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ABSTRACT: Relative deprivation has been hypothesized as one of the pathways accounting for the link between income inequality and health. We tested this hypothesis in a large national sample of men and women in Japan. Our survey included a probability sample of 22,871 men and 24,243 women aged 25-64, from whom information was gathered on demographic variables, household income, occupation or employment status, and self-rated health. Our measure of relative deprivation was the Yitzhaki Index, which calculates the deprivation suffered by each individual as a function of the aggregate income shortfall for each person relative to everyone else with higher incomes in that person's reference group. We modeled several alternative reference groups, including others with the same occupation, others of the same age group, and others living in the same geographic area (prefecture), as well as combinations of these. Generalized estimating equations demonstrated that higher relative deprivation was associated with worse self-rated health. Even after controlling for absolute income as well as other sociodemographic factors, the odds ratio and its 95% confidence intervals (CI) for poor health ranged from 1.09 (95% CI: 1.02-1.16) to 1.18 (95% CI: 1.11-1.26) for men and from 1.10 (95% CI: 1.04-1.16) to 1.16 (95% CI: 1.09-1.23) for women per 1 million increase in the Yitzhaki Index. As such, relative income deprivation is associated with poor self-rated health independently of absolute income, and relative deprivation may be a mechanism underlying the link between income inequality and population health.
Social Science [?] Medicine 09/2008; 67(6):982-7. · 2.70 Impact Factor
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ABSTRACT: The aim of this study was to assess the effectiveness of early home-based intervention as a community health service and evaluate the influence of both early maternal depression and mother-infant relationships on child behavioral problems at age 2 in a longitudinal setting.
A randomized controlled trial was conducted in this study. A total of 95 mother-infant pairs were assigned randomly to intervention (48) or control (47) groups. The intervention group received monthly specific home visits between the infant ages of 5 and 9 months while the control group received only routine center-based services. Maternal depression and the mother-infant relationship were assessed by medical checkups at the ages of 4 and 10 months. Child behavioral problems were assessed at age 2.
The intervention had no significant impact on child behavioral problems. However, for mothers who had a disturbed relationship with their infants, the rate of improvement in the quality of the relationship was higher in the intervention group. Disturbed mother-infant relationships at 10 months and early maternal depression significantly increased the risk of high scores on the Child Behavior Checklist (CBCL).
These findings indicate that intervention is most likely to have a positive impact on the quality of mother-infant relationships in cases where the relationship is disturbed and that a disturbed mother-infant relationship and maternal depression during infancy are relevant to the future mental health of the child. To prevent difficulties in child functioning, more prolonged interventions focusing on disturbed mother-infant relationships may be required.
Early Human Development 11/2007; 83(10):683-91. · 2.05 Impact Factor
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ABSTRACT: We analyzed the data of a nationwide opinion survey reported in a previous study and clarified the importance of socioeconomic status and individual belief on people's opinion regarding the pros and cons of gestational surrogacy. In this study, we analyzed the data of this nationwide opinion survey to identify the effect of providing information about assisted reproductive technology (ART) on the people's attitude towards not only gestational surrogacy but also other ART procedures.
This was a cross-sectional study. A nationwide opinion survey on ART was conducted in 2003. The participants included 3647 people (1564 people received only the questionnaire and 2083 people received the questionnaire and a brochure containing information about ART). Multivariate-adjusted odds ratio and 95% confidence interval were obtained using logistic regression models for understanding the manner in which the knowledge about ART affects the attitude of the general population towards ART, which uses donor gametes and surrogacy.
With regard to gestational surrogacy, men in the brochure group could not clearly express their opinions when compared with those in the no-brochure group (odds ratio (OR): 0.69; 95% confidence interval (CI): 0.53-0.89). In contrast, with regard to donor insemination, women in the brochure group could clearly express their opinions when compared with those in the no-brochure group (OR, 1.24; CI, 1.02-1.52). Information about ART, especially in men, promoted disapproval of partial surrogacy (OR, 0.59; CI, 0.44-0.78) and gestational surrogacy (OR, 0.64; CI, 0.48-0.86). On the other hand, for other ART procedures, we found no significant association between receiving information via the brochure and people's attitude towards the technology.
There were gender differences in attitude toward surrogacy that was affected by providing information about ART. Moreover, determining community attitudes, we observed that a good understanding of the information provided facilitates the expression of a clear opinion, thereby assisting respondents in deciding whether or not they approve of a certain technology.
