研究者詳細 - 賴藤　貴志

論文 - 賴藤　貴志

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Associations of Particulate Matter With Stroke Mortality A Multicity Study in Japan 査読

Takashi Yorifuji, Saori Kashima

JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 55 ( 7 ) 768 - 771 2013年7月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Objective: Evidence linking short-term exposure to outdoor air pollution with hemorrhagic stroke is inconclusive. Methods: We evaluated the effects of suspended particulate matter (SPM) on cardiovascular disease mortality, focusing on types of stroke, from March 2005 to December 2010, in five selected prefectures in western Japan. A multicity time-series analysis was used, and Asian dust was adjusted in the models. Results: Even after adjusting for Asian dust, the same-day SPM was positively associated with several types of stroke mortality. Following a 10-mu g/m(3) increase in SPM, rate ratios were 1.014 (90% confidence interval [CI]: 1.002 to 1.026) for stroke, 1.030 (90% CI: 1.004 to 1.056) for intracerebral hemorrhage, and 1.016 (90% CI: 1.003 to 1.030) for ischemic stroke mortality. Conclusions: Short-term exposure to outdoor air pollution may increase the risks of hemorrhagic stroke as well as ischemic stroke mortality.

DOI： 10.1097/JOM.0b013e3182973092

Association of Birth Length and Risk of Hospitalisation among Full-term Babies in Japan 査読

Tsuguhiko Kato, Takashi Yorifuji, Sachiko Inoue, Hiroyuki Doi, Ichiro Kawachi

PAEDIATRIC AND PERINATAL EPIDEMIOLOGY 27 ( 4 ) 361 - 370 2013年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：WILEY-BLACKWELL

Background Barker's fetal programming hypothesis suggests that disproportionate size at birth may have a lifelong impact on one's health. However, the literature on birth length is considerably more sparse compared with birthweight. We, therefore, examined the relationship between birth length and hospitalisation early in life among Japanese children. Methods We used the nationwide Longitudinal Survey of Babies in 21st Century and restricted the study subjects to full-term singleton babies (n=44057). We estimated the effects of birth length and birthweight on the risk of hospitalisation using log linear regression models. We controlled for a set of neonatal and maternal factors. Results Birth length was associated with the chance of hospitalisation due to all causes between 6 and 18 months of age. In addition, the association was stronger than that with birthweight. Adjusted risk ratios showed that the relationship between birth length and hospitalisation was U-shaped: 1.16 [95% confidence intervals, 1.08, 1.25] at 30-48cm, 1 [Reference] at 49cm, 1.13 [1.04, 1.22] at 50cm, and 1.11 [1.02, 1.20] at 51-60cm. Short babies with low or high weight, as well as long babies with low weight, seem to be at increased risk of hospitalisation. Conclusions We found a U-shaped relationship between birth length and risk of hospitalisation due to all causes during the period from 6 to 18 months.

DOI： 10.1111/ppe.12062

Natural selection in utero: Evidence from the great east japan earthquake 査読

R. Catalano, T. Yorifuji, I. Kawachi

American Journal of Human Biology 25 ( 4 ) 555 - 559 2013年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

Objectives: Controversy remains over whether declines in male births reported after population stressors result from either or both reduced conception of males or increased selection in utero against male fetuses. We use monthly birth cohorts to determine if Japanese male births following the Great East Japan Earthquake of 2011 fell below levels expected from female births and from history (i.e., autocorrelation) among cohorts exposed to the Earthquake at or after conception. Methods: We apply interrupted time-series methods to 69 months (i.e., April, 2006 through December, 2011) of birth data from the most and least affected prefectures as well as from the remainder of Japan. We estimate expected male births from female births and from autocorrelation. Results: Findings varied by distance from the greatest damage but suggest sensitive periods both early and late in gestation when population stressors may induce selection against males in utero. Support for reduced conception of males appeared only in the prefectures most damaged by the Earthquake. Conclusions: Results align with the claim that natural selection has conserved mechanisms that reduce the odds of a male live birth during stressful times by reducing the conception of males and by increasing the rate of spontaneous abortion among male fetuses. Am. J. Hum. Biol. 25:555-559, 2013. © 2013 Wiley Periodicals, Inc.

