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1.  Body mass index, blood pressure, and glucose and lipid metabolism among permanent and fixed-term workers in the manufacturing industry: a cross-sectional study 
BMC Public Health  2014;14:207.
Background
Temporary employment, a precarious form of employment, is recognized as social determinant of poor health. However, evidence supporting precarious employment as a risk factor for health is mainly obtained from subjective data. Studies using objective clinical measurement data in the assessment of health status are limited. This study compared body mass index (BMI), lipid and glucose metabolism, and health-related lifestyle factors between permanent workers and fixed-term workers employed in the manufacturing industry.
Methods
Data of 1,701 male manufacturing industry workers <50 years old in Japan were collected and analyzed. Anthropometric data were BMI, calculated using measured height and weight of study participants, and blood pressure. For lipid metabolism, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were determined. For glucose metabolism, fasting plasma glucose and hemoglobin A1c (HbA1c) levels were measured. Multiple regression analysis adjusted for age and lifestyle factors was performed.
Results
BMI was significantly higher in permanent workers (22.9 kg/m2) compared with fixed-term workers (22.4 kg/m2). The leaner population (BMI < 18.5) was greater among fixed-term workers (8.3%) compared with permanent workers (4.0%), whereas the overweight population (BMI ≥ 25.0) was greater among permanent workers (21.4%) compared with fixed-term workers (18.1%). Although fixed-term workers tended not to be overweight, regression analysis adjusted for age and lifestyle factors suggested that fixed-term employment was significantly associated with higher blood pressure (systolic β = 2.120, diastolic β = 2.793), triglyceride (β = 11.147), fasting blood glucose (β = 2.218), and HbA1c (β = 0.107) compared with permanent workers (all p < 0.01).
Conclusions
Fixed-term workers showed more health risks, such as poorer blood pressure and lipid and glucose metabolism, even when adjusted for age and lifestyle variables, although BMI of fixed-term workers were lower than permanent workers. Precarious work might contribute to a deteriorating health status even among less overweight populations.
doi:10.1186/1471-2458-14-207
PMCID: PMC3942209  PMID: 24576216
Job insecurity; Unstable employment; Precarious employment; Flexible work; Fixed-term workers; Temporary work; Social determinants of health; Manufacturing industry
2.  An overview of the China National Tobacco Corporation and State Tobacco Monopoly Administration 
Objectives
China is facing a serious public health problem in active and passive smokers. Confronted with this, China has taken some measures to control tobacco. However, this information has not been surveyed at academic level. Our aim is to investigate information relating to tobacco controls in China.
Methods
To find information relating to tobacco control, we reviewed and analysed the China National Tobacco Corporation (CNTC) and State Tobacco Monopoly Administration (STMA) mainly by systematic examination of documents made available in the University of California, San Francisco Legacy Tobacco Documents Library and China Tobacco database.
Results
Eleven relevant documents met our research purpose, and 18 further relevant documents were found on the CNTC, STMA and Tobacco China database websites. As a result, 29 relevant articles were included in our analysis. We describe the CNTC and STMA’s history, structure, and relation to the Chinese Government ministry and to other tobacco companies, and China’s tobacco control in detail.
Conclusions
The Chinese cigarette market is dominated by a state-owned monopoly, the STMA. Under the protection of the Law of the People’s Republic of China on Tobacco Monopoly, the STMA controls all aspects of the tobacco industry. As far as the Chinese tobacco monopoly is concerned, although smoking harms people’s health, restraining smoking threatens social stability and government income, which may be more serious problems for any government. China still has a long way to go in creating smoke-free environments.
doi:10.1007/s12199-012-0288-4
PMCID: PMC3541807  PMID: 22696197
China; Epidemiology; Public health; Smoking; Tobacco control
3.  Cancer Mortality in Chinese Chrysotile Asbestos Miners: Exposure-Response Relationships 
PLoS ONE  2013;8(8):e71899.
Objective
This study was conducted to assess the relationship of mortality from lung cancer and other selected causes to asbestos exposure levels.
Methods
A cohort of 1539 male workers from a chrysotile mine in China was followed for 26 years. Data on vital status, occupation and smoking were collected from the mine records and individual contacts. Causes and dates of death were further verified from the local death registry. Individual cumulative fibre exposures (f-yr/ml) were estimated based on converted dust measurements and working years at specific workshops. Standardized mortality ratios (SMRs) for lung cancer, gastrointestinal (GI) cancer, all cancers and nonmalignant respiratory diseases (NMRD) stratified by employment years, estimated cumulative fibre exposures, and smoking, were calculated. Poisson models were fitted to determine exposure-response relationships between estimated fibre exposures and cause-specific mortality, adjusting for age and smoking.
Results
SMRs for lung cancer increased with employment years at entry to the study, by 3.5-fold in ≥10 years and 5.3-fold in ≥20 years compared with <10 years. A similar trend was seen for NMRD. Smokers had greater mortality from all causes than nonsmokers, but the latter also had slightly increased SMR for lung cancer. No excess lung cancer mortality was observed in cumulative exposures of <20 f-yrs/ml. However, significantly increased mortality was observed in smokers at the levels of ≥20 f-yrs/ml and above, and in nonsmokers at ≥100 f-yrs/ml and above. A similarly clear gradient was also displayed for NMRD. The exposure-response relationships with lung cancer and NMRD persisted in multivariate analysis. Moreover, a clear gradient was shown in GI cancer mortality when age and smoking were adjusted for.
