Development of a rating scale for measuring resistance to persuasive health messages

BACKGROUND@#Pretesting is the key to understanding how the intended audience will react to the message. Resistant reactions affect message processing or can lead to undesirable boomerang effects. The objective of this study was to develop a rating scale for measuring active (reactance) and passive (disengagement) resistance to persuasive health messages.@*METHODS@#Six candidate items (3 items for disengagement and 3 items for reactance) were generated based on literature review. A web-based survey was conducted among Japanese adults aged 25-64 years to verify the reliability and validity of the 6-item resistance scale. Participants were asked to rate one of the advance care planning (ACP) promotion messages. All scale items were scored on a 1-to-5 point Likert scale and they were averaged to produce the resistance score.@*RESULTS@#Explanatory factor analysis revealed a two-factor solution that agreed with the disengagement and reactance domains, respectively. Correlation coefficients between each set of items ranged between 0.30-0.69. Cronbach alpha (0.86) indicated satisfactory internal consistency of the set of items. Confirmatory factor analysis showed a good fit of the two-factor model with CFI = 0.998, SRMR = 0.011, and RMSEA = 0.041. The resistance score showed a moderate positive correlation with negative emotional responses (displeasure γ = 0.55, anger γ = 0.53) and was significantly inversely related to the persuasiveness score (γ = -0.50). Multivariable logistic regression analysis showed that the odds ratio for ACP intention per 1-point increase in the resistance score was 0.47 (95% confidence interval 0.40-0.56) with adjustment for the persuasiveness score.@*CONCLUSION@#The 6-item resistance scale exhibited adequate reliability and validity for measuring audience resistance when applied to the ACP promotion messages in Japanese people. The scale will be useful for pretesting health messages to make them more acceptable to the intended audience.@*TRIAL REGISTRATION@#Not applicable; this is not a report of intervention trial.

Changes in health status, workload, and lifestyle after starting the COVID-19 pandemic: a web-based survey of Japanese men and women

BACKGROUND@#This study aimed to examine the change in health status of the general public after starting the COVID-19 pandemic and its association with changes in workload and lifestyle.@*METHODS@#A web-based survey was conducted in November 2020, about 9 months after starting the COVID-19 pandemic in Japan, among 8000 Japanese men and women aged 25-64 years. Participants asked for the changes after starting the COVID-19 pandemic in health status, workload, daily life, and health behavior. Ordinal logistic regression was performed to elucidate factors associated with deterioration in general health status.@*RESULTS@#A deterioration in general health status was reported by 17.0% of male and 19.4% of female. There has been a clear shift to sedentary life with decreasing moderate activity and increasing screen time. The multivariate analysis revealed that deteriorated work style, increased burden of housework, decreased moderate activity, increased digital media exposure, and increased body weight were significantly associated with deteriorating health status.@*CONCLUSION@#Both men and women have experienced significant changes in workload and lifestyle since the COVID-19 pandemic started. People should be aware of the risks associated with their recent life changes and take self-care measures to prevent serious health consequences.

Responses to persuasive messages encouraging professional help seeking for depression: comparison between individuals with and without psychological distress