DOI： 10.1002/ajhb.22414

Contribution of smoking to the gender gap in life expectancy in Japan 査読

T. Yorifuji, S. Takao, S. Inoue, S. Tanihara, I. Kawachi

Public Health 127 ( 5 ) 482 - 484 2013年5月

Residential proximity to major roads and adverse birth outcomes: a hospital-based study 査読

Takashi Yorifuji, Hiroo Naruse, Saori Kashima, Soshi Takao, Takeshi Murakoshi, Hiroyuki Doi, Ichiro Kawachi

ENVIRONMENTAL HEALTH 12 ( 1 ) 34 2013年4月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BIOMED CENTRAL LTD

Background: Exposure to air pollution has been demonstrated to increase the risk of preterm birth and low birth weight (LBW). Although evidence has accumulated on characteristics associated with increased risk of air pollution-related health effects, most studies have been conducted in the adult population and evidence on reproductive outcomes is limited. We examined whether socio-economic position (SEP) and parental characteristics (parental behavior and co-morbidity) modified the relationship between air pollution and adverse birth outcomes.
Methods: Data were extracted from a perinatal hospital database based in Shizuoka, Japan. We restricted the analysis to mothers who delivered live-born single births from January 1997 to December 2010 (n = 16,615). Each birth was assigned proximity to major roads. Multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated for the outcomes of preterm birth and term LBW. We stratified subjects by individual/area-level SEP and parental characteristics. We then measured interactions on the additive scale between the respective factors and exposure.
Results: Lower SEP at both individual and area levels was associated with the increased occurrence of adverse birth outcomes. Living within 200 m from a major road increased the risk of preterm birth by 1.5 times (95% CI: 1.3-1.9) and LBW by 1.2 times (95% CI: 0.9-1.6). Mothers with lower individual SEP defined by household occupation experienced higher ORs for term LBW (OR = 3.1, 95% CI: 1.2-8.2) compared with those with higher individual SEP. In contrast, mothers who lived in the highest area-level SEP region (i.e., affluent areas) showed slightly higher point estimates compared with those who lived in middle or poor areas. In addition, maternal diabetic and hypertensive status modified the association between proximity and preterm birth, while maternal smoking status modified the association between proximity and term LBW.
Conclusions: The present study demonstrated that air pollution is an independent risk factor for adverse birth outcomes. Mothers with lower individual SEP and mothers living in higher SEP region may be susceptible to the adverse effect of air pollution. Maternal diabetic, hypertensive, and smoking status may also increase susceptibility to this air pollution-related health effect.

DOI： 10.1186/1476-069X-12-34

Does Habitual Physical Activity Prevent Insomnia? A Cross-Sectional and Longitudinal Study of Elderly Japanese 査読

Sachiko Inoue, Takashi Yorifuji, Masumi Sugiyama, Toshiki Ohta, Kazuko Ishikawa-Takata, Hiroyuki Doi

JOURNAL OF AGING AND PHYSICAL ACTIVITY 21 ( 2 ) 119 - 139 2013年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：HUMAN KINETICS PUBL INC

Few epidemiological studies have examined the potential protective effects of physical activity on insomnia. The authors thus evaluated the association between physical activity and insomnia in a large population-based study in Shizuoka, Japan. Individual data were obtained from participants in an ongoing cohort study. A total of 14,001 older residents who completed questionnaires were followed for 3 yr. Of these, 10,211 and 3,697 participants were eligible for the cross-sectional and longitudinal analyses, respectively. The authors obtained information about the frequency of physical activity and insomnia. Then, the adjusted odds ratios and 95% confidence intervals between physical activity and insomnia were estimated. Habitual physical activity was related to lower prevalence of insomnia. Frequent physical activity also reduced the incidence of insomnia, especially difficulty maintaining sleep. For elderly people with sufficient mobility and no preexisting disease, high-frequency physical activity (e.g., 5 or more days/wk) may help reduce insomnia.