European Journal of Obstetrics & Gynecology and Reproductive Biology 07/2007; 132(2):193-9. · 1.97 Impact Factor
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ABSTRACT: Although gestational surrogacy offers several advantages, this procedure has given rise to some ethical and legal issues. We aimed to clarify the factors affecting the attitude of the Japanese toward gestational surrogacy.
Cross-sectional study.
Nationwide opinion surveys concerning assisted reproductive technologies (ART) were carried out in 1999 and 2003. Participants included 2568 and 3647 people from the general public surveyed in 1999 and 2003, respectively (1564 people received only the questionnaire, and 2083 people received a questionnaire and brochure about ART).
Multivariate-adjusted odds ratio and 95% confidence interval from logistic regression models for factors affecting the attitude toward gestational surrogacy.
In both surveys, approximately half of respondents approved of gestational surrogacy; 20-30% disapproved of the procedure. People with high socioeconomic status clearly expressed their opinion on this issue. A liberal attitude toward gender role promoted approval of gestational surrogacy; a liberal attitude toward family had the opposite effect.
Our findings suggest that socioeconomic status affects people's expression of their opinion regarding this issue, while attitudes toward this procedure were influenced by individual belief. Considering socioeconomic status and diversity of individual belief is required for further discussion on this topic.
European Journal of Obstetrics & Gynecology and Reproductive Biology 06/2006; 126(1):39-47. · 1.97 Impact Factor
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ABSTRACT: Disability-free life expectancy (DFLE) data for 47 prefectures in Japan were reported in 1999; however, few studies have identified the factors associated with the length of the DFLE. The objective of this study was to elucidate the primary factors that explain differences in DFLEs in Japan.
In our ecological study, 47 prefectures in Japan were used as units of analysis. The DFLEs for men and women at 65 years of age (DFLE65), calculated by Hashimoto et al using Sullivan's method, were set as dependent variables. From various national surveys, 181 factors associated with demographics, socioeconomic status, health status and health behaviors, medical environment, social relationships, climate, and other areas were gathered as independent variables. Pearson's or Spearman's correlation coefficients were calculated to screen independent variables potentially associated with the DFLE65s. Then, multivariate linear regression analyses were conducted for the selected 24 independent variables after adjusting for the proportion of older people (65 years or more) and population density.
Multivariate linear regression analyses revealed that the large number of public health nurses per 100,000 population, a good self-reported health status, and a high proportion of older workers were significantly associated with long DFLE65s for both genders.
These three factors could potentially explain the differences in DFLE of the older population in Japan.
Journal of Epidemiology 12/2005; 15(6):219-27. · 1.86 Impact Factor
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ABSTRACT: Carcinomas of the biliary tract have a poor prognosis. It is important to understand the molecular genetic characteristics of these tumours in order to employ newer effective treatments and to improve patient prognosis. There is increasing evidence that overexpression of tyrosine kinase growth factor receptors such as ErbB-2, epidermal growth factor receptor (EGFR), and Met may play important roles in the development of biliary tract carcinomas. The aim of this study was to assess the potential for novel chemotherapies targeting these receptors. Overexpression of the tyrosine kinase receptor proteins was examined by immunohistochemistry in 221 biliary tract carcinomas, of which 28 were from the intrahepatic bile duct, 78 from the extrahepatic bile duct, 89 from the gall bladder, and 26 from the ampulla of Vater. Positively stained tumours were further examined for gene amplification by fluorescence in situ hybridization. Overexpression of ErbB-2 was found in 15.7%, 11.5%, and 5.1% of carcinomas of the gall bladder, ampulla of Vater, and extrahepatic bile duct, respectively, and gene amplification was present in 79% of these. Overexpression of EGFR was found in 8.1% of tumours with no predominant location and was also associated with gene amplification with high frequency (77%). Met overexpression, most frequent in intrahepatic bile duct carcinomas (21.4%), was not associated with gene amplification. It is proposed that the new adjuvant chemotherapies could be directed to carcinomas of the biliary tract in which ErbB-2 and EGFR are overexpressed.
