[Show abstract][Hide abstract] ABSTRACT: Objectives The objective of this study was to investigate the cumulative return to work (RTW) rate and to clarify the predictors of the time to full-time RTW (full RTW) and resignation among Japanese stroke survivors, within the 365-day period following their initial day of sickness absence due to stroke.
Setting This study was based on tertiary prevention of occupational health in large-scaled Japanese companies of various industries.
Participants The participants in this study were 382 Japanese workers who experienced an episode of sickness leave due to clinically certified stroke diagnosed between 1 January 2000 and 31 December 2011. Data were obtained from an occupational health register. Participants were followed up for 365 days after the start day of the first sickness absence. The cumulative RTW rates by Kaplan-Meier estimates and predictors for time to full RTW and resignation by Cox regression were calculated.
Results A total of 382 employees had their first sickness absence due to stroke during the 12-year follow-up period. The cumulative full RTW rates at 60, 120, 180 and 365 days were 15.1%, 33.6%, 43.5% and 62.4%, respectively. Employees who took sick leave due to cerebral haemorrhage had a longer time to full RTW (HR, 0.50; 95% CI 0.36 to 0.69) than those with cerebral infarction. Older employees (over 50 years of age) demonstrated a shorter time to resignation than younger employees (HR, 3.30; 95% CI 1.17 to 9.33). Manual workers had a longer time to resignation than non-manual workers (HR, 0.24; 95% CI 0.07 to 0.78).
Conclusions Cumulative RTW rates depended on the subtype of stroke, and older age was a predictor of resignation.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to elucidate the recall accuracy of mobile phone calls among young people using new software-modified phone (SMP) technology. A total of 198 Japanese students aged between 10 and 24 years were instructed to use a SMP for 1 month to record their actual call statuses. Ten to 12 months after this period, face-to-face interviews were conducted to obtain the self-reported call statuses during the monitoring period. Using the SMP record as the gold standard of validation, the recall accuracy of phone calls was evaluated. A total of 19% of the participants (34/177) misclassified their laterality (i.e., the dominant side of ear used while making calls), with the level of agreement being moderate (κ-statistics, 0.449). The level of agreement between the self-reports and SMP records was relatively good for the duration of calls (Pearson's r, 0.620), as compared with the number of calls (Pearson's r, 0.561). The recall was prone to small systematic and large random errors for both the number and duration of calls. Such a large random recall error for the amount of calls and misclassification of laterality suggest that the results of epidemiological studies of mobile phone use based on self-assessment should be interpreted cautiously.Journal of Exposure Science and Environmental Epidemiology advance online publication, 18 March 2015; doi:10.1038/jes.2015.13.
No preview · Article · Mar 2015 · Journal of Exposure Science and Environmental Epidemiology
[Show abstract][Hide abstract] ABSTRACT: Although the association between depression and body composition has been widely discussed, the effects of depression on lean body mass (LBM) are unclear. The present study aimed to investigate the association of depression with LBM.
The study included 2406 participants aged 18-69 years. The sex and body mass index (BMI) stratified analysis of covariance was performed to compare total LBM and percentage LBM (%LBM) in subjects with different depression score levels. Multiple linear regression analysis was conducted to estimate the association between depression score and serum albumin level.
An analysis of covariance stratified by sex showed that participants with moderate-to-severe depression had significantly decreased total LBM and total and regional %LBM in men, except for total LBM and percentage gynoid LBM, which was observed in women. In the BMI stratified analysis of covariance, depression was significantly associated with decreased total and regional %LBM and with increased total and regional percentage fat body mass. In people with BMI≥25kg/m(2), the associations between depression or depressive syndrome and LBM, and total and regional %LBM are stronger compared to those with BMI<25kg/m(2). Multiple linear regression analysis showed that depression score was significantly negatively associated with serum albumin level.
This is a cross-sectional study based on a general population, some information about clinical diagnosis and medication use is not available.
Depression had a significant negative association with LBM and serum albumin level.
No preview · Article · Mar 2014 · Journal of Affective Disorders
[Show abstract][Hide abstract] ABSTRACT: Although serum C-peptide was previously considered biologically inactive, a growing number of recent studies have shown that it is an active peptide with important physiologic functions. The present study aimed to investigate the association of serum C-peptide level with bone mineral density (BMD) in residents of the United States.
