[Hokkaido igaku zasshi] The Hokkaido journal of medical science最新文献

Purpose: To examine reliability and validity of Kano Test for Social Nicotine Dependence (KTSND), a scale assessing the psychosocial acceptability of smoking, and to develop a new version when validity or reliability of KTSND was not acceptable.

Methods: We carried out a self-administered cross-sectional survey on undergraduate university students. The participants completed the KTSND, and supplemented three questions on the attitudes toward tobacco control policies and smoking states. Using daily smokers, we examined the relationship between the KTSND and Fagerström Test for Nicotine Dependence (FTND). In each study, we examined test-retest reliability and construct validity, discriminant and convergent validity, and factor validity.

Results: Although the KTSND had high internal consistency (Cronbach's a 0.82) and high test-retest reliability (r=0.72), the results of factor analysis were unacceptable; we expected three factors to be extracted, however, only two factors of "Overestimate of smoking usefulness" and "Allege smoking as a taste and/or culture" were extracted. Using the Kano's Test for Assessing Acceptability of Smoking (KTAAS), the new version of KTSND in which a question was replaced with another one, the third factor of "Neglect of harm of tobacco smoking" was extracted adding to the above-mentioned two. KTAAS had also both high internal consistency (Cronbach's alpha 0.82) and test-retest reliability (r=0.66). Overall, the KTSND and the KTAAS score differed according to smoking states, and the nonsmokers' scores were the lowest.

Conclusion: The KTSND was a popular questionnaire in Japan, however, its validity assessed using factor analysis was not acceptable, while KTAAS had sufficient reliability and validity, and might assess the cognition and attitude affirming or accepting tobacco smoking among university students.

In this symposium, we explained etiology, prevention and treatment for hepatocellular carcinoma (HCC). It has been revealed that the carcinogenesis in hepatocellular carcinoma is almost caused by the infection of hepatitis virus B and/or C. Therefore, the carcinogenesis in hepatocellular carcinoma is able to be prevented. Even if the carcinogenesis in hepatocellular carcinoma occurs, the diagnosis and treatment in the worldwide level; radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), hepatectomy, and liver transplantation will be offered to patients with HCC in Japan. We hope that this symposium would help the attendance to understand the prevention and treatment for HCC.

Background: Eating behavior change (EBC) is essential to remedy metabolic syndrome (MetS). We carried out our clinic-based health and nutrition intervention informed by the transtheoretical model (TTM) to promote EBC. In particular, we aimed to foster EBC among individuals who were in the cognitive stage (C-level stage) of their health behavior, in contrast to the model positing that those in C-level stage are less likely to adopt EBC than those in the behavioral stage (B-level stage). The degree of each one's risk for MetS was also examined.

Subjects: The study population comprised 108 adults (38 males aged 58 +/- 10.8 SD and 70 females aged 60 +/- 6.6).

Methods: SUBJECTS were given instruction and support for over a 3-month period. MetS diagnostic criteria values, dietary intake and TTM were measured before and/or after the intervention. On the basis of their MetS and TTM scores, subjects were classified into two groups according to risk (high or low) and stage (C or B). Multiple linear regression analysis was performed.

Results: In both risk groups, EBC stage scores advanced in many subjects, progressing from C to B-level stage. Reduction in abdominal circumference and improvement of the MetS criteria values were also observed particularly in the high-risk group and those in the B-level stage. Stage-specific improvements in physical characteristics, the MetS criteria values and energy intake were likewise seen in both risk groups. Abdominal circumference reduction was negatively and positively correlated with EBC stage scores and fat energy ratio, respectively.

Conclusion: From the results, it was proved that improvements of MetS criteria values concomitantly occurred with reduction of eating energy intake, especially fat energy, as well as advance of EBC from C to B-level stage. In addition, we found it effective to let the participants recognize their degrees of risk for MetS.

