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Socioeconomic factors and hypoxia play major roles in the prevalence of glucose intolerance in highlanders. Hypoxemia and polycythemia were closely associated with glucose intolerance after adjustment for the effects of lifestyle changes in our study. Tibetan people may be vulnerable to glucose intolerance, with polycythemia as a sign of poor hypoxic adaptation. Epigenetics is also play a role in its vulnerability with quick lifestyle change. Prevention of lifestyle-related diseases and health education should be advocated, especially in high altitude dwellers with rapidly prevailing socioeconomic globalization.

特集2: フィールド医学 = Special Issue 2: Field Medicine, 本誌公刊にあたっては、京都大学学士山岳会、京都大学「霊長類学・ワイルドライフサイエンス」・リーディング大学院からの助成をうけました。

本稿は, 高所プロジェクトの提唱してきた「糖尿病アクセル仮説」の一部について検証した科学論文 (Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland. BMJ open 2016) のレビューである。耐糖能障害がライフスタイルと低酸素血症といかに関連するかを, 中国からインドにわたるチベット高原 (2900-4800m) の1258人の住民において研究された。社会経済的要因, 高度3500m 以上在住, および低酸素血症が, 高所住民の耐糖能異常の増加に大きく関与していることが報告された。低酸素血症, 多血症, 耐糖能異常の3者には密接な関係があり, 加齢とライフスタイル変化がその関係を促進している (糖尿病アクセル仮説) ことが検証された。, The association between glucose intolerance and high altitudes (2900-4900m) was clarified in Tibetan highlanders. The hypothesis was verified that dwelling at high altitudes have vulnerability to diabetes accelerated by lifestyle change or aging. 1258 subjects (40-87 years) were examined; farmers in Domkhar (2900-3800m), nomads in Haiyan, Ryuho, and Changthang (3000-4800m), and urban dwellers in Leh and Jiegu (3300-3700m). The prevalence of glucose intolerance was higher in urban dwellers and in farmers compared with nomads. Dwelling at a higher altitude was significantly associated with fasting hyperglycemia (odds ratios for >4500 and 3500-3999m were 3. 59 and 2. 07 vs 1.0, 特集2: 総合地球環境学研究所「高所プロジェクト」特集 = Special Issue 2: The High Altitude Project in Research Institute for Humanity and Nature

The prevalence of hypertension in 2800 people in Ladakh was studied cross-sectionally from 2007 to 2011. We found 37.0% crude prevalence rate in the total subjects. The associated factors with hypertension were aging, overweight, dwelling at higher altitude, engagement in modernized sedentary occupation, and rural-to-urban migration. There was the interaction of both altitude and lifestyle change for the effect of hypertension., 特集2: 総合地球環境学研究所「高所プロジェクト」特集 = Special Issue 2: The High Altitude Project in Research Institute for Humanity and Nature

The prevalence of hypertension in 2800 people in Ladakh was studied cross-sectionally from 2007 to 2011. We found 37.0% crude prevalence rate in the total subjects. The associated factors with hypertension were aging, overweight, dwelling at higher altitude, engagement in modernized sedentary occupation, and rural-to-urban migration. There was the interaction of both altitude and lifestyle change for the effect of hypertension., 特集2: 総合地球環境学研究所「高所プロジェクト」特集 = Special Issue 2: The High Altitude Project in Research Institute for Humanity and Nature

Geriatric Depression Scale-15(GDS-15)を用いて, ラダーク3 地域の心理的状況や社会・文化的背景を考察した. また実際の生活状況の違いも老研式活動能力指標を用いて検討し, 高知県T 町を参考値として比較した. GDS-15 において, ラダーク3地域と高知県T 町では回答の傾向に違いが見られた. 老研式活動能力指標において, 手段的自立の一部の質問や知的能動性の下位項目は, ラダーク3地域の地域特性にそぐわない可能性が示唆された. 一方, 社会的役割は, ラダーク3地域の実情を反映していると考えられる., The aim of this study was to examine the results of answers of 15-item Geriatric Depression Scale (GDS-15) and Tokyo Metropolitan Institute of Gerontology, Index of Competence (TMIG-IC) among the elderly living in different 3 regions in highland Ladakh (Domkhar, Leh, Chanthang) in India and in Tosa town, Japan. There were different characteristics in answers in GDS-15 and in TMIG-IC among elderly in 3 regions in Ladakh and in Tosa town. Socio-cultural background affects on the results of internationally validated screening method for depression or for higher activities of daily living of the community-living were discussed. It seems that some questions of GDS-15 and instrumental activities of daily living and intellectual activity as subscales of TMIG-IC were strongly affected by the socio-cultural backgrounds in the regions.

