identified between 1988 and 1992 in three rural communities (total population = 47,000) located in Akita and Ibaraki. We analyzed survival rates and activity of daily living by sex, age-group and stroke subtypes. Successful review of computed tomography (CT) for 84 percent of the strokes (249 out of 297) was possible and the data were used for subtype analyses. RESULTS: For all strokes (n = 297) survival rates were 85% for 30 day, 70% for one year, 62% for three year. The rates tended to be lower in women than in men. The rates were lowest in ages less than 60 at thirty day, and in ages 80 and older at the end of the first and third year. Intracerebral hemorrhage with ventricular rupture, subarachnoid hemorrhage and cortical cerebral infarction had lower survival rates than intracerebral hemorrhage without ventricular rupture and lacunar infarction. Based on Cox's proportional hazard model, risk ratio for death was 2.07 in ages 70-79, and 3.80 in ages 80 and older compared with ages 60-69. The risk ratio was 3.46 for intracerebral hemorrhage with ventricular rupture, 3.38 for subarachnoid hemorrhage and 2.46 for cortical cerebral infarction compared with lacunar infarction. The proportion of stroke survivors who need assistance from others in the first and third years tended to be higher in women than in men. The proportion was higher in older patients than in the younger, and higher for intracerebral hemorrhage with ventricular rupture and cortical cerebral infarction than in other subtypes of stroke. From logistic regression analysis, the odds ratio for disability in the first year was 6.55 for ages 80 and older compared with ages 60-69. The odds ratio was 5.61 for intracerebral hemorrhage with ventricular rupture, 4.53 for cortical cerebral infarction compared with lacunar infarction. In the third year the odds ratio was significant for ages 70-79, and decreased for intracerebral hemorrhage with ventricular rupture (odds ratio = 2.98), and increased for cortical cerebral infarction (odds ratio = 6.06). CONCLUSIONS: Survival and disability in stroke depended on age and stroke subtypes. Even after age adjustment, stroke subtypes with large cerebral involvement had worse prognosis than stroke subtypes. Community-based hypertension control programs are important to prevent any subtypes of stroke. Stroke subtypes as well as age should be taken into account to develop effective care and medical treatments for strokes.

Activities of Daily Living↗

PubMed1998

[Characteristics and outcome of stroke patients discharged from hospitals in an urban area of Japan].

The purpose of this study was to obtain the overall characteristics and outcome in stroke patients in an urban area of Japan, in order to develop some strategies for a community-based care system for improvement of the prognosis and activities of daily life in stroke patients. The present study, based on 4 hospitals in Yao city in Osaka, showed results as follows: 1) The number of stroke patients discharged from 4 hospitals during a recent one year period was 377 (216 men and 161 women). 2) The proportion of patients who died was 27%. Of the living patients, the proportions of patients who had motor paralysis or speech disturbance at discharge were 54% and 27%, respectively. 3) The proportion of patients who were to return to their home was 77% for all living patients. The proportion of patients who were not able to walk by themselves, or needed assistance in at least one of the activities of daily life was 31% and 28%, respectively, for all living patients who were to return to their home. This study showed that stroke registry from major hospitals in an urban area is useful for obtaining the overall characteristics of stroke patients in the area and promote community-wide programs in the prevention and home care of stroke.

Activities of Daily Living↗

PubMed1997

[Effectiveness of a health education class to increase fish intake evaluated by serum fatty acid compositions].

For prevention of cardiovascular disease, we recommended increased fish intake for 50 middle-aged women and men of 40-83 years old at a three-month community-based health education program in an inland farming community. The effectiveness of the education program was evaluated by examining changes in serum lipids and serum fatty acid compositions. For comparison, we selected 48 men and women of 38-82 years old did not participated in the program. Before education, there was no significant difference in the dietary frequency of fish, meat, egg and dishes prepared with oil, mean values of serum lipids or serum fatty acid compositions except for saturated fatty acid, gamma-linolenic acid, dihomo-gamma-linolenic acid and alpha-linolenic acid. After three months, the frequency of fish intake of one or more times per day increased from 33% to 43% in the education group while the frequency of fish intake did not change in the control group. In the education group, serum n3 polyunsaturated fatty acid composition increased from 8.8% to 10.6%. This fatty acid increase was primarily observed in eicosapentaenoic acid and docosahexaenoic acid. The n3/n6 ratio increased from 0.21 to 0.31. In the control group, no change was observed in n3 polyunsaturated fatty acids. This study suggests that the community-based dietary education increased fish intake and serum n3 polyunsaturated fatty acids in women and men of 40 years old or older.