Critical Appraisal of the 1977 Diagnostic Criteria for Minamata Disease 査読

Takashi Yorifuji, Toshihide Tsuda, Sachiko Inoue, Soshi Takao, Masazumi Harada, Ichiro Kawachi

ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 68 ( 1 ) 22 - 29 2013年1月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD

Large-scale food poisoning caused by methylmercury was identified in Minamata, Japan, in the 1950s (Minamata disease). Although the diagnostic criteria for the disease remain current, few studies have been carried out to assess the diagnostic accuracy of the criteria. From a 1971 population-based investigation, data from 2 villages were selected: Minamata (high-exposure area; n = 779) and Ariake (low-exposure area; n = 755). The authors examined the prevalence of neurologic signs characteristic of methylmercury poisoning and the validity of the criteria. A substantial number of residents in the exposed area exhibited neurologic signs even after excluding officially certified patients. Using paresthesia of the extremities as the gold standard of diagnosis, the criteria had a sensitivity of 66%. The current diagnostic criteria as well as the official certification system substantially underestimate the incidence of Minamata disease.

DOI： 10.1080/19338244.2011.627894

Long-term exposure to traffic-related air pollution and the risk of death from hemorrhagic stroke and lung cancer in Shizuoka, Japan 査読

Takashi Yorifuji, Saori Kashima, Toshihide Tsuda, Kazuko Ishikawa-Takata, Toshiki Ohta, Ken-ichi Tsuruta, Hiroyuki Doi

SCIENCE OF THE TOTAL ENVIRONMENT 443 397 - 402 2013年1月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ELSEVIER SCIENCE BV

A number of studies have linked exposure to long-term outdoor air pollution with cardiopulmonary disease; however, the evidence for stroke is limited. Furthermore, evidence with the risk for lung cancer (LC) is still inconsistent. We, therefore, evaluated the association between long-term exposure to traffic-related air pollution and cause-specific mortality. Individual data were extracted from participants of an ongoing cohort study in Shizuoka, Japan. A total of 14,001 elderly residents completed questionnaires and were followed from December 1999 to January 2009. Annual individual nitrogen dioxide (NO2) exposure data, as an index for traffic-related exposure, were modeled using a Land Use Regression model and assigned to the participants. We then estimated the adjusted hazard ratios (HRs) and their confidence intervals (CIs) associated with a 10 mu g/m(3) elevation in NO2 for all-cause or cause-specific mortality using time-varying Cox proportional hazards models. We found positive associations of NO2 levels with all-cause (HR = 1.12, 95% CI: 1.07-1.18), cardiopulmonary disease (HR = 1.22, 95% CI: 1.15-1.30), and LC mortality (HR = 1.20, 95% CI: 1.03-1.40). Among cardiopulmonary disease mortality, not only the risk for ischemic heart disease (HR = 1.27,95% CI: 1.11-1.47) but also the risks for stroke were elevated: intracerebral hemorrhage (HR = 1.28,95% CI: 1.05-1.57) and ischemic stroke (HR = 1.20,95% CI: 1.04-1.39). The present study supports the existing evidence that long-term exposure to traffic-related air pollution increases the risk of cardiopulmonary as well as LC mortality, and provides additional evidence for adverse effects on intracerebral hemorrhage as well as ischemic stroke. (C) 2012 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.scitotenv.2012.10.088

Asian dust and daily all-cause or cause-specific mortality in western Japan 査読

Saori Kashima, Takashi Yorifuji, Toshihide Tsuda, Akira Eboshida

OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 69 ( 12 ) 908 - 915 2012年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BMJ PUBLISHING GROUP