Background and aim: Highland is one of the most severe places to get enough foods in the world. However, our current study found relatively high prevalence of lifestyle-related diseases such as obesity, hypertension and diabetes even in such remote highland. Assessing dietary status is important to show one of the backgrounds of these lifestyle-related diseases. This study aims to reveal the nutritional intake of the people living in Ladakh and analyze the relation between nutritional intake and diabetes. Settings and subjects: In July 2010, we conducted health check-up including nutritional assessment in Leh, the central city of Ladakh, and in Domkhar village located about 120km northwest of Leh. Study subject was people aged 40 years and older who joined health check-up and answered nutritional assessment (Leh: 109, Domkhar: 40). Methods: Diabetic status was diagnosed by 75g oral glucoses tolerance test. Total energy intake was estimated using 24h recall method. Food quality was determined using an 11-item Food Diversity Score Kyoto (FDSK-11). Body mass index were determined by measuring height and body weight. Results: Mean of total energy intake per day was; Leh: men 2305kcal/day (N=51), women 1933 kcal/day (N=58), Domkhar: men 2272 kcal/day (N=18), women 2226 kcal/day (N=22). When we divided subjects into 3 groups; 1) people who had low energy intake than the energy requirement by the guideline, 2) those who had adequate energy intake (up to standard requirement plus 300 kcal/day and 3) those who took high total energy intake (more than the 2) level) for statistical analysis. We found higher prevalence of diabetes in not only high energy intake group, but in low energy intake group, compared to adequate energy intake group. Food diversity was low in the low energy intake group in Leh, which can be considered as unbalanced diet such as carbohydrate excessive dietary style and that might lead to be diabetic status. Conclusion: Low energy intake can be also one of the risks of diabetes, with the background of poor food variety in highland.

Background: On 1 August 2010, an entire hemisphere of the sun erupted. Filaments of magnetism snapped and exploded, shock waves raced across the stellar surface, and billion-ton clouds of hot gas billowed into space. A coronal mass ejection (CME) headed directly for Earth. The huge solar storm triggered unusual northern and southern auroras appearing on the night of August 3. Geomagnetic turbulence in Japan was observed on 4 August. The CME could have driven disastrous flooding occurring in Ladakh on 5 and 6 August 2010 in association with an annual acrophase of environmental temperature recorded by us there and also reported in Pakistan and in Gansu, China. A heat wave and smog were presumably associated with the CME in Moscow on 2-9 August. Aim: A chronoecologic health watch in Ladakh, using "glocal comprehensive assessment (GCA)" to study the human circulation, autonomic nervous system activity and health quality as a physiological system at high altitude, complements a chronoecological study in Japanese towns. Ladakh is a very arid region of east Kashmir, adjacent to Tibet, at an altitude of 2500 to 4600 m between the Karakoram and the Himalaya ranges. Subjects: 3418 Ladakh residents, i.e., 549, 461, 447, 164, 788, 420 and 589 citizens, were checked out annually since 2004 to 2010, respectively. High-altitude environments have less oxygen, lower pressure, cold temperature and strong UV-radiation. From June 2009 to September 2011, we monitored, every 30-min, among other data, air temperature, relative humidity, air pressure, wind direction, wind speed, rainfall, upward/downward long/short wave radiation and UVradiation investigated in chronomic serial sections with a 24-hour and a separate 7-day cosine fit. Results: Disastrous floods on 5 August followed the CME on 1 August 2010, seen in serial sections of rainfall. Meteorological observation disclosed a disruption of 1/f fractal scaling of the environmental temperature before the floods in Ladakh, whereas serial sections showed the circannual acrophase. Annual Health Watch shows, as compared to Japanese subjects, that residents in Ladakh slept less (7.8 vs. 6.9 hours, p

Aim: Humans adjusted to ambient hypoxia via the alteration of chemoreceptor reflex sensitivity. However, it has not yet been established how we can measure it. Thus, the aim of this investigation is to propose a method how to measure it using a newly developed pulse oximetry monitor. Methods: We assessed it as a relation between a phasic change of hypoxemic condition and an alteration of heart rate. We planned two types of investigations. Effects of high altitude on pulse oximetry (SpO2) and heart rate (HR) were observed by 25-minute continuous monitoring of SpO2 and HR. The first study was done in 3 healthy subjects (29-year and 56-year women and a 59-year man) along with a trip for about 10 days from Japan to Himalayan valley. More than 6 times of measurement of SpO2 and HR were done before and during the trip. Another observation of the 25-minute continuous monitoring was done in 44 Ladakhi priests (17-90 years men, average 49.1 years of age) living at an altitude of 2, 500 to 3, 720 meters. Results: SpO2 and HR were simultaneously monitored each cardiac beat in each subject. As an index of chemoreceptor reflex sensitivity (CRS), we measured a slope of the fitting line, showing a correlation between a prominent decrease of SpO2 and a phasic increase in HR. First investigation showed CRS changed from 0 msec/% at Japan before a trip to 42.5 msec/% during a trip at Himalayan valley. The second investigation showed higher measures of CRS of the 44 priests, average 46.1 msec/%, ranged from 3.3 to 148.5 msec/%. People living at high altitude have a higher sensitivity of chemoreceptor reflex compared to the low-latitude peers, although it has been fully habituated and fully adapted. Conclusions: We need a glocal, i.e., global and local, comprehensive assessment (GCA), including a measurement of CRS, for a more fruitful treatment. Longitudinal observations of GCA should help us to prevent strokes and other cardiovascular events, especially at high-altitude.