Conclusion
There were clear exposure-response relationships in this cohort, which imply a causal link between chrysotile asbestos exposure and lung cancer and nonmalignant respiratory diseases, and possibly to gastrointestinal cancer, at least for smokers.
doi:10.1371/journal.pone.0071899
PMCID: PMC3749214  PMID: 23991003
4.  Factors associated with the use of home-visit nursing services covered by the long-term care insurance in rural Japan: a cross-sectional study 
BMC Geriatrics  2013;13:1.
Background
In Japan, there is a large increase in the number of elderly persons who potentially need home-visit nursing services (VNS). However, the number of persons using the VNS has increased only little in comparison to the number of individuals who use home social services, which are also covered by the Long-Term Care Insurance (LTCI) system. This cross-sectional study investigated the predictors of the VNS used under the LTCI system in Japan.
Methods
We used 1,580 claim data from all the users of community-based services and 1,574 interview survey data collected in 2001 from the six municipal bodies in Japan. After we merged the two datasets, 1,276 users of community-based services under the LTCI were analyzed. Multiple logistic regression models stratified by care needs levels were used for analysis.
Results
Only 8.3% of the study subjects were VNS users. Even among study participants within the higher care-needs level, only 22.0% were VNS users. In the lower care level group, people with a higher care level (OR: 3.50, 95% CI: 1.50–8.93), those whose condition needed long term care due to respiratory or heart disease (OR: 4.31, 95% CI: 1.88–89.20), those whose period of needing care was two years or more (OR: 2.01, 95% CI: 1.14–3.48), those whose service plan was created by a medical care management agency (OR: 2.39, 95% CI: 1.31–4.33), those living with family (OR: 1.86, 95% CI: 1.00–3.42), and those who use home-help services (OR: 2.12, 95% CI: 1.17–3.83) were more likely to use the VNS. In the higher care level group, individuals with higher care level (OR: 3.63, 95% CI: 1.56–8.66), those with higher income (OR: 3.79, 95% CI: 1.01–14.25), and those who had regular hospital visits before entering the LTCI (OR: 2.36, 95% CI: 1.11–5.38) were more likely to use the VNS.
Conclusions
Our results suggested that VNS use is limited due to management by non-medical care management agencies, due to no caregivers being around or a low income household. The findings of this study provide valuable insight for LTCI policy makers: the present provision of VNS should be reconsidered.
doi:10.1186/1471-2318-13-1
PMCID: PMC3574859  PMID: 23280140
Home-visit nursing service; Long-term care insurance; Care management; Community-based service; Care-needs level; Living alone; Income level; Home-help service
5.  Impacts of early smoking initiation: long-term trends of lung cancer mortality and smoking initiation from repeated cross-sectional surveys in Great Britain 
BMJ Open  2012;2(5):e001676.
Objective
To show long-term trends of smoking initiation in Great Britain including unanalysed data and assess the impact of early smoking initiation on the lung cancer mortality in later ages focusing on birth cohorts.
Design
Reanalysis of repeated cross-sectional surveys conducted 13 times during 1965–1987.
Setting
Great Britain.
Participants
Men and women aged 16 years and over in each survey.
Primary outcome measures
Smoking initiation for 1898–1969 birth cohorts and lung cancer mortality in 1950–2009.
Results
In men, 1900–1925 birth cohorts showed high smoking initiation (>32%, >50% and >80% at 15, 17 and 29 years old, respectively). Correspondingly, the lung cancer mortality in these cohorts exceeded 1 per 1000 at a young age (50–54 years old). In women, smoking initiation increased clearly from the 1898 cohort to the 1925 cohort (2% to 12%, 4% to 24%, and 13% to 54% at 15, 17 and 29 years old, respectively). Correspondingly, the age at which the mortality exceeded 1 per 1000 became younger (75–79 to 60–64 years old). In both men and women, short-term decreases in initiation were seen from the late-1920s cohorts. Correspondingly, lung cancer mortality decreased. In women, initiation increased again after the mid-1930s cohorts, and mortality increased after they became 60–64 years old.
Conclusions
Clear relationships between smoking initiation and lung cancer mortality across birth cohorts were observed. Countries with rapid increases in initiation in teens should not underestimate the risk in the distant future. Because of the long time lags within cohorts compared with rapid changes in smoking habits across cohorts, age-specific measures focusing on birth cohorts should be monitored.
doi:10.1136/bmjopen-2012-001676
PMCID: PMC3488725  PMID: 23048061
Public Health; Preventive Medicine; Statistics & Research Methods
6.  The possible absence of a healthy-worker effect: a cross-sectional survey among educated Japanese women 
BMJ Open  2012;2(5):e000958.
