Reiko Sakashita

Objective: This paper aims to establish a potential reference standard for the process of transition from milk to solid food in infants and preschool children in Japan, using the transitional food process (TFP) scale described by Sakashita et al. The background for variation and delay in the process are also discussed. Design: A randomized sample survey covering entire Japan. Setting: Mailing self-completion of questionnaires. Subjects: Randomized sample of 14 000 children aged 0-6 y and their family from 13 prefectures in Japan, namely Hokkaido, Aomori, Iwate, Niigata, Tokyo, Saitama, Fukui, Nagano, Nagoya, Hyogo, Yamaguchi, Kagoshima, and Okinawa. Methodology: Questionnaires requesting the TFP scale and background factors were sent to 14 000 children and families. The percentile ages were calculated. An eating ability index (EAI: number of accepted foods/total number of foods) × 100) was calculated. Regression analysis by analysis of covariance (ANCOVA; SPSS, 1997) was used to determine the influence of background factors on EAI. Results: From the 6747 (48.2%) effective answers received, percentile curves of the acceptability of each food on the scale were drawn, and used as initial reference standards. The 50 percentile age range of these 20 standard foods covers from 5 to 42 months after birth. The sensitive period for increasing the acceptance of foods in children was between 6 months and 2 1/2y of age. ANCOVA regression model (R2=0.605) showed that EAI was mostly influenced by age (P=0.000), followed by feeding style (P=0.000), infant food preparation (P=0.000), information source (P=0.000), and birth order (P=0.003). The dominant cause of digestive system problems was shown to be infection, not too-hard food. It seems that breast feeding, bottle feeding with chewing-type nipples, and the manner of preparing infant foods from the family table promote the progress in acceptance. Children whose mothers followed the information given in books or magazines showed a slower progress. Conclusions: It seems appropriate to use this reference standard in the study of the transitional process from milk to solid food in infants and preschool children in Japan. © 2004 Nature Publishing Group. All rights reserved.

The structure and function of the human body (integrated anatomy and physiology) is regarded as a subject of fundamental importance in nursing education, providing basic knowledge and evidence of the workings of the human body. However, it contributes little towards developing nursing care, since it appears to focus neither on daily life nor on actual nursing practice. This paper aims to clarify the role of this subject in nursing education and to uncover the barriers preventing its application to nursing practice. The paper also presents break-through proposals that will enable a start to be made in developing the subject further in nursing education. A total of five sessions were held involving eight individuals (two males and six females), including a nursing administrator, a nursing educator and a staff nurse (all working at hospitals) and two teachers in nursing practice as well as three teachers of anatomy and physiology at the college. The sessions were taped and each talk was described and classified into a category. It was confirmed that knowledge of the structure and function of the human body is useful and necessary for nursing practice, and also that nursing practice contributes to the understanding of the human body. Three categories of desirable knowledge emerged: a) a basic knowledge was seen as necessary, b) a detailed knowledge was not generally considered necessary, and c) occasionally detailed knowledge was necessary. Three categories of barriers were also identified, namely a) that the subject was inherently difficult to apply in nursing b) theory and practice were seen as difficult to integrate, and c) the subject was considered inherently difficult. New, break-through ideas were a) learning through case studies and b) refresher courses in both theory and practice. Some learning techniques were suggested, such as letting students teach, running frequent refresher courses, and using audio-visual material. For further study, it is recomended that experimental class should be performed, beginning with a typical case in nursing practice and using problem based learning, in order to evaluate the effect on integration of theory and practice and the efficient use of manpower and time.