Adult↗

PubMed1996

Passive smoking and plasma fibrinogen concentrations.

To examine the effect of passive smoking on plasma fibrinogen, a coronary risk factor, a cross-sectional study was conducted between 1990 and 1993 for 1,780 Japanese women aged 45-74 years who resided in Kyowa town, Ibaraki-ken, Japan. Fibrinogen concentrations controlling for age, body mass index, ethanol intake, serum total cholesterol, diabetes mellitus, and menopausal status were 8.6 (95% confidence interval 1.6-15.6) mg/dl higher in women exposed passively to smoking outside the home (n = 435) and 11.2 (95% confidence interval 3.0-19.3) mg/dl higher in women exposed both in and outside the home (n = 272) than in women unexposed in either location (n = 524). These effects of passive smoking were about 40-60% of that of current active smoking. An effect of passive smoking at home only was small and not statistically significant. The association between fibrinogen and passive smoking was primarily observed in women aged 45-59 years but not in those aged 60-74 years. Passive smoking may raise the risk of coronary heart disease partly by increasing plasma fibrinogen concentrations.

Aged↗

PubMed1996

Polymorphism of the apolipoprotein B gene and blood lipid concentrations in Japanese and Caucasian population samples.

To examine whether a racial difference in apolipoprotein B (Apo B) gene polymorphism between Japanese and American Caucasians corresponds with the lower blood cholesterol concentrations in Japanese than in Americans, we examined the EcoRI polymorphism of the Apo B gene for 271 nonsmoking men and women aged 47-69 years in two population-based samples: rural Japanese living in Akita and Caucasians living in Minneapolis-St. Paul, Minnesota, USA. Mean values of serum cholesterol concentrations were significantly lower in Japanese than in Caucasians for both men and women (difference = 25-26 mg/dl). An allele-specific polymerase chain reaction was conducted to examine the Eco RI cutting site at the 12669 cDNA position of the Apo B gene. The allele R2 (absence of the cutting site) has been associated with lower cholesterol concentrations in two previous studies. The frequency of the R2 allele was 6% for Japanese and 17% for Caucasians (P < 0.001), and this race difference in allele frequency was identical for men and women. After controlling for age, body mass index, alcohol intake, and for women, menopausal status and hormone replacement therapy, the adjusted mean (SE) cholesterol level among Japanese was 204 (3) mg/dl for genotype R1R1 and 185 (7) mg/dl for genotype R1R2 or R2R2 combined (P = 0.01). The respective mean values among Caucasians were 224(5) mg/dl and 232(7) mg/dl (P = 0.36). The polymorphism had a similar effect on total cholesterol concentrations for both men and women. The observed lower prevalence of the R2 allele in Japanese than in Caucasians indicates that this variation in the Apo B gene does not explain the racial difference in blood cholesterol concentrations.

Aged↗

PubMed1996

Lipoprotein(a) and its correlates in Japanese and U.S. population samples.

To examine whether serum levels of lipoprotein(a) [Lp(a)], a potential coronary risk factor, are higher in Caucasian-Americans than in Japanese, a circumstance that would correspond to the higher mortality from coronary heart disease in the United States than in Japan, we analyzed serum Lp(a) levels in 300 nonsmoking men and women aged 47-69 years. Participants were drawn from two population-based samples: rural Japanese living in Akita and Caucasians living in Minneapolis-St. Paul, MN. Geometric mean and median serum Lp(a) concentrations were higher (P < 0.05) in Japanese than in Caucasians for both men (difference in geometric mean = 3.2 mg/dL) and women (difference = 5.3 mg/dL). There was however, no racial difference in the proportion of elevated Lp(a) concentrations (i.e., > or = 30 mg/dL) in either sex. Alcohol intake was inversely correlated with Lp(a) levels in Japanese men, who had a high average alcohol intake, but not in other sex and racial groups. Serum Lp(a) was nonsignificantly but consistently correlated with plasma fibrinogen and LDL-cholesterol for all sex and racial groups. With adjustment for alcohol intake, LDL-cholesterol, and plasma fibrinogen, the Japanese-Caucasian difference in geometric mean Lp(a) values was even larger for men and was not changed for women. Results of the present study do not support the hypothesis that racial differences in Lp(a) concentrations contribute to the higher mortality rate from coronary heart disease in the United States than in Japan.