【目的】生活環境が全く異なるレー・ドムカル・チャンタンに住む高齢者のうつ症状, QOLの実態とこれら2つの関連を明らかにした. 【方法】対象者は50歳以上の男女で, レーでは227名, ドムカル198名, チャンタン130名であった. うつ症状はGDS-15を採用し, 主観的QOLはVASを使用し健康度, 家族関係, 友人関係, 経済的満足度, 幸福度を測定した. 3地域のQOL, GDSの平均値を比較し, 幸福度とGDS各項目との関連を検討した. 【結果・結論】うつ症状はチャンタンが最も有意に低かった. QOLでは友人関係は3地域で有意差が認められず, 健康度, 経済的満足度, 幸福度はレーが最も有意に低かった. GDS項目別にみると, チャンタンではレー, ドムカルに比べても生活に対する空虚や不安といったうつ症状が明らかに低かった. いずれの地域においても, 幸福度とGDSによるうつ症状の多さとは, 負の相関が認められた. 3地域では幸福の関連要因は異なった. これには自然環境や都市化の度合い, それに伴う地域のつながりの違いも少なからず影響していると考えられる, 【Aim】The aim of this study was to compare the association between 15 item of geriatric depression scale and quantitative subjective quality of life assessed by visual analogue scale among the elderly living in the three regions in Ladakh in India. 【Method】Study subjects consisted of 227 participants in medical check in Leh, 198 in Domkhar, 130 in Changthang. All subjects were aged 50 years or more. Depressive status was assessed using GDS-15. Subjective QOLs (health status, family relationship, friendship, financial satisfaction, happiness) were assessed using visual analogue scale (VAS). 【Result】Depressive status in Changthang was significantly lowest among the three regions. QOL scores in Leh were significantly lowest among the regions except for friendship. People in Leh or Domkhar had higher prevalence of depressive symptoms especially answered "yes"to negative questions compared with those in Changthang. All regions had a negative correlation between GDS scores and subjective happiness. But the individual GDS-questions associated with subjective happiness were different among people in the three regions. The differences might be brought about by socio economic globalism including connection with community and natural environment.

背景と目的: 高所住民は人種や遺伝的背景の違いにより異なった高所への適応形態を示すことが知られている. 一般にヒトは低酸素である高所環境に暴露されると肺血管収縮をきたし肺高血圧を呈するようになるが, その程度は様々である. 我々はインド・ラダーク地域の高所住民において, 心電図および心臓超音波検査を用いて, 肺高血圧症の評価をすることを目的とした. 方法: インド・ラダーク地域の標高3000-4500mに住む地域住民ボランティア838人(男性357人・平均年齢57.7±13.1歳, 女性481人・平均年齢55.3±12.3歳)を対象に, 2009年7月, 2010年8月, 2011年7月に健康診断を行い, 問診, 診察, 血液検査(血算, 一般生化学検査), 心電図検査, 呼吸機能検査, 心臓超音波検査を施行した. 心電図検査での右室肥大所見は(1)右軸偏位(90-180°), (1)I, aVL, V5, V6でのS波, (3)V1からV3までのS波の絶対値より高いR波の3項目で評価した. また心臓超音波検査では連続波ドップラー法を用いた三尖弁逆流の圧較差を用いて推定された肺動脈圧が30mmHg以上のものを肺高血圧と診断した. その他に各エコー項目の測定や他の弁膜症の評価をした. さらに, ECGにおける右室肥大所見と心臓超音波検査による肺高血圧所見の一致を評価するためにKappa coefficientを用いた検定を行った. 結果：心電図検査と心臓超音波検査をともに施行した517人のうち心電図で右室肥大所見を認めたのは50人であった. そのうち心臓超音波検査で3人の弁膜症を除いて肺高血圧所見を認めたのは11人(22.0%)であった. また心電図検査で右室肥大所見を認めなかった467人の中でも16人の弁膜症を除いた111人(23.7%)に心臓超音波検査で肺高血圧所見を認めた. Kappa coefficientは0.012(p=0.678)であり, 心電図による右室肥大所見と心臓超音波検査による肺高血圧所見は一致性が低いことが示唆された. 結語: 心電図と心臓超音波検査にはどちらにも長所と短所があり, 肺高血圧所見の検出には両者の併用が有用であると考えられた., Background: Highlanders show different type of adaptation to hypoxic environment depending on the race or genetic background. It is generally believed that hypoxic environments predispose high altitude dwellers to pulmonary vasoconstriction. However, high altitude dwellers do not necessarily present pulmonary hypertension (PH). It has been reported that prevalence of PH differs significantly depending on the race or genetic background. In this study we evaluated the electrocardiogram (ECG) and echocardiography of the dwellers living in Ladakh to assess the prevalence of PH. Method: We recruited 838 (357 male, age=57.7±13.1years; 481 female, age=55.3±12.3years) subjects from Ladakh (altitude; 3000m-4800m) in India in July 2009, August 2010, and July 2011. We administered ECG and echocardiography (TITANR ; Sonosite, Inc, Bothell, WA, USA) to the subjects and evaluated the findings. Estimated systolic pulmonary artery pressure more than 30mmHg was defined as PH. We diagnosed right ventricular hypertrophy (RVH) if the subject's ECG met one of the following criteria: 1) Right axis deviation, 2) S wave in I, aVL, V5-6, 3) high R wave in V1-3 in ECG. Kappa coefficient was calculated to test the strength of agreement for RVH diagnosis in use between ECG and echocardiography. Results: We were able to analyze both the echocardiography and ECG in 517 individuals. In remaining 321 individuals, echocardiography was not available because of their pigeon chest. According to the echocardiography data, PH was present in 122 individuals (23.6%) of Ladakh. Eleven out of 50 subjects with RVH in ECG (22.0%) and 111 out of 467 subjects without RVH in ECG (23.7%) showed PH by echocardiography. Kappa coefficient was 0.012(p=0.678) suggesting low agreement between the RVH criteria of ECG and echocardiography. Conclusion: The RVH findings by ECG are not associated with PH evaluated by echocardiography in high altitude population. A combination of ECG and echocardiography may be useful for screening of high-altitude pulmonary hypertension.