The Journal of Pathology 08/2005; 206(3):356-65. · 6.32 Impact Factor
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ABSTRACT: Rapid population aging in Japan has led to rising demands for informal care giving. Traditionally, care giving for aging parents has fallen disproportionately on the shoulders of women living in multigenerational households. However, rising labor force participation by Japanese women, declining marriage and fertility rates, and women's changing expectations have combined to produce unprecedented strains on traditional multigenerational households where care giving to elders traditionally takes place. In this paper, we explored gender-specific relationships between family structure, stress and worries, and health behaviors, using linked data from two national surveys conducted in Japan: the 1995 Comprehensive Survey of the Living Conditions of People on Health and Welfare, and the 1995 National Nutrition Survey. We found that women in multigenerational households reported more care-giving worries, and also less future health and financial worries. Living with parents was associated with protective health behaviors (less smoking, less heavy drinking), but also more sedentary behavior among women, while men in "sandwich" families (i.e., living with both parents and children) reported heavier smoking. The association of family structure and health behavior was not mediated by worries. Living alone was associated with worse health for women. These findings suggest gender-specific patterns of worries and health behaviors that reflect both the health-protecting and health-damaging effects of living in multigenerational households.
Social Science [?] Medicine 08/2004; 59(1):69-81. · 2.70 Impact Factor
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ABSTRACT: Overexpression of HER-2 and the epidermal growth factor receptor (EGFR) has been observed in many cancers, sometimes accompanied by gene amplification. To assess whether novel chemotherapies targeting these overexpressed proteins may be effective for the treatment of colorectal cancers, we examined the exact frequency of HER-2 and EGFR overexpression, the relationship between gene amplification and protein expression, and the heterogeneity of gene amplification within and between primary and metastatic tumors. We evaluated 244 colorectal cancers immunohistochemically. All tumors found to overexpress HER-2 or EGFR were further analyzed for gene amplification by fluorescent in situ DNA hybridization. Overexpression of HER-2 and EGFR was found in 8 (3%) and 19 (8%) of the 244 colorectal carcinomas, respectively. Gene amplification was observed in 100 and 58% of the tumors exhibiting HER-2 and EGFR overexpression, respectively. HER-2 amplification in cancer cells was characterized by clusters of hybridization signals, suggesting amplicons in homogeneously staining regions that were predominant in most primary and metastatic tumors. EGFR amplification, observed as scattered signals reminiscent of amplicons in double minute chromosomes, or coamplification of EGFR with the centromeric regions was observed as a minor population within primary tumors, and found in variety of populations in metastatic tumors. Overexpression of HER-2 and EGFR were observed in only a small fraction of colorectal carcinomas, but were frequently accompanied by gene amplification.Keywords: HER-2, EGFR, FISH, colorectal cancer, immunohistochemistry, gene amplification
Modern Pathology 05/2004; 17(8):895-904. · 4.79 Impact Factor
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ABSTRACT: We examined whether fatty liver, as diagnosed with abdominal ultrasonography, is an independent risk factor for diabetes mellitus during 10 years of follow-up. A total of 840 subjects (467 men and 373 women) were followed for the entire 10 years. The criteria for being non-diabetic were having no history of diabetes, having a fasting plasma glucose level of less than 110 mg/dl and a serum hemoglobin A1c level of 6.4% or less. We indicated that every examine received all examinations after 12 hours of fasting. Well-trained technicians performed abdominal ultrasonography. Although univariate analysis revealed that the presence of fatty liver was related to hyperglycemia 10 years later, multiple logistic regression analysis did not support this finding. In the multiple logistic regression analysis fasting plasma glucose levels at the baseline and age were significantly related to hyperglycemia (odds ratio [OR] = 1.16, 95% confidence interval [CI]: 1.11-1.21, OR = 1.07, 95% CI: 1.01-1.14, respectively). Fatty liver was not an independent risk factor for hyperglycemia in our follow-up study 10 years after the first diagnosis. The high fasting plasma glucose levels were a risk factor for diabetes, even in the normal range.
Journal of Epidemiology 02/2003; 13(1):15-21. · 1.86 Impact Factor
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Toru Ishihara, Yasuhisa Takeda,
Takasi Mizutani,
Masako Okamoto,
Minako Koga,
Unai Tamura,
Nanae Yamada,
Shunyue Cheng,
Kazuhiko Nakamura,
Sumio Iijima,
Zentaro Yamagata
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ABSTRACT: A longitudinal study was analyzed to clarify relationships between infant lifestyle, obesity, features of family life and adolescent obesity.
Subjects in the present study were born between April 1987 and March 1991, in Enzan City, Yamanashi prefecture. Infant height and weight were measured and questionnaires were collected at medical check-ups at 1.5- and 3-year-of age. Adolescent height and weight were measured in April 2000. Obese adolescents were defined as those with on obesity index > or = 20%.
