Validity and reliability of Japanese version of the MAPO index for assessing manual patient handling in nursing homes.

OBJECTIVES: Low back pain (LBP) among caregivers in Japanese nursing homes has long been considered an occupational health issue. This study aimed to verify the reliability and validity of our developed Japanese version of the Movement and Assistance for Hospitalized Patients (J-MAPO) index, a risk assessment tool for LBP, in nursing homes. METHODS: Two inspectors assessed 15 nursing homes using J-MAPO, and deduced 3 LBP risk levels as follows: low, moderate, and high risk. Caregivers in nursing homes responded to a self-administered questionnaire on LBP over the past 12 months. Data from 296 caregivers with no missing data were used. We further used logistic regression models to analyze the association between LBP as a dependent variable, and J-MAPO risk level as an independent variable. We used Cohen kappa coefficient to assess interrater reliability to further assess the agreement between the 2 inspectors. RESULTS: The multivariate logistic regression analysis showed that the adjusted odds ratio and 95% CIs for LBP increased progressively with J-MAPO risk level (Low-risk: 1.00; Moderate-risk: 1.70 [0.74-3.91]; High-risk: 2.67 [1.28-5.56]). Furthermore, the J-MAPO risk levels assessed by the 2 inspectors were in perfect agreement (κ = 1) observed for interrater reliability using Cohen kappa coefficient. CONCLUSIONS: There was high interrater reliability, and J-MAPO risk levels were associated with LBP. Therefore, our results suggest that the J-MAPO is a useful risk assessment tool for LBP in Japanese nursing homes.

What digital health technology types are used in mental health prevention and intervention? Review of systematic reviews for systematization of technologies.

Digital health technology has been widely applied to mental health interventions worldwide. Using digital phenotyping to identify an individual's mental health status has become particularly important. However, many technologies other than digital phenotyping are expected to become more prevalent in the future. The systematization of these technologies is necessary to accurately identify trends in mental health interventions. However, no consensus on the technical classification of digital health technologies for mental health interventions has emerged. Thus, we conducted a review of systematic review articles on the application of digital health technologies in mental health while attempting to systematize the technology using the Delphi method. To identify technologies used in digital phenotyping and other digital technologies, we included 4 systematic review articles that met the inclusion criteria, and an additional 8 review articles, using a snowballing approach, were incorporated into the comprehensive review. Based on the review results, experts from various disciplines participated in the Delphi process and agreed on the following 11 technical categories for mental health interventions: heart rate estimation, exercise or physical activity, sleep estimation, contactless heart rate/pulse wave estimation, voice and emotion analysis, self-care/cognitive behavioral therapy/mindfulness, dietary management, psychological safety, communication robots, avatar/metaverse devices, and brain wave devices. The categories we defined intentionally included technologies that are expected to become widely used in the future. Therefore, we believe these 11 categories are socially implementable and useful for mental health interventions.

[Association between subjective chewing conditions and dietary habits in Japanese workers].

OBJECTIVES: Previous studies on the elderly have reported that they avoid fiber-rich and hard foods in favor of softer foods as chewing ability declines. However, evidence of worker chewing conditions and dietary habits is scarce. This study aimed to clarify the association between chewing conditions and dietary habits in workers. METHODS: The subjects included 6,703 workers (45.6 ± 10.2 years, range 18-64 years) who underwent medical and dental check-ups from April 2018 to March 2019 with no missing data. We classified workers into two groups, those with good chewing conditions (GCC) and those with poor chewing conditions (PCC) according to their responses to the chewing condition item in our questionnaire. We performed logistic regression analysis using the questionnaire dietary habits item response as the objective variable and chewing conditions as the explanatory variable and adjusting for sex, age, number of present teeth, periodontal pocket depth, oral hygiene status, Body Mass Index, smoking habits, alcohol intake, exercise habits, history of present illness, and stages of transtheoretical model. Additionally, we performed subgroup analysis using a similar framework stratified by sex and age groups (under 40 or older). RESULTS: We found significant negative associations with PCC for the following dietary habits (p < .05): Awareness of balanced diet; Regular consumption of dark green and deep yellow vegetables; Eating slowly and chewing well; Frequent consumption of seaweed and small fish; Having three meals at almost at the same time every day; Having breakfast almost every day; Eating protein dishes with every meal; Frequently consuming dairy products; Finishing eating at least two hours before bedtime. Furthermore, we found significant positive associations with PCC for the following items (p < .05): Having on average two or more bottles/cans of juice or coffee a day; Frequently eating heavy meat dishes; Frequently eating deep-fried foods such as fried dishes and pork cutlets; Frequently having instant or processed foods; Eating two or more kinds of Western or Japanese confectioneries or snacks on average a day; Frequently eating salty food; Regularly having snacks or late-night meals. Additionally, similar trends were also observed following subgroup analysis, regardless of sex or age. CONCLUSIONS: This study suggests that workers with PCC may retain undesirable dietary habits, regardless of sex and age. Therefore, it is necessary to expand dental check-ups in the workplace and to promote dental health guidance that targets all workers.