Objectives
Despite being highly educated in comparison with women in other member countries of the Organisation for Economic Cooperation and Development, Japanese women are expected to assume traditional gender roles, and many dedicate themselves to full-time housewifery. Women working outside the home do so under poor conditions, and their health may not be better than that of housewives. This study compared the self-rated health status and health behaviours of housewives and working women in Japan.
Design
Cross-sectional survey.
Setting
A national university in Tokyo with 9864 alumnae.
Participants
A total 1344 women who graduated since 1985 and completed questionnaires in an anonymous mail-based survey.
Primary and secondary outcome measures
Health anxiety and satisfaction, receipt of health check-ups, eating breakfast, smoking, and sleep problems according to job status and family demands: housewives (n=247) and working women with (n=624) and without (n=436) family demands. ORs were used for risk assessment, with housewives as a reference.
Results
After adjustment for satisfaction with present employment status and other confounding factors, working women were more likely than housewives to feel health anxiety (with family demands, OR: 1.68, 95% CI1.10 to 2.57; without family demands, OR: 3.57, 95% CI 2.19 to 4.50) and health dissatisfaction (without family demands, OR: 3.50, 95% CI 2.35 to 5.21); they were also more likely than housewives to eat an insufficient breakfast (with family demands, OR: 1.91, 95% CI 1.22 to 3.00; without family demands, OR: 4.02, 95% CI 2.47 to 6.57) and to have sleep problems (ORs: 2.08 to 4.03).
Conclusions
No healthy-worker effect was found among Japanese women. Housewives, at least those who are well educated, appear to have better health status and health-related behaviours than do working women with the same level of education.
doi:10.1136/bmjopen-2012-000958
PMCID: PMC3467618  PMID: 22964114
7.  Under-diagnosis of pain by primary physicians and late referral to a palliative care team 
BMC Palliative Care  2012;11:7.
Background
Under-diagnosis of pain is a serious problem in cancer care. Accurate pain assessment by physicians may form the basis of effective care. The aim of this study is to examine the association between late referral to a Palliative Care Team (PCT) after admission and the under-diagnosis of pain by primary physicians.
Methods
This retrospective study was performed in the Teikyo University teaching-hospital for a period of 20 months. We investigated triads composed of 213 adult cancer inpatients who had coexisting moderate or severe pain at the initial PCT consultation, 77 primary physicians, and 4 palliative care physicians. The outcome of the present study was the under-diagnosis of pain by primary physicians with routinely self-completed standard format checklists. The checklists included coexisting pain documented independently by primary and palliative care physicians at the time of the initial PCT consultation. Under-diagnosis of pain was defined as existing pain diagnosed by the palliative care physicians only. Late referral to PCTs after admission was defined as a referral to the PCT at ≥20 days after admission. Because the two groups displayed significantly different regarding the distributions of the duration from admission to referral to PCTs, we used 20 days as the cut-off point for “late referral.”
Results
Accurate pain assessment was observed in 192 triads, whereas 21 triads displayed under-diagnosis of pain by primary physicians. Under-diagnosis of pain by primary physicians was associated with a longer duration between admission and initial PCT consultation, compared with accurate pain assessment (25 days versus 4 days, p < 0.0001). After adjusting for potential confounding factors, under-diagnosis of pain by the primary physicians was significantly associated with late (20 or more days) referral to a PCT (adjusted odds ratio, 2.91; 95% confidence interval, 1.27 − 6.71). Other factors significantly associated with under-diagnosis of pain were coexisting delirium and case management by physicians with < 6 years of clinical experience.
Conclusions
Under-diagnosis of pain by primary physicians was associated with late referral to PCTs. Shortening the duration from admission to referral to PCTs, and increasing physicians’ awareness of palliative care may improve pain management for cancer patients.
doi:10.1186/1472-684X-11-7
PMCID: PMC3423067  PMID: 22676380
Palliative care team; Pain; Primary physician; Cancer; Referral; Concordance
8.  Association between Insomnia Symptoms and Hemoglobin A1c Level in Japanese Men 
PLoS ONE  2011;6(7):e21420.
Background
The evidence for an association between insomnia symptoms and blood hemoglobin A1c (HbA1c) level has been limited and inconclusive. The aim of this study was to assess whether each symptom of initial, middle, and terminal insomnia influences HbA1c level in Japanese men.
Methods
This cross-sectional study examined 1,022 male workers aged 22–69 years with no history of diabetes at a Japanese company's annual health check-up in April 2010. High HbA1c was defined as a blood level of HbA1c ≥6.0%. Three types of insomnia symptoms (i.e., difficulty in initiating sleep, difficulty in maintaining sleep, and early morning awakening) from the previous month were assessed by 3 responses (i.e., lasting more than 2 weeks, sometimes, and seldom or never [reference group]).
Results
The overall prevalence of high HbA1c was 5.2%. High HbA1c was positively and linearly associated with both difficulty in maintaining sleep (P for trend  = .002) and early morning awakening (P for trend  = .007). More specifically, after adjusting for potential confounding factors, high HbA1c was significantly associated with difficulty in maintaining sleep lasting more than 2 weeks (adjusted odds ratio, 6.79 [95% confidence interval, 1.86–24.85]) or sometimes (2.33 [1.19–4.55]). High HbA1c was also significantly associated with early morning awakening lasting more than 2 weeks (3.96 [1.24–12.59]).