BACKGROUND@#The persuasive effect of health messages can depend on message features, audience characteristics, and target behaviors. The objective of this study was to compare the responses to persuasive messages encouraging professional help seeking for depression between individuals with and without psychological distress.@*METHODS@#A cross-sectional web-based survey was conducted on Japanese adults aged 35-45 years, who randomly received one of three persuasive messages that aimed to promote help-seeking intentions for depression. The primary message statements were as follows: (1) depression can happen to anyone, (2) depression needs treatment, and (3) depression improves with treatment. Participants rated the messages in terms of comprehensibility, persuasiveness, emotional response, and intended future use. Help-seeking intention for depression was measured using vignette methodology before and after exposure to the messages. Eligible participants who had not received medical treatment for their mental disorders were classified as either distressed (K6 score ≥ 5, N = 824) or non-distressed (K6 score < 5, N = 1133) and analyzed.@*RESULTS@#No significant differences in comprehensibility or persuasiveness scores were observed between the messages, but the distressed group had significantly lower scores than the non-distressed group. Negative emotional responses such as surprise, anger, fear, sadness, guilt, and anxiety were significantly stronger when reading message 2, while a positive emotional response such as happiness was significantly stronger when reading message 3. These emotional responses were more prominent in the distressed than in the non-distressed group. After reading messages 1, 2, and 3, the proportions of participants in the distressed group who reported having a positive help-seeking intention increased by 35.1%, 32.1%, and 27.7%, respectively, and by 6.4%, 17.3%, and 15.2%, respectively in the non-distressed group. Multiple logistic regression analysis among participants having no help-seeking intention before exposure to the messages showed that message 2 had a significantly greater effect of increasing help-seeking intentions in the non-distressed group.@*CONCLUSION@#The exposure to persuasive messages may promote help-seeking intentions for depression. It seems likely that loss framing will work better than neutral and gain framing. Meanwhile, the responses to persuasive messages may differ to some extent between distressed and non-distressed individuals, as individuals with psychological distress are likely to be more susceptible to persuasive messages than those without.@*TRIAL REGISTRATION@#Not applicable; this is not a report of intervention trial.

Antiviral Face Masks for the Prevention of Influenza Infection: a Meta-analysis / General Medicine

<b>Objective: </b>We performed a meta-analysis to examine the effectiveness of face masks for preventing influenza infection.<br><b>Methods: </b>A literature search was conducted to identify clinical trials that compared the incidence of influenza infection among family members with and without the use of antiviral face masks; some trials also contained the use of hand hygiene in the intervention group. Data from each trial were combined using a random effects model with the DerSimonian-Laird method to calculate pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).<br><b>Results: </b>The meta-analysis included seven randomized controlled trials that met our inclusion criteria. With the use of antiviral face masks, the pooled ORs (95% CIs) of laboratory proven infection were 0.69 (0.22–2.18). The pooled ORs (95% CIs) of influenza-like illness (ILI) were 1.07 (0.65–1.78). With the use of antiviral face masks and concomitant hand hygiene, the pooled ORs (95% CIs) of laboratory proven infection were 0.70 (0.35–1.39) in early intervention cases, and 0.93 (0.66–1.30) in all cases. The pooled ORs (95% CIs) of ILI were 1.01 (0.47–2.19) in early intervention cases, and 1.06 (0.53–2.13) in all cases.<br><b>Conclusion: </b>No statistically significant differences were detected in the incidence of influenza infection by wearing antiviral face masks, suggesting that distribution of face masks in primary care settings may not be enough to prevent influenza-like illnesses amongst family members.

Research for the Effective Use of the Medication Guides for Patients / 社会薬学

The Medication Guides for Patients (MGPs) are being offered as information on prescription drugs for patients by the Ministry of Health, Labour and Welfare (MHLW). The MHLW published the Risk Management Plan in April, 2012, and it noted that the MGPs should be utilized in usual risk minimization activities. It is not clear, however, whether the MGPs are efficiently utilized in actual settings. Hence, we conducted a questionnaire survey of the pharmacists in the pharmacies with dispensing and the hospitals in Mie and Yamagata prefectures to investigate the actual circumstances of MGPs utilization and to understand the existing barriers associated with the use of the MGPs as medication instructions for patients. We sent the questionnaires by mail and obtained responses from 444 facilities (33.9%) of 1,309 facilities. The recognition level of the MGPs was about 30 percent in the dispensing pharmacies, and about 50 percent in the hospitals. The MGPs were utilized as a common communication tool with the patients in approximately 20 percent of the facilities. Many respondents requested that the frequency of important and other adverse reactions should be described in the MGPs, and wider ranges of MGPs should be further implemented.<BR>Moreover, our data suggests the problem is that the present MGPs are mainly applied to special types of patients, such as those with higher literacy level or those who requested a detailed explanation. Thus, it is apparent that it is necessary to review the MGPs contents again to improve their practical benefits and disseminate them more widely.

