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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

We diagnosed 64 cases of neurological diseases, in the survey during 2001 to 2012, consisting of 1) ALS; 17 cases of probable and definite ALS, 10 cases of possible ALS, including three cases with cognitive impairment (CI), 2) 13 cases of ALS and/or parkinsonism including five cases with CI, 3) 19 cases of parkinsonism including one case with CI, 4) 2 cases of poliomyeloradiculitis, 5)one case of Dopa responsive dystonia. Crude point prevalence rate of pure ALS was estimated at least 73-133/100, 000 people and that of overlap of ALS and parkinsonism was at least 53-98/100, 000 by the survey in Bade in 2007 and in the villages along Edera and Dumut rivers in 2010. Though lower than the prevalence previously reported, the recent prevalence of ALS in this region of Papua is still higher than the global average.

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] The way people feel bad is different according to the culture. Although group related bias named differential item functioning (DIF) is studied in various scales including depression scale, DIF has not been studied in primary health questionnaire-9(PHQ-9), which is translated into over 80 languages. We evaluated DIF of PHQ-9 at Yushu (China) and Tosa(Japan). [Methods] Among the participants of health check-up program (Yushu; n=184, Tosa; n=305), those who were positive in one of the two question depression screening questions were included in our study (Yushu; n=44, Tosa: n=132). Certified psychiatrist checked PHQ-9 and answers of each item were dichotomized. [Results] Positive rate in Q1 (interest loss), Q2 (depressed mood), Q4 (easy fatigability) and Q6 (self-reproach) were greater in Yushu compared with Tosa after adjustment of age. Positive rates in Q3 and Q4 were high in Tosa and those in Q1, Q2, Q4 and Q5 were high in Yushu. [Conclusion] DIF related to the regions were seen in Yushu and Tosa town. The contributing items to the diagnosis of major depression were different according to the region. As the phenotype of major depression could be different in each region, we should be aware of them in the diagnosis and intervention.

Background: Explanatory models (EM) increase help-seeking behavior, treatment satisfaction and good relationships with clinicians. Tibet experienced political pressures and experienced two big earthquakes in modern times, which should have influenced the prevalence of depression in the region. However, there were no studies on depression and its explanatory models in Tibet region. Method: Among the persons who joined in the community health-checkup, those with positive depression screening test were included in the study. The number of subjects was 42 in Yushu. The vignette of depression and questions from semi-structured explanatory model interview were used to clarify the EM. The pattern of response was analyzed quantitatively and qualitatively. Results: The percentage of subjects who regarded the person in the vignette as being ill was 78.6%. The main problem and the cause of the case which subjects recognized was related to the social and familial matter, especially partner related matter, which was about 70 to 80%. As for the actions against the problem, 47.6% of the subjects sought solution in employment, but no one answered they sought solution in medicine. However, 85.7% of subjects appreciated doctor's role in the situation, when asked. There were no significant relation between the cognition of illness and the medical help seeking potential. The percentage of subjects who were diagnosed with depressive disorder other than major depression was 35.7%. Conclusion: EM and its relation to the help seeking behavior may be different according to the communities, which should be cared in the intervention in the help seeking behavior.

【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.

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.

インド・ラダークでの過去の医学調査によって, 高所住民における生活習慣病の実態が明らかになり, その背景ともいえる食事の調査を実施することは重大な課題であった. 本稿では, 現地での詳細な食事調査に向けて, ラダークでよく食べられている基本料理における栄養成分のデータベースを構築し報告する. ここで報告する料理の栄養成分データは, それぞれの料理の成分や分量を「秤量法」により計測し, 栄養価計算を行い算出した. ラダークにおいて主に食べられている料理(ツァンパ, 麺類, パン類, ご飯類)を網羅しており, 住民を対象に行う今後の食事調査において有用なデータベースといえる, Previous medical survey in Ladakh revealed actual existence of lifestyle-related disease in highland, so that food survey is highly important as one of its backgrounds. Aim of this study is to develop Nutrients Database on Ladakhy main diet for further nutritional assessment of the villagers. Each nutrients data was calculated by using Food Weighting Method. This database covers main staple foods in Ladakh such as Tsampa, noodle, bread and rice, and will be very useful for the further food survey in Ladakh.

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

Objective: Meat is one of the most popular foods seen at the daily meal for Tibetan highlanders. However, little is reported about the actual frequency of meat intake and its relation to their health. Meat intake is known to associate with aging, thus we aim to examine the frequency of meat intake and its relation to health of the elderly highlanders in Qinghai plateau, China. Methods: The study population consisted of 238 community-dwelling elderly subjects aged 60 years or more (174 Han elderly subjects, 64 Tibetan ones). Food questionnaire was carried out 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: High frequency of meat intake was found in Tibetan elderly (about 70% of the Tibetan subjects eat meat everyday) compared to the Han elderly living in the same area. The higher frequency of meat intake was related to older age in Tibetan subjects, which is opposite result of Japanese ones. ADL was significantly higher in the Han elderly with higher frequency of meat intake than those with lower frequency, but not in Tibetan ones. A close association was found between frequency of meat intake and financial satisfaction in Tibetan elderly subjects, but no relation were seen between depression, QOL and frequency of meat intake. Conclusion: Frequency of meat intake and its relation to health in Tibetan subjects had appeared a different character from Han and Japanese ones. Cultural tradition on foods seems to be well influenced in Tibetan elderly highlanders.

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.

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.