Conclusion
Insomnia symptoms, particularly difficulty in maintaining sleep and early morning awakening, were found to have a close association with high HbA1c in a dose-response relationship.
doi:10.1371/journal.pone.0021420
PMCID: PMC3128595  PMID: 21747936
9.  Increased number of Judo therapy facilities in Japan and changes in their geographical distribution 
Background
Judo therapy is a well established Japanese co-medical profession specializing in outpatient manual treatment of fractures and sprains. Recently, the number of judo therapists has been rapidly increasing as a result of proliferation judo therapy academies. This study examines whether such rapid increases have improved geographical distribution of judo therapy facilities in Japan.
Methods
The number of judo therapy facilities and the population in each municipality were obtained from the Web yellow pages and from Japanese census data for 2004, 2006, and 2008, respectively. Lorenz curves and Gini indices were calculated to demonstrate distributions of judo therapy facilities per 100,000 people. A bootstrapped method was used to identify statistical significances of differences in Gini indices.
Results
In all municipalities, the mean numbers of judo therapy facilities per 100,000 people were 15.3 in 2004, 15.8 in 2006, and 17.6 in 2008. The Gini indices for judo therapy facilities nationally were 0.273 in 2004, 0.264 in 2006, and 0.264 in 2008. The numbers of judo therapy facilities increased significantly between 2006 and 2008 (p < 0.05) but the indices did not change significantly in the same period. The Gini indices for local towns and villages remained unchanged and were consistently higher (p < 0.05) than those in urban areas throughout the study periods.
Conclusion
Our results suggest that recent increases in the number of judo therapy facilities have not necessarily led to greater equality in their geographic distribution in terms of Gini indices.
doi:10.1186/1472-6963-11-48
PMCID: PMC3051884  PMID: 21352604
10.  Effort-reward imbalance and its association with health among permanent and fixed-term workers 
Background
In the past decade, the changing labor market seems to have rejected the traditional standards employment and has begun to support a variety of non-standard forms of work in their place. The purpose of our study was to compare the degree of job stress, sources of job stress, and association of high job stress with health among permanent and fixed-term workers.
Methods
Our study subjects were 709 male workers aged 30 to 49 years in a suburb of Tokyo, Japan. In 2008, we conducted a cross-sectional study to compare job stress using an effort-reward imbalance (ERI) model questionnaire. Lifestyles, subjective symptoms, and body mass index were also observed from the 2008 health check-up data.
Results
The rate of job stress of the high-risk group measured by ERI questionnaire was not different between permanent and fixed-term workers. However, the content of the ERI components differed. Permanent workers were distressed more by effort, overwork, or job demand, while fixed-term workers were distressed more by their job insecurity. Moreover, higher ERI was associated with existence of subjective symptoms (OR = 2.07, 95% CI: 1.42-3.03) and obesity (OR = 2.84, 95% CI:1.78-4.53) in fixed-term workers while this tendency was not found in permanent workers.
Conclusions
Our study showed that workers with different employment types, permanent and fixed-term, have dissimilar sources of job stress even though their degree of job stress seems to be the same. High ERI was associated with existing subjective symptoms and obesity in fixed-term workers. Therefore, understanding different sources of job stress and their association with health among permanent and fixed-term workers should be considered to prevent further health problems.
doi:10.1186/1751-0759-4-16
PMCID: PMC2990722  PMID: 21054838
11.  Analysis of a tobacco vector and its actions in china: the activities of japan tobacco 
Tobacco Induced Diseases  2010;8(1):13.
Japan Tobacco (JT) is the third largest tobacco company in the world, and China, the world's largest tobacco consumer, is one of the most important targets for JT. To provide information for tobacco control, we reviewed and analyzed JT and its tactics and strategies in the Chinese market mainly by systematic examination of documents which are made available in the University of California, San Francisco Legacy Tobacco Documents Library. As a result, JT has had a special interest to expand sales of its cigarettes in the Chinese market.
doi:10.1186/1617-9625-8-13
PMCID: PMC2984582  PMID: 20979655
12.  Lung cancer mortality from exposure to chrysotile asbestos and smoking: a case–control study within a cohort in China 
Objective
To confirm the association between exposure to chrysotile asbestos and lung cancer risk and to demonstrate the combined effect of smoking and asbestos exposure.
Methods
A case–control study of 1139 asbestos workers identified 41 male lung cancer cases in 2001; each case was matched by age (±5 years) with five controls. Workers in seven workshops were categorised into high-, medium- and low-exposure subgroups, and conditional logistic regression was applied to estimate the odds ratios for lung cancer risk associated with the different exposure levels. Smoking, age at first exposure, and exposure duration were considered as covariates/confounding factors. A joint effect of asbestos exposure and smoking on lung cancer risk was analysed using a conditional logistical model.