Objective: This paper describes the development of a reliable scale of standards for use in evaluating the progress of the transition from milk to solid food in infants and preschool children. The maturation of chewing and swallowing behavior in infants and young children, which enables processing of solid food, varies, and a scale would assist not only in the instruction of mothers and nurses but also in preventing delay in the introduction of solid food. Design: A range of 159 reference foods were selected on the basis of intake during the period of transition from liquid to solid food. These foods were listed in our previous study, Validity and reliability were tested to create a scale. Methodology: Foods were selected on the basis of 50% of the subjects studied being able to eat them, and on the food groups classified by cluster analyses using the Varclus procedure of SAS. Validity, of the scale was tested by using Pearson's correlation coefficient between the scale score of selected food items and the total score of all 159 food items. The total score of 159 food items was calculated using the general linear models (GLM) procedure of SAS. Reliability was tested using Cronbach's coefficient α. Setting: Public health centers in Aomori, Tokyo, Saitama, Nagano, and Okinawa (Japan). Subject: Five hundred and eighty healthy mothers and children from 2 to 46 months were randomly selected and 470 (81.0%) completed the study. To avoid regional bias, subjects were drawn from northern to southern prefectures in Japan, namely Aomori, Tokyo, Saitama, Nagano, and Okinawa. Results: Twenty food items were selected. By analyzing the score correlation using Pearson's correlation coefficient (R = 0.97, P < 0.001) and GLM (R2 = 0.95, P < 0.001), it was confirmed that these 20 food items adequately represented the original 159. The reliability was also found to be sufficient (Cronbach's coefficient α = 0.96). Conclusions: The findings demonstrate that a scale of standards for measuring progress in chewing ability can be created using 20 food items. Such a standard will provide a useful basis against which to assess delay of solid food introduction in childhood.

Secular changes in dental disorders among three populations were compared. Material used comprised 829 Japanese dry skulls and 1089 living Japanese, 1160 Chinese skulls, and 1326 British and Scottish skulls. Prevalence of tooth-to-denture-base discrepancy (the discrepancy), the frequency of carious, and carious and missing teeth, as well as the mean score of tooth attrition were calculated. The discrepancy and carious teeth showed relatively steady progression in the Japanese group, the only exception being a high frequency of carious teeth in the Yayoi period. In the British material, the prevalence of the discrepancy and frequency of carious teeth showed an increasing trend but there were local variations. In the Chinese group, neither the discrepancy nor the dental caries seem to show any meaningful trend. There were significant correlations between discrepancy and tooth attrition in the Japanese, and between discrepancy and carious teeth in the British. The Chinese data did not show any significant correlations, possibly because their economy was multifarious from pastoral to stock farming. The main determinative factor of the discrepancy and dental caries seemed to be the influence of the primary economy of the groups.

th to denture base discrepancy (the discrepancy) is the difference between the dental arch length and the sum of crown diameters of teeth in the jaw, a concept which was originally developed in orthodontics. Since the cause-effect relationship between a soft diet and the discrepancy has been demonstrated, the size of the discrepancy should indicate the amount of load on the masticatory system from chewing foods in jaws from archaeological periods. The dietary condition of 71 citizens compared to that of 186 slaves from the Yin-Shang period of China was reconstructed through a study of the discrepancy. The prevalence of the discrepancy in the Yin-Shang period was around 15%, almost the same as it was during the later Jomon to Yayoi (3000- 2000 BP) periods, when rice agriculture was introduced into Japan, and also the same as for present-day pastoralists around Lake Turkana, Kenya. Although the frequency of the discrepancy was slightly higher in male citizens, there were no significant differences in the frequencies between male citizens and female citizens or slaves. The differences in diet may not have been fundamental since the Yin-Shang period would be at the very beginning of the age in which differences of diet according social class began to appear, with implications for the load on the masticatory system. At that time agriculture may not been sufficiently intensified in variety or quantity to have produced a differentiation of the diet between social classes.