Objective Desert dust, which is included in course particles, is considered to have potential toxicity. The effect modification of desert dust on associations between anthropogenic air pollution and mortality has been evaluated. However, the independent effects of Asian dust are less clear. Thus, we evaluated the effects of Asian dust on mortality independent of particulate matter (PM) in western Japan.
Methods We obtained daily mean concentrations of Asian dust using Light Detection and Ranging measurements and suspended particulate matter (SPM) concentrations (approximately PM8) during March 2005 to December 2010. We then evaluated city-specific associations of Asian dust and SPM with daily mortality using a time-series analysis targeting 1 379 052 people aged 65 or above living in 47 cities. The city-specific results were then combined with a Bayesian-hierarchical model.
Results Asian dust did not modify the effects of SPM on mortality. Meanwhile, Asian dust was adversely associated with mortality independent of SPM. The excess risk following a 10 mu/m(3) increase in mean of the current to the previous 2 days Asian dust concentration was 0.6% (95% CI 0.1 to 1.1) for heart disease, 0.8% (95% CI 0.1 to 1.6) for ischaemic heart disease, 2.1% (95% CI 0.3 to 3.9) for arrhythmia and 0.5% (95% CI 0.2 to 0.8) for pneumonia mortality. Furthermore, the effects of Asian dust were stronger in northern areas close to the Eurasian continent (source of Asian dust).
Conclusions Asian dust had adverse effects on circulatory and respiratory mortality independent of PM.

DOI： 10.1136/oemed-2012-100797

Trends of preterm birth and low birth weight in Japan: a one hospital-based study 査読

Takashi Yorifuji, Hiroo Naruse, Saori Kashima, Takeshi Murakoshi, Tsuguhiko Kato, Sachiko Inoue, Hiroyuki Doi, Ichiro Kawachi

BMC PREGNANCY AND CHILDBIRTH 12 162 2012年12月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BIOMED CENTRAL LTD

Background: The proportions of preterm birth (PTB, ie., delivered before 37 gestational weeks) and low birth weight (LBW, ie., birth weight less than 2500 g at delivery) have been rising in developed countries. We sought to examine the factors contributing to the rise in Japan, with particular focus on the effects of obstetric interventions.
Methods: We used a database maintained by one large regional hospital in Shizuoka, Japan. We restricted the analysis to mothers who delivered live singleton births from 1997 to 2010 (n = 19,221). We assessed the temporal trends in PTB and LBW, then divided the study period into four intervals and compared the proportions of PTB and LBW. We also compared the newborns' outcomes between the intervals.
Results: PTB, in particular medically indicated PTB, increased considerably. The increase was largely explained by changes in caesarean sections. The neonatal outcomes did not worsen, and instead the Apgar scores and proportions requiring neonatal intensive care unit (NICU) admission improved. In particular, the risks of NICU admission in the interval from 2007 to 2010 were decreased among all births [odds ratio (OR): 0.84; 95% confidence interval (CI): 0.75, 0.95] and medically indicated births (OR: 0.44; 95% CI: 0.29, 0.68) compared with the interval from 1997 to 2000.
Conclusions: Despite the increases in PTB as well as LBW, the present study suggests benefits of obstetric interventions. Rather than simple categorization of PTB or LBW, indicators such as perinatal mortality or other outcomes may be more appropriate for evaluation of perinatal health in developed countries.

DOI： 10.1186/1471-2393-12-162

Frequency of Antenatal Care Visits and Neonatal Mortality in Indonesia 査読

Juliani Ibrahim, Takashi Yorifuji, Toshihide Tsuda, Saori Kashima, Hiroyuki Doi

JOURNAL OF TROPICAL PEDIATRICS 58 ( 3 ) 184 - 188 2012年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：OXFORD UNIV PRESS

Objective: To examine the relationship between frequency of antenatal care visits, as a whole and in each trimester, and neonatal mortality in Indonesia. Subjects: 13 055 single births from the fifth Indonesia Demographic Health Survey in 2006-07. Methods: Estimate adjusted odds ratios (ORs) and their 95% confidence intervals (95% CIs). Results: Pregnant women who had more antenatal care visits experienced a lower risk of neonatal mortality and more benefit in the last trimester: the ORs against the 0-1 visit group, were 0.76 (95% CI 0.45-1.29) for 2 visits group, 0.54 (95% CI 0.33-0.87) for 3 visits group and 0.31 (95% CI 0.17-0.57) for 4 visits group, respectively. Individual ORs as a whole period were not significant, but ORs declined markedly at 7 visits or more. Conclusion: The results may provide a valuable recommendation for the care of pregnant women in Indonesia.