Epidemiological approach to nosocomial infection surveillance data: the Japanese Nosocomial Infection Surveillance System

Surveillance of nosocomial infection is the foundation of infection control. Nosocomial infection surveillance data ought to be summarized, reported, and fed back to health care personnel for corrective action. Using the Japanese Nosocomial Infection Surveillance (JANIS) data, we determined the incidence of nosocomial infections in intensive care units (ICUs) of Japanese hospitals and assessed the impact of nosocomial infections on mortality and length of stay. We also elucidated individual and environmental factors associated with nosocomial infections, examined the benchmarking of infection rates and developed a practical tool for comparing infection rates with case-mix adjustment. The studies carried out to date using the JANIS data have provided valuable information on the epidemiology of nosocomial infections in Japanese ICUs, and this information will contribute to the development of evidence-based infection control programs for Japanese ICUs. We conclude that current surveillance systems provide an inadequate feedback of nosocomial infection surveillance data and, based on our results, suggest a methodology for assessing nosocomial infection surveillance data that will allow infection control professionals to maintain their surveillance systems in good working order.

Low back pain deprives the Japanese adult population of their quality of life: a questionnaire survey at five healthcare facilities in Japan

<p><b>OBJECTIVES</b>To estimate the degree to which low back pain (LBP) deprives the Japanese adult population of their quality of life (QOL) in terms of quality-adjusted life-years (QALYs).</p><p><b>METHODS</b>A questionnaire survey was conducted among participants of health examinations at five healthcare facilities in Japan. Age- and sex-specific mean values of the EQ-5D score were calculated for (1) those who reported LBP and interference with daily activities (IDA) due to the pain (n = 251), (2) those who reported LBP but no IDA (n = 955), and (3) those who reported no musculoskeletal pain (n = 2887). To estimate the loss of QALYs due to LBP in the Japanese adult population, we multiplied the age- and sex-specific mean differences of the EQ-5D scores between the LBP with (or without) IDA group and the no pain group by the corresponding age- and sex-specific numbers of people with LBP with (or without) IDA in Japan.</p><p><b>RESULTS</b>Among the entire Japanese adult population of 103 million people, 11,800,000 (4,910,000 men and 6,890,000 women) were estimated to suffer from LBP, and 2,403,000 (976,000 men and 1,427,000 women) people were estimated to encounter IDA due to the pain. The loss of QALYs due to LBP in the Japanese adult population was estimated at 947,000 (9.18 per 1000 population). The loss of QALYs due to IDA in the LBP people was estimated at 139,000 (1.35 per 1000 population).</p><p><b>CONCLUSIONS</b>The estimated loss of QALYs due to LBP suggests that LBP substantially deprives the Japanese adult population of their QOL.</p>

Body image, body satisfaction and dieting behavior in Japanese preadolescents: The Toyama birth cohort study

<p><b>OBJECTIVES</b>To examine the relationships between body image, body satisfaction and dieting behavior in the context of pubertal changes in Japanese preadolescents.</p><p><b>METHODS</b>A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture.</p><p><b>RESULTS</b>The percentages of those who perceived themselves fat, wanted to be thinner, and had tried dieting, which increased with body mass index (BMI), were significantly higher in girls than in boys (34.2% vs. 20.0%, 58.0% vs. 26.0%, and 17.3% vs. 5.7%, respectively). Independent of sex and BMI, those who wanted to be thinner and those who had tried dieting were more frequently observed in those who perceived themselves fat, and those who had tried dieting were more frequently observed in those who wanted to be thinner. Pubertal changes were significantly associated with dieting behavior, but their relationships to body image and body satisfaction differed between sexes; for boys, those who perceived themselves fat were more frequently observed in those without pubertal changes; whereas for girls, those who wanted to be thinner were more frequently observed in those with pubertal changes.</p><p><b>CONCLUSIONS</b>Dieting behavior of Japanese preadolescents was associated with whether they perceived themselves fat and wanted to be thinner, sometimes independent of whether they were actually overweight. Pubertal changes might induce a positive perspective of growing fat among boys and a desire to be thinner among girls, with the consequence that dieting behavior would be reinforced in those with pubertal changes.</p>

