Prevalence of hypertension at high altitude: cross-sectional survey in Ladakh, Northern India 2007-2011

Objective: Prevalence of hypertension was examined in a widely dispersed (45 110 km2) representative group of Ladakhi in Northern India. The influence of hypoxic environment of wide-ranged altitude (2600–4900 m) and lifestyle change on hypertension was studied. Methods: 2800 participants (age 20–94 years) were enrolled. Systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure of ≥90 mm Hg and/or taking current anti-hypertensive medicine was defined as hypertension. Height and weight for body mass index and SpO2 were examined. The rural population comprised six subdivisions with a distinct altitude, dietary and occupational pattern. Participants in the urban area of Leh consist of two groups, that is, migrants settled in Leh from the Changthang nomadic area, and dwellers born in Leh. The prevalence of hypertension in the two groups was compared with that in the farmers and nomads in rural areas. The effects of ageing, hypoxia, dwelling at high altitude, obesity, modernised occupation, dwelling in an urban area, and rural-to-urban migration to hypertension were analysed by multiple logistic regression. Results: The prevalence of hypertension was 37.0% in all participants and highest in migrants settled in Leh (48.3%), followed by dwellers born in Leh town (41.1%) compared with those in rural areas (33.5). The prevalence of hypertension in nomads (all: 27.7%, Tibetan/Ladakhi: 19.7/31.9%)) living at higher altitude (4000–4900 m) was relatively low. The associated factors with hypertension were ageing, overweight, dwelling at higher altitude, engagement in modernised sedentary occupations, dwelling in urban areas, and rural-to-urban migration. The effects of lifestyle change and dwelling at high altitude were independently associated with hypertension by multivariate analysis adjusted with confounding factors. Conclusions: Socioeconomic and cultural factors play a big role with the effect of high altitude itself on high prevalence of hypertension in highlanders in Ladakh

介護予防基本チェックリストカテゴリーと新規要介護認定との関連: 日本の1農村地域における24カ月のコホート研究

京都大学0048新制・課程博士博士(社会健康医学)甲第18687号社医博第63号新制||社医||8(附属図書館)31620京都大学大学院医学研究科社会健康医学系専攻(主査)教授 今中 雄一, 教授 中原 俊隆, 教授 横出 正之学位規則第4条第1項該当Doctor of Public HealthKyoto UniversityDFA

Physical Activity Attenuates the Obesity-Induced Dysregulated Expression of Brown Adipokines in Murine Interscapular Brown Adipose Tissue

In recent years, brown adipose tissue (BAT), which has a high heat-producing capacity, has been confirmed to exist even in adults, and it has become a focal point for the prevention and the improvement of obesity and lifestyle-related diseases. However, the influences of obesity and physical activity (PA) on the fluid factors secreted from BAT (brown adipokines) are not well understood. In this study, therefore, we focused on brown adipokines and investigated the effects of obesity and PA. The abnormal expressions of gene fluid factors such as galectin-3 (Lgals3) and Lgals3 binding protein (Lgals3bp), whose proteins are secreted from HB2 brown adipocytes, were observed in the interscapular BAT of obese mice fed a high-fat diet for 4 months. PA attenuated the abnormalities in the expressions of these genes. Furthermore, although the gene expressions of factors related to brown adipocyte differentiation such as peroxisome proliferator-activated receptor gamma coactivator 1-α were also down-regulated in the BAT of the obese mice, PA suppressed the down-regulation of these factors. On the other hand, lipogenesis was increased more in HB2 cells overexpressing Lgals3 compared with that in control cells, and the overexpression of Lgals3bp decreased the mitochondrial mass. These results indicate that PA attenuates the obesity-induced dysregulated expression of brown adipokines and suggests that Lgals3 and Lgals3bp are involved in brown adipocyte differentiation

The Comparison of Comprehensive Geriatric Functions of Community-Dwelling Elderly People Living in Cotahuasi and Puyca Located in La Union Province, Arequipa, Peru