DOI： 10.1093/tropej/fmr067

Does Open-air Exposure to Volatile Organic Compounds near a Plastic Recycling Factory Cause Health Effects? 査読

Takashi Yorifuji, Miyuki Noguchi, Toshihide Tsuda, Etsuji Suzuki, Soshi Takao, Saori Kashima, Yukio Yanagisawa

JOURNAL OF OCCUPATIONAL HEALTH 54 ( 2 ) 79 - 87 2012年3月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：JAPAN SOC OCCUPATIONAL HEALTH

Does Open-air Exposure to Volatile Organic Compounds near a Plastic Recycling Factory Cause Health Effects?: Takashi YORIFUJI, et al. Department of Human Ecology, Okayama University Graduate School of Environmental Sciences-Objectives: After a plastic reprocessing factory began to operate in August 2004, the residents around the factory in Neyagawa, Osaka, Japan, began to complain of symptoms. Therefore, we conducted an exposure assessment and a population-based epidemiological study in 2006. Methods: To assess exposure, volatile organic compounds (VOCs) and total VOCs were measured at two locations in the vicinity of the factory. In the population-based study, a total of 3,950 residents were targeted. A self-administered questionnaire was used to collect information about subjects' mucocutaneous or respiratory symptoms. Using logistic regression models, we compared the prevalence of symptoms in July 2006 by employing the farthest area from the factory as a reference, and prevalence odds ratios (PORs) and their 95% confidence intervals (Cis) were estimated. Results: The concentration of total VOCs was higher in the vicinity of the factory. The prevalence of mucocutaneous and respiratory symptoms was the highest among the residents in the closest area to the factory. Some symptoms were significantly increased among the residents within 500 m of the factory compared with residents of an area 2800 m from the factory: e.g., sore throat (POR=3.2, 95% CI: 1.3-8.0), eye itch (POR=3.0, 95% CI: 1.5-6.0), eye discharge (POR=6.0, 95% CI: 2.3-15.9), eczema (POR=3.0, 95% CI: 1.1-7.9) and sputum (POR=2.4, 95% CI: 1.1-5.1). Conclusions: Despite of the limitations of this study, these results imply a possible association of open-air VOCs with mucocutaneous and respiratory symptoms. Because this kind of plasticre cycling factory only recently came into operation, more attention should be paid to the operation of plastic recycling factories in the environment. (J Occup Health 2012; 54: 79-87)

DOI： 10.1539/joh.11-0202-oa

Short-term effect of severe exposure to methylmercury on atherosclerotic heart disease and hypertension mortality in Minamata 査読

Sachiko Inoue, Takashi Yorifuji, Toshihide Tsuda, Hiroyuki Doi

SCIENCE OF THE TOTAL ENVIRONMENT 417 291 - 293 2012年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ELSEVIER SCIENCE BV

Recent studies suggest potential adverse effects of methylmercury exposure on myocardial infarction and hypertension, although the evidence is still limited. We thus evaluated this association using age-standardized mortality ratios (ASMRs) in Minamata, where severe methylmercury poisoning had occurred. We obtained mortality data from annual vital statistics and demographic statistics from census. We then compared mortality of atherosclerotic heart disease including degenerative heart disease and hypertension in Minamatacity with those in Kumamoto Prefecture, which includes Minamata city, as a control. We estimated ASMRs and 95% confidence intervals (CIs) during the period from 1953 to 1970. ASMRs of atherosclerotic heart disease were continuously decreased during the period from 1953 to 1967. In contrast, the ASMR of hypertension was significantly elevated during the period from 1963 to 1967 (SMR= 1.38, CI; 1.06-1.80); but they decreased later. Although dilution is present in this ecological study, our study supports the notion that methylmercury exposure induces hypertension. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.scitotenv.2011.11.076