Incidence and outcome of sepsis in Japanese intensive care units: The Japanese nosocomial infection surveillance system

<p><b>OBJECTIVES</b>To determine the incidence of sepsis in Japanese intensive care units (ICUs) and to evaluate the impact of sepsis on mortality and length of stay (LOS).</p><p><b>METHODS</b>Using the JANIS database for the period between June 2002 and June 2004, 21,895 eligible patients aged ≥16 years, hospitalized in 28 participating ICUs for ≥24 hours, were monitored until ICU discharge. Adjusted hazard ratio (HR) with 95% confidence interval (CI) for the incidence of sepsis was calculated using Cox's proportional hazard model. Standardized mortality ratio (SMR) was calculated on the basis of the crude mortality in patients without nosocomial infection (NI) for respective APACHE II categories. Mean LOS for survivors was assessed by two-way analysis of variance with adjustment for APACHE II.</p><p><b>RESULTS</b>Sepsis was diagnosed in 450 patients (2.1%), with 228 meeting the definition on ICU admission and 222 during the ICU stay. The overall incidence of sepsis was 1.02/100 admissions or 2.00/1000 patient-days. A significantly higher HR for the incidence of sepsis was found in men (1.54, 95% CI: 1.14-2.07), APACHE II ≥21 (2.92, 95% CI: 1.92-4.44), ventilator use (3.30, 95% CI: 1.98-5.49), and central venous catheter use (3.45, 95% CI: 1.90-6.28). SMR was determined to be 1.18 (95% CI: 0.82-1.21) in NI patients without sepsis and 2.43 (95% CI: 1.88-3.09) in NI patients with sepsis. Mean LOS for survivors was calculated to be 11.8 days (95% CI: 11.3-12.4) in NI patients without sepsis and 15.0 days (95% CI: 13.3-17.0) in NI patients with sepsis compared with 3.8 days (95% CI: 3.8-3.9) in patients without NI.</p><p><b>CONCLUSIONS</b>Sepsis is not very common in Japanese ICUs, but its development leads to further increases in mortality and LOS in patients with NI.</p>

Incidence and Outcome of Sepsis in Japanese Intensive Care Units: The Japanese Nosocomial Infection Surveillance System

Objectives: To determine the incidence of sepsis in Japanese intensive care units (ICUs) and to evaluate the impact of sepsis on mortality and length of stay (LOS). Methods: Using the JANIS database for the period between June 2002 and June 2004, 21,895 eligible patients aged ³16 years, hospitalized in 28 participating ICUs for ³24 hours, were monitored until ICU discharge. Adjusted hazard ratio (HR) with 95% confidence interval (CI) for the incidence of sepsis was calculated using Cox's proportional hazard model. Standardized mortality ratio (SMR) was calculated on the basis of the crude mortality in patients without nosocomial infection (NI) for respective APACHE II categories. Mean LOS for survivors was assessed by two-way analysis of variance with adjustment for APACHE II. Results: Sepsis was diagnosed in 450 patients (2.1%), with 228 meeting the definition on ICU admission and 222 during the ICU stay. The overall incidence of sepsis was 1.02/100 admissions or 2.00/1000 patient-days. A significantly higher HR for the incidence of sepsis was found in men (1.54, 95% CI: 1.14–2.07), APACHE II ³21 (2.92, 95% CI: 1.92–4.44), ventilator use (3.30, 95% CI: 1.98–5.49), and central venous catheter use (3.45, 95% CI: 1.90–6.28). SMR was determined to be 1.18 (95% CI: 0.82–1.21) in NI patients without sepsis and 2.43 (95% CI: 1.88–3.09) in NI patients with sepsis. Mean LOS for survivors was calculated to be 11.8 days (95% CI: 11.3–12.4) in NI patients without sepsis and 15.0 days (95% CI: 13.3–17.0) in NI patients with sepsis compared with 3.8 days (95% CI: 3.8–3.9) in patients without NI. Conclusions: Sepsis is not very common in Japanese ICUs, but its development leads to further increases in mortality and LOS in patients with NI.