The study included 6,625 participants aged 12-85 years. Total and regional BMD were measured using dual-energy X-ray absorptiometry. Stratified multiple linear regression analysis was performed to determine the association of the serum C-peptide level with BMD. Three regression models were produced for each stratum. All models were adjusted for ethnicity, height, weight, education level, physical activity, smoking status, alcohol use, triglycerides and creatinine level, and models 2 and 3 were further adjusted for the fasting plasma glucose (FPG) and alkaline phosphatase (ALP) levels, respectively.
Sex-specific results showed a significant association between the serum C-peptide level and total BMD in both sexes. Stratified analyses based on age and body mass index showed that serum C-peptide levels were significantly negatively associated with most regional BMD, and most of these associations remained significant after stratification based on the serum insulin level.
The serum C-peptide level was significantly negatively associated with the total and most regional BMD. These findings suggest that serum C-peptide may have biological activity associated with bone metabolism and therefore serum C-peptide control is advisable in order to reduce the risk of low bone mineral density.
[Show abstract][Hide abstract] ABSTRACT: Although elevated serum C-peptide level as an indicator of insulin resistance increases the obesity-associated risk of cardiovascular disease among diabetic patients, evidence indicating that serum C-peptide level is associated with stroke in nondiabetic subjects is limited. The aim of this study is to evaluate the association between serum C-peptide level and ever stroke in nondiabetic subjects and investigated the associations of serum C-peptide level with body fat distribution and stroke events among nondiabetic subjects.
This study was a population-based cross-sectional study that included 7030 participants aged 12-85 years. Body fat distribution was determined by dual-energy X-ray absorptiometry. Serum C-peptide level was measured using the radioimmunoassay method. The association between serum C-peptide level and body fat distribution was evaluated by multiple linear regression models. Logistic regression analysis was performed to calculate the odds ratio (OR) of serum C-peptide level being associated with ever stroke.
A total of 103 nondiabetic subjects reported having a stroke. Logistic regression analysis revealed a high-serum C-peptide level significantly associated with ever stroke among nondiabetic subjects (OR: 3.71, 95% confidence interval: 1.78-7.75). Meanwhile, in multiple linear regression analysis, serum C-peptide level was positively associated with total and regional fat distribution among nondiabetic subjects.
The serum C-peptide level is strongly associated with the ever stroke in nondiabetic subjects and significantly associated with total and regional body fat distribution.
No preview · Article · Oct 2013 · Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association
[Show abstract][Hide abstract] ABSTRACT: Serum C-peptide is an active peptide that has important physiological functions and characteristics in the elderly. The present study aimed to investigate the association between physical activity and serum C-peptide level independent of insulin level among the elderly.
The study included 1700 elderly participants aged ≥65 years. Stratified analysis of covariance was used to compare serum C-peptide levels in participants with different physical activity levels. Two separate multiple linear regression models were created to estimate the association between physical activity and serum C-peptide level.
The results of analysis of covariance stratified by sex, body mass index and serum insulin level showed that those who engaged in vigorous physical activity had lower serum C-peptide levels than those who engaged in light or no physical activity. Separate multiple linear regression analysis showed that in those with low serum C-peptide levels (≤0.621 nmol/L), physical activity was significantly positively associated with the serum C-peptide level. In contrast, physical activity was negatively associated with the serum C-peptide level among those with serum C-peptide level >0.621 nmol/L.
The serum C-peptide level showed a significant two-way association with physical activity. The present findings suggest that physical activity modification is important for improving serum C-peptide levels among the elderly. Geriatr Gerontol Int 2013; ●●: ●●-●●.
No preview · Article · Sep 2013 · Geriatrics & Gerontology International
[Show abstract][Hide abstract] ABSTRACT: Objective:
The objective of this study was to elucidate new evidence on the presence of a relationship among sleep duration, cardiovascular mortality and total mortality, and to investigate sleep duration-related multiple biochemical changes.
The longitudinal study is based on the SAKUCESS study of 12,489 residents of Japan aged 20-79 years at baseline.