青海省高地住民の漢人とチベット人を比較すると, 糖尿病, 高血圧を含めた生活習慣病と多血症を特徴とする慢性高山病の発症の違いがあるとともに, 生活習慣病と慢性高山病との関連の仕方においても違いを認めた. 進化的な低酸素適応の違いが, 生活習慣病の現れ方の違いに影響を与えている可能性がある. 高血圧の頻度において, 青海省では, 漢人よりチベット人で高血圧が少なかった一方, 観光地化されたシャングリラのチベット人で高血圧は多く, 近年の急激なライフスタイルの変化により, 高血圧の罹患においても, 高地住民は脆弱である可能性がある. シャングリラと同様に, 青海省のチベット人は, 生活機能障害や身体の障害において, 漢人や日本人より障害が大きいにもかかわらず, 主観的Quality of life(QOL)においては, 健康度を除いて, 家族関係, 友人関係, 経済状態, 幸福度において明らかに高く, その原因のひとつとして, スピリチュアルな要素が重要と思われた. 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, 主観的なQOLと客観的なQOLにどう影響しているかを調べながら, チベット人の高いQOLを支える価値観や, それを支える高地の「老人智」を追求していく必要がある., There was the close association of polycythemia with life-style related diseases (high blood pressure and glucose intolerance) in high-altitude elderly people. Han people had higher hemoglobin concentration after adjustment of age, sex and life-style related diseases compared with Tibetan people. The difference of hemoglobin concentration may be due to Tibetans undergoing a much longer period of adaptation than Han people. The further and longitudinal study may be needed to disclose the association between the different ways of hypoxic adaptation with susceptibility to life-style related diseases. It should be also disclosed that how life-style related diseases would aggravate the risk of CMS. The prevention of life-style related diseases may be important for the prevention of CMS in highlanders. We have reported that subjective quality of life of elderly highlanders is higher in spite of having more disorders and they have characteristic sense of value compared with that of the elderly population in Japan. There may be characteristic" wisdom of the aged", i.e. wisdom for the sustainable livelihood, sense of value with high quality of life and community-networks for supporting and respecting elderly people in the harsh high-altitude environments. "Wisdom of the aged" will be studied further in various perspectives.

Amyotrophic lateral sclerosis (ALS) and parkinsonism-dementia occurred in the highest incidence among primitive Auyu and Jakai people on the southern coastal plain of West New Guinea (Indonesia, Papua) (Gajdusek DC, 1982). After the survey of Gajdusek DC the study is rare about neurodegenerative diseases in Papua. To clarify the prevalence of neurodegenerative diseases in people in West New-Guinea we had the fieldwork survey in 2001-02 and 2006-07. In the survey of people in village of Kepi, Bade and others (population of9700) in 2001-02, 5 patients with parkinsonism and 11 patients with ALS and related diseases and 6 cerebro-vascular diseases were found. In the survey of people in village of Bade and others (population of 8100) in 2007, 6 patients with parkinsonism and 6 patients with ALS and related diseases and 10 cerebro-vascular diseases were found. West New Guinea is the high prevalence area of neurodegenerative diseases still now and cerebro-vascular diseases are increasing. Following-up study should be carried out further.

1999年7月19日から8月29日にかけて, インドネシア・イリアンジャヤ州・ソロバ村周辺地域において, 現地住民を対象に, 医学学術調査を実施した(第一次隊:7月19日-98年8月17日, 第二次隊:8月15日-8月29日). 派遣母体は, 高知医大アジア・僻地医療を支援する会と高知医大フィールド医学研究会であり, 前者は第一次隊として, 3年前から計画しているソロバ村診療所設立に必要な井戸の削掘ならびに予備的医学調査として現地の医療状況に関する情報の収集と現地住民のライフスタイルの把握を行った. 第二次隊は, 現役医師ならびに看護婦を含めた医療隊として, 現地住民に対する施療に従事するのと併行して, 諸種医学調査にたずさわった. 本地域は, 政治的理由によって, 外国人による諸種の調査が困難な地域であるため, とりわけ, 原住民に関する医学的実態はいままで明らかにされていない. 以下は, その行動の概要である.

We had a chance to examine the people Iive in Irian Jaya in lndonesia. We visitted Soroba village and examined the blood chemistry of Dani tribe. They eat only sweet potatoes .every meal and very rarely pork. 215 people visitted our camp and we could examine 176 people (88 males and 88 females，mean age 37-year old). We checked total protein(TP), albumine(Alb), total cholesterol(Tcho), total biIirubin(TB), serum transaminase(GOT, GPT), lactate dehydrogenase(LDH), blood urea nitrogen(BUN), Creatinine(Cre), glucose(Glu). Compare with ]apanese, TP was rather higher but Alb and Tcho were lower. Only in women GPT was higher. Other results were similar as Japanese. Comparing between male and female，A lb and Cre were higher in male. There were no difference in other results. Between age and laboratory data, there were only mild correlation with Alb, BUN and Glu.

パキスタン国のフンザ地方グルミット村において, �55歳以上の中・高年者の住む家庭.35軒を訪問し, 日常の生活状況, 同居する家族の構成, 使用言語, についてアンケート調査を行った. また, フンザ老人の主観的幸福感をVisual Analogue Scale of Happiness("VAS-H"), 主観的幸福度スケールを用いて評価した. 一部の対象者に対しては, より簡便なVASを考案し, VAS-HとNew VASとの関係を比較した.