太田 充彦

Background and aims: Coronary heart disease (CHD) and stroke have common risk factors, but some of these differ in the magnitude or direction of associations between CHD and stroke. We assessed whether the impact of each risk factor differed between CHD and stroke mortality in Asians. Methods: In total, 104 910 subjects aged 40-79 years without histories of cancer, CHD and stroke at baseline were followed between 1988 and 2009. Competing- risks analysis was used to test for differences in the associations of each risk factor with two endpoints (CHD and stroke). Population attributable fractions (PAFs) were also calculated for these endpoints to estimate the population impact of each risk factor. Results: During a median 19.1-year follow-up, 1554 died from CHD and 3163 from stroke. The association of hypertension with CHD was similar to that with stroke in terms of the magnitude and direction (multivariable-adjusted hazard ratio for CHD: 1.63 vs. stroke: 1.73 in men and 1.70 vs. 1.66 in women). Conversely, the magnitude of these associations differed for smoking (CHD: 1.95 vs. stroke: 1.23 in men and 2.45 vs. 1.35 in women) and diabetes (1.49 vs. 1.09 in men and 2.08 vs. 1.39 in women). The highest PAF for CHD was caused by smoking in men and by hypertension in women; that for stroke was caused by hypertension in both sexes. Conclusions: Hypertension associations and PAFs were consistent between CHD and stroke, but not for other risk factors. These findings may be useful to optimize public health intervention strategies. (C) 2017 Elsevier B.V. All rights reserved.

<p>目的 「事業場における治療と職業生活の両立支援のためのガイドライン（両立支援ガイドライン）」の認知，両立支援のための職場環境・労務管理体制の整備の実態，それらと事業場規模，事業場内産業保健スタッフ，過去の私傷病退職者・がん罹患者の有無との関連の探索。</p><p>方法 某労働基準監督署管内の1,002事業場を対象に自記式質問紙調査を実施した。両立支援ガイドラインの認知割合，両立支援のための職場環境として啓発研修，相談・申出窓口，事業場内外の関係者間の情報交換の枠組みの有無，および，私傷病時に利用可能な労務管理制度として時差出勤，所定労働時間の短縮，時間単位の休暇，試し出勤，傷病・病気休暇の有無を調べ，事業場の規模による違いをコクラン・アーミテージ検定にて検定した。それらと事業場内産業保健スタッフ，および過去3年間に私傷病で退職した従業員・がんに罹患した従業員の有無との関連を調べ，Fisher正確確率検定で検定した。</p><p>結果 266事業場から回答があり，回答率は27%であった。両立支援ガイドライン認知の割合は19%で，その割合は事業場規模が大きいほど高かった。啓発研修は7%，相談・申出窓口は38%，情報交換の枠組みは33%の事業場で行われており，事業場規模が大きいほどこの割合が高かった。従業員数50人未満の小規模事業場においては，事業場内産業保健スタッフのいる事業場で啓発研修（20%），相談・申出窓口（52%），情報交換の枠組み（48%）の実施割合が産業保健スタッフのいない事業場よりも高かった。両立支援のための各種労務管理制度の導入割合は1～3割で，時間単位の休暇および傷病休暇・病気休暇は，事業場規模が大きいほど導入割合が高かった。過去3年間に私傷病で退職した従業員・がんに罹患した従業員の有無と両立支援のための職場環境・労務管理制度の有意な関連はなかった。ガイドラインを認知していた事業場では，従業員数50～299人の中規模事業場では所定労働時間の短縮がより多く実施されていた。</p><p>結論 両立支援ガイドライン認知の割合は低く，さらなる周知が望ましい。両立支援のための職場環境・労務管理制度の導入割合は一部先行研究よりも高く，事業場規模，産業保健スタッフの有無による違いを認めた。</p>