Epidemiological evidence on methylmercury neurotoxicity 査読

Jordi Julvez, Takashi Yorifuji, Anna L. Choi, Philippe Grandjean

Methylmercury and Neurotoxicity 13 - 35 2012年1月

記述言語：英語掲載種別：論文集(書籍)内論文出版者・発行元：Springer US

Methylmercury neurotoxicity has been gradually recorded over several decades. Designs of recent epidemiologic studies have improved to focus their assessments in developmental neurotoxicity. The developing brain, due to rapid physiologic changes and a protective system under development, is particularly vulnerable to the exposure to environmental insults. This chapter aims to systematically review and discuss the state-of-the-art epidemiological studies published up to the present days. We also describe and discuss some of the methodological problems. For example, the uncertainties (confounding) derived from a situation in which an association between an exposure and an outcome is distorted because it is mixed with the effect of a confounding variable. A majority of the studies have demonstrated that methylmercury exposure is neurotoxic to adults and children, but stronger adverse effects would result if negative confounding derived from the nutritional factors of seafood is taken into consideration in the data analyses. The EU and US decision to take preventive measures occurred at a substantial delay following the discovery of these neurotoxic effects.

DOI： 10.1007/978-1-4614-2383-6_2

Residential proximity to major roads and placenta/birth weight ratio 査読

Takashi Yorifuji, Hiroo Naruse, Saori Kashima, Takeshi Murakoshi, Toshihide Tsuda, Hiroyuki Doi, Ichiro Kawachi

SCIENCE OF THE TOTAL ENVIRONMENT 414 98 - 102 2012年1月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ELSEVIER SCIENCE BV

Exposure to air pollution has been demonstrated to increase the risk of preterm birth and low birth weight. We examined whether proximity to major roads (as a marker of exposure to air pollution) is associated with increased placenta/birth weight ratio (as a biomarker of the placental transport function). Data on parental characteristics and birth outcomes were extracted from the database maintained by a major hospital in Shizuoka Prefecture, Japan. We restricted the analysis to mothers who delivered liveborn single births from 1997 to 2008 (n = 14,189). Using geocoded residential information, each birth was classified according to proximity to major roads. We examined the association between proximity to major roads and the placenta/birth weight ratio, using multiple linear regression. Proximity to major roads was associated with higher placenta/birth weight ratio. After adjusting for potential confounders, living within 200 m of a major road increased the ratio by 0.48% (95% CI = 0.15 to 0,80). In addition, proximity to major roads was associated with lower placenta weight and birth weight. These observed associations were stronger among participants living closer to major roads. Exposure to traffic-related air pollution is associated with higher placenta/birth weight ratio. Impaired placental oxygen and nutrient transport function might be a mechanism for explaining the observed association between air pollution and low birth weight as well as preterm birth. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.scitotenv.2011.11.001

Evaluating the need for and effect of percutaneous transluminal angioplasty on arteriovenous fistulas by using total recirculation rate per dialysis session (o"Clearance Gapo") 査読

Toyomu Ugawa, Kazufumi Sakurama, Takashi Yorifuji, Munenori Takaoka, Yasuhiro Fujiwara, Narutoshi Kabashima, Daisuke Azuma, Takahiro Hirayama, Kohei Tsukahara, Sunao Morisada, Atsuyoshi Iida, Keitaro Tada, Naoki Shiba, Nobuo Sato, Shingo Ichiba, Koichi Kino, Masaki Fukushima, Yoshihito Ujike