Body Image, Body Satisfaction and Dieting Behavior in Japanese Preadolescents: The Toyama Birth Cohort Study

Objectives: To examine the relationships between body image, body satisfaction and dieting behavior in the context of pubertal changes in Japanese preadolescents. Methods: A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12–13) born in Toyama prefecture. Results: The percentages of those who perceived themselves fat, wanted to be thinner, and had tried dieting, which increased with body mass index (BMI), were significantly higher in girls than in boys (34.2% vs. 20.0%, 58.0% vs. 26.0%, and 17.3% vs. 5.7%, respectively). Independent of sex and BMI, those who wanted to be thinner and those who had tried dieting were more frequently observed in those who perceived themselves fat, and those who had tried dieting were more frequently observed in those who wanted to be thinner. Pubertal changes were significantly associated with dieting behavior, but their relationships to body image and body satisfaction differed between sexes; for boys, those who perceived themselves fat were more frequently observed in those without pubertal changes; whereas for girls, those who wanted to be thinner were more frequently observed in those with pubertal changes. Conclusions: Dieting behavior of Japanese preadolescents was associated with whether they perceived themselves fat and wanted to be thinner, sometimes independent of whether they were actually overweight. Pubertal changes might induce a positive perspective of growing fat among boys and a desire to be thinner among girls, with the consequence that dieting behavior would be reinforced in those with pubertal changes.

Body image and body satisfaction play important roles in the path to dieting behavior in Japanese preadolescents: The Toyama birth cohort study

<p><b>OBJECTIVES</b>To analyze the path to dieting behavior in Japanese preadolescents.</p><p><b>METHODS</b>A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture.</p><p><b>RESULTS</b>While increasing with body mass index (BMI), the percentage of those who had tried dieting was higher in those who perceived themselves fat than in those who perceived themselves thin or average. Of those who wanted to be thinner, 16.1% of boys and 26.8% of girls had tried dieting. Path analysis in nonobese subjects (2,116 boys and 2,334 girls) showed that (1) body image was primarily based on BMI, (2) body image led to body dissatisfaction, and (3) body dissatisfaction led to dieting behavior. Pubertal changes had a significant effect on body image (path coefficient <0)for boys and body satisfaction (path coefficient >0) for girls, in addition to that on BMI. Maternal BMI had a significant effect on BMI but not on body image, body satisfaction, or dieting behavior.</p><p><b>CONCLUSIONS</b>Body image and body satisfaction play important roles in the path to dieting behavior in Japanese preadolescents. Pubertal changes may reinforce dieting behavior, but the mechanism may differ by sex.</p>

Body Image and Body Satisfaction Play Important Roles in the Path to Dieting Behavior in Japanese Preadolescents: The Toyama Birth Cohort Study

Objectives: To analyze the path to dieting behavior in Japanese preadolescents. Methods: A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture. Results: While increasing with body mass index (BMI), the percentage of those who had tried dieting was higher in those who perceived themselves fat than in those who perceived themselves thin or average. Of those who wanted to be thinner, 16.1% of boys and 26.8% of girls had tried dieting. Path analysis in nonobese subjects (2,116 boys and 2,334 girls) showed that (1) body image was primarily based on BMI, (2) body image led to body dissatisfaction, and (3) body dissatisfaction led to dieting behavior. Pubertal changes had a significant effect on body image (path coefficient <0) for boys and body satisfaction (path coefficient >0) for girls, in addition to that on BMI. Maternal BMI had a significant effect on BMI but not on body image, body satisfaction, or dieting behavior. Conclusions: Body image and body satisfaction play important roles in the path to dieting behavior in Japanese preadolescents. Pubertal changes may reinforce dieting behavior, but the mechanism may differ by sex.