Excess intake of iodine is a suspected risk factor for thyroid cancer. Previous epidemiological research from Japan reported that daily intake of seaweed was associated with a four-fold higher risk in postmenopausal women, whereas others reported a null association. A major source of iodine intake in Japan is from edible seaweeds, and it is reported to be among the highest in the world. We examined the association between seaweed intake frequency and the risk of thyroid cancer in women in the Japan Collaborative Cohort Study followed from 1988 to 2009. Seaweed intake, together with other lifestyle-related information was collected using a self-administered questionnaire at baseline. Seaweed intake frequency was categorized as follows: 1-2 times/week or less, 3-4 times/week, and almost daily. Hazard ratios and the 95% confidence intervals of thyroid cancer incidence according to seaweed intake frequency were estimated using Cox proportional hazards regression. During 447876 person-years of follow-up (n=35687), 94 new cases of thyroid cancer were identified. The crude incidence rate was 20.9 per 100000 person-years. The hazard ratio of thyroid cancer in women who consumed seaweed daily compared with women who ate it 1-2 times/week or less was 1.15 (95% confidence interval: 0.69-1.90, P for trend=0.59). Further analyses did not indicate any association between seaweed intake and the risk of thyroid cancer on statistically adjusting for potential confounding variables as well as on stratification by menopausal status. The present study did not find an association between seaweed intake and thyroid cancer incidence in premenopausal or in postmenopausal women. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

OBJECTIVE: To investigate differences in the association of parental history of diabetes with the risk of type 2 diabetes mellitus (T2DM) in the offspring according to the sex of the parent and the offspring's body weight. METHODS: A prospective cohort study of 4446 middle-aged non-diabetic Japanese men and women were followed in Aichi Prefecture, central Japan, from 2002 to 2011. Subjects were categorized by their self-reported parental history of diabetes ("no parental history," "father only," "mother only," and "both"). The association of parental history of diabetes and incidence in the offspring was examined according to overweight status adjusted for age, sex, birth weight, smoking, alcohol consumption, physical activity, total energy intake, body mass index, and number of metabolic syndrome components. RESULTS: During follow-up (median 8.9 years), 277 subjects developed T2DM. Parental history of diabetes was positively associated with T2DM incidence. However, stratified analysis by overweight status revealed that only maternal history was associated with increased T2DM incidence in non-overweight subjects (hazard ratio=2.35, 95% confidence interval: 1.41-3.91). While in overweight subjects, paternal history was significantly associated with higher T2DM incidence (hazard ratio=1.98, 95% confidence interval: 1.19-3.28). CONCLUSIONS: Our results suggest that parental history of diabetes mellitus is associated with the incidence of T2DM in offspring differently according to the sex of the affected parent and the offspring's body weight.

Although the global prevalence of both the overweight and obese is on the rise, there are variations among regions or countries, and sexes. Approximately half or more than half of the population are overweight/obese defined as body mass index &gt;= 25 kg/m(2) in the Americas (61.1%), Europe (54.8%), and Eastern Mediterranean (46.0%) according to the World Health Organization, while a much lower prevalence is observed in Africa (26.9%), South-East Asia (13.7%), and the Western Pacific (25.4%). Females are more likely to be overweight/obese in the Eastern Mediterranean, Africa, South-East Asia and the majority of countries in the Americas and Western Pacific but not in the most of the countries in Europe. These region-sex-ethnicity differences in prevalence may be a clue to the causes of the obesity epidemic. Epidemiological studies done in the USA, Europe, and Asia found that higher BMI was significantly associated with increased incidence of coronary artery disease (CAD) and ischemic stroke, but the association with hemorrhagic stroke incidence was not always consistent. The association of BMI with CAD and ischemic stroke was generally independent of known mediators, which would indicate the importance of controlling or preventing overweight/obesity for the prevention of cardiovascular disease.

Background: Smokers' nonsmoking partners may be expected to encourage the smokers to quit smoking. However, there is little evidence regarding whether this expectation is applicable to the cases of middle-aged Japanese male smokers.Objective: We examined the relationship between living with a nonsmoking partner and smoking cessation of middle-aged Japanese male smokers.Methods: A prospective cohort study was performed. Five hundred seventy nine male smokers were observed for two years during which no intensive smoking cessation interventions were offered to either the subjects or their partners. The smoking status of the subjects and their partners was assessed based on the subjects' self-reporting. Age, the number of cigarettes smoked per day, educational background, illness being treated, frequent alcohol use, and occupational class of the subjects at the baseline were considered as the covariates related to their smoking behaviors. Using a multiple logistic regression analysis, we calculated the odds ratio of living with a nonsmoking partner at the baseline on smoking cessation of the subjects at the follow-up adjusted for the covariates.Results: At the follow-up, smoking cessation rates were 5.7% (24/419) among the subjects who were living with a nonsmoking partner at the baseline and 4.4% (7/160) among those who were not. The difference in cessation rates between these two groups was not statistically significant. The adjusted odds ratio of living with a nonsmoking partner at the baseline on smoking cessation was 0.79 (95% confidence interval: 0.31, 2.01, p = 0.625).Conclusion: This study did, not show that living with a nonsmoking partner significantly facilitated smoking cessation of middle-aged Japanese male smokers. It may be an excessive, unreal expectation that nonsmoking women in Japan automatically encourage their middle-aged male smoking partners to quit smoking when no intensive support for smoking cessation is offered.