Seventy-one skulls from the Yin-Shang period tombs of Anyang, China, were examined for the incidence of observable dental diseases, including dental caries, alveolar bone resorption (an index of periodontal disease), ante-mortem tooth loss and tooth attrition. Because the remains were excavated from tombs with funerary items, the burials are believed to be of Anyang citizens. Our study indicates carious tooth frequency in the Yin- Shang period was rather low (2.9-4.0%). Periodontal disease frequency was 18.3-26.9%, and ante-mortem tooth loss frequency was 2.0-7.5%. To determine the relative prevalence of overall dental health in the Yin-Shang populations, observations from the 42 male crania were compared to those from 183 male crania of slaves from 'sacrificial pits' from the Yin-Shang period (Inoue et al. [1992] J. Anthropol. Soc. Nippon 100:1-29). Results from this comparison indicate no apparent difference between social classes in younger age groups. However, in the older ages the rates of the ante-mortem tooth loss, periodontal disease and tooth attrition were significantly higher in the citizen sample. The findings would suggest dietary development in the Yin-Shang period was not dissimilar enough between social classes to induce clear differences in dental diseases at least at younger ages. Conversely, it appears there must have been significant differences between social class diets in the earlier phase of the Yin-Shang period to produce the differences in dental disease present in the older samples.

It was reported that the activity of the masticatory muscles is reduced in bottle fed babies. The effects of chewing type bottle teats distributed in Japan on masticatory muscle activity were evaluated. Myoelectric activities of the masseter muscles of 12 babies bottle fed with chewing type bottle teats were recorded and analyzed by the same method as in the previous study. The electromyographic records of 12 breast fed babies and 12 babies bottle fed with regular sucking type bottle teats, which were reported in a previous study, were used as controls. The results show that the masseter muscle activity of babies bottle fed with chewing type bottle teats was similar to that of breast fed babies qualitatively as well as quantitatively. However, activity was visibly different from that of babies bottle fed with sucking type bottle teats, showing significant difference by ANOVA. These data suggest that babies who are ingesting milk from chewing type bottle teats do so with a chewing action similar to that of breast feeding, but very different from that of bottle feeding with sucking type bottle teats. The conclusion was that the chewing type bottle teat is useful for establishing masseter muscle activity.

Our previous studies suggested that there are significant differences in the growth of the jaw and in muscle activity between breast- and bottle-fed infants. To confirm these differences quantitatively, myoelectric activities of the masseter muscles of bottle-fed babies were studied. Twelve bottle-fed babies, as well as 12 breast-fed babies as a control group, were examined electromyographically during bottle or breast feeds. The duration time of sucking bursts, interval time, cycle time, 0-to-peak amplitude, integrated amplitude of bursts, and integrated amplitude/duration tune were measured and the number of bursts over 30μV was counted. All differences of means were significant by t-test. The masseter muscle activity in bottle-fed babies is significantly reduced. Our results are contrary to previous papers in which almost the same sucking actions in both breast and bottle feeding were reported. The reason why previous researchers thought that the sucking patterns in breast- and bottle-fed babies are essentially the same is considered, and the implications of the differences for dental health are discussed. © 1995.

The oral condition of 1274 living people was examined in 3 districts of Kenya and in 117 Kenyan skulls of recent age from the Natural History Museum, London; Cambridge University; and the Smithsonian Institution, Washington D.C. The traits of ritual ablation of mainly mandibular central incisors were observed in 57 cases out of 233 examinees of over 10 years of age (24.5%) in Lodwar, 29 of 210 (13.8%) in Kericho, and 3 of 190 (1.6%) in Nairobi, and in 25 mandibles out of 29 skills (86.2%). Thus, the existence of ritual ablation of the front teeth in modern Kenyans was confirmed, but the incidence is lower than in the skeletal group, and much less in urbanized areas than in rural districts. The size of the remaining space showed a significant correlation with tooth-to-denture-base discrepancy, but not with the lapse of time since extraction. © 1995, The Society of Practical Otolaryngology. All rights reserved.