Circadian rhythm is essential for the organism since it allows anticipatory metabolic regulations to prepare for up-coming feeding or rest period. Disturbances of the biological rhythm predispose to metabolic disorders such as obesity, dyslipidemia, hypertension and diabetes. Moreover, certain pathological events, such as cardiovascular accidents occur more frequently at specific time of the day. In this investigation we have confirmed circadian clock work functions well in Himalayan residents at an altitude of 4, 500 m. Thus, it is speculated some kinds of the specific environment, such as hypoxic, hypobaric, cold, or windy conditions may play an important role in the coordination of keeping health and the circadian output.

目的：うつ病は高齢者に最も多くみられる精神疾患の一つであり, 高齢者のQuality of Lifeに悪影響を与えているが, 有病率は地域によってばらつきが大きい. アメリカでは高所では自殺率が高く, 一因として低酸素環境とうつ病の関連が指摘されている. しかしヒマラヤやアンデス地域でも同様の傾向があるかはまだわかっていない. そこで私たちはインド・ラダーク, 中国青海省, ペルーの高地在住の高齢者のうつ病の調査を行うことを目的とする. 対象と方法：私たちは2009年7月-2011年7月にこれらの地を訪問し, 本調査に同意が得られた地域住民を対象にして, インド・ラダーク地方ドムカル村(標高3800m)のラダーキー114人(平均年齢69.2歳, 女性58.8%), チャンタン高原(4500-4800m)のラダーキー/チベット人206人(平均年齢55.1歳, 女性43.7%), 中国青海省玉樹(3700m)のチベット人173人(平均年齢66.5歳, 女性61.3%), ペルー山間部のプイカ(3600m)およびチュルカ(3800m)のアンデス先住民103人(平均年齢69.0歳, 女性68.0%)を対象とした. 参加者全員に対し, 身体診察や血液検査などに加えて, Patient Health Questionaire-2(PHQ-2)を用いてうつ病のスクリーニングを行った. PHQ-2の1項目以上が陽性であった住民に対し専門医が半構造化面接を行い, うつ病の有無を診断した. 結果：PHQ-2の1項目以上陽性であったのはドムカル村で7.0%, チャンタン高原で5.3%, 青海省で66.5%, プイカで15.5%であった. これらの住民に対して専門医が面接したところ, DSM-IVの大うつ病性障害の診断基準を満たしたのは, それぞれ2例(1.8%), 4例(1.9%), 4例(2.3%), 3例(2.9%)であった. うつ病発症の原因として, 他地域と同様, 近親者との死別や健康の問題といったライフイベントの存在が挙げられた. 結語：ヒマラヤおよびアンデスの高地在住の高齢者のうつ病有病率はいずれも低く, 有病率が低い理由として宗教, 家族・地域の結びつきなどの文化的要因が考えられる., Objective: Depression is one of the most common mental disorders seen in elderly people and it has a negative impact on their quality of life. Suicide rates in the United States are higher in higher altitude areas, and hypoxia has been cited as a factor in these higher rates. There may be a significant correlation between rates of depression and altitude, but little data exist outside the United States. The purpose of the present study is to conduct a survey of depression among the elderly residing in the Himalayas and the Andes. Metho: We visited Ladakh (altitude 3800-4800m) in India, Qinghai (3700m) in China and Puyca (3600m) in Peru between July 2009 and July 2011. We recruited 114 farmers from Domkhar in Ladakh (mean age, 69.2 years; female-male ratio, 58.8%), 206 nomads from Changthang in Ladakh (55.1 years; 43.7%), 173 Tibetan subjects from Qinghai (66.5 years; 61.3%) and 103 indigenous Andean subjects from Puyca (69.0 years; 68.0%). The two-item Patient Health Questionnaire (PHQ-2) was administered to the subjects. A psychiatrist interviewed the residents with a single or double positive score in PHQ-2.Result: The ratio of subjects with one or more positive score in PHQ-2 was significantly higher in Qinghai than in other regions. (Domkhar vs. Changthang vs. Qinghai vs. Puyca = 7.0% vs. 5.3% vs. 66.5% vs. 15.5%, P

Objective: Food diversity has been studied as one of the important health-related factors. However, the effect of environmental differences on the relation between food diversity and health status remains unclear. Aim of this study is to reveal the relations between food diversity and health status of elderly highlanders, both in urban and rural settings in Qinghai plateau in China, and Ladakh in India. Methods: The study population consisted of; Qinghai YuShu (urban):191, Qinghai Haiyuan(rural): 64, Ladakh Leh (urban): 127, Ladakh Domkhar (rural): 115 elderly subjects aged 60 years or more who joined the medical survey. Food diversity was determined using an 11-item Food Diversity Score Kyoto (FDSK-11). Health status including Activities of daily living (ADL), screening-based depression and quality of life (QOL) were interviewed. Results: FDSK-11 score were; YuShu:7.9, Haiyuan:7.4, Leh:6.7, Domkhar:6.4. Both in Qinghai and Ladakh, ADL were significantly lower in the elderly with lower food diversity than those with higher diversity, both in urban and rural settings. However, the significant relations between lower QOL and lower food diversity were seen only in urban settings, and not in rural ones both in Qinghai and Ladakh. Lower food diversity was significantly related to depressive mood in urban area, but not in rural ones both in Qinghai and Ladakh. Conclusion: We found the urban-rural differences on food diversity and its relations to health status, and which were the same phenomenon in two different highland settings.

