Rumi Seko

OBJECTIVES: Employment support for working age people with disease is important. We investigated the intention to work among outpatients with malignant neoplasms, ischemic heart disease, and cerebrovascular disease. METHODS: We used anonymous data from the 2007, 2010, and 2013 Comprehensive Survey of Living Conditions in Japan, a self-administered nationwide questionnaire survey. Data for 154,445 participants (76,059 men and 78,386 women) aged 20-64 years were analyzed using logistic regression models adjusted for covariates. RESULTS: The number of outpatients with malignant neoplasms, ischemic heart disease, and cerebrovascular disease was 851, 1,037, and 716, respectively. The adjusted odds ratio for not working in people with the intention to work was significantly higher among outpatients with the three diseases than among non-outpatients, for both men and women. The adjusted odds ratio for intention to seek permanent work in unemployed people with the intention to work was lower among outpatients with cerebrovascular disease than among non-outpatients for men (p=0.093), and was significantly higher among outpatients with malignant neoplasms than among non-outpatients for women (p=0.007). CONCLUSIONS: This study identified a high proportion of unemployed people with the intention to work among outpatients with these three diseases, and suggests that there are disease-associated differences in employment type sought.

目的 手助けや見守りを要する者がいる世帯における主介護者と他の世帯員について,健康とストレスの状況を平成22年国民生活基礎調査の匿名データに基づいて解析した。方法 統計法36条に基づく匿名データを利用した。20歳以上の世帯員から,40歳未満の手助けや見守りを要する者とその世帯員などを除く,72,024人を解析対象者とした。男女ごとに,手助けや見守りを要する者がいない世帯の世帯員を基準として,手助けや見守りを要する者がいる世帯の主介護者と他の世帯員について,通院,健康意識,悩みやストレス,こころの状態のオッズ比をそれぞれロジスティック回帰で年齢を調整して推定した。結果 手助けや見守りを要する者がいない世帯の世帯員を基準とする年齢調整オッズ比をみると,主介護者において,「悩みやストレスあり」は男性で2.14と女性で2.49,「健康意識がよくない」は男性で1.36と女性で1.31,「こころの状態がよくない」は男性で1.86と女性で1.65であり,いずれも有意(p<0.05)に大きかった。他の世帯員において,「悩みやストレスあり」は男性で1.11と大きい傾向(p<0.1),女性で1.26と有意に大きく,「こころの状態がよくない」は女性で1.30と有意に大きかった。結論 手助けや見守りを要する者がいる世帯において,主介護者には健康とストレスによくない状況があることが確認された。他の世帯員には,主介護者と同様に悩みやストレスが生じていること,女性では精神的問題の生ずる可能性が大きいことおよび主介護者と異なり健康意識の低下が生ずる可能性が大きくないことが示唆された。(著者抄録)

<p> Taking action in response to health examination results is important to stay healthy. We aimed to investigate the associations between occupation, employment type and company size, and having a health examination and taking action in response to the results among Japanese employees. We focused on three particular actions by employees in response to health examination results: paying attention to one's health, receiving health guidance, and visiting a medical institution. We used anonymous data from the 2010 Comprehensive Survey of Living Conditions of Japan, a self-administered nationwide questionnaire survey. The data of 23,963 employees (12,938 male and 11,025 female) aged 20–64 yr were analyzed using logistic regression models adjusted by covariates. There were significant changes in odds ratios for receiving a health examination by occupation, employment type and company size. We found significant odds ratios for receiving health guidance by occupation and company size, but there was almost no significant association with paying attention to one's health and visiting a medical institution. These results confirmed that receiving a health examination was associated with occupational factors, and suggested that receiving health guidance after health examination results was associated with occupation and company size.</p>

<p>Objectives: The aim of this study was to investigate changes in health university students' attitudes toward community service before and after a community-oriented education program using team-based learning (TBL). </p><p>Methods: A community-oriented educational program using TBL was carried out with a total of 529 3rd- and 4th-year students in seven faculties of two departments at Fujita Health University, and a questionnaire survey was conducted before and after the program. There were eight questions on students' attitude toward community service.</p><p>Results: Responses with no missing information from 431 students were used in the analysis. There were significant increases in the number of positive responses to three questions after TBL. The item "I think there are things that university students can do as members of the community" increased from 81.9% before TBL to 86.5% after, "I can form specific images of activities that benefit the community" increased from 46.0% before to 70.3% after, and "In the future I want to participate in activities that benefit the community" increased from 74.7% before to 80.3% after.</p><p>Conclusion: The results suggest that this community-oriented educational program using TBL raised the motivation of university students in medical and health science programs to practice community health care.</p>