Acta Medica Okayama 66 ( 6 ) 443 - 447 2012年

記述言語：英語掲載種別：研究論文（学術雑誌）

The functioning of an arteriovenous fistula (AVF) used for vascular access during hemodialysis has been assessed mainly by dilution methods. Although these techniques indicate the immediate recircula-tion rate, the results obtained may notcorrelate with Kt/V. In contrast, the clearance gap (CL-Gap) method provides the total recirculation rate per dialysis session and correlates well with Kt/V. We assessed the correlation between Kt/V and CL-Gap as well as the change in radial artery (RA) blood flow speed in the fistula before percutaneous transluminal angioplasty (PTA) in 45 patients undergoing continuous hemodialysis. The dialysis dose during the determination of CL-Gap was 1.2 to 1.4 Kt/V. Patients with a 10% elevation or more than a 10% relative increase in CL-Gap underwent PTA (n = 45), and the values obtained for Kt/V and CL-Gap before PTA were compared with those obtained immediately afterward. The mean RA blood flow speed improved significantly (from52.9 to 97.5 cm/ sec) after PTA, as did Kt/V (1.07 to 1.30) and CL-Gap (14.1% to 0.2%). A significant correlation between these differences was apparent (r = 0.436 and/&gt
= 0.003). These findings suggest that calculating CL-Gap may be useful for determining when PTA is required and for assessing the effectiveness of PTA, toward obtaining better dialysis. © 2012 by Okayama University Medical School.

Methyl Mercury Exposure at Niigata, Japan: Results of Neurological Examinations of 103 Adults 査読

Kimio Maruyama, Takashi Yorifuji, Toshihide Tsuda, Tomoko Sekikawa, Hiroto Nakadaira, Hisashi Saito

JOURNAL OF BIOMEDICINE AND BIOTECHNOLOGY 2012年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：HINDAWI PUBLISHING CORPORATION

Background. Large-scale poisonings caused by methyl mercury (MeHg) have occurred in Japan (Minamata in the 1950s and Niigata in the 1960s) and Iraq (in the 1970s). The current WHO neurological risk standard for adult exposure (hair level: 50 mu g/g) was based partly on evidence from Niigata which did not consider any cases who were diagnosed later and/or exposed to low level of MeHg (hair mercury level less than 50 mu g/g). Methods. Early in the Niigata epidemic in June 1965 there were two extensive surveys. From these two surveys, we examined 103 adults with hair mercury measurement who consulted two medical institutions. We compared the prevalence and the distribution of neurological signs related to MeHg poisoning between exposure categories. Result. We found 48 subjects with neurological signs related to MeHg poisoning who had hair mercury concentration less than 50 mu g/g. Among the neurological signs, sensory disturbance of the bilateral distal extremities was observed more frequently, followed by disequilibrium, hearing impairment, and ataxia, in groups with hair MeHg concentration both below 50 mu g/g and over 50 mu g/g. Conclusion. The present study suggests the possibility that exposure to MeHg at levels below the current WHO limits could cause neurologic signs, in particular, sensory disturbance.

DOI： 10.1155/2012/635075

The role of medicine in the decline of post-War infant mortality in Japan 査読

Takashi Yorifuji, Shinichi Tanihara, Sachiko Inoue, Soshi Takao, Ichiro Kawachi

PAEDIATRIC AND PERINATAL EPIDEMIOLOGY 25 ( 6 ) 601 - 608 2011年11月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：WILEY-BLACKWELL

Yorifuji T, Tanihara S, Inoue S, Takao S, Kawachi I. The role of medicine in the decline of post-War infant mortality in Japan. Paediatric and Perinatal Epidemiology 2011; 25: 601-608.
The infant mortality rate (IMR) in Japan declined dramatically in the immediate post-War period (1947-60) in Japan. We compared the time trends in Growth Domestic Product (GDP) in Japan against declines in IMR. We then conducted a prefecture-level ecological analysis of the rate of decline in IMR and post-neonatal mortality from 1947 to 1960, focusing on variations in medical resources and public health strategies. IMR in Japan started to decline after World War II, even before the era of rapid economic growth and the introduction of a universal health insurance system in the 1960s. The mortality rates per 1000 infants in 2009 were 2.38 for IMR, 1.17 for neonatal mortality and 1.21 for post-neonatal mortality. The rate of decline in IMR and preventable IMR (PIMR) during the post-War period was strongly correlated with prefectural variations in medical resources (per capita physicians, nurses, and proportion of in-hospital births). The correlation coefficients comparing the number of physicians in 1955 with the declines in IMR and PIMR from 1947 to 1960 were 0.46 [95% confidence interval (CI) 0.19, 0.66] and 0.39 [95% CI 0.11, 0.61], respectively. By contrast, indicators of public health strategies were not associated with IMR decline. The IMR in Japan has been decreasing and seems to be entering a new era characterised by lower neonatal compared with post-neonatal mortality. Furthermore, the post-War history of Japan illustrates that improvement in infant mortality is attributable to the influence of medical care, even in the absence of rapid economic development.