2500 m以上の高所に居住している人口は世界で1億4000万人以上であり, そのうち8000万人がアジアに住んでいると報告されている. 心房細動はよく見られる重要な不整脈の一つであり, 脳梗塞のリスクとしても知られているが, 今まで高所住民における心房細動の有病率についての報告はない. 本研究では高所住民における心房細動の有病率と背景にある基礎疾患の有無を明らかにすることを目的とした. 我々は2009年から2011年にかけてインドのラダーク(標高3000-4800 m), 中国の玉樹(3700 m)に居住している40歳以上の現地住民に対し健康診断を行った. ラダークで733人(平均年齢57.6±11.9歳, 女性418人), 玉樹で448人(平均年齢58.2±11.1歳, 女性254人)の心電図を記録し解析した. 高血圧の有病率は45.3%, 糖尿病型と診断されたのは11.2%であった. 心房細動は3人に認められ, それぞれ80歳女性, 60歳男性, 65歳男性であった. 高血圧はそのうち1人に認められたが, 糖尿病型の者はいなかった. 全体としての心房細動の有病率は0.25%(1181人中3人)であり, 他の地域における報告に比べ明らかに少ないと考えられた, Objective: More than 140 million people worldwide live over 2500 meters above sea level (m). Of them, 80 million live in Asia. Atrial fibrillation (Af), one of the most common arrhythmia, is a potent risk factor for cerebral infarction. However prevalence of Af at high altitude has not been described. The aim of this study was to estimate prevalence and clinical presentation of Af at high altitude. Methods: We conducted health checkup of the dwellers aged 40 years old or above at Ladakh in India (altitude 3000-4800m) and at Yushu in China (3700m) between 2009 and 2011. Seven hundred thirty three ECGs at Ladakh (age 57.6±11.9 years, 418/733 women) and 448 ECGs at Yushu (age 58.2±11.1 years, 254/448 women) were recorded and analyzed. Results: Hypertension and diabetes mellitus were detected in 535 subjects (45.3%) and in 132 subjects (11.2%), respectively. Af was diagnosed in 3 people, who were 80 year-old female, 60 year-old male, and 65 year-old male. Hypertension was detected in one subject, and diabetes mellitus was not detected in these three subjects. The overall prevalence of Af in our study was 0.25 %, which was markedly low as compared to the previous estimates in other areas. Conclusion: It was suggested that prevalence of Af at high altitude was remarkably lower than the prevalence reported in other areas.

私達は, 低地から高地に移動したときにヘモグロビンを増加させることは高地への適応形態の一つと考えられているが, ラダーク地方に定住する住民は多血を呈しておらず, 代償的に心収縮力が増加していることを明らかにした. この差が種族によるものなのか急性期または慢性期の高所への曝露が原因なのか明らかではない. そこで慢性期の高所の適応が種族によって異なる可能性を明らかにするために, 同じ標高に定住するラダーク住民とペルー住民におけるヘモグロビン濃度や心機能を比較した. ペルー在住のメスチソ92人(標高2600m, 平均年齢, 73.3歳, 男/女性38/54人), インディオ62人(標高2600m, 3800m, 平均年齢, 67.1歳, 男/女性19/43人)およびインドラダーク地方在住のラダーキー(標高3200m, 3800m, 平均年齢, 62.8歳, 男/女性26/40人), チベット人(標高3200m, 平均年齢, 65.6歳, 男/女性48/65人)を対象とし2010 年8 月～ 9 月に健康診断を行い, 問診, 診察, 採血検査(血算, 一般生化学検査), SpO2 測定, 心臓超音波検査を行い比較した. ペルーとラダークの比較でヘモグロビンはペルーの方がラダークより高い値であり, 同じペルー内とラダーク内では高地住民の方が低地住民よりも有意に高い値を示した(Cotahuasi: 15.3±0.19 vs.Churca:16.9±0.39g/dl, P=0.0015, Leh: 14.3±0.18 vs. Domkhar Gongma: 15.5±0.31g/dl, P=0.0063). 人種別の比較ではチベット人が他の人種よりも有意差をもってヘモグロビンが低い結果を得た(Tibetan:14.1±2.2g/dl vs. Ladakhi: 15.4±2.7g/dl, P=0.0003, vs. Mestizo: 15.3±1.6g/dl, P=0.0005, vs. Indio: 16.2±1.8g/dl, P, Adaptation to high altitudes differs according to area and race. One of the fundamental physiological responses to hypoxia is an increased hemoglobin concentration. However, as we previously reported, in Ladakh, our investigation revealed not increased hemoglobin but rather a high ejection fraction (EF). To clarify differences in adaptation according to area and race, we evaluated hemoglobin concentrations and cardiac functions in Peru and Ladakh (altitude; 2600-3800m). We recruited 154 subjects from Cotahuasi (2600 m) [ethnicity: Mestizo/Indio=92/20] and Churca (3800m) [ethnicity: Mestizo/Indio=0/42] in Peru in August 2010 (Mestizo: age=73.3±8.4years, sex M/F=38/54 and Indio: age=67.1±9.4years, sex M/F=19/43), and 179 subjects from Leh (3200 m) [ethnicity: Ladakhi/Tibetan=11/113] and Domkhar (3800 m) [ethnicity: Ladakhi/Tibetan=55/0] in Ladakh, India in September 2010 (Ladakhi; age=62.8±9.9years, sex M/F=26/42 and Tibetan; age=65.6±0.9years, sex M/F=48/65). We assessed cardiac functions using echocardiography and laboratory tests. The hemoglobin level in Peru was higher than that in Ladakh, and in both Peru and Ladakh, that of subjects living in the highlands was higher than that of those in the lowlands (Cotahuasi: 15.3±0.19 vs. Churca: 16.9±0.39g/dl, P=0.0015; Leh: 14.3±0.18 vs. Domkhar:15.5±0.31g/dl, P=0.0063). As to ethnicity, the hemoglobin level of Tibetans was significantly lower than that of other subjects (Tibetan: 14.1±2.2g/dl vs. Ladakhi: 15.4±2.7g/dl, P=0.0003, vs. Mestizo: 15.3±1.6g/dl, P=0.0005, vs. Indio: 16.2±1.8g/dl, P