At 1.5-years-of age, 883 responses to the questionnaire were obtained, and 737 subjects were followed to adolescence (83.5%). Mean follow-up period was 10 years 11 months. A high Kaup index at 1.5-years-of age (odds ratio (OR) 2.61; 95% confidence interval (CI) 1.11-6.12) and when 3-years-of age (OR 5.34; CI 2.54-11.23), as well as maternal obesity (OR 5.32; CI 2.67-10.60) represented risk factors for adolescent obesity. Of the lifestyle items, "playing alone inside" at 1.5-years-of age (adjusted OR 3.01; CI 1.01-8.99) and "taking snacks without time constraints" at 3-years-of age (adjusted OR 2.12; CI 1.25-3.61) were additional risk factors. In food items, only low intake of cow's milk displayed a significant relationship with adolescent obesity, the link being negative with an adjusted OR of 0.63 (CI 0.41-0.95). Covariance structural analysis was performed and a causal model was constructed. Maternal obesity, obesity at 3-years-of age, playing alone inside, taking snacks without time constraints, and low intake of cow's milk were all associated with obesity in infancy. Maternal obesity affected methods of answering child demands, in turn affecting snacking habits.
Adolescent obesity displays relationships with maternal obesity, a high Kaup index in infancy, play activity, snacking habits, and intake of cow's milk. Although genetic factors exert a strong influence, these components of infant lifestyle all play a role in the development of adolescent obesity.
[Nippon kōshū eisei zasshi] Japanese journal of public health 02/2003; 50(2):106-17.
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ABSTRACT: We investigated the prevalence of musculoskeletal disorders (MSD) and skin disease within a Japanese compact disk (CD) manufacturing plant. For this study, a stratified cross-section of workers completed self-reported questionnaires distributed over a 6-month time period. Low back pain (LBP) was the most commonly reported category (affecting 20.1%), followed by MSD of the shoulder (15.4%), neck (10.1%) and head (5.4%). Dermatitis was the most frequent skin disease (affecting 8.1%), followed by eczema (3.4%), acne (3.4%) and xerosis (2.7%). The odds of suffering neck MSD was 10.8 times higher among staff who sat in a chair all day (95% CI 1.8-112.8, P < 0.05). Standing all day was also a risk factor for this condition (OR 8.2, 95% CI 1.2-81.7, P < 0.05). Female gender increased the risk of shoulder MSD 4.3 fold (95% CI 1.4-13.7, P < 0.05), as did alcohol consumption (OR 3.3, 95% CI 1.1-11.9, P < 0.05). The odds of suffering any skin disease were significantly enhanced by working longer than 12 months in one's current job (OR 10.7, 95% CI 1.5-7.3, P < 0.05) and having a history of atopic disease (OR 7.2, 95% CI 2.6-21.4, P < 0.001). Overall, the staff within our study reported generally lower levels of MSD and skin disease than in previous investigations of other workplaces.
Journal of UOEH 12/2002; 24(4):397-404.
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ABSTRACT: Few studies have investigated the association between smoking and ultrasonographically diagnosed gallbladder (GB) disease, and their results were uncertain. This study was conducted to examine the association between smoking and drinking and GB diseases.
A total of 9,947 subjects (age, 30-69 years; 4,953 men and 4,994 women) voluntarily received a paid medical check-up at our center in Yamanashi Prefecture in Japan. All of the subjects underwent abdominal ultrasonographic (US) examination, a demographic check, and a biochemical test, and answered a self-administered questionnaire asking about smoking habits and alcohol consumption. Of the 9,947 subjects, 483 had gallstones, 819 had gallbladder polyps, and 169 were in a state of postcholecystectomy. We compared the findings in this group with the findings in 8,417 people (4,144 males and 4,273 females) with normal gallbladder.
Multiple regression analysis among males showed that cigarette smoking was inversely related to GB polyps (odds ratio, [OR], 0.76; 95% confidence internal [CI], 0.59-0.98 and OR, 0.74; 95% CI, 0.56-0.98, respectively, for current and ex-smokers). Ex-smokers a showed positive association with the postcholecystectomy state (OR, 2.56; 95% CI, 1.18-5.52). Light drinkers showed an inverse relation to GB stones (OR, 0.69; 95% CI, 0.49-0.99), and heavy drinkers showed an inverse relation to GB polyps (OR, 0.68; 95% CI, 0.51-0.90). Current drinkers showed an inverse relation to the postcholecystectomy state (OR, 0.48; 95% CI, 0.28-0.83).
Cigarette smoking was inversely related to gallbladder polyps in males and was positively related to the postcholecystectomy state. Drinking was inversely related to gallstones, GB polyps, and the postcholecystectomy state in males.
Journal of Gastroenterology 02/2002; 37(6):455-62. · 4.16 Impact Factor