In the study, compared to respondents who reported 7h of sleep, long sleep duration (≥9h) was associated with an increased risk of cardiovascular disease mortality and total mortality in men, hazard ratios (HRs) were 1.70 (95% confidence interval [CI]=1.07-2.70) and 2.73 (95% CI=1.22-6.11) and an increased risk of total mortality in women, HR was 1.85 (95% CI=1.09-3.13). Sleep duration was significantly associated with changes in blood biochemical levels. The results of the logistic regression analysis showed that the levels of multiple biochemical parameters are associated with increased risk of total mortality.
This is the first large longitudinal study to indicate that sleep duration was associated with changes in multiple biochemical levels in the blood and total mortality.
[Show abstract][Hide abstract] ABSTRACT: To better understand the role of motivation in determining exercise participation at the population level, we performed a questionnaire survey of 385 Japanese adults (mean age: 55.0 years, SD: 10.9 years). At baseline, the motivation subscales (intrinsic motivation, identified regulation, and external regulation), self-efficacy, and enjoyment all showed significant differences across the stages of change for exercise. Intrinsic motivation and enjoyment had similar findings, with the highest scores being noted in the maintenance stage. Among the 385 subjects, 183 completed the follow-up questionnaire 3 months later. After 3 months, most of the participants (86.9%) who were in the maintenance stage at baseline remained in the same stage. The number of participants who dropped to a lower stage after 3 months was 23. The changes of exercise stage over the 3-month period differed significantly for identified regulation, introjected regulation, and motivation. There were significant time and group interactions for intrinsic motivation and identified regulation. These findings suggest the importance of intrinsic motivation and identified regulation for performance of regular exercise, as well as the role of introjected regulation for promoting behavioral change among Japanese adults.
No preview · Article · Mar 2012 · Global Health Promotion
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The Japanese government amended the Preventive Vaccination Law in November 2001 to specify elderly people aged ≥65 years as the target population for influenza vaccinations. The vaccine coverage among this age group rapidly increased thereafter. Our goal was to evaluate how this amendment affected the nationwide mortality rate of chronic obstructive pulmonary disease (COPD). METHODS: The number of monthly COPD deaths by gender and age was obtained from the Monthly Vital Statistics Reports of the Ministry of Health, Labour and Welfare. Data between January 1995 and December 2009 were used for analyses. The COPD mortality rate for each month was calculated separately for the two age groups: age <65 years and age ≥65 years. Changes in the COPD mortality rates after amendment were evaluated each month using the Poisson regression analysis to calculate risk ratios (RRs) and to compute 95% confidence intervals (95% CIs) adjusting for gender, age, trend and seasonal variations. RESULTS: After amendments to the law, a statistically significant reduction in the COPD mortality rates were observed in January (RR 0.84; 95% CI 0.81-0.88), February (RR 0.85; 95% CI 0.81-0.89) and March (RR 0.92; 95% CI 0.88-0.96) among the population aged ≥65 years. However, in the population aged <65 years, statistically no significant changes in the COPD mortality rate were found in any month after the amendments were made. CONCLUSION: A legal approach to improving influenza vaccine coverage for the elderly population would contribute to the risk reduction of COPD deaths during the influenza season.
Preview · Article · Dec 2011 · The European Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: This study aims to examine the effectiveness of lifestyle factors in predicting general cardiovascular events and to investigate the feasibility of using the lifestyle model as a self-screening tool. The authors conducted a longitudinal study over a 10-year follow-up in Japan. Logistic regression analysis was used to create prediction models for general cardiovascular disease (CVD) death. The authors estimated the predictive power of the models by calculating the area under the receiver operating characteristic (AUROC) curve. The total of 6 traditional and 5 lifestyle risk factors were significantly associated with the incidence of CVD events. Hazard ratios (HRs) were 0.26 (95% confidence interval [CI] = 0.17, 0.41) for regular physical activity, 0.57 (95% CI = 0.50, 0.67) for moderate- or high-intensity work, and 1.72 (95% CI = 1.31-2.26) for short sleep duration; the HRs for traditional and Western dietary patterns were 1.53 (95% CI = 1.12, 2.09) and 2.62 (95% CI = 1.46, 4.68), respectively. The AUROC curve was significantly different between the classic and lifestyle prediction models. These results suggest that lifestyle factors are significant predictors of CVD events.