INTRODUCTION: A prospective cohort study was conducted to examine the effects of psychosocial job characteristics on smoking cessation. Previous studies have failed to indicate consistently that psychosocial job characteristics predicted smoking cessation. Using the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models simultaneously, we assessed psychosocial job characteristics more comprehensively than did previous researchers. METHODS: This study was performed using a population derived from a corporate manufacturing group in Japan. At the baseline, 579 (41%) of 1,423 middle-aged (> or = 39 years) male employees were smokers. These male smokers were considered as the study subjects and were asked to undergo a follow-up examination after 2 years. Prospective analysis of the relationship between psychosocial job characteristics at the baseline and smoking cessation at the follow-up was performed. Job strain, social support, effort-reward imbalance, and overcommitment to work were assessed as psychosocial job characteristic factors. RESULTS: The smoking cessation rate among the study subjects at the follow-up was recorded as 5% (31/579). No psychosocial job characteristic factors at the baseline were significantly related to smoking cessation at the follow-up. DISCUSSION: Even with the simultaneous use of the DCS and ERI models, we did not find positive results in terms of the prospective effects of psychosocial job characteristics on smoking cessation. Considering the results of relevant previous studies and those of the present study, we suppose that psychosocial job characteristics could have essentially little effect on smoking cessation.

OBJECTIVE: To examine the prospective effects of psychosocial job characteristics evaluated with the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models on insomnia. METHODS: A prospective cohort study with a two-year observation was performed. The subjects were 1022 middle-aged (>or= 39 years) Japanese workers. The following associations were analyzed: high job strain, low social support, effort-reward imbalance, and overcommitment to work at the baseline with self-reported persistence and future onset of insomnia. RESULTS: Among those who were insomniacs at the baseline (N=292), low social support [adjusted odds ratio (95% CI): 2.00 (1.18, 3.40)] and effort-reward imbalance [2.40 (1.13, 5.10)] at the baseline had a significant relationship to insomnia at the follow-up. Among those who were not insomniacs at the baseline (N=730), overcommitment to work [1.75 (1.16, 2.66)] and high job strain [1.72 (1.06, 2.79)] at the baseline were associated with insomnia at follow-up. CONCLUSIONS: Prospective effects of psychosocial job characteristics on insomnia differed between its persistence and future onset. Proportionate reward for work effort and sufficient support at work assist recovery from insomnia, while overcommitment to work and high job strain cause future onset of insomnia.

In this prospective cohort study for Japanese patients with established ischemic heart disease (IHD), the authors investigated the rate of success of smoking cessation 3 months after hospital discharge and its related factors. The subjects included 90 current smokers admitted for IHD. A total of 58 subjects (64%) had quit smoking for 3 months after being discharged. In comparison with subjects with acute myocardial infarction, those with stable angina (SA) showed a significantly lower frequency of smoking cessation (relative risk of resuming smoking (95% confidence interval):2.06 (1.09, 3.92), p=0.036). This relationship remained significant even after controlling for sex, age, and scores of the Fagerstrom Test for Nicotine Dependence (adjusted odds ratio:3.39 (1.01, 11.37), p=0.048). However, it became insignificant when hospital admission followed by emergency medical service (EMS) care was additionally adjusted (adjusted odds ratio:2.48 (0.36, 16.97), p=0.356). The smoking cessation rate in this study was identical to that observed in studies conducted in Japan prior to the recent social changes with regard to tobacco use. SA still appears to be a risk factor for smoking resumption after discharge. Experiencing EMS care would be an intermediate variable in this relationship.