目的 女性の喫煙状況について,世帯の種類および配偶者・父親・母親の喫煙状況との関連性を,平成16年国民生活基礎調査の匿名データに基づいて解析した。方法 統計法36条に基づく匿名データを利用した。20歳以上の女性から,喫煙状況が不詳の3,510人と過去喫煙の415人を除く37,772人を解析対象者とした。女性の現在喫煙割合について,世帯の種類,配偶者・父親・母親の喫煙状況別に算定・比較した。年齢構成の影響を調整して比較するために,女性の現在喫煙者数の観察値を分子,その期待値を分母とする比(女性の現在喫煙割合の年齢調整比)を算定した。結果 女性の現在喫煙割合は20〜44歳で18.3〜22.9%で,その後,年齢とともに低下した。女性の現在喫煙割合の年齢調整比は女性全体で1に対して,三世代世帯と夫婦と未婚の子のみの世帯で有意に小さく,ひとり親と未婚の子のみの世帯と単独世帯で有意に大きく,夫婦のみの世帯で有意でなかった。配偶者が非喫煙での女性の現在喫煙割合の年齢調整比は三世代世帯,夫婦と未婚の子のみの世帯,夫婦のみの世帯で0.27〜0.49と有意に小さかった。母親が現在喫煙での年齢調整比は三世代世帯,夫婦と未婚の子のみの世帯,ひとり親と未婚の子のみの世帯で1.57〜2.15と有意に大きく,父親が現在喫煙での年齢調整比はひとり親と未婚の子のみの世帯のみで有意に大きかった。結論 女性の喫煙状況について,世帯の種類で異なること,配偶者と母親の喫煙状況と強く関連することが示唆され,匿名データ利用に有用性があると考えられた。(著者抄録)

Objectives: We examined whether selected factors were associated with activity limitation used to calculate the healthy life expectancy in accordance with the target of Health Japan 21 (the second term). <br>Methods: Data for 6251 subjects were obtained from the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, both of which were conducted by the Ministry of Health, Labour and Welfare of Japan in 2010. The age-adjusted odds ratios (AOR) of limitation of activity for the assessed factors were estimated using a logistic model.<br>Results:, The percentage of persons with activity limitation was 12.1% of men and 15.6% of women. For men, low body mass index (BMI) (AOR: 2.02, p=0.008), high blood pressure (AOR: 1.53, p=0.021), high hemoglobin A1c (HbA1c) (AOR: 1.99, p=0.000), a small number of steps (AOR: 1.68, p=0.002), and high intake of salt (AOR: 0.69, p=0.010) were significantly associated with limitation of activity. For women, high BMI (AOR: 1.49, p=0.003), a small number of steps (AOR: 1.48, p=0.009), and high intake of salt (AOR: 0.77, p=0.017) were significantly associated with activity limitation. <br>Conclusion: We identified several factors that were associated with activity limitation. Our results from cross-sectional data require careful interpretation before concluding whether these relationships are causal

Objectives An earlier study using the data from the Japanese Long-term Care Insurance (LTCI) system reported a scenario for achieving the target of Health Japan 21 (the second term): future gains in health expectancy from 2011 to 2020 must be larger than gains in expectancy. According to this scenario (the Healthy Life Expectancy Extension Scenario), the proportion of disability (cases≥Care Level 2 in LTCI disability certification) will gradually decrease by 1% per year from 2011. The purpose of this study was to estimate the cost savings in long-term care and medical care if the Healthy Life Expectancy Extension Scenario is achieved.<br/>Methods We used data from Japanese national statistics and a survey conducted in Osaki city, Miyagi. The natural course of disability cases (≥Care Level 2) was estimated under the assumption that the future population composition would be equal to the population projections for Japan and the future proportion of disabilities for each age grade would be equal to that of 2010. Then, the decrease in the number of disabilities based on the Healthy Life Expectancy Extension Scenario was calculated. Finally, the cost savings in long-term care and medical care associated with the assumed decrease in the number of disability cases was calculated.<br/>Results When the disability cases (≥Care Level 2) were shifted to "no disability certification (not requiring care)," a total estimated cost reduction of 5,291 billion yen was achieved from 2011 to 2020. Furthermore, a total estimated reduction of 2,491 billion yen was achieved for the same period when all disability shifts to "Care Level 1" were accounted for.<br/>Conclusion As a rough calculation, if the Health Japan 21 (second term) target is achieved, approximately 2,500–5,300 billion yen will be saved in the cost of long-term care and medical care.