生後2日目から生後2ヵ月未満の健康な乳児41名を対象とし,哺乳瓶哺乳時の瓶内圧の測定と,咬筋,側頭前腹の活動電位の記録とを行った。生後1週未満の新生児では瓶内圧の低下は全く認められないか,あるいは弱くて,咀嚼筋の活動電位が優勢にみられ,生後の早い時期では咬合型の顎運動が存在する。この傾向は日齢が進行しても母乳哺育児では変わらず,咬合型の顎運動が確認され,瓶内圧の低下は全くみられないか,あるいは非常に弱いものが多かった。しかし哺乳瓶哺乳を行うものでは,日齢にともない,瓶内圧の低下が著しくなる傾向が認められ,吸引型の哺乳行動は哺乳瓶哺乳という哺育環境に対する適応現象である

1)乳房哺育児と哺乳瓶哺育児とでは,哺乳パターンが異なること,すなわち,乳房哺育児においては,咀嚼筋の活動と顎運動主体の哺乳パターンであるが,吸引主体の哺乳パターンを示し,咀嚼筋の活動が失われていくことが再確認された.2)育児上問題となっていた「ミルク嫌い」の重要な原因のひとつとして,乳房哺育児と哺乳瓶哺育児の哺乳パターンの相違が考えられた.3)哺乳パターンは不変なものではなく,学習可能なものと考えられ,現在,自分が使っている乳首から最も効率よく乳汁が飲める方法を学習していくものであることが示唆された.4)哺乳瓶用乳首使用による咀嚼器官の発達の低下の弊害を防ぐ方法として,測定用乳首のような機能をもつ乳首を使うことの可能性が示唆された

本研究は,各群が,群として認められるに足りる形態学的な根拠をもつかどうかを検討し,さらに文化の影響としての歯科疾患が,同じ生活圏に存在したと考えられる異なる民族群においてどのように分布するかを知り,形質と文化との独立性をさらに確かめることを目的とした.総数398体(男性251体,女性39体,不明あるいは不確実のもの108体)のうちから選んだ保存状態の良いもの220体(男性143体,女性16体,不明あるいは不確実のもの59体)である.研究方法は,主として形態学的な計測と,歯科的問題に関する診査とによった.計測値ではSella turcica, Point A,下顎などに関連する項目に欠損値が多く,また,群別では,標本数が極端に少ない3群に欠損値が多くみられた

現代ケニアにおける文化,身体形態,歯科疾患,保健環境などに関する綜合的な調査を行う可能性を探るための予備調査で,ナイロビを中心に西部から北部辺境部にかけての諸部族と接触し,一部のものの口の中を観察した.8人のものに風習による抜歯痕が見られ,また,この風習の意味や抜歯の時期と方法などについての聞き取りを行うことができた.抜歯痕が認められたものは,4部族8人で,このうちルオ族の1人を除く7人では下顎両側中切歯が,またルオ族の1人は下顎両側の6前歯が抜去されていた.抜歯の理由は,単なる風習であると考えているものが4人,破傷風あるいは蛇に噛まれた場合に,歯の食いしばりがあっても水あるいは牛乳を流し込むことができるようにというものが4人であった.抜歯の時期は6歳頃で,長老が子供達を集め,小刀を2本歯の間に差し込んで歯を動揺させて抜くという

Recently, the authors investigated skulls from the Yin-Shang period, a great collection of the Institute of History and Philology, Academia Sinica, the Republic of China (Taiwan). Their roentgenographic cephalograms were taken of two hundred thirty eight well preserved skulls. In analyzing these x-ray pictures, however, a difficult problem occurred in judging the sex of each individual, because no method had been developed before for this purpose. In this study, therefore, it was attempted to develop a method for evaluating the sex of individuals through roentgenographic cephalometrics.<br>As the first step of the study, 45 skulls of the recent Atayals, in which the sex of each individual was recorded, were used as materials for devising the method of analysis. Glabella and mastoid were adopted as objects of measurement, and nine measuring items were established as shown in Table 2 and Fig. 2. Using a discriminant function which was created from only three variables, namely MaHT, GMPN, and GMFH, from 41 individuals with no missing value, the total cases of 45 individuals were classified into two sexual groups with 93.30% correct.<br>The second step of the study was to apply the newly designed method to six skeletal populations from the Yin-Shang period, of which individuals were classified into three groups of male, female, and sex uncertain, according to YOUNG (1985a). Using discriminant functions which were created from the data obtained from the male and female skulls, the uncertain individuals were divided into two groups of male and female, though the reliability of a few cases were less than 0.7.<br>From these results, the items and the method of measurement seemed to work as favourably as the traditional method of sex determination by direct observation of skulls. Another merit of this method is easiness of measurement on a twodimensional plane in comparison with a direct measuring method on actual skulls. Putting all the findings together, the roentgenographic cephalometric method used in the present study is effective enough for sex discrimination.

