地域ケアの展開 ―ポピュレーションアプローチ―

健康政策として「ポピュレーションアプローチ」の重要性が示されるようになっている。地域ケアにおけるポピュレーションアプローチの展開について概説した。生活習慣や健康課題の改善への取り組みを事例として挙げた。未だ途上ではあるが、地域づくりの大きなビジョン、そして地域の保持・発展に対する明確な意識を持ちつつ、アプローチを練成していくことが肝要である

The association between adiponectin, HDL-cholesterol and α1-antitrypsin-LDL in female subjects without metabolic syndrome

<p>Abstract</p> <p>Background</p> <p>Oxidized low-density lipoprotein (LDL) may act as an atheroprotective (anti-atherosclerotic) agent under some conditions. While the α1-antitrypsin (AT)-LDL complex is considered a type of oxidized LDL, its clinical relevance remains unknown. The aim of the present study was to investigate the association between AT-LDL and anti-atherosclerotic variables such as HDL-cholesterol and adiponectin in subjects with and without metabolic syndrome (MetS).</p> <p>Methods</p> <p>In asymptomatic females (n = 194; mean age, 54 years) who were divided into non-MetS (n = 108) and MetS groups (n = 86), the fasting levels of serum AT-LDL, adiponectin and glucose/lipid panels were measured, in addition to body mass index (BMI) and blood pressure.</p> <p>Results</p> <p>The MetS group showed significantly higher BMI, blood pressure, glucose and triglyceride levels as well as significantly lower levels of HDL-cholesterol and adiponectin than the non-MetS group. A multivariate-adjusted analysis revealed that in the non-MetS group, AT-LDL was significantly, independently and positively correlated with adiponectin (β = 0.297, P < 0.05), along with HDL-cholesterol (β = 0.217, P < 0.05). In the MetS group, AT-LDL was significantly, independently and positively correlated with LDL-cholesterol only (β = 0.342, P < 0.05).</p> <p>Conclusions</p> <p>These data suggest that AT-LDL may exert anti-atherosclerotic effects in female subjects without MetS. More studies are required to clarify the clinical roles of AT-LDL in relation to the pathophysiology of MetS.</p

飲泉による身体効果

温泉療法の一つである「飲泉」の身体への効果について既報文献をもとにレビューした。医学中央雑誌ならびにPubMedを用いて12編の原著文献を収集した。主として、胃腸、胆膵、糖代謝に関する検討がみられた。これに基づくと、飲泉は消化器系や代謝系に好ましい効果を持つ可能性があった。報告数の過少さや研究方法の限界から、飲泉の効果を確立するためにはさらに検証していく必要があると考えられた

Paraoxonase 1 in Chronic Kidney Failure

In this review we summarize the findings from the literature and our own laboratory on the decreased PON1 activity in renal failure, the mechanisms proposed and the effect of interventions. In addition to profound alterations in lipoproteins, reduced serum PON1 activity has been clearly established in the past decade and could contribute to accelerated development of atherosclerosis in ESRD and in HD. PON1 lactonase activity is lower in ESRD patients. Hemodialysis partially restores PON1 lactonase and the other activities. PON1 activity recovery after dialysis suggests that uremic toxins may play a mechanistic role in PON1 inactivation. Lower PON1 activity in CRF patients is associated with low thiol concentration, high CRP, and is beneficially enhanced with vitamin C and flavonoids. Changes in HDL subclasses, namely lower HDL3 in these patients may also play a role in PON1 lower activity. Future research should focus on: (1) mechanistic studies on causes for low PON1 activity and mass; (2) prospective studies focusing on whether there is an added predictive value in measuring PON1 activity (and PON1 activity in HDL3) in this patient population; (3) intervention studies attempting to increase PON1 activity