Aged↗

PubMed1996

Stereopsis with normal and reversed binocular parallax using a head mounted display in normal and strabismic subjects.

A virtual reality system using a head mounted display (HMD) was constructed for the purpose of finding out how human beings perceive the three-dimensional world. Four ophthalmologically normal subjects and 4 strabismic patients (2 with exotropia, 2 with esotropia) were examined. They wore the HMD and viewed some familiar objects (e.g. human face) and an unfamiliar object (e.g. tangled ropes) under normal parallax, reversed parallax, and monocular conditions. They also attempted the ring and hook test under each condition. They recognized the normal familiar objects under each condition, but some normal subjects were confused when they perceived unfamiliar objects. The normal subjects barely passed the ring and book test under the reversed parallax condition. The results of the strabismic subjects showed change under each condition. Stereoptic ability in normal and strabismic patients were considered based on the above. Also considered were some stereoptic keys, binocular parallax, monocular stereoptic keys such as shadows, shades, texture, etc., the near reflex and the fact that the objects were familiar. It was found that the strabismic patients used monocular stereoptic keys more than normal people to supplement their lack of binocular parallax perception.

Adult↗

PubMed1996

Plasma fibrinogen and its correlates in urban Japanese men.

BACKGROUND: The intention of the study was to examine determinants of plasma fibrinogen concentrations in Japanese men. METHODS: A cross-sectional study was conducted in 1991 among 995 male employees aged 40-59 years in two urban companies. RESULTS: The overall mean value (standard deviation) of plasma fibrinogen concentration was 257 (57) mg/dl. There was a strong dose-response relationship between cigarette smoking and plasma fibrinogen concentration. Plasma fibrinogen was positively associated with age and serum total cholesterol, and inversely associated with ethanol intake, dietary intake of sea foods such as squid, octopus or shrimp. Intake of other major protein and lipid resources such as meat, eggs and milk, or intake of vegetables was not related to plasma fibrinogen. An effect of dietary intake of sea foods on plasma fibrinogen was small but significant after controlling for the other covariates; an 80 g/week larger intake of sea foods was associated with a 3.9 mg/dl (95% confidence interval: 0.5, 7.3) lower fibrinogen concentration. CONCLUSIONS: This study confirms the relation of known coronary risk factors to plasma fibrinogen in Japanese men, and suggests that dietary intake of sea foods affects plasma fibrinogen concentrations.

Adult↗

PubMed1996

Community-based education classes for hypertension control. A 1.5-year randomized controlled trial.

Community-based hypertension control is important for primary prevention of cardiovascular disease. In this study, untreated men and women aged 35 to 69 years were randomly assigned to an intervention (n=56) or control (n=55) group in a 1.5-year community-based education program. Subjects had no evidence of hypertensive end-organ defects and had screening blood pressures of 140 to 179 mm Hg systolic and/or 90 to 109 mm Hg diastolic, with no difference in mean blood pressure between groups (148 to 150 mm Hg for mean systolic and 83 to 84 mm Hg for mean diastolic pressures). The intervention group took four education classes in the first 6 months and four classes during the next year, and the control group took two classes. Health education focused on reduced dietary sodium and increased milk intake, brisk walking, and, if necessary, reduction of alcohol and sugar intakes. Antihypertensive medication was started less often in the intervention than in the control group at 1.5 years (9% versus 24%, P <.05). Mean systolic pressure was 5 to 6 mm Hg less in the intervention than in the control group at both 6 months and 1.5 years (P <.05), with or without inclusion of those subjects who began antihypertensive medication. Diastolic pressure and body mass index did not change significantly between groups. Urinary sodium excretion declined in the intervention but not in the control group (differences between groups: P=.04 at 6 months and P=.07 at 1.5 years). According to a behavioral questionnaire, sodium reduction and milk increase were greater in the intervention than the control group (sodium: P <.01 at 6 months and P=.08 at 1.5 years; milk: P <.001 at 6 months and P <.01 at 1.5 years). Mean ethanol intake was reduced in the intervention but not the control group (P=.04 at 1.5 years). This community-based hypertension control program was effective in reducing systolic pressure levels by nonpharmacological means during the first 6 months and maintaining the reduction for 1.5 years.