Objectives&emsp;We attempted to predict health expectancy in Japan for the period between 2011 and 2020, considering the target of Health Japan 21 (the second term) that future gains in health expectancy be larger than in life expectancy.<br/>Methods&emsp;We used data from Japanese national statistics. Health expectancy between 2011 and 2020 was predicted using the Sullivan method under the assumption that future mortality was equal to the estimate in Population Projections for Japan (January 2012), and under three scenarios of future prevalence of bad health status.<br/>Results&emsp;The numbers of expected years without activity limitation at birth for males and females in 2020 were predicted as 71.2 and 74.3, respectively, under the scenario that prevalence of activity limitation was constant since 2010; 71.4 and 74.5 under the scenario that the prevalence followed the recent trend; and 71.7 and 74.9 under the scenario that the prevalence decreased with such a rate that future gains in health expectancy were equal to in life expectancy. The rate of decrease in the prevalence in 2010&ndash;2020 in the last scenario was estimated to be 0.95 in males and 0.96 in females. The numbers of expected years with subjective well-being at birth in 2020 predicted under above three scenarios were between 69.5 and 71.2 in males and between 72.9 and 74.6 in females. The rate of decrease in the last scenario was estimated to be 0.96 in males and 0.97 in females. The numbers of expected years without care needs at age 65 in 2020 predicted under above three scenarios were between 18.0&ndash;18.2 in males and between 21.2&ndash;21.5 in females. The rate of decrease in the last scenario was estimated to be 0.90 in males and 0.91 in females.<br/>Conclusion&emsp;The health expectancy in 2011&ndash;2020 was predicted under some scenarios of future prevalence of bad health status. The rate of decrease in the future prevalence of bad health status was estimated with a view to the accomplishment of the target of Health Japan 21 (the second term).

Background: Using a previously developed method for calculating expected years of life with care needs based on data from the Japanese long-term care insurance system, we examined recent trends in expected years of life with care needs by age group and prefecture.<BR>Methods: Information on care needs was available from the long-term care insurance system of Japan. Expected years of life with care needs by age group and prefecture in 2005&ndash;2009 were calculated.<BR>Results: Expected years of life with care needs at age 65 increased from 1.43 years in 2005 to 1.62 years in 2009 for men, and from 2.99 to 3.44 years for women. As a proportion of total life expectancy, these values show an increase from 7.9% to 8.6% in men and from 12.9% to 14.4% in women. Expected years with care needs did not increase in the age groups of 65 to 69 and 70 to 74 years but markedly increased in the age group of 85 years or older. Expected years with care needs increased in every prefecture during the period studied. The difference in 2005 between the 25th and 75th percentiles in prefectural distributions was 0.16 years for men and 0.35 years for women. The difference remained nearly constant between 2005 and 2009.<BR>Conclusions: Expected number of years of life with care needs increased among Japanese from 2005 to 2009, and there was a wide range in distribution among prefectures. Further studies on coverage of care needs under the long-term insurance program are necessary.

Background: Although disability-free life expectancy has been investigated in Japan, gains from elimination of diseases and injuries have not been examined.<BR>Methods: We used data from the 2007 Japanese national health statistics to calculate the number of years with and without activity limitation that could be expected from eliminating 6 selected diseases and injuries.<BR>Results: At birth, the number of expected years of life without and with activity limitation was 70.8 and 8.4, respectively, in males and 74.2 and 11.8 in females. More than 1.0 expected years without activity limitation were gained from eliminating malignant neoplasms and cerebrovascular diseases; smaller gains were observed after eliminating other diseases and injuries. Elimination of cerebrovascular diseases, dementia, and fracture decreased expected years with activities of daily living (ADL) limitation, and elimination of shoulder lesions/low back pain decreased expected years with non-ADL limitation.<BR>Conclusions: Elimination of diseases and injuries increased expected years with and without activity limitation among Japanese, which suggests that improved prevention of those diseases and injuries&mdash;including cerebrovascular diseases and dementia&mdash;would result in longer disability-free life expectancy and fewer years of severe disability.

Background: There have been few reports on longitudinal change in activities of daily living (ADL), functional capacity, and life satisfaction in patients with subacute myelo-optico-neuropathy (SMON).<BR>Methods: A total of 1309 SMON patients 40 to 79 years of age underwent a medical examination conducted by the SMON Research Committee during the period from 1993 through 1995 (baseline) in Japan; 666 (51%) were followed-up after 12 years and were thus eligible for analysis. We calculated scores for ADL, functional capacity, and life satisfaction at baseline, and at 3, 6, 9, and 12 years after baseline, using data from medical examinations conducted in 1993 through 2007. The Barthel Index, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and the patient&rsquo;s response to the question &ldquo;Are you satisfied with life?&rdquo; were used to assess ADL, functional capacity, and life satisfaction, respectively.<BR>Results: As compared with baseline, the mean scores for ADL, functional capacity, and life satisfaction were all significantly lower after 12 years in men and women, with the exception of life satisfaction in women. The change in scores for functional capacity from baseline to year 12 was significantly associated with change in life satisfaction; however, the changes in ADL and age at baseline were not.<BR>Conclusions: We observed decreases in ADL, functional capacity, and life satisfaction among SMON patients. Our results suggest that a decrease in life satisfaction can be prevented by maintaining or improving functional capacity.