Results
54% of cases had high exposure and 24% low exposure, while 24% of controls had high exposure and 44% low exposure. Smoking was more common in cases (90%) than in controls (73%). The adjusted OR for lung cancer was 3.66 (95% CI 1.61 to 8.29) for high exposure and was elevated slightly for medium exposure (1.25; 95% CI 0.47 to 3.31). Smoking was related to lung cancer risk (OR 3.33; 95% CI 1.10 to 10.08). In comparison with the low-exposure non-smoking group, the OR for the high-exposure smoking group was 10.39 (1.34 to 82.45), in contrast to 5.23 (0.50 to 54.58) for high-exposure non-smoking workers.
Conclusions
These results confirm the strong association between exposure to chrysotile asbestos and lung cancer risk, and support an interactive effect of asbestos exposure and smoking which is more than additive.
doi:10.1136/oem.2009.051615
PMCID: PMC2991074  PMID: 20833758
Chrysotile asbestos; asbestos textile; smoking; lung cancer mortality; nested case-control study; occupational exposure; epidemiology; cancer; mortality studies; asbestos
13.  A case report of acute dermatitis that developed during an experiment examining the bromination of 3-hexylthiophene 
Occupational cases with allergic reaction to fragrance substances, which refer to various chemicals providing aroma characteristics, are arising with its recent usage diversification from pharmaceutical, perfume industry to aromatic remedies. However, chemicals responsible for fragrance allergy have hardly been identified because its component is complex and its sensitization is not frequent. This report will present a case of acute allergic dermatitis that is likely induced by 3-hexylthiophene, one of aromatic compounds often contained in fragrance substances. The case, who was a 27-year male researcher engaged in organic chemical synthesis for six years, was exposed to 3-hexylthiophene and its product (2-bromo-3-hexylthiophene) through an experiment in May 2004 and itching, swelling and eczema immediately developed from face to back. This case of sensitization to 3-hexylthiophene suggests that it be a possible allergen for fragrance allergy.
doi:10.1186/1745-6673-5-3
PMCID: PMC2842484  PMID: 20187972
14.  British American Tobacco's tactics during China's accession to the World Trade Organization 
Tobacco Control  2007;16(2):133-137.
Background
China entered the World Trade Organization (WTO) in 2001 after years of negotiations. As a WTO member, China had to reduce tariffs on imported cigarettes and remove non‐tariff barriers to allow foreign cigarettes to be more competitive in the Chinese market. Among foreign tobacco companies, British American Tobacco (BAT) was the most active lobbyist during China's WTO negotiations.
Objective
To review and analyse BAT's tactics and activities relating to China's entry into the WTO.
Methods
Internal tobacco industry documents were reviewed and are featured here. Industry documents were searched mainly on the website of BAT's Guildford Depository and other documents' websites. 528 documents were evaluated and 142 were determined to be relevant to China's entry into the WTO.
Results
BAT was extremely active during the progress of China's entry into the WTO. The company focused its lobbying efforts on two main players in the negotiations: the European Union (EU) and the US. Because of the negative moral and health issues related to tobacco, BAT did not seek public support from officials associated with the WTO negotiations. Instead, BAT lobbyists suggested that officials protect the interests of BAT by presenting the company's needs as similar to those of all European companies. During the negotiation process, BAT officials repeatedly spoke favourably of China's accession into the WTO, with the aim of presenting BAT as a facilitator in this process and of gaining preferential treatment from their Chinese competitor.
Conclusions
BAT's activities clearly suggest that tobacco companies place their own interests above public health interests. Today, China struggles with issues of tobacco control that are aggravated by the aggressive practices of transnational tobacco companies, tobacco‐tariff reductions and the huge number of smokers. For the tobacco‐control movement to progress in China, health advocates must understand how foreign tobacco companies have undermined anti‐tobacco activities by taking advantage of trade liberalisation policies. China should attach importance to public health and comprehensive tobacco‐control policies and guarantee strong protection measures from national and international tobacco interests supported by international trade agreements.
doi:10.1136/tc.2006.018374
PMCID: PMC2598483  PMID: 17400952
15.  Development of a questionnaire to assess ‘Hie’ symptoms using an evidence-based analysis 
Objectives
Certain symptoms and signs are culturally specific. ‘Hie’ (chill sensation) is a major symptom experienced by Japanese people; however, it is not easily understood by Westerners. Although Hie is not life-threatening, it greatly hampers the quality of life in sufferers. To develop a remedy for Hie, valid and reliable measures are required. This is the first study aimed at developing a standardized questionnaire to quantitatively measure Hie symptom.
Methods
This was a cross-sectional study. To identify question items, we conducted a literature search using published books that mention Hie and related symptoms. The first draft of the questionnaire was prepared by selecting 31 items, including three empirically used items, using the Delphi method. A total of 744 Japanese volunteers completed the draft questionnaire. Simple correlation and factor analyses were performed to select items for the final version of Hie questionnaire and for evaluating its test–retest reliability.