2010年8月にインド北部のラダークを襲った集中豪雨は, 各地で洪水や土砂崩れを引き起こし, 甚大な被害をもたらした. 死者は約200人に達し, 約1万人が被災したとされている. 私たちは被災後1か月後に最も被害の大きかったチョグラムサル地域で, 318人(男性128人, 女性190人, 平均年齢58.6 歳)を対象に調査を行った. 参加者全員に対し, 身体診察と同時にthe two-item Patient Health Questionnaire(PHQ-2)を用いたうつ病のスクリーニングを行い, 家屋と家族の被災状況に留意しながら, 不安, 恐怖, 抑うつ, 不眠など具体的な症状の有無を確かめ, 症状が強い住民に対して, 専門医が精神疾患の有無を診断した. DSM-IV診断基準に適合したPTSDは2例, 大うつ病は5例であり, 災害後の地域住民の有病率を検討した他国の先行研究よりも少数で, その理由をチベット文化も背景に入れながら考察した. チベット文化圏では社会・文化規定性や民族的気質がPTSDや大うつ病の発症に抑制的に働いている可能性がある., Heavy rainfall in northern India in August of 2010 caused flash flooding, seriously damaging homes and infrastructure. To examine the impact of this disaster in Ladakh, we visited Choglamsar, near the town of Leh where the flood had the most severe impact. In total, 318 survivors (mean age, 58.6 years; female-male ratio, 59.7%; Tibetan refugees, 86.2%) participated in the survey. We applied the two-item Patient Health Questionnaire (PHQ-2) with questions covering background characteristics and disaster exposure. A psychiatrist interviewed the survivors with a single or double positive score in the PHQ-2 or with post-traumatic stress disorder (PTSD) symptoms. There were only 2 PTSD cases and 5 with major depressive disorders. PTSD and depression were less common in the Tibetan cultural areas than in other areas. The social background and temperamental characteristics of the Tibetan culture may play a suppressive role in psychiatric disorders.

生活習慣病と診断された者の身体活動量として1 日の歩数を測定し, 彼らの生活実態を探ることを目的とした. 40歳以上のドムカルの住民(ラダーキー)のうち, 高血圧, 耐糖能異常のいずれかに該当した23名(平均年齢61歳, 男性13名 女性10 名)の歩数を1-3 日間にわたって測定した. 年齢と歩数には負の相関が見られ(r =-0.71, p, Objective of the study is to investigate the daily activities of people with hypertension or diabetes using a pedometer to count daily walking steps in one day. We measured walking steps during 1-3days in 23 subjects aged 40 years or over (mean age: 61years old, male/female:13/10) diagnosed as cases of hypertension or impaired glucose tolerance in Domkhar village. There was a significant negative correlation between age and walking steps (r =-0.71, p

Aim: Numerous physiologic studies attempted to explain the effects of ambient hypoxia on humans, and now we know how humans adapted to it through changes in the expression of hypoxia-related genes. However, little is investigated about the gender difference from a view point of glocal (combined global and local) comprehensive assessment. Methods: We studied the effects of high altitude on pulse oximetry (SpO2), blood pressure (BP), heart rate (HR), aortic stiffness of cardio-ankle vascular index (CAVI). Subjects were 1, 858 Ladakhis (777 men and 1081 women). We investigated the gender difference of compensatory mechanisms by comparing the cardiovascular functions among 3 groups of high altitudes, i.e., from 2500 to 3000 m, from 3200 to 3720 m, and from 3800 to 4590m. Results: There observed no significant differences of the cardiovascular function among the three altitudes in men, but in women systolic BP became higher along with the altitudes and incidences of ECG findings, including 1st degree of AV block, ST depression and abnormal Q waves, became more frequent along with altitude. In addition, Ladakhi women showed steeper negative slope of the regression line between SpO2 and age, and larger slope of the regression line between systolic and diastolic BPs and age, compared with Ladakhi men. Conclusions: Our study indicates an existence of gender difference of adaptation to ambient hypoxia especially on cardiovascular functions, which suggests a need for the glocal comprehensive assessment for the better diagnosis and for the more fruitful treatment in community dwellers, especially at higher altitude.