幼稚園児107名の食行動の観察から噛める子・噛めない子の判別には,"食べるのが遅い"が最も高い偏相関を示した.ついで"食べないで呆然とする","片手で弁当箱を押さえて食べる","ため息をつく","食物が口からこぼれそうになる"などの食行動がみられた

食生活の短期的影響としてとりあげた歯肉炎においてもまったく同様であり2つの歯科疾患の原因として共通なパターンの食生活があげられることを再確認されると共に飲物などの間食を控え食事が充分おいしく食べられるようにするといった食生活指導の目標は,正しかったと考えられる

Five thousand eight hundred elderly persons (2, 212 males and 3, 588 females) aged 40 years or above, who lived in Miyako district, Okinawa, were examined for the occuccence of dental caries, periodontal diseases, and tooth loss with reference to systemic conditions of the examinees.<BR>The Average number per person of present, intact, and carious teeth decreased with increase of age, and the rate of carious teeth (the total, untreated and heavy) and tooth loss increased. However, the relative number of persons who suffered from dental diseases, namely dental caries. periodontal diseases, or untreated tooth defects, decreased with higher age. Compared to ambulatory (non-bed-ridden) persons aged 60 years or higher, the bed-ridden had fewer present and intact teeth and the rate of untreated and severe carious teeth was higher. The Majority of the bed-ridden also had multiple and severe dental diseases, mainly dental caries and tooth loss, at higher rate. The tooth defects were mostly untreated but no other dental diseases coexisted in most of the cases.<BR>A significant number (41.3%) of the examinees had systemic disorders, mainly cardiovascular diseases. Most of the patients suffered from multiple diseases (40.2%) and required medical treatment (51.9%). Approximately two-thirds (63.4%) of the examinees required dental treatment. The bed-ridlen had generally a multiple number of systemic diseases, of which more than half (55.3%), compared to onefourth (28.1%) for the healthy, required prompt medical examination and treatment. The neccessity of dental treatment was higher (61.9%) for the bed-ridden than for the ambulatoy (53.9%), and in most cases prompt treatment was desirable.

A dental health examination of 908 inhabitants, 40 years of age and over, of Ueno, Okinawa, was carried out in concurrence with a general health examination.<BR>This study is deals especially with dental caries and general diseases. The prevalence of dental caries was 81.8%, and the prevalence of untreated dental caries was 42.6%, and these decreased with advancing age. This tendency was particularly marked in those aged 70 years and over, and also indicated the influence of the high rate of missing teeth in inhabitants of this age. The ratio of carious teeth, the ratio of untreated teeth, and the ratio of missing teeth increased with advancing age. This tendency was particularly marked in those aged 80 years and over.<BR>Some general diseases were present in 55.5% of the inhabitants examined, 36.4% of whom were suffering from two diseases or more. Particularly in subjects aged 60 years and over, the prevalence was as high as 67.6%, 58.9% of which were evaluated as requiring treatment. The incidence of locomotorial, connective tissue and cardiovascular diseases, and nervous, sensory diseases was high, and 28.1% of the sujects with carious teeth requiring treatment were also suffering from gneral diseases for which treatment was necessary. The incidence of general complications in the subjects aged 60 years and over was particularly high, 37.7%. These results suggest that it is necessary to formulate a new medical examination system that will be able to accomodate general conditions in the aged for the establishment of dental science and treatment in this group.