[Evaluating the relationship between oral health status in male workers and question item regarding subjective chewing symptoms].

OBJECTIVES: In recent years, the relationship between oral health status and various diseases has been increasingly reported worldwide, leading to a growing understanding of the importance of oral health. This study aimed to investigate the relationship between oral health status, determined after a dental health check-up, and chewing condition, determined via a questionnaire for specific health check-ups with the newly added chewing condition item-When you chew your food, which most accurately describes your chewing-. METHODS: From 20,834 Japanese workers who underwent dental health check-ups and specific health check-ups from April 2018 to March 2019, 4,011 male workers (51.2 ± 6.1 years, range 40-64 years) were extracted for this study. Participants were divided into two groups, the good chewing condition group (GCG) and poor chewing condition group (PCG), according to their responses to a questionnaire regarding chewing conditions. We collected and compared data on subjects' age, smoking status, number of teeth present, number of filled teeth, number of decayed teeth, number of missing teeth with prosthetic treatment, periodontal pockets, gingival bleeding, oral hygiene status, and Eichner's classification. Additionally, to clarify the risk associated with chewing condition, we performed stepwise multiple logistic regression analysis with good chewing condition/poor chewing condition as the dependent variable, and age, smoking status, number of teeth present, number of filled teeth, number of missing teeth with prosthetic treatment, periodontal pockets, oral hygiene status, and Eichner's classification as the independent variables. RESULTS: The result of stepwise multiple logistic regression analyses, the odds ratio (OR) and 95% confidence interval (95% CI) of the factors that remained in the final model were as follows; the number of decayed teeth (OR = 1.18 [95% CI: 1.12-1.24]); periodontal pockets of 3 mm or less vs. 6 mm or more (OR = 1.63 [95% CI: 1.12-2.37]); Eichner's classification A1 vs. A2 (OR = 1.40 [95% CI: 1.08-1.82]), A3 (OR = 1.66 [95% CI: 1.09-2.52]), B1 (OR = 3.38 [95% CI: 2.04-5.61]), B2 (OR = 5.26 [95% CI: 2.46-11.2]), B3 (OR = 4.28 [95% CI: 1.20-15.2]), B4 (OR = 7.59 [95% CI: 1.06-54.5]). CONCLUSIONS: The results of this study suggest a significant association between the newly added "chewing condition" item in the questionnaire for specific health check-ups and oral status; the number of decayed teeth, periodontal pockets, Eichner's classification.

[Association between periodontal pocket depth determined during dental check-ups and new onset of diabetes in community residents: the LIFE study].