Results
The following ten question items were ultimately selected: feeling a breeze, shivery feeling, tolerance, sensitivity to cold, Hie-like sensation in an airplane, dislike of air conditioning, use of gloves, use of an electric blanket, use of heavy clothing and need for heating devices. Of the ten Hie-related question items, five pertained to physical symptoms and the other five to daily behaviours. The internal consistency of the ten-item questionnaire was high, with a Cronbach’s alpha of 0.85. The test–retest reliability of the questionnaire was preserved by the paired two-tailed t test.
Conclusions
A new questionnaire was developed to evaluate the subjective symptom of Hie. This questionnaire demonstrated sufficient reliability and could be used as a tool to assess this symptom.
doi:10.1007/s12199-008-0050-0
PMCID: PMC2698230  PMID: 19568894
Culture; Hie; Japan; Questionnaires; Traditional medicine
16.  Benzodiazepine prescription and length of hospital stay at a Japanese university hospital 
Background
The relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan. This study was done to assess the association between bed days and BDZ in a Japanese hospital.
Methods
21,489 adult patients (55.1% men, mean age 59.9 years old) hospitalized between April, 2005 and December, 2006 were enrolled in the study. Patient age, sex, ICD-10 diagnosis, prescription profile, and days of hospital stay were assessed in 13 non-psychiatric departments using a computer ordering system. Patients prescribed a benzodiazepine during hospitalization were defined as positive.
Results
Of the total sample, 19.9% were allocated to the benzodiazepine (+) group. Female sex and older age were significant factors associated with benzodiazepine prescription. The median number of bed days was 13, and the likelihood of BDZ significantly increased with the number of bed days, even after controlling for the effects of age, gender, and ICD-10 diagnosis. For example, when the analysis was limited to patients with 50 bed days or longer, the percentage of BDZ (32.7%) was equivalent to that of a report from France.
Conclusion
Irrespective of department or disease, patients prescribed benzodiazepine during their hospital stay tended to have a higher number of bed days in the hospital. The difference in the prevalence of BDZ between this study and previous Western studies might be attributed to the relatively short length of hospital stay in this study. Because BDZs are often reported to be prescribed to hospitalized patients without appropriate documentation for the indications for use, it is important to monitor the rational for prescriptions of benzodiazepine carefully, for both clinical and economical reasons.
doi:10.1186/1751-0759-3-10
PMCID: PMC2765986  PMID: 19818119
17.  Association Between PM10 and O3 Levels and Hospital Visits for Cardiovascular Diseases in Bangkok, Thailand 
Journal of Epidemiology  2009;19(4):182-188.
Background
The association between air pollution and cardiovascular diseases is well known, but previous studies only assessed mortality and hospital admissions in North America, Europe, and Northeast Asia. Few studies have been conducted in less-developed countries in regions with a tropical climate. This study evaluated whether short-term exposures to fine particulate matter (PM10) and ozone (O3) were associated with hospital visits for cardiovascular diseases (CVD; ICD-10th, I00–I99) in central Bangkok, Thailand.
Methods
Data from hospital records were obtained from 3 major government hospitals. All hospital visits were stratified by age group and category of CVD. Daily PM10 and O3 levels reported by the Pollution Control Department from April 2002 to December 2006 (1736 days) were used in a time-series analysis with a generalized additive model procedure.
Results
Exposure on the previous day to PM10 and O3 had a positive association with hospital visits for CVD among elderly (≥65 years) individuals. The increase in CVD hospital visits in this age group was 0.10% (95% CI, 0.03–0.19) with a 10 µg/m3 increase in PM10, and 0.50% (95% CI, 0.19–0.81) with an increase in O3.
Conclusions
In central Bangkok, a short-term association was observed between increases in daily levels of PM10 and O3 and the number of daily emergency hospital visits for CVD, particularly among individuals aged ≥65 years.
doi:10.2188/jea.JE20080047
PMCID: PMC3924107  PMID: 19525614
PM10; ozone; cardiovascular diseases; hospital visits; Bangkok; air pollution
18.  The Shift of Residents From University to Non-University Hospitals in Japan: A Survey Study 
Journal of General Internal Medicine  2008;23(7):1105-1109.
Background
Between 2003 and 2004, when the new postgraduate medical education program was introduced in Japan, the number of university residents decreased from 5,923 to 3,264 (−31%), whereas the number of non-university residents increased from 2,243 to 4,110 (+45%).
Objective
To identify potential reasons for the shift of residents from university to non-university hospitals.
Design
Cross-sectional mailed survey.
Participants
The subjects were 1,794 2nd-year residents at 91 university hospitals and 2,010 2nd-year residents at 659 non-university hospitals.
Measurements
Data on hospital demographics, resident demographics, and resident satisfaction with training were collected in 2006 and were compared between university and non-university hospitals.
Results
Compared to non-university hospitals, university hospitals were more likely to have >700 beds (55% vs. 10%, p<0.001) and to have more teaching resources and free access to international medical journals (84% vs. 62%, p<0.001). Nevertheless, one-half (47%) of the university residents reported that they were not satisfied with the residency system and clinical skills training and attributed their dissatisfaction to “daily chores,” “low salary,” and “poor clinical opportunities.” Logistic regression analyses indicated that the proportions of residents who were satisfied with income (OR: 0.32, 95% CI: 0.26–0.40) and the residency system (OR: 0.52, 95% CI: 0.40–0.68) and clinical skills training (OR: 0.77, 95% CI: 0.60–0.99) were significantly lower for university residents than for non-university residents.