目的 健康増進計画の目標評価項目の1つに挙げられている65歳平均自立期間について,愛知県の国民健康保険各保険者において算定を行い,そのばらつきと人口規模との関係,利用する死亡資料の期間の違いについて検討を行った。方法 愛知県の国民健康保険団体連合会を構成する58保険者(32市,25町村および1事務組合)を対象として,対象地域の人口,死亡者数および介護保険法に基づく要介護度II～Vの認定者数を用いて,2005年の保険者別,男女別の65歳平均自立期間とその95%信頼区間を算定した。ただし,算定にあたっては,人口および死亡者数を2005年の1年間(以下,1年間)利用したものと2004～2006年の3年間(以下,3年間)利用の2通り行った。結果 資料を1年間利用した場合の2005年の65歳平均自立期間推定値の平均値は,男16.91±1.08年,女20.03±1.02年であり,男女とも対象の人口規模に応じかなりのばらつきが認められた。1年間利用と3年間利用した場合の比較では,男女とも各推定値のばらつきは3年間利用の方が小さかった。また,1年間利用と3年間利用した場合の各推計値は,男女とも正の相関を示し,相関係数は男が0.78,女が0.84であった。死亡資料を1年間利用した場合における平均自立期間の各推定値の95%信頼区間の幅は,一定条件下で1年間の死亡資料に基づき人口規模に応じて試算をした95%信頼区間の幅に,男女ともほぼ一致をした。このことから,平均自立期間の推定値のばらつきの大よその大きさは,全国資料に基づく試算値で見積もることが可能であることが示唆された。結論 要介護認定者数に基づく平均自立期間は,人口規模の小さい地域での適用が可能であり有用であると考えられた。ただし,人口規模が小さい地域においては,3年間の人口および死亡者数を利用することや,平均自立期間の推定値に併せて,その95%信頼区間を明示することが望ましいと考えられた。(著者抄録)

目的 介護保険に基づく平均自立期間の算定方法(厚生労働科学研究費補助金による「健康寿命の地域指標算定の標準化に関する研究班」が提案)に関して調査を行い,その適切性などを検討した。方法 都道府県,特別区と指定都市(以下,都道府県等)の健康福祉担当部局主管課長87人と保健所長517人に対して,調査票を配布・回収した。調査内容は指標の名称と要介護の定義(提案方法では介護保険の要介護2～5)の適切性などとし,回答は「適切」「どちらかといえば適切」「どちらかといえば適切でない」「適切でない」などの4肢択一形式とした。結果 都道府県等は69人(79%),保健所は388人(75%)から調査票が回収された。平均自立期間という名称の適切性に対して「適切」または「どちらかといえば適切」の回答割合は90%であった。要介護2～5以外の介護保険の要介護度で,あるいは介護保険以外で,要介護の適切な定義に対して「ある」または「どちらかといえばある」の回答割合は10%以下であった。平均自立期間の意味に対して,地域保健担当者による理解が「容易」または「どちらかといえば容易」の回答割合は92%,一般住民でのそれは61%であった。市区町村の算定に対して「重要」または「どちらかといえば重要」の回答割合は81%であった。都道府県健康増進計画以外への活用に対して「可能」または「どちらかといえば可能」の回答割合は68%であった。いずれの回答割合ともに都道府県等と保健所に大きな差がなかった。結論 提案された平均自立期間の算定方法は都道府県等からおおよそ支持されたと考えられる。今後,市区町村の算定と都道府県健康増進計画以外への活用を検討することが重要であろう。(著者抄録)

Background: In Japan, life expectancy at birth is currently the highest in the world. However, recent trends in disability-free life expectancy in Japan have not been examined.<BR>Methods: We used data from Japanese national surveys for the period 1995&ndash;2004. These surveys included information on activity status measured by common self-reported instruments. The numbers of expected years with and without activity limitation were estimated by using the Sullivan method.<BR>Results: The numbers of expected years of life without activity limitation, at birth, in 1995 and 2004 were 68.5 and 69.7, respectively, in males and 72.1 and 73.0 in females. As a proportion of total life expectancy, at birth, these values represent a decrease from 89.7% to 88.6% in males and from 87.1% to 85.3% in females. The proportion of expected years with a limitation of some activities except activities of daily living (ADL) increased in males and females. The proportion of those with an ADL limitation increased in females, but not in males.<BR>Conclusions: The trends in expected years with and without activity limitation suggest that the duration of life with a light or moderate disability increased in Japanese males and females during the period 1995&ndash;2004.

