Factors related to Japanese internal medicine doctors' retention or migration to rural areas: a nationwide retrospective cohort study

BACKGROUND@#Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas.@*METHODS@#This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old).@*RESULTS@#Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention.@*CONCLUSIONS@#Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.

Inflammation as a cardiovascular risk factor and pulse wave velocity as a marker of early-stage atherosclerosis in the Japanese population

Inflammation and pulse wave velocity (PWV) are a potential risk factor and marker, respectively, for atherosclerosis in the primary prevention setting. Atherosclerosis is now generally accepted to be an inflammatory disorder of the arterial wall, and the high-sensitivity C-reactive protein (hs-CRP) level has been reported to be a strong predictor of cardiovascular events. High-sensitivity-CRP is associated with two factors related to inflammation: (1) the local production of CRP by atheromatous tissue or coronary artery smooth muscle cells and (2) adipose tissue as a potent source of inflammatory cytokines. Based on studies in North America and Europe, hs-CRP has been established as a cardiovascular risk factor and a cut-off value has been recommended. However, Japanese have lower hs-CRP values than their Western counterparts, partly because Japanese have a lower body mass index (BMI), which correlates positively to hs-CRP, and partly because lifestyle and genetic factors can affect hs-CRP values. Therefore, a cut-off value needs to be established by cohort studies for the Japanese population. Carotid-femoral PWV is most commonly measured by applanation tonometry, particularly in Europe, but this method is critically dependent upon the accurate placing of transducers over the arteries and is both time-consuming and complex. A novel device has been recently developed in Japan that measures brachial-ankle PWV (baPWV) using a volume-rendering method. Brachian-ankle PWV is a suitable screening method because of its technical simplicity and shorter measurement time. It is associated not only with conventional cardiovascular risk factors but also with new risk factors, such as inflammation, gamma-glutamyltransferase, chronic kidney disease, and psychosocial factors. However, a suitable cut-off value has yet to be established.

Relation of dampness to sick building syndrome in Japanese public apartment houses

<p><b>OBJECTIVES</b>The effect of dampness on sick building syndrome (SBS) symptoms has not been fully investigated in Japan. The purpose of this study is to elucidate the possible effects of dampness on SBS symptoms among residents in Japanese public apartment houses.</p><p><b>METHODS</b>A questionnaire was used to investigate the degree of dampness in public apartment houses in Asahikawa, Japan, and its effect on SBS symptoms, involving 480 residents in 64 buildings. Dampness indicators were as follows: condensation on the windowpanes, condensation on the walls and/or closets, visible mold in the bathrooms, visible mold on the walls, window frames, and/or closet, moldy odor, slow drying of the wet towels in bathrooms, water leakage, and bad drainage in bathrooms.</p><p><b>RESULTS</b>All dampness indicators except for visible mold in bathrooms had significantly higher odds ratios (ORs) for all or any SBS symptoms after adjustment. The dampness index, the number of positive dampness indicators, was significantly related to all SBS symptoms after adjustment.</p><p><b>CONCLUSIONS</b>There are serious problems relating to dampness in Japanese public housing, which affects the health of residents. There is a need to educate the residents about the relationship between dampness and SBS, and building problems should be rectified.</p>

Comparative Study of Simple Semiquantitative Dust Mite Allergen Tests

Objective: Two simple, commercially available and semiquantitative dust mite allergen tests, namely, the Acarex test® and Mitey Checker®, were compared using 2 and 10 μg of Der 1 allergen per gram of dust, as evaluated by enzyme-linked immunosorbent assay (ELISA), to clarify which method is better suited for practical use. Methods: Mite allergen exposure levels of 106 floor, bed and sofa surfaces were evaluated by the Acarex test®, Mitey Checker®, and ELISA. A template of 100 cm×100 cm was placed on the same surfaces to identify the examined areas. A dust collection filter was attached to a vacuum cleaner, and the area in the template (1 m2) was vacuumed. Then, to evaluate the other two tests, samples from the two other areas in the template (1 m2) that neighbored each other and did not overlap were vacuumed. Results: To predict Der 1 levels of 2 μg/g dust or higher, the sensitivity and specificity of the Acarex test® were 100% and 13.3%, and those of Mitey Checker® were 91.8% and 71.1%, respectively. To predict Der 1 levels of 10 μg/g dust or higher, the sensitivity and specificity of the Acarex test® were 50.0% and 96.2%, and those of Mitey Checker® were 85.7% and 79.5%, respectively. Compared with Der 1<2.0, 2.0-9.9, ≥10.0 (μg/g dust), the percent agreement and kappa of the Acarex test® were 47.2% and 0.234, and those of Mitey Checker® were 70.0% and 0.505, respectively. Conclusion: To evaluate mite allergen exposure level for practical use in Japanese living environments, Mitey Checker® is better than the Acarex test® because of its higher sensitivity and specificity.