Aged↗

PubMed1996

Epidemiology of cerebrovascular disease: stroke epidemic in Japan.

Japan had the highest mortality from stroke among developed countries in 1960, but experienced rapid changes in diet and other lifestyles with economic growth between the 1960s and the 1980s, which provided an unique opportunity to observe a natural experiment of changes in risk factors and stroke. Blood pressure levels declined due to improvements of drug treatment for hypertension and to dietary improvements such as sodium reduction. An increase in mean values of ethanol intake and body mass index did not correspond with a decline of blood pressure levels. Serum total cholesterol increased with an increased intake of meat, egg, milk and dairy products. Age-adjusted mortality rate of stroke declined 70% between 1960 and 1990. The changes of diet, blood pressure levels and stroke were more evident in rural populations than in urban populations. Risk factors of stroke has been investigated prospectively, and hypertension was found to be the most important risk factor. A low blood cholesterol was associated with the increased risk of intracerebral hemorrhage, which has been confirmed in several Japanese populations, Japanese Americans and Caucasian Americans. Thus, a rise in serum cholesterol suggested to contribute in part to a decline in intracerebral hemorrhage. Risk factors for cerebral infarction include age, atrial fibrillation and hypertensive endorgan effects such as resting electrocardiogram and fundscopic examination. A community-based hypertension control program for stroke prevention has been evaluated; a larger decline in stroke incidence in the intervention community (69%) than in the reference community (49%, the difference: p < 0.001). Effective community programs stimulated the formation of the 1982 national act on health and medical care in which every municipal government is required to conduct health screenings and education for residents aged 40 and over to prevent cardiovascular diseases.

Cerebrovascular Disorders↗

PubMed1996

A case-reference study on plasma fibrinogen concentrations and coronary atherosclerosis in Japanese.

To examine contribution of plasma fibrinogen concentrations to coronary atherosclerosis in Japanese, a cross-sectional study was conducted from 1991 to 1993 for 169 myocardial infarction cases and 1 : 1 matched references. All cases had one to three coronary vessels with 50 percent or more stenosis. References were chosen out of Osaka residents who had no cardiac event by matching sex and age ((+)-3 years) with cases. Mean (SD) values of plasma fibrinogen concentration were 322 (81) mg/dl in men and 377 (77) mg/dl in women for cases, and were 282 (56) mg/dl in men and 277 (48) mg/dl in women for references; mean plasma fibrinogen was significantly higher in cases than in references for both men and women. Furthermore, mean plasma fibrinogen was progressively higher as the number of stenotic vessels increased for men, and similar trend was seen for women. The case-reference difference remained significant even after adjusting smoking status, hypertension, serum total cholesterol, serum HDL cholesterol. Although plasma fibrinogen concentration was reported lower in Japanese than in American Caucasians, plasma fibrinogen is suggested to be a risk factor for myocardial infarction among Japanese as so among Caucasians.

Adult↗

PubMed1996

Intake ratio of water-insoluble dietary fiber to the water-soluble one in Japanese: an estimation on dietary records and the secular consideration on the national nutrition survey.

Thirty-four foods were analyzed in order to determine the content of water-soluble dietary fiber (SDF) and insoluble dietary fiber (IDF). Using the results with the standard table for 227 foods, the intake ratio of IDF/SDF of an average Japanese was calculated for the period 1946-1990. The ratio was 3.22 in 1990 as calculated on the food intakes shown in the national nutrition survey, and the secular change was not detected since 1946 when the ratio was 3.30. The ratio was also shown to be well preserved between types of households including the age of the head. Using dietary records of 60 healthy city workers (average 42.8 years) for 4 weeks, however, the weekly average ratio for an individual was found to vary in the range of 2.25-5.13 although the total average for 60 individuals was 3.33. Thus, the well preserved IDF/SDF intake ratio for an average Japanese showed, on the contrary, a wide variation of food selection between each person.

Adult↗

PubMed1996

[The relation of alcohol intake to constitutional and biochemical variables in Japanese populations].