Conclusions
Hospital size and teaching resources do not overcome the other characteristics of university hospitals that lead to residents’ dissatisfaction.
doi:10.1007/s11606-008-0644-7
PMCID: PMC2517916  PMID: 18612753
non-university hospital; postgraduate medical education program; resident characteristics; resident satisfaction; University hospitals
19.  Gender differences in the use of transportation services to community rehabilitation programs 
BMC Geriatrics  2009;9:24.
Background
Prevention and reduction of disability among community-dwelling older adults have been an important health policy concern in Japan. Moreover, it has also become a gendered issue due to the recent rapid growth in older females than males with disability living in their own homes. The aim of this study is to examine whether there is a gender difference in the use of community rehabilitation programs in Japan, and if so, whether the lack of transportation services and accompanying caregivers are the reasons for the gender difference.
Methods
This study was based on surveys of the program administrators and the primary caregivers of the program participants from 55 randomly selected community rehabilitation programs (CRP) in the Tokyo metropolitan area. Questions included sociodemographic characteristics of program participants, types of transportation services provided by the CRP, caregiver's relationship to participant, and the nature of family support. Bivariate statistical analysis was conducted.
Results
Although there were more females than males with disability residing in communities, our findings showed that females were less likely to use CRP than males (1.3% and 2.3%, respectively; X2 = 93.0, p < 0.0001). Lower CRP use by females was related to lower availability of transportation services (36% without transportation service and 46% door-to-door services) and fewer caregivers accompanying the participants to CRP.
Conclusion
This study builds on previous research findings, which suggest gender inequality in access to CRP.
doi:10.1186/1471-2318-9-24
PMCID: PMC2716345  PMID: 19558702
20.  Tobacco companies are booming despite an economic depression 
During the past year, an economic crisis has affected economies and life styles throughout the world. However, the three largest transnational tobacco companies – Philip Morris International, British American Tobacco, and Japan Tobacco – showed excellent returns during this period, reflecting more widespread indirect exposure to smoking.
doi:10.1186/1617-9625-5-9
PMCID: PMC2702326  PMID: 19523244
21.  Competition or complement: relationship between judo therapists and physicians for elderly patients with musculoskeletal disease 
Objectives
Among the complementary and alternative medical services available in Japan, only judo therapists are covered under the national health-insurance program without a referral from a physician. Many orthopedists claim that judo therapists deprive them of potential patients. If such competition exists, fewer patients would be expected to visit orthopedists in areas where many patients visit judo therapists. Therefore, we examined the correlation between the number of patients visiting judo therapists and those visiting physicians for musculoskeletal diseases.
Methods
In a cross-sectional study covering each prefecture in Japan (n = 47), we obtained figures for the numbers of judo therapist facilities and elderly patients (over 70 years old) who visited them and the numbers of orthopedists and patients who visited physicians for musculoskeletal diseases. Correlations between the numbers of practitioners per 100,000 population and the numbers of their patients per 100,000 population were examined by prefecture.
Results
There were positive correlations between the numbers of judo therapist facilities and elderly patients who visited them (r = 0.72, P < 0.01, n = 47), and between the numbers of orthopedists and elderly patients who visited physicians for musculoskeletal diseases (r = 0.32, P = 0.03). However, there was no significant correlation between the numbers of elderly patients who visited judo therapist facilities and those who visited physicians (r = 0.06, P = 0.68) for musculoskeletal diseases.
Conclusions
This study did not find a negative correlation between the numbers of patients visiting judo therapists and patients visiting physicians for musculoskeletal diseases. Thus, these results do not support the orthopedists’ claim that the two services compete for patients.
doi:10.1007/s12199-007-0021-x
PMCID: PMC2698256  PMID: 19568896
Distribution; Health-care service; Judo therapist; Elderly patient; Orthopedist
22.  Changes in body mass index by birth cohort in Japanese adults: results from the National Nutrition Survey of Japan 1956–2005 
Background The National Nutrition Survey, Japan (NNS-J) provides annual anthropometric information for a whole nation over 50 years. Based on this survey, the mean body mass index (BMI) of Japanese men and elderly women has increased in recent decades, but that of young women has decreased. We examined the effect of birth cohort on this phenomenon.
Methods We analysed data from the NNS-J for subjects aged 20–69 years. BMI during 1956–2005 and the prevalence of overweight and obesity (BMI ≥ 25 kg/m2) during 1976–2005 were estimated.
Results The BMI increased with age in every birth cohort, with similar increments, and did not peak until 60–69 years of age. However, with cross-sectional age, the BMI usually peaked before 60–69 years of age. The differences among cohorts already existed at 20–29 years of age, and slightly increased in men between 20–29 and 30–39 years of age. The BMI in all male age groups increased from the 1891–1900 through 1971–80 cohorts. However, in women, the figure increased until the 1931–40 cohorts, but later decreased. Changes in prevalence were generally consistent with changes in BMI. The recent increase (decrease in young women) in the mean BMI is attributable to birth cohort, indicating that thinner (fatter) and less recent birth cohorts have been replaced by fatter (thinner) ones.