BACKGROUND: Evidence is still insufficient regarding the effects of Power Rehabilitation (PR) on physical performance and higher-level functional capacity of community-dwelling frail elderly people. METHODS: This nonrandomized controlled interventional trial consisted of 46 community-dwelling elderly individuals with light levels of long-term care needs. They were allocated to the intervention (I-group, n = 24) and control (C-group, n = 22) groups. Of them, 32 persons (17 in the I-group; 15 in the C-group) (median age, 77 years; sex, 28% male) completed the study. The I-group subjects underwent PR twice a week for 12 weeks. The outcomes were physical performance (muscle strength, balance, flexibility, and mobility) and higher-level functional capacity as evaluated by the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) and the level of long-term care need as certified by the public long-term care insurance. RESULTS: The I-group demonstrated a significant improvement in the measured value of the timed up-and-go test (median change, a decrease of 4.4 seconds versus a decrease of 0.2 seconds, p = 0.033) and the timed 10-meter walk (a decrease of 3.0 seconds versus an increase of 0.2 seconds, p = 0.007) in comparison with the C-group. No significant change was observed in the TMIG-IC scores or in the level of long-term care need in the I-group. CONCLUSION: PR improved mobility of community-dwelling frail elderly people; however, such improvement did not translate into higher-level functional capacity. Our findings demonstrate the difficulty in transferring the positive effects associated with PR into an improvement in higher-level functional capacity.

OBJECTIVE: The objective was to clarify factors, including Internet-accessed advice for smoking cessation, associated with smoking cessation among participants of the Quit Smoking Marathon (QSM), a one-month smoking cessation program involving use of e-mails and a mailinglist. METHODS: The subjects were 88 volunteers who aimed to quit smoking and completed the QSM program. Those who remained abstinent from smoking at 1 year thereafter were defined as successful quitters. Factors associated with successful smoking cessation were examined by multiple logistic regression analysis adjusted for confounders and separately for use of nicotine replacement therapy (NRT). RESULTS: Successful smoking cessation was reported by 49 subjects (55.7%). For the NRT-free group, sending 10 or more e-mails to the mailing-list was significantly associated with successful smoking cessation [odds ratio: 10.7, P=0.015]. CONCLUSION: Frequent e-mailing to the mailing-list followed by obtaining personal advice is an effective way to quit smoking among QSM participants not using NRT.

BACKGROUND AND PURPOSE: The details of risky psychosocial job characteristics related to insomnia are unclear, although potential relationships between the two have been suggested. The study objective was to clarify these relationships by using the demand-control-support (DCS) model and the effort-reward imbalance (ERI) model. PATIENTS AND METHODS: A cross-sectional questionnaire survey was conducted with 1081 middle-aged (39 years and older) workers in a corporate group of electric products in Osaka, Japan. The study variables included insomnia symptoms (non-refreshing sleep, difficulty falling asleep, frequent sleep disruption, and early morning arousal) and psychosocial job characteristics which were evaluated using the DCS and ERI models, gender, age, disease, sleep-related factors, occupational status, and health practices. RESULTS: ERI [odds ratio (95% confidence interval): 2.27 (1.43, 3.60)], overcommitment [1.86 (1.40, 2.47)], and high job strain [1.55 (1.12, 2.15)] were independently associated with insomnia. The odds ratio of insomnia for individuals with high job strain was increased by adding ERI or overcommitment. CONCLUSIONS: The ERI and DCS models describe the adverse psychosocial job characteristics related to insomnia. Simultaneously employing these two models is more useful than employing a single model to identify workers at risk of insomnia. The conceptual framework derived from the job stress models assists in defining preventive measures for insomnia in workers.

This study focuses on the predictability of two alternative questionnaires for nicotine dependence, i.e., the Fagerstrom Tolerance Questionnaire (FTQ) and the Tobacco Dependence Screener (TDS), each of which represents a different aspect of dependence, among patients with coronary heart disease (CHD). Twenty-nine male inpatients that had been newly diagnosed as CHD were followed up for 30 weeks after hospital discharge. The baseline information included age, number of cigarettes per day, years of smoking, disease type (angina pectoris [AP] or acute myocardial infarction [AMI), whether they had received a briefing on smoking cessation, the FTQ, and the TDS. At 30 weeks after hospital discharge, 19 (66%) were abstainers. The group with a high TDS score (of 6 or greater) was significantly less likely to quit smoking than the group with a low TDS score (p=0.046). The FTQ score was not significantly different between the abstainers and non-abstainers. The subjects with AP were significantly less likely to quit smoking than those with AMI (p=0.021). Multiple logistic regression analysis showed that belonging to the high-TDS group and being diagnosed as AP were significantly associated with failure in smoking cessation (p<0.05). The present study suggests that the TDS may have higher predictability than the FTQ concerning smoking cessation among CHD inpatients.