高所住民の心肺機能, および肺高血圧の頻度を明らかにするため, 我々はインド・ラダーク地方の地域住民242名を対象とし, 問診, 診察, 血液検査, 心電図検査, 呼吸機能検査, 心臓超音波検査を施行した. 男女ともに多血症を呈した住民は少なく, 呼吸機能低下や明らかな心不全徴候を含む慢性高山病を呈する住民はいなかった. 女性では左室駆出率が有意に高値で, ヘモグロビンと負の相関をしており, 周囲の環境に適応した結果と考えられた., The aim of this study is to investigate cardiopulmonary function and pulmonary hypertension in healthy highlanders. We estimated 242 subjects (mean age, 55±13; male/female, 84/158). Blood pressure, pulse, SpO2, respiratory function, electrocardiography, echocardiography, chronic mountain sickness (CMS) score, and hemoglobin were measured. A few subjects had polycythemia and no one had CMS. The left ventricular ejection fraction in women was higher than that in men and had an inverse correlation with hemoglobin. This finding may represent a consequence of adaptation to the high-altitude environment.

ヒマラヤ・チベット高所のグローバリゼーションの浸透の異なる地域を比較することによって, 生活習慣病と老化の変容の実態が明らかになってきた. 高所環境適応への長期の歴史との密接な関連の中で, 生活習慣病の変容が, 今まさに起こっていること. また, 最近のグローバル化のライフスタイルの変化による, 健康や老化の変容への影響が非常に大きいことである. さらに, 今後の課題としては, 高所の特徴である低酸素に対する進化的身体的適応が, 生活習慣病の発症や老化の変容に予防的に働くのか, あるいは, 促進しているのか. 高所への文化的適応としての高地文明と, グローバル化による生活の変化の中で, どのように, 老人のQOL の向上につなげていくべきかを追求していく必要がある., Elderly highlanders have had long-term adaptation to the harsh environment of hypoxia and low food resources; however, rapid changes in life styles associated with the progress of global modernization and urbanization might overwhelm high altitude adaptation with lifestyle-related diseases and the change of ageing in elderly highlanders in Himalaya/Tibet. Worthy of study is the question of whether elderly highlanders who have had evolutionary adaptation to hypoxic environments are vulnerable to lifestyle-related diseases associated with globalism.

うつ病の有病率は地域や文化によって異なることが報告されているが, 高所地域における有病率は明らかではない. 60 歳以上の地域在住のラダーク人114人(平均年齢69.2歳, 女性58.8%), 青海省玉樹のチベット民族173人(66.51歳, 女性61.3%)を対象に, Patient Health uestionaire-2(PHQ-2)とGeriatric Depression Scale-15(GDS)を用いてうつ病のスクリーニングを行った. スクリーニング陽性の住民に対し専門医が構造化面接を行い, うつ病の有無を診断したところ, ラダークでは1.8%, 青海省では2.3%にうつ病がみられ, 2つの地域でうつ病の表現型は異なった., To determine the prevalence of depression in the high-altitude regions of Ladakh and Qinghai, we recruited 114 Tibetan subjects from Ladakh, India (mean age, 69.2 years; female-male ratio, 58.8%) and 173 Tibetan subjects from Qinghai, China (66.5 years; 61.3%). The two-item Patient Health Questionnaire (PHQ-2) and the Geriatric Depression Scale (GDS) were administered to the subjects. A psychiatrist interviewed the residents with a single or double positive score in PHQ-2 and with a score of ≧ 5 points on the GDS. The prevalence of depression over 60 years old was 2.6% in Ladakh and 2.3% in Qinghai. There were differences in expression of the symptoms of depression according to the culture.

Aim: To investigate the association of comprehensive health of elderly highlanders in Qinghai in China with biological and cultural adaptation to hypoxic environment. Methods: Activities of daily living (ADL), screening-based depression, quality of life (QOL) and checking-up of metabolic syndrome including community-based oral glucose tolerance test were assessed in 393 community-dwelling elderly subjects in Haiyuan and 219 Tibetan highlanders in YuShyu. Results: Tibetan elderly highlanders were more disabled in ADL, but had higher QOL than Han elderly ones in Haiyuan. Blood pressure measurements, rate of hypertension and hemoglobin concentrations in Tibetan elderly highlanders were lower than Han ones in Haiyuan. Despite of lower ADLs, subjective QOLs in Tibenatn elderly was higher than Han elderly in Haiyuan. Prevalence of metabolic syndrome was higher and scores in ADL was lower in Tibetan elderly in YuShyu than those in Haiyuan. Conclusion: Prevalence of metabolic syndrome in elderly highlanders in Haiyuan was not still high even now, however, that in YuShyu was increasing. Further investigation on physiological adaptability to hypoxic environment and human ageing phenomena in global context may open new research frontier for ageing science.