Background: Patients with subacute myelo-optico-neuropathy (SMON) suffer from a number of serious neurological symptoms that adversely affect their activities of daily living (ADL). However, the effects of these neurological symptoms on functional capacity and life satisfaction have not been reported.<BR>Methods: We analyzed data from 1,300 SMON patients aged 55&ndash;94 years that was obtained at medical check-ups carried out by the SMON Research Committee in 2004&ndash;2006 in Japan. The neurological symptoms investigated were visual impairment, dysbasia, symptoms of the lower extremities, and sensory symptoms. Neurological symptoms were classified by severity. The Barthel Index, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and the participant&rsquo;s response to the question &ldquo;Are you satisfied with life?&rdquo; were used to evaluate ADL, functional capacity, and life satisfaction, respectively. Data were analyzed using a proportional odds model with the scores for these items as ordinal dependent variables.<BR>Results: For most neurological symptoms, scores for ADL, functional capacity, and life satisfaction were significantly lower in participants with severe or moderate neurological symptoms than in those with nearly normal results upon examination. The odds ratio for life satisfaction due to superior functional capacity was significant after adjustment for sex, age, and ADL score.<BR>Conclusion: The presence of neurological symptoms in SMON patients was associated with low functional capacity, life satisfaction, and ADL. Our results suggest that the life satisfaction of SMON patients can be increased by improving their functional capacity.

We studied the probability of fatty liver (FL) onset by subjecting FL risk factors to logistic regression analysis and clarifying the probability of FL disappearance due to weight loss. Subjects were 611 people with an average age of 50.6&plusmn;9 years who underwent thorough medical checkups. Of risk factors for FL, we analyzed BMI, HDL cholesterol (HDL), triglyceride (TG), HbA₁c (A₁c), and uric acid (UA) to investigate FL onset probability. Results indicated that probability in terms of the average risk factor score for people without FL was estimated at 15% for men and 1% for women. At a A₁c of 6.5%, probability was 75.5% for men and 22% for women. At a TG of 200 mg/dl, probability was almost 100% for men and 85% for women. Regarding the effects of weight loss from a multiple risk syndrome state, the probability of FL onset at a BMI of 26 kg/m², A₁c of 5.8%, UA of 7.0 mg/dl, TG of 150 mg/dl, and HDL of 39 mg/dl was 88% for men and 46% for women. With weight loss of 1 kg/m² of BMI, the probability decreased to 59% for men and 9.3% for women, and with weight loss of 2 kg/m² of BMI, it decreased to 20% for men and 7.6% for women. These findings suggest that weight loss of approximately 10% for men and 5% for women is sufficient for reducing the FL risk.

OBJECTIVES: This study attempted to clarify the acute effects of cigarette smoking on autonomic nervous function among taxi drivers under ordinary work conditions. METHODS: Holter electrocardiographic recordings from 20 healthy middle-aged taxi drivers were analyzed for the time from 0800 in the morning to 0159 at night. The amplitudes (milliseconds) of the high-frequency (HF) component and the ratio of the low-frequency component to HF (LF/HF) were calculated as changes in the R-R interval, and time-course changes were investigated by a complex demodulation method. The exact starting time of smoking was identified with the use of a specially designed cigarette lighter. The mean LF/HF and HF for 5 minutes immediately prior to smoking were calculated as the baseline, and the means for every 5 minutes up to 15 minutes were calculated. The average values of these parameters for all of the cigarette smoking within the same time span of 0800-1659 and 1700-0159 were also determined. RESULTS: The LF/HF significantly increased (P<0.05) within 5 minutes from the baseline immediately after smoking. This significant change in LF/HF was observed only at night. Although the interactive effect of the time of day on time course changes was not significant for the LF/HF or HF, the reactivity to increase LF/HF and decrease HF was more prominent at night. CONCLUSIONS: Cigarette smoking significantly increased LF/HF within 5 minutes during ordinary taxi driving. Nighttime smoking seemed to have a more potent acute effect on the cardiac modulation of taxi drivers than in the daytime. The sympathomimetic and parasympatho-withdrawal response of smoking may play an additional role in increasing cardiac risk among taxi drivers.