Conclusions A cohort effect was quantitatively demonstrated based on a repeated annual survey. In Japan, the differences in BMI among cohorts were already established by young adulthood.
doi:10.1093/ije/dyn182
PMCID: PMC2639362  PMID: 18782894
Aging; body mass index; cohort effect; cross-sectional studies
23.  Do overweight children necessarily make overweight adults? Repeated cross sectional annual nationwide survey of Japanese girls and women over nearly six decades 
Objective To compare growth curves of body mass index from children to adolescents, and then to young adults, in Japanese girls and women in birth cohorts born from 1930 to 1999.
Design Retrospective repeated cross sectional annual nationwide surveys (national nutrition survey, Japan) carried out from 1948 to 2005.
Setting Japan.
Participants 76 635 females from 1 to 25 years of age.
Main outcome measure Body mass index.
Results Generally, body mass index decreased in preschool children (2-5 years), increased in children (6-12 years) and adolescents (13-18 years), and slightly decreased in young adults (19-25 years) in these Japanese females. However, the curves differed among birth cohorts. More recent cohorts were more overweight as children but thinner as young women. The increments in body mass index in early childhood were larger in more recent cohorts than in older cohorts. However, the increments in body mass index in adolescents were smaller and the decrease in body mass index in young adults started earlier, with lower peak values in more recent cohorts than in older cohorts. The decrements in body mass index in young adults were similar in all birth cohorts.
Conclusions An overweight birth cohort in childhood does not necessarily continue to be overweight in young adulthood. Not only secular trends in body mass index at fixed ages but also growth curves for wide age ranges by birth cohorts should be considered to study obesity and thinness. Growth curves by birth cohorts were produced by a repeated cross sectional annual survey over nearly six decades.
doi:10.1136/bmj.a802
PMCID: PMC2518696  PMID: 18719011
24.  The Quality Control Assessment of Commercially Available Coenzyme Q10-Containing Dietary and Health Supplements in Japan 
Coenzyme Q10 (CoQ10) has been widely commercially available in Japan as a dietary and health supplement since 2001 and is used for the prevention of lifestyle-related diseases induced by free radicals and aging. We evaluated CoQ10 supplements to ensure that these supplements can be used effectively and safely. Commercially available products were selected and assessed by the quality control tests specified in the Japanese Pharmacopoeia XV. When the disintegration time of CoQ10 supplements was measured, a few tested supplements did not completely disintegrate even after incubation in water for an hour at 37°C. In the content test, many samples were well controlled. However, a few supplements showed low recovery rates of CoQ10 as compared to manufacturer’s indicated contents. Among soft capsule and liquid supplements, the reduced form of CoQ10 (H2CoQ10), as well as the oxidized form, was detected by HPLC with electrochemical detector. The results for experimental formulated CoQ10 supplements demonstrated that H2CoQ10 was produced by the interaction of CoQ10 with vitamins E and/or C. From these results, we concluded that quality varied considerably among the many supplement brands containing CoQ10. Additionally, we also demonstrated that H2CoQ10 can be detected in some foods as well as in CoQ10 supplements.
doi:10.3164/jcbn.2007017
PMCID: PMC2170950  PMID: 18193106
coenzyme Q10; ubiqinol-10; quality control; dietary and health supplement; food
25.  Patient Contribution to the Medical Dialogue and Perceived Patient-Centeredness 
Background
Relatively few studies have directly addressed the interaction dynamics and consequences of a companion's presence in the medical visit, and their findings have been contradictory.
Objectives
To examine how patient's contribution to the medical dialogue, with or without the presence of a visit companion, is related to the perception of the medical visit as patient-centered.
Design
Observational study using pre- and postvisit questionnaires and audiotape recording of medical visits.
Participants
One hundred and fifty-five patients aged 65 or over; 63 in medical visits that included the presence of a companion and 82 in visits that did not include a companion.
Main Outcome Measure
Patient ratings of visit patient-centeredness.
Results
Long visits (greater than 10 minutes long) and visits in which patients were verbally active were rated as more patient-centered by patients than other visits. Since patients were generally less verbally active in visits that included a companion, accompanied visits, especially if they were less than 10 minutes long, received lower patient-centered ratings than others. The presence of a companion was not related to length of the visit, suggesting that the verbal activity of the companion was off-set by decreased verbal activity of the patient.
Conclusions
Our results have suggested that patients are more likely to perceive their physician and visit as patient-centered when they have an opportunity to engage directly in the medical dialogue. A minimal amount of “talk-time” for patients themselves should be safeguarded even in a short visit, when a companion is present.
doi:10.1111/j.1525-1497.2005.0200.x
PMCID: PMC1490229  PMID: 16191136
patient-centeredness; patient participation; patient-physician communication; companion; elderly

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