More than 140 million people worldwide live in over 2500 meters highland above sea level. Of them, 80 million live in Asia, and 35 million live in the Andean mountains. This article described the comparison of the comprehensive geriatric functions of community-dwelling elderly people living in Cotahuasi and Puyca located in La Union Province, Arequipa, Peru. The study population consisted of 240 highlanders (mean age: 69.5, male/female: 85/155) living in Cotahuasi (altitude 2, 600-2, 700 m), Pampamarca (3, 000-3, 300 m), Puyca (3, 600 m), and Churca (3, 800 m). All of these towns are located in La Union Province, Arequipa, Peru. Cotahuasi is the capital of La Union Province, and Pampamarca is a rural suburb. Puyca and Churca are rural villages located at higher altitudes (>3, 500 m) along an upper tributary of the Cotahuasi River. The medical survey of community-dwelling elderly people living in these towns was carried out in August in 2010. The scores in ADL, TMIG, FRI, GDS and subjective QOL between Cotahuasi and Puyca were significant differences. The mean age of subjects in Cotahuasi was significantly higher than those in Puyca. The percentage of subjects with diabetes and taking diabetes medicine were significantly higher in Cotahuasi people than in Puyca ones. The percentage of history of stroke and oseoarthropathy were significantly higher in Cotahuasi than in Puyca. We should pay attention to the approximately 10% of the total population in the world were living in mountain areas where socioeconomic globalization was increasing. Further investigations must remit the prevalence of lifestyle-related disease and human ageing phenomena in highlanders

The postcard intervention against depression among community-dwelling older adults: study protocol for a randomized controlled trial.

[Background]Depression in older adults deteriorates quality of life and increases morbidity, mortality, and medical expenses. Medicine and social policy should work together to decrease this burden. Existing prevention studies are often based on time-consuming psychotherapies, which therefore are not feasible for a wide application at the community level. Postcard interventions have been shown to be effective for patients after hospitalization for major depression, drug overdose, or self-harm. This paper describes the protocol of a pragmatic, randomized controlled trial designed to examine the efficacy of a postcard intervention for depression among community-dwelling individuals aged 65 years or older. [Methods/Design]This is a pragmatic, non-blinded, parallel comparison, randomized controlled trial using Zelen’s design in a community setting. Participants will include community-dwelling older adults (aged 65 years or older) with limited social support (indicated by eating meals alone) and with symptoms of depression (scoring 4 or higher on the 15-item Geriatric Depression Scale (GDS)). The intervention will consist of sending postcards with handwritten messages and seasonal reports from a historical city to participants once a month for eight consecutive months. Self-addressed, stamped envelopes will be enclosed to facilitate non-obligatory replies. Primary outcomes will be changes in the GDS scores that are administered to all elderly inhabitants of the community every year as part of annual health checks. Secondary outcomes include quality of life as measured by a visual analogue scale, and self-rated basic and advanced activities of daily living. We will also examine the subjective sense of effectiveness of the intervention, recollection of the number of intervention mailings received, and the number of mailed replies as the index of the acceptability of the postcard intervention. The time × group interaction for two consecutive years will be analyzed using a generalized linear mixed model. To detect an effect size of 0.5 at alpha error of 0.05 and statistical power of 0.80, 63 participants per group are required. Based on an estimated consent and dropout rate of 70%, a total of 180 subjects will be recruited

Factor structures of a Japanese version of the Geriatric Depression Scale and its correlation with the quality of life and functional ability.

We investigated the 15-item Geriatric Depression Scale (GDS-15) with regard to its factors and, reproducibility, as well as its relationship to activities of daily living, social factors, medical conditions, and quality of life for community-dwelling elderly people in Japan. The study population consisted of 736 community-dwelling elderly participants aged 65 or older. Exploratory factor analysis of the data and correlation coefficients between factors and activities of daily living, quality of life, social factors, and medical conditions were calculated for two consecutive years. The reproducibility of the results was also evaluated. As the result, GDS-15 had three reproducible factors specified as follows: factor I, "energy loss and pessimistic outlook"; factor II, "positive mental status (reversed)"; and factor III, "empty feeling." Comparing our findings with a review of research in this area, positive items (excluding "feel full of energy") seem to compose an universal factor. Factor I correlated best with quality of life, factor II with activities of daily living, and factor III with subjective cognitive function. These results suggest the GDS-15 can be used to assess the functional ability and quality of life, as well as depressive mood in older adults