A dental health examination of 1, 243 inhabitants, 40 years of age and over, of Irabu-cho, Okinawa, was carried out in concurrence with a general health examination.<BR>The rate of carious teeth, the rate of untreated teeth, and the rate of missing teeth increased with advancing age, and the rate of intact teeth and rate of treated teeth decreased. This tendency was particularly marked in those aged 80 years and over.<BR>The prevalence of dental caries was 67.5%, and the prevalence of untreated dental caries was 34.2%, which was lower than the nation-wide average, and also indicated the influence of the high rate of missing teeth in inhabitants of this area.<BR>Some general diseases were present in 45.6% of the inhabitants examined, 25% of which were suffering from two diseases or more. Particularly in subjects aged 60 years and over, the prevalence was as high as 57.1%, 62.8% of which were evaluated as requiring treatment. Cardiovascular diseases were present in 58.6% of the subjects with general diseases; the incidence of hypertension was the highest, and 32.3% of the subjects with carious teeth requiring treatment were also suffering from general diseases for which treatment was necessary. The incidence of general complications in the subjects aged 60 years and over was particularly high, 41.8%.

For evaluating the severity of periodontal disease in deciduous dentition, we used to examine the mesial parts of the gingival margins of all the teeth in the mouth. This method, however, takes too much time for application to mass screening. The purpose of this study was, therefore, to design a simplified method.<BR>Materials used were dental health examination data of periodontal disease in the Miyako Islands in Okinawa, obtained from 667 cases of three-year-old children, and 143 cases of one-and-a-half-year-old children. Principal component analysis and multiple regression analysis were applied to these data to select the standard teeth, and to proove the appropriateness of the teeth selected. Comparing the mean scores of periodontal disease of each tooth, high scores were observed at the most posterior teeth in the maxilla. As the result of principal component analysis, the teeth were divided into three groups, i. e. maxillary anterior teeth, mandibular anterior teeth, and maxillary and mandibular posterior teeth in three-year-old children. On the basis of these results each of the most posterior teeth in the maxilla, the maxillary lateral deciduous incisors, and the mandibular deciduous incisors were selected as standard teeth, because no dominant difference was observed between the teeth on the right and left sides. Multiple regression analysis showed that this model predicted means of the periodontal score of all the teeth very well, and adding other variables of teeth did not improve the prediction much. The correlation coefficient between the mean of these teeth and that of Periodontal score was very high (r=0.89-0.90). Almost the same results were obtained in one-and-half-year-old children, in which the unerupted maxillary 2nd deciduous molar was replaced by the most posterior teeth in the maxilla (r=0.87-0.91).

Processing the data from dental health examinations requires detailed procedures for many items. In order to use the computed data to the best advantage for regional health programs and for personal health guidance, the arrangement of our work environment to enable precise data processing is an urgent need. For this, we used to process examination data on the main computer system of the Computer Center, at the University of Tokyo. However, preparing a file for the data processing on a computer is always annoying and time consuming. Therefore, we designed here an input software to directly prepare a data file on a personal computer, and put it to trial in an actual dental health examination. We were able to file and process the examination data very quickly. The application of a computer to dental health examinations is thus very useful and helpful for further development of dental health science

To investigate the extent of oral diseases in the aged, a dental examination was conducted in combination with medical examinations of elderly inhabitants of Miyako district, Okinawa pref.<BR>Abnormal oral findings were noted in 1, 655 (29.19 %) of 5, 670 examinees. The incidence of oral disease tended to increase with age. Among the oral disease detected, oral mucosal diseases showed the highest frequency. Suspected malignant tumors were found in 0.14%, benign tumors in 4.36 %, leukoplakia in 1.29 % and diseases presumably due to insufficient oral care by dentists or patients in 8.77 % of the examinees. Evaluation of the state of disease revealed that a higher proportion of systemic diseases were under medical treatment as compared with oral diseases. Further detailed examination was indicated in 50 (0.88 %) examinees with oral diseases.