To investigate associations of alcohol intake to constitutional and biochemical variables, cross-sectional studies of men aged 40-59 years from six geographical and occupational populations with varied lifestyles were conducted in the 1990's. Systolic and diastolic blood pressures, glutamic oxaloacetic transaminase, gamma glutamyl transpeptidase, HDL-cholesterol, and uric acid were linearly associated with alcohol intake in all six populations. Drinkers of 2+ drinks (46 g ethanol or more) per day showed higher levels of triglyceride, glutamic pyruvic transaminase than never-drinkers. In two urban occupational populations, men who mainly drank beer had higher uric acid levels; men mainly drinking sake had higher blood pressures and lower serum total cholesterol; men mainly drinking whiskey had higher obesity indices. These differences in constitutional and biochemical variables related to type of alcoholic beverage consumed may be due to differences in lifestyles such as diet and physical activity.

Adult↗

PubMed1995

Alcohol intake and the risk of cardiovascular disease in middle-aged Japanese men.

BACKGROUND AND PURPOSE: Understanding the effects of alcohol intake on stroke and other cardiovascular diseases is an important issue for public health. METHODS: A 10.5-year prospective study of the relationship between alcohol intake and cardiovascular disease incidence was conducted in 2890 men, aged 40 to 69 years and free of a history of stroke and coronary heart disease, in three rural communities of Japan. RESULTS: One hundred seventy-eight strokes (40 intracerebral hemorrhages, 18 subarachnoid hemorrhages, 104 nonhemorrhagic strokes, and 16 unclassified strokes), 34 coronary heart disease events, and 19 sudden unclassified deaths occurred. Drinkers of > or = 70 g/d ethanol had an approximately 2.5 times higher age-adjusted risk of all stroke than never-drinkers; the excess risk was more evident for hemorrhagic stroke than nonhemorrhagic stroke. When hypertension category, serum total cholesterol level, cigarette smoking, and diabetes mellitus were taken into account, these excess risks were reduced but remained significant for all stroke (2.0; 95% confidence interval, 1.3 to 3.1) and hemorrhagic stroke (3.4; 95% confidence interval, 1.2 to 9.2). A J-shaped relationship was suggested between alcohol intake and risk of nonhemorrhagic stroke; drinkers of < 42 g/d ethanol had a slightly lower risk and heavy drinkers had a higher risk than never-drinkers. Current drinkers had a slightly lower risk of coronary heart disease than never-drinkers, although the risk difference was not statistically significant. The age-adjusted risk of sudden death was 10 times higher in heavy drinkers than never-drinkers, and the excess risk did not change when the covariates were controlled for. Total cardiovascular disease showed a similar pattern as did all stroke. CONCLUSIONS: Heavy drinking appeared to increase the risk of hemorrhagic stroke, in part due to hypertension, and to increase the risk of sudden death, which was probably due to drinking per se. Light or moderate alcohol consumption seemed to protect against nonhemorrhagic stroke and coronary heart disease.

Age Factors↗

PubMed1995

[Relation of serum fatty acids with serum lipids and blood pressure in women].

We studied the correlation of serum fatty acids, a potential coronary risk factor, with serum lipids and blood pressure. The subjects were women aged 40-69 of four Japanese populations (fishing, coastal farming, inland farming and urban populations) and a Caucasian population in which different dietary habits have been reported. Within populations, the total cholesterol level was not correlated with serum fatty acids. HDL-cholesterol was inversely correlated with saturated fatty acids and monounsaturated fatty acids, and positively correlated with polyunsaturated fatty acids although not significantly so in all populations. LDL-cholesterol was not correlated with saturated fatty acids and mono polyunsaturated fatty acids, but was positively correlated with polyunsaturated fatty acids. Triglyceride was positively correlated with saturated fatty acids and monounsaturated fatty acids, and inversely correlated with polyunsaturated fatty acids for all populations. Blood pressure correlated positively with saturated fatty acids, and inversely with polyunsaturated fatty acids although these associations were not statistically significant.

Adult↗

PubMed1995

Polymorphisms of the beta fibrinogen gene and plasma fibrinogen concentration in Caucasian and Japanese population samples.