Impact of intensive care unit-acquired infection on hospital mortality in Japan: A multicenter cohort study

<p><b>OBJECTIVES</b>To elucidate factors associated with hospital mortality in intensive care unit (ICU) patients and to evaluate the impact of ICU-acquired infection on hospital mortality in the context of the drug resistance of pathogens.</p><p><b>METHODS</b>By using the Japanese Nosocomial Infection Surveillance (JANIS) database, 7,374 patients who were admitted to the 34 participating ICUs between July 2000 and May 2002, were aged 16 years or older, and who stayed in the ICU for 48 to 1,000 hours, did not transfer to another ICU, and did not become infected within 2 days after ICU admission, were followed up until hospital discharge or to Day 180 after ICU discharge. Adjusted hazard ratios (HRs) with the 95% confidence intervals (CIs) for hospital mortality were calculated using Cox's proportional hazard model.</p><p><b>RESULTS</b>After adjusting for sex, age, and severity-of-illness (APACHE II score), a significantly higher HR for hospital mortality was found in ventilator use, central venous catheter use, and ICU-acquired drug-resistant infection, with a significantly lower HR in elective or urgent operations and urinary catheter use. The impact of ICU-acquired infection on hospital mortality was different between drug-susceptible pathogens (HR 1.11,95% CI:0.94-1.31) and drug-resistant pathogens (HR 1.42,95% CI: 1.15-1.77).</p><p><b>CONCLUSIONS</b>The use of a ventilator or a central venous catheter, and ICU-acquired drug-resistant infection were associated with a high risk of hospital mortality in ICU patients. The potential impact on hospital mortality emphasizes the importance of preventive measures against ICU-acquired infections, especially those caused by drug-resistant pathogens.</p>

Association between APACHE II score and nosocomial infections in intensive care unit patients: A multicenter cohort study

<p><b>OBJECTIVE</b>To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients.</p><p><b>METHODS</b>Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator; central venous catheter, and APACHE II score (0-5, 6-10, 11-15, 16-20, 21-25, 26-30, and 31+).</p><p><b>RESULTS</b>There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection.</p><p><b>CONCLUSIONS</b>Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.</p>

Association between APACHE II Score and Nosocomial Infections in Intensive Care Unit Patients: A Multicenter Cohort Study

Objective: To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients. Methods: Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator, central venous catheter, and APACHE II score (0-5, 6-10, 11-15, 16-20, 21-25, 26-30, and 31+). Results: There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection. Conclusions: Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.

Impact of Intensive Care Unit-Acquired Infection on Hospital Mortality in Japan: A Multicenter Cohort Study