DOI： 10.1111/j.1365-3016.2011.01216.x

Diesel vehicle emission and death rates in Tokyo, Japan: A natural experiment 査読

Takashi Yorifuji, Ichiro Kawachi, Mariko Kaneda, Soshi Takao, Saori Kashima, Hiroyuki Doi

SCIENCE OF THE TOTAL ENVIRONMENT 409 ( 19 ) 3620 - 3627 2011年9月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ELSEVIER SCIENCE BV

Evidence linking air pollution with adverse cardiopulmonary outcomes is accumulating. However, few studies have been conducted to evaluate whether vehicle emission control improves public health. We thus evaluated the effect of a diesel emission control law on mortality rates in 23 wards of Tokyo metropolitan area, Japan. We obtained daily counts of mortality and concentrations of nitrogen dioxide (NO(2)) and particulate matter less than 2.5 mu m in diameter (PM(2.5)) from April 2003 to December 2008. Time-series and interrupted time-series analysis were employed to analyze the data in two periods: prior to the introduction of tighter restrictions (April 2003 to March 2006) and after the enforcement (April 2006 to December 2008). Concentrations of air pollutants gradually decreased during the study period: from 36.3 ppb (NO(2)) and 22.8 mu g/m(3) (PM(2.5)) to 32.1 ppb and 20.3 mu g/m(3), respectively. Air pollutants were positively associated with circulatory and pulmonary disease mortality, especially cerebrovascular disease. Each same-day PM(2.5) increase of 10 mu g/m(3) was associated with a 1.3% increase in cerebrovascular mortality rate (95% confidence interval: 0.2-2.4). Rate ratios were attenuated after the enforcement in most of the outcomes, probably due to reduced toxicity of the pollutants. In the crude interrupted time-series analysis, reductions of standardized mortality rates after the enforcement were the greatest in high traffic areas. Even after adjustment of longer-time trend, mortality rate from cerebrovascular disease was reduced by 8.50% (p<.001) with dose-response relationship. However, the declines in other cause-specific mortality became equivocal. This natural experiment in Tokyo suggests that emission controls improved air quality. Although suggestive, further data are needed to conclusively demonstrate an impact on mortality rates. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.scitotenv.2011.06.002

Regional disparities in compliance with tobacco control policy in Japan: an ecological analysis 査読

Takashi Yorifuji, Shinichi Tanihara, Soshi Takao, Ichiro Kawachi

TOBACCO CONTROL 20 ( 5 ) 374 - 379 2011年9月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：B M J PUBLISHING GROUP

Background The slow progress of tobacco control policy in Japan reflects the tension among the interests of the Finance Ministry (which remains the majority shareholder of Japan Tobacco, Inc), the Health Ministry, tobacco growers and consumers.
Methods We sought to examine regional disparities in compliance with national tobacco control legislation (the 2003 Health Promotion Law). Specifically, we sought to examine whether prefecture-level compliance with legislation was correlated with decreases in smoking prevalence, and decreases in lung cancer mortality rates. We also examined whether prefectural involvement in growing tobacco was associated with lower compliance with the law.
Results From 2001 to 2007, higher prefectural compliance with tobacco control laws was associated with decreased prevalence of smoking. Decreased tobacco consumption was in turn associated with declining lung cancer mortality. Prefectures involved in growing tobacco exhibited lower levels of compliance with national tobacco control laws. The same prefectures also exhibited the worst improvement in smoking prevalence.
Conclusions This study in Japan suggests that tobacco control policies are being unevenly implemented across prefectures, and that measures to counteract the influence of local tobacco culture are required to reduce the disparities in regional tobacco control outcomes in that country.

DOI： 10.1136/tc.2010.041442

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