We reported previously that plasma fibrinogen was significantly higher in U.S. Caucasians than in Japanese, which may contribute to the higher mortality rate of coronary heart disease in the United States than in Japan. To examine the contribution of genetic variations to the race difference in plasma fibrinogen levels, restriction fragment length polymorphisms (RFLPs) of the beta fibrinogen gene were examined in 293 nonsmoking Caucasians and Japanese men and women aged 47-69 years. Three RFLPs were detected by digestion of genomic DNA using the BclI restriction enzyme, polymerase chain reaction (PCR) products using HaeIII and HindIII. The alleles B2 (4.2 kb, BclI digestion), H2 (957 b, HaeIII) and Hd2 (465 b. HindIII) were associated with higher fibrinogen concentrations in previous studies. Because of a strong linkage disequilibrium between HaeIII and HindIII polymorphisms, the data of HindIII was presented. The frequency of the B2 allele was 22% (95% Cl: 17-27%) for Caucasians and 13% (10-17%) for Japanese (the difference: p < 0.01). The respective frequency of the Hd2 allele was 26% (21-31%) and 12% (8-16%) (p < 0.001). After controlling for age, body mass index, alcohol intake, triglycerides, fish intake, and for women, menopausal status and hormone replacement therapy, the adjusted mean fibrinogen level among Caucasians was 289 mg/dl for genotype B1B1 and 301 mg/dl for genotype B1B2 or B2B2 combined (p = 0.18), and 285 mg/dl for Hd1Hd1 and 306 mg/dl for Hd1Hd2 or Hd2Hd2 combined (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

Serum total cholesterol and mortality in a Japanese population.

Although the relation between serum total cholesterol and coronary heart disease is well established, the relation with mortality from non-coronary disease is controversial. Inverse relations of serum cholesterol with hemorrhagic stroke and cancer have stimulated the examination of cholesterol-non-coronary mortality associations. The population surveyed is 12,187 men and women aged 40-69 years living in Yao City, a suburb of Osaka, who undertook baseline examinations between 1975 and 1984 and had no history of stroke and coronary heart disease at baseline. The subjects were followed on average 8.9 years until the end of 1988 using systematic mortality surveillance. During the follow-up, there were 343 deaths, comprising 170 cancer deaths (International Classification of Death 9th edition: ICD-9, 140-239), 21 coronary heart disease deaths (ICD-9, 410-414), 67 other cardiovascular deaths (ICD-9, 390-458 excluding 410-414), and 85 non-cardiovascular, non-cancer deaths. There was a significant inverse association of serum cholesterol with total and cancer mortality for men, and no significant association for women. The cholesterol-disease association, although not significant, was positive for coronary heart disease and other cardiovascular disease deaths, and inverse for non-cardiovascular, non-cancer deaths in both sexes. The inverse association of serum cholesterol with total and cancer mortality for men remained significant after controlling for age, job classification, hypertension category, usual alcohol intake, cigarette smoking, and relative weight index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

[Family make-up is associated with the admission rate of stroke patients--difference between Kochi and Shimane Prefectures and in a rural community].

Kochi Prefecture had a higher admission rate for patients with cardiovascular disease, particularly for stroke, than Shimane Prefecture which has a similar socio-economic level. Kochi Prefecture had a smaller average number of persons in a household, a lower proportion of three generation households, and a lower proportion of households with six persons or more than Shimane Prefecture. The decline in number of persons in a household was greater in Kochi Prefecture than in Shimane Prefecture from 1960 to 1985, especially between 1970 and 1975. The association between family make-up and hospital discharge one year after stroke was examined in a rural community in Kochi Prefecture. Two hundred forty nine patients aged 40 years and older who were admitted immediately after stroke events were registered between 1969 and 1988, and they were followed for one year. According to family make-up, the subjects were divided into four groups: 1) persons who lived with spouse and daughter-in-law, 2) persons who lived with spouse, 3) persons who lived with daughter-in-law, 4) persons who lived without spouse and daughter-in-law. Although mean age and the proportion of serious cases were not different between group 1 and group 4, the proportion of admitted patients of group 1 was significantly lower than that of group 4. About 60% of group 1 had households with six persons or more. Group 2 had the lowest proportion of admitted patients, but this group was significantly younger than other groups. Within group 3, the proportion of admitted patients was higher in households in which the daughter-in-law had a job than in households in which she did not. These results suggest that the high admission rate in Kochi Prefecture is attributable to households which are short of personnel for home care.

Adult↗