Objectives　Recent studies have shown a bidirectional association between diabetes and periodontal disease. However, the longitudinal association between periodontal pocket depth and new onset of diabetes remains controversial. Therefore, this study aimed to examine the association between periodontal pocket depth and new onset of diabetes using dental check-up data in a community-based population.Methods　The study comprised 5,163 participants aged≥20 years (mean age±standard deviation, 57.4±13.9 years; women, 66.3%) who underwent dental check-ups between April 2016 and March 2019 in a Tokyo ward. We classified the participants into three groups using community periodontal index codes from dental check-ups: healthy periodontal pocket group, periodontal pocket 4-5 mm group, and periodontal pocket ≥6 mm group. The participants were followed until the end of March 2020. Additionally, data on individuals who developed diabetes in the same ward were acquired from the National Health Insurance and Latter-Stage Older Persons Health Care System using ICD-10 codes. As the study outcome, we identified individuals who developed diabetes after the dental check-up date. Diabetes incidence rates were compared using the log-rank test and Cox regression analysis. Additionally, we performed a sensitivity analysis using a similar framework.Results　The log-rank test showed that the cumulative incidence of diabetes between the three groups was significantly different (P<0.01). A Cox regression analysis model adjusted for sex, age, smoking habits, number of teeth present, and oral hygiene status showed that the diabetes development hazard ratio (HR) for the periodontal pocket ≥6 mm group was 1.44 (95% confidence interval [CI]; 1.04-2.00) when compared with that of the healthy periodontal pocket group. In the sensitivity analysis of individuals aged ≥40 years, the HR for the periodontal pocket ≥6 mm group was 1.55 (95% CI; 1.11-2.16) when compared with that of the healthy periodontal pocket group. Similarly, among men aged ≥40 years, the HR for the periodontal pocket ≥6 mm group was 1.72 (95% CI; 1.04-2.85) when compared with that of the healthy periodontal pocket group. However, no significant association between new onset of diabetes and periodontal pocket depth was found for women aged ≥40 years (HR=1.39, 95% CI; 0.89-2.18).Conclusion　This The study suggests a longitudinal association between periodontal pocket depth and new onset of diabetes. The association was particularly pronounced in men aged ≥40 years. Therefore, men aged <40 years should maintain good oral health through appropriate dental health guidance to prevent the future development of diabetes.

Medical visits and health-care expenditures of patients attending orthopedic clinics during the COVID-19 pandemic in Japan: LIFE Study.

BACKGROUND: The first state of emergency for coronavirus disease 2019 (COVID-19) in Japan was imposed from April to May 2020. During that period, people were urged to avoid non-essential outings, which may have reduced their access to health care. METHODS: Using health-care claims data from a city in Fukuoka prefecture, Japan, we conducted a retrospective cohort study of the state of emergency's impact on patients' medical visits to orthopedic clinics and their associated health-care expenditures. These measures were compared between 2019 and 2020 using a year-over-year analysis and unpaired t-tests. RESULTS: The analysis showed that medical visits in 2020 significantly decreased by 23.7% in April (P < 0.01) and 17.6% in May (P < 0.01) when compared with the previous year. Similarly, monthly outpatient health-care expenditure significantly decreased by 2.4% (P < 0.01) in April 2020 when compared with April 2019. In contrast, the health-care expenditure per capita per visit significantly increased by 1.5% (P < 0.01) in June 2020 (after the state of emergency was lifted) when compared with June 2019. CONCLUSION: As orthopedic clinics in Japan are reimbursed using a fee-for-service system, the increases in per capita expenditures after the state of emergency may be indicative of physician-induced demand. However, we posit that it is more likely that a post-emergency increase in anti-inflammatory and analgesic treatments for spondylopathies, low back pain and sciatica induced a temporary rise in these expenditures.

Does difficulty in chewing induce subjective musculoskeletal symptoms? A case-control study.

OBJECTIVES: Risk factors associated with the development of musculoskeletal disorders and symptoms remain an important issue worldwide. This study aimed to investigate the relationship between oral health problems such as difficulty chewing and the occurrence of stiff neck/shoulders (SN/S) and low back pain (LBP). DESIGN: Case-control study. SETTING AND PARTICIPANTS: This study was conducted from 1 April 2018 to 31 March 2020. The subjects were 77 341 workers among 646 281 workers from several employers in Japan. OUTCOME MEASURES: Participants were asked to evaluate their subjective SN/S and LBP symptoms using a self-administered questionnaire. METHODS: We defined the chewing condition using a questionnaire, and workers who responded with 'I can chew anything' were classified as the good condition group (GCG), and those who responded with 'Sometimes I have difficulty chewing due to problems with the teeth, gums, or bite' or 'I can hardly chew' were classified as the poor condition group (PCG). Setting the year 2018 as the baseline, we performed a logistic regression model using propensity score and inverse probability weighting (IPW) methods and chewing condition groups as explanatory variables and SN/S and LBP as objective variables. RESULTS: The IPW-adjusted logistic regression model showed that the OR of SN/S was approximately 1.25 (95% CI 1.17 to 1.33) times higher in the PCG than that in the GCG (p<0.001). Similarly, the OR of LBP was about 1.37 (95% CI 1.27 to 1.48) times higher in the PCG than that in the GCG in the IPW-adjusted logistic regression model (p<0.001). CONCLUSIONS: Our study suggests that the occurrence of SN/S and LBP symptoms in workers could be predicted depending on the presence of difficulty in chewing. Therefore, oral health and health guidance are gaining importance for the prevention of subjective musculoskeletal symptoms.