Primary care physicians (PCPs) are said to play a leading role in the early diagnosis of depression. Sometimes however, symptoms can be overlooked or misdiagnoses may occur, and this may be due to differences in the way that PCPs and patients perceive depression. The aim of this study is to clarify factors that may contribute to suspicions, or awareness of depression, focusing especially on perceptual dissimilarities between PCPs and patients. We conducted our research using qualitative methodology, with individual interviews being conducted with five experienced primary care physicians working in a rural area, and five patients who had been in consultation with PCPs. The main interview topic of this study was the triggers for their, or their patients', depression. From our interviews we discerned five categories of factors: "mental manifestations," "physical manifestations," "events in the patient's private life," "social environment and conditions" and "others." Our findings suggest that a critical difference in the perception of depression may exist between PCPs and patients. PCPs should be more alert to uncommon conditions of depression, as well as the more prevalent symptoms. We found that PCP's latent abilities and attitudes, such as "intuition," "subjectivity," and "experience", are often cues in the diagnosis of depression. This is in accordance with existing research on the subject. On the patients' side, sometimes sufferers do not notice the symptoms of depression by themselves, which may also be a serious problem. In conclusion, we, as medical professionals, must take care to be aware of these distinctions in order to swiftly detect depression, and to better treat our patients.

Objectives: An atonic pupil, defined as a dilated pupil of unknown origin, is a rare postoperative complication of ophthalmic surgery. We studied the incidence of atonic pupils after uncomplicated phacoemulsification and intraocular lens implantation (PEA+IOL) and analyzed the clinical profiles of four cases of atonic pupil.

Methods: We surveyed 54 ophthalmologists in 28 hospitals to determine their clinical experience with atonic pupils after uncomplicated PEA+IOL procedures and the total number of PEA+IOL procedures performed. The medical charts of four cases of atonic pupils were reviewed retrospectively.

Results: The response rate was 77.8% (42/54). Surgeon experience with PEA+IOL ranged from 1 to 15 years. Three of 42 ophthalmologists (7.1%) had had at least one case of an atonic pupil after uncomplicated PEA+IOL. Four of 58,887 cases (incidence, 0.0067%) developed an atonic pupil after uncomplicated PEA+IOL. All four cases had glare and three cases were treated with an iris contact lens, an iris diaphragm ring, and photochromic lenses. There were no specific common characteristics among the cases beyond ocular pain and headache perioperatively.

Conclusions: The incidence of atonic pupil was very low. Most patients with an atonic pupil have some symptoms that require treatment.

The Doppler echocardiography derived peak instantaneous systolic pressure gradient (peak instantaneous Doppler PG), the mean PG (mean Doppler PG) and the aortic valvular area are the accepted standard for determining the prognosis and optimal timing of intervention because of good agreement between Doppler-derived and catheter-measured PGs in adult patients with aortic valvular stenosis. However, several investigators reported that pressure recovery can cause discrepancies between Doppler-derived and catheter-measured PGs, so that the correction for pressure recovery has been proposed. In pediatric patients with aortic valvular stenosis, the discrepancy between Doppler-derived and catheter-measured PGs and the correction for pressure recovery have not been studied well. Therefore, the purpose of current study was to clarify the role of echocardiography for estimating the prognosis and optimal timing of intervention and to assess the influence of pressure recovery on the Doppler-derived PG in pediatric patients with aortic valvular stenosis. Thirteen pediatric patients with aortic valvular stenosis were studied with echocardiography and cardiac catheterization. PG determined by the catheterization was compared with PG determined by the echocardiography with linear regression and Bland and Altman analysis. As result, Doppler-derived PGs corrected for pressure recovery did not correlated well with catheter-measured PGs. By contrast, Doppler-derived PGs correlated well with catheter-measured PGs. In particular, the mean Doppler PG correlated excellently with the mean catheter PG. In conclusion, the mean Doppler PG demonstrated an excellent correlation with the mean catheter PG without the correction for pressure recovery. Thus, the mean Doppler PG is useful in order to determine the prognosis and optimal timing of intervention in pediatric patients with aortic valvular stenosis.