Objectives: To elucidate factors associated with hospital mortality in intensive care unit (ICU) patients and to evaluate the impact of ICU-acquired infection on hospital mortality in the context of the drug resistance of pathogens. Methods: By using the Japanese Nosocomial Infection Surveillance (JANIS) database, 7,374 patients who were admitted to the 34 participating ICUs between July 2000 and May 2002, were aged 16 years or older, and who stayed in the ICU for 48 to 1,000 hours, did not transfer to another ICU, and did not become infected within 2 days after ICU admission, were followed up until hospital discharge or to Day 180 after ICU discharge. Adjusted hazard ratios (HRs) with the 95% confidence intervals (CIs) for hospital mortality were calculated using Cox’s proportional hazard model. Results: After adjusting for sex, age, and severity-of-illness (APACHE II score), a significantly higher HR for hospital mortality was found in ventilator use, central venous catheter use, and ICU-acquired drug-resistant infection, with a significantly lower HR in elective or urgent operations and urinary catheter use. The impact of ICU-acquired infection on hospital mortality was different between drug-susceptible pathogens (HR 1.11, 95% CI: 0.94-1.31) and drug-resistant pathogens (HR 1.42, 95% CI: 1.15-1.77). Conclusions: The use of a ventilator or a central venous catheter, and ICU-acquired drug-resistant infection were associated with a high risk of hospital mortality in ICU patients. The potential impact on hospital mortality emphasizes the importance of preventive measures against ICU-acquired infections, especially those caused by drug-resistant pathogens.

Preventive strategy for hypertension based on attributable risk measures

<p><b>OBJECTIVES</b>To examine the effective preventive strategy for hypertension in a Japanese male population, based on attributable risk measures.</p><p><b>METHODS</b>A 7-year follow-up study of hypertension among 6,306 middle-aged male office workers in a Japanese telecommunication company.</p><p><b>RESULTS</b>In terms of population attributable risk percentage (PAR%), regular alcohol intake and physical inactivity showed great contributions to the development of hypertension in the population no less than obesity. The PAR% of each risk factor varied by age group, and the total PAR% of the three modifiable risk factors was considerably higher in the 30-39 year old group (71%) than in the older groups.</p><p><b>CONCLUSIONS</b>Reduced alcohol intake and increased physical activity, as well as weight control, may have a larger impact on prevention of hypertension in younger groups than in older groups.</p>

The impacts of health examinations and smoking on disease mortality risk in Japan: a longitudinal cohort of 720,611 Japanese life insured persons

<p><b>OBJECTIVES</b>To evaluate the impacts of health examinations (HE) and smoking on disease mortality risk in Japan.</p><p><b>METHODS</b>By using the large cohort database of a Japanese life insurance company, 720,611 subjects aged 20 to 80 years, who had contracted for life insurance between April 1, 1995 and March 31, 1998, were followed up until September 30, 1999. Cox's proportional hazard model was used to estimate age-adjusted relative risk (RR) for disease death.</p><p><b>RESULTS</b>After adjusting for age, disease mortality in smokers was significantly higher than that in non-smokers (men, RR 1.51, 95% CI: 1.25-1.81; women, RR 1.54, 95% CI: 1.12-2.11). Meanwhile, disease mortality in HEees (those who had got HE within the past 2 years) was significantly lower than that in non-HEees (men, RR 0.70, 95% CI: 0.56-0.88; women, RR 0.71, 95% CI: 0.54-0.92). The magnitude of the impact of HE on disease mortality risk varied according to smoking status. Non-smokers showed a significantly lower risk associated with HE, whereas smokers did not.</p><p><b>CONCLUSIONS</b>HE may allow an appreciable reduction in disease mortality, however, the reduction effect may be limited to non-smokers. Smoking cessation may be essential to improve the preventive effects of HE.</p>

Parental influence on the development of obesity in 9-year-old Japanese children: the Toyama birth cohort study

<p><b>OBJECTIVES</b>To examine parental influence on the development of obesity in 9-year-old Japanese children.</p><p><b>METHODS</b>A 6-year follow-up study of obesity among 6,102 children born in Toyama prefecture.</p><p><b>RESULTS</b>After adjusting for obesity at age 3, either paternal obesity or maternal obesity at the age 3 survey more than double the risk of obesity at age 9 in both genders. Increases in parental body mass indexes (BMIs) from the age 3 survey through the age 9 survey were significantly associated with obesity at age 9 in girls.</p><p><b>CONCLUSIONS</b>Not only parental obesity but also increases in parental BMIs were likely to be associated with development of obesity in children.</p>