Fitting the task to a person with disabilities: A case of return-to-work support for a patient due to left-sided poststroke hemiplegia using tailor-made jigs-and-tools.

BACKGROUND: A 45-year-old Japanese male pharmacist developed a stroke in December 2018; hence, he had left-sided hemiplegia due to the after-effects of cerebral stroke. This paper reports the return-to-work (RTW) and after RTW support for poststroke patients from a combined ergonomic and rehabilitation perspective. METHODS: From April 2019 to July 2020, we visited hospitals and workplaces multiple times, making various preparations for workplace accommodation and exchanging information as follows: allowing staggered working hours; securing the flow routes in the back room; equipping a cane holder on his working desk; and adjusting the position of the work tablet. In August 2020, after RTW, we conducted a brief evaluation of residual motor function and an on-site task analysis, and we subsequently made a support tool. RESULTS: In July 2020, his RTW was eventually realized. Moreover, as a result of introducing the tailor-made support tool, the duration of certain tasks that he had been claiming to be difficult was reduced when compared to that before support-tool use, and the average task duration before and after support-tool use was 32.8 s and 10 s, respectively (reduced by approximately 69.5%). CONCLUSION: To augment our efforts, hospital staff, support staff in his workplace, and his employer collaborated to make various workplace accommodations for the smooth realization of RTW before and after RTW. In the present case, the ergonomic and rehabilitation approach after RTW might have contributed to ease of task, work efficiency, and the potential for future job retention.

[Verification of the effects of three percent weight loss at 6 months and application possibility of assessment at 3 months after the specific health guidance for male workers].

OBJECTIVES: This study aimed to evaluate the effects of ≥ 3% body weight loss at 6 months in male workers and verify the application possibility of assessment at 3 months after specific health guidance. METHODS: We recruited 5,031 Japanese male workers (aged 40-64 years) who had undergone health checkups and completed specific health guidance from 2008 to 2017. Participants were divided into three groups according to the percentage of weight reduction (≥ 3%, 0%-3%, ≤ 0%) after 6 months of health guidance. We compared the body weight, waist circumference, and blood pressure at 3- and 6-months with baseline data within and between groups. Similarly, in the medical examination of the next fiscal year (n = 2,889), body weight, waist circumference, blood pressure, triglyceride levels, high-density lipoprotein-cholesterol (HDL-C) levels, plasma glucose levels, and the prevalence and improvement rates of metabolic syndrome (MetS) of specific health checkups were also compared. Furthermore, we calculated the weight reduction target after 3 months to arrive at a ≥ 3% weight reduction for 6 months. Based on the target, we investigated the prevalence and improvement rates of MetS in the next fiscal year. RESULTS: A total of 1,349 (26.8%) participants had a ≥ 3% weight reduction, 2,059 (40.9%) had a < 3% weight reduction, and 1,623 (32.3%) had no weight reduction. At the 6-month follow-up, waist circumference and blood pressure levels had increasingly improved with greater reductions in weight. The following year, body weight, waist circumference, blood pressure, triglyceride levels, HDL-C levels, and plasma glucose levels had improved in the ≥ 3% weight loss group, whereas plasma glucose levels had not improved in the 0-3% weight loss group. Additionally, only triglyceride levels and diastolic blood pressure had improved in the no weight reduction group. In the ≥ 3% weight loss group, the prevalence rate of MetS was the lowest (7.