インド・ラダックの医学の問題をレビューし, 予備調査の結果や情報収集とあわせて今後の課題を概説した. インド・ラダックでは, 高血圧と脳梗塞の問題, 貧困と野菜の不足と胃癌の問題, 塵肺, 硅肺の問題がある. 社会・経済的グローバリゼーションに伴うライフスタイルの変化が, 疾病, 老化のあり方とともに, 老人のwell-being にどう影響するかを今後, 医学, 文化, 生態の各学問分野の連携により, 環境や生態のバックグラウンドとの因果関係を調べていく必要がある., The health problem in Ladakh in India was reviewed. There were the problems on hypertension, stroke, gastric cancer associated with poverty and low intake of vegetable, pneumoconiosis, and silicosis. Now, rapid lifestyle changes with socio-economic globalization are occurring and effects will be prominent. The influence of changing lifestyles on these diseases and quality of life in the elderly should be studied from interdisciplinary and comprehensive perspectives, including medicine, geography, agriculture, anthropology, meteorology, ecology and economics.

高所では, 低圧と低酸素の他に, 温度, 風, 日照, 紫外線の影響, 昼夜の温度差, 生活様式, その他不明の要因が, 複雑に交錯して, 生命予後・疾病予後に影響を及ぼし, 高所地域住民の寿命は60歳余りと短いとされている. そこで本研究では, 平地に住む高知県T 町ならびに北海道U 町の地域住民の調査結果と比較することにより, ヒマラヤ地域に住む高所住民の健康のあり方を考察した. 2004年8月-2008年7月の間に, ラダック(Ladakh)地域の41集落(標高3300m から4590m)地域住民946名(13-92 歳, 平均51.4 歳, 男453 名, 女493 名)を対象に, 総合的機能評価を行ない, 北海道U 町住民183名と, 高知県T 町住民311名の, フィールド医学調査と比較した. 冠動脈疾患とメタボリック症候群の頻度は, 各々, 2%, 3%と少なく, 心房細動例は認められなかった. 一方, 頭痛の訴えは32%と多かった, ラダック地域住民の睡眠時間は, U町住民よりも長かったが(p < 0.01), 就眠までの時間は, 短時間であった(25.6 vs. 15.5 分, p < 0.005). ラダック住民は, 歩く速さが遅く(Up & Go; 12.9 vs. 14.6sec, p < 0.0005), Functional Reach が短く(26.4 vs. 21.7cm, p < 0.05), ボタンつけはずしに長い時間を要した(p < 0.00001). SpO2 はT 町に比し低く(96.6 vs. 85.2%, p < 0.00001), 呼吸数は頻数であった(18.3 vs. 22.1回/分, p, This investigation was particularly focused on chronoecology in Ladakh, to study quality of health as a physiological system at high altitude, as a comparison with the chronoecological study in Japanese T-town, Kochi and U-town, Hokkaido. Effects of high altitude on life style and cardiovascular function were studied by glocal (i.e., global and local) comprehensive assessment, including a questionnaire on sleep habit, in 946 Ladakhis (from 13 to 92 years, average 51.4 years of age, 453 men and 493 women), living at altitudes of 3300 to 4590 m, and in Japanese residents of 183 U-town and 311 T-town. Residents in the high-altitude community of Ladakh had a less frequent suffering from coronary artery disease, atrial fibrillation and metabolic syndrome (3%, 0%, 3%, respectively), but a longer sleeping time (p

This investigation was particularly focused on chronoecology in Ladakh, to study circulation as a physiological system at high altitude, as a comparison with the chronoecological study in several Japanese towns. Aortic stiffness of cardio-ankle vascular index (CAVI) was measured using a VaSera instrument (Fukuda Denshi, Tokyo) in 25, 211 Japanese (13, 366 men and 11, 845 women) and in 1, 336 Ladakhis (561 men and 815 women), living at an altitude of 3250 to 4647 m. Effects of high altitude on neuro-cardiovascular function were studied by glocal (i.e., global and local) comprehensive assessment, including the Kohs block design test, the Up & Go, the Functional Reach and the Button tests, in Japanese T-town (80.7 years, 97 men and 227 women), in Japanese U-town (79.9 years, 47 men and 70 women), and in Leh, Ladakh (74.7 years, 19 men and 21 women) at an altitude of 3250 m. Residents in the highaltitude community of Leh had a poorer cognitive function, estimated by the Kohs block design test (9.0 vs. 16.4 points, p

Domkhar consists of three villages located in the northwestern part of Ladakh, at altitudes between 2900 and 4000 meters above sea level. We visited there in July, 2008 and conducted medical check-ups for the elderly and interviewed with them. About 73% of elderly residents over 60 years old who took our medical checkups had blood pressures of 140/90 mmHg or higher. Knee pain was the most common symptom supposed to be associated with heavy physical activities in the mountain. The average arterial blood oxygen saturation was 91.4±3.6 % among males and 88.7±4.8 % among females. The average hemoglobin level was 15.9±2.8 g/dl among males and 13.9±2.9 g/dl among females. Three out of 17 residents had a casual blood sugar 140 mg/dl or more. The average subjective quality of life (QOL) measured by visual analogue scale was 52.7±18.0 in health, 82.2±10.0 in family relationship, 82.7±9.9 in friendship, 62.4±21.3 in economics and 69.4±19.0 in happiness. We should pay more attention to the impact of changing lifestyle and environments on prevalence of lifestyle-related diseases and QOL in the elderly in highland worlds.