No preview · Article · Dec 2011 · Asia-Pacific Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: Preferences among people for health system goals are important determinants in developing health policy. The aim of this study was to determine preferences for health system goals and their associations with sociodemographic characteristics in Japan. Participants were randomly selected from the general population in 5 prefectures and were asked to rank 5 health system goals in order of preference: health, health inequality, responsiveness, responsiveness inequality, and fair financing. Associations between sociodemographic characteristics and preferences for health system goals were examined using multinomial logistic regression analysis. A total of 4936 persons responded to this study. Health system goals in order of preference were health inequality (37.6%), responsiveness inequality (20.9%), health (18.4%), responsiveness (16.0%), and fair financing (7.1%). Sociodemographic characteristics such as gender, age, family status, education completed, and usage of health care services were associated with the preferred health system goal. Health policy makers should take these associations into account when developing prospective policy.
No preview · Article · Aug 2011 · Asia-Pacific Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to examine the association between shift work and the metabolic syndrome (MetS) using a large-scale longitudinal study design. Data were collected from a historical cohort of health checkups in the Japanese population. The baseline survey, which involved 16,952 inhabitants of the Minami Saku area of the Nagano Prefecture, was started in 1978. A nested case-control study was conducted between 1987 and 1990. This analysis was restricted to 6,712 men and women (age range 25-59 years). A conditional logistic regression model was used to estimate the risk of MetS associated with shift work. Compared with the day workers, shift workers had a significantly higher risk of MetS (odds ratio 1.87; 95% CI, 1.13-3.08). Our results demonstrate that shift work was strongly associated with MetS. The study suggests appropriate dietary habits as a basis for managing the MetS risk of shift workers.
No preview · Article · Apr 2011 · International journal of occupational and environmental health
[Show abstract][Hide abstract] ABSTRACT: Results of case-control studies of mobile phone use and acoustic neuroma have been inconsistent. We conducted a case-case study of mobile phone use and acoustic neuroma using a self-administered postal questionnaire. A total of 1589 cases identified in 22 hospitals throughout Japan were invited to participate, and 787 cases (51%) actually participated. Associations between laterality of mobile phone use prior to the reference dates (1 and 5 years before diagnosis) and tumor location were analyzed. The overall risk ratio was 1.08 (95% confidence interval (CI), 0.93-1.28) for regular mobile phone use until 1 year before diagnosis and 1.14 (95% CI, 0.96-1.40) for regular mobile phone use until 5 years before diagnosis. A significantly increased risk was identified for mobile phone use for >20 min/day on average, with risk ratios of 2.74 at 1 year before diagnosis, and 3.08 at 5 years before diagnosis. Cases with ipsilateral combination of tumor location and more frequently used ear were found to have tumors with smaller diameters, suggesting an effect of detection bias. Furthermore, analysis of the distribution of left and right tumors suggested an effect of tumor-side-related recall bias for recall of mobile phone use at 5 years before diagnosis. The increased risk identified for mobile phone users with average call duration >20 min/day should be interpreted with caution, taking into account the possibilities of detection and recall biases. However, we could not conclude that the increased risk was entirely explicable by these biases, leaving open the possibility that mobile phone use increased the risk of acoustic neuroma.
Full-text · Article · Feb 2011 · Bioelectromagnetics
[Show abstract][Hide abstract] ABSTRACT: In this study, we compared the choice of medical specialty and subspecialty interest among problem-based-learning (PBL) graduates and non-PBL graduates.
Questionnaires were mailed to a total of 1398 female doctors who graduated from Tokyo Women's Medical University (TWMU) between 1989 and 2003. The response rate was over 30%, giving 248 respondents who had undergone a PBL curriculum (PBL+) and 220 subjects who had not (PBL-). Current specialty of the graduates were compared between the PBL+ and PBL-, and also compared with the general Japanese female doctors (Control 1 and 2) of similar age groups. Respondents were analysed in terms of their interests in subspecialty medical care or general medical practise, which includes comprehensive medical care, primary care and basic medicine. Internal medicine doctors working in the university hospitals were compared with those working outside the university hospitals. Internal medicine doctors were also compared with specialists in ophthalmology, otolaryngology, dermatology and psychiatry. Subjects were compared by odds ratio (OR) to examine group difference in the field of interest. OR >2.0 was considered statistically significant.
Most doctors in all groups chose internal medicine. More PBL+ internal medicine doctors showed interests in comprehensive medical care and primary care; more PBL+ internal medicine doctors working outside university hospitals showed interest in comprehensive medical care and primary care when compared with those who were working in the university hospitals. The PBL- graduates did not show such a characteristic.