Comparative study of simple semiquantitative dust mite allergen tests

<p><b>OBJECTIVE</b>Two simple, commercially available and semiquantitative dust mite allergen tests, namely, the Acarex test(®) and Mitey Checker(®), were compared using 2 and 10 μg of Der 1 allergen per gram of dust, as evaluated by enzyme-linked immunosorbent assay (ELISA), to clarify which method is better suited for practical use.</p><p><b>METHODS</b>Mite allergen exposure levels of 106 floor, bed and sofa surfaces were evaluated by the Acarex test(®), Mitey Checker(®), and ELISA. A template of 100 cm×100cm was placed on the same surfaces to identify the examined areas. A dust collection filter was attached to a vacuum cleaner, and the area in the template (1 m(2)) was vacuumed. Then, to evaluate the other two tests, samples from the two other areas in the template (1 m(2)) that neighbored each other and did not overlap were vacuumed.</p><p><b>RESULTS</b>To predict Der 1 levels of 2 μg/g dust or higher, the sensitivity and specificity of the Acarex test(®) were 100% and 13.3%, and those, of Mitey Checker(®) were 91.8% and 71.1%, respectively. To predict Der 1 levels of 10 μg/g dust or higher, the sensitivity and specificity of the Acarex test(®) were 50.0% and 96.2%, and those of Mitey Checker(®) were 85.7% and 79.5%, respectively. Compared with Der 1<2.0, 2.0-9.9.≥10.0 (μg/g dust), the percent agreement and kappa of the Acarex test(®) were 47.2% and 0.234, and those of Mitey Checker(®) were 70.0% and 0.505, respectively.</p><p><b>CONCLUSION</b>To evaluate mite allergen exposure level for practical use in Japanese living environments, Mitey Checker(®) is better than the Acarex test(®) because of its higher sensitivity and specificity.</p>

Indoor Airborne Mold Spores in Newly Built Dwellings

Objective: To investigate the relationships between sick building syndrome and mold in newly-built dwellings. Methods: Symptoms of 61 residents in 18 dwellings were surveyed by standardized questionnaires. Mold sampling was done by gravity sampling using an open Petri dish. Potato dextrose agar (PDA) and dichloran-18% glycerol agar (DG-18) were used as the culture medium. Results: There were 6 dwellings in which at least one inhabitant complained of one or more symptoms and 12 dwellings in which none of the inhabitants complained of symptoms. There was a tendency for the dwellings with inhabitants reporting symptoms to have larger colony forming units (CFU) on PDA than those without inhabitants reporting symptoms (p=0.1), but there was no difference in DG-18 result. There was a tendency for the dwellings with inhabitants reporting symptoms to have larger CFU of Cladosporium on PDA than those without (p=0.08), but there was no difference in DG-18 result. Significantly more Ulocladium sp. was detected in the dwellings with inhabitants reporting symptoms than in those without (p=0.03). Cladosporium cladosporioides was detected in all the dwellings with inhabitants reporting symptoms and 75% of the dwellings without. Cladosporium macrocarpum and Cladosporium herbarum were detected in 33% of the dwellings with inhabitants reporting e symptoms and none of the dwellings without (p=0.1). Conclusion: Cladosporium was dominant in the Japanese newly-built dwellings studied, and Cladosporium and Ulocladium were probably associated with the residents’ symptoms in these newly-built dwellings.

Indoor airborne mold spores in newly built dwellings

<p><b>OBJECTIVE</b>To investigate the relationships between sick building syndrome and mold in newly-built dwellings.</p><p><b>METHODS</b>Symptoms of 61 residents in 18 dwellings were surveyed by standardized questionnaires. Mold sampling was done by gravity sampling using an open Petri dish. Potato dextrose agar (PDA) and dichloran-18% glycerol agar (DG-18) were used as the culture medium.</p><p><b>RESULTS</b>There were 6 dwellings in which at least one inhabitant complained of one or more symptoms and 12 dwellings in which none of the inhabitants complained of symptoms. There was a tendency for the dwellings with inhabitants reporting symptoms to have larger colony forming units (CFU) on PDA than those without inhabitants reporting symptoms (p=0.1), but there was no difference in DG-18 result. There was a tendency for the dwellings with inhabitants reporting symptoms to have larger CFU ofCladosporium on PDA than those without (p=0.08), but there was no difference in DG-18 result. Significantly moreUlocladium sp. was detected in the dwellings with inhabitants reporting symptoms than in those without (p=0.03).Cladosporium cladosporioides was detected in all the dwellings with inhabitants reporting symptoms and 75% of the dwellings without.Cladosporium macrocarpum andCladosporium herbarum were detected in 33% of the dwellings with inhabitants reporting e symptoms and none of the dwellings without (p=0.1).</p><p><b>CONCLUSION</b>Cladosporium was dominant in the Japanese newly-built dwellings studied, andCladosporium andUlocladium were probably associated with the residents' symptoms in these newly-built dwellings.</p>