More PBL+ graduates who chose internal medicine showed interest in holistic medical practices such as primary care and community medicine and more PBL+ specialists showed sustained interest in their respective fields.
Full-text · Article · Jan 2007 · Annals of the Academy of Medicine, Singapore
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The purpose of our study was to compare the characteristics of medical practitioners who prefer using the Internet as their information resource and those who prefer using printed materials.METHODS: From December 2002 to January 2003, a non-anonymous questionnaire was sent out by post to members of the Japanese Medical Association (JMA) and physicians working in hospitals. Contributing factors were examined by using logistic regression analysis.RESULTS: The response rates for the questionnaires were 18.7% (n=1868) for JMA physicians and 68.0% (n=5901) for hospital physicians. Factors associated with the preference for using the Internet were: ‘younger age’; ‘use of the Internet to solve clinical problems and uncertainties’; ‘use of personal computers at work’; and, ‘use of personal computers at home’.CONCLUSION: The results of this study show that, although some younger physicians prefer printed materials, providing medical information via the Internet is better suited for younger physicians who are making full use of computers. In contrast, older physicians prefer printed materials because they tend to be less familiar with using computers and may have limited accessibility to the Internet. Therefore, using both the Internet and printed materials to provide medical information is necessary to meet the needs of the larger physician population.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effectiveness of mass treatment with ivermectin of scabies outbreak in institutional settings. To determine the factors, such as host susceptibility and scabetic exposure level associated with the onset of scabies.
The authors investigated a nosocomial scabies outbreak in a close psychiatric ward. The index case was a man with steroid-induced localized crusted scabies. Twenty-six patients were diagnosed with scabies, 4 of them had relapse of scabies, while no staff was infested. Despite frequent surveillance and treatment of symptomatic patients with 1% gamma-benzenehexachloride (gamma-BHC: Lindane), new cases were observed. Thus, all 69 patients in the ward were treated with ivermectin (200 microg/kg) simultaneously on day 105 of the outbreak (the mass treatment). Patients who had scabies were compared with patients who had no scabies in terms of age, body weight, diabetes, physical functions, topical administration of corticosteroid, proximity to the index patient, and problematic behavior.
The mass treatment was implemented without a significant adverse event. Although two patients developed symptoms of scabies after the mass treatment, no patient in the ward had been diagnosed with scabies since the 98th day of the treatment. Regarding factors associated with the scabies onset, the only statistically significant factor was proximity to the index patient with crusted scabies.
Oral ivermectin was safe and effective for controlling scabies in institutional settings. The exposure level to scabetic mites was more important than host susceptibility in determining the risk of scabies onset.
No preview · Article · Dec 2005 · Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene)
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: physicians' awareness regarding evidence-based medicine (EBM), clinical practice guidelines, and clinical information resources were rarely examined in Japan. We need to know them prior to the initiation of the Medical Information Network Distribution Service (Minds) by the Japan Council for Quality Health Care (JCQHC) .METHODS: A total of 10, 000 directors/owners of private clinics (CDs: clinic physicians) affiliated with the Japan Medical Association (JMA) and 8682 physicians working for hospitals certified by the JCQHC (HDs: hospital physicians) were randomly selected and surveyed by a mailed questionnaire.RESULTS: The response rate to the questionnaire was 18.7% (n=1865) among CDs and 67.8% (n=5885) among HDs. The percentage of respondents who uses internet was 39.9% among CDs and 69.3% among HDs. The information resource most commonly used by all respondents was medical journals, followed by textbooks. The percentage of respondents who used medical literature database was 10.8% among CDs and 49.7% among HDs, respectively. Approximately 80% of all respondents approved implementing EBM in daily practice. Fifty percent of all respondents indicated to have used clinical practice guidelines, and 90% of all the guideline users replied that clinical practice guidelines are useful tools for clinical decision-making. Over half of HDs required to access to the abstracts of the literature cited in the guidelines.CONCLUSIONS: Many physicians who responded to the survey acknowledged that EBM will contribute to improving the quality of medical services. They are positive in using clinical practice guidelines that include a series of recommendations proposed by specialists in the relevant field (s) in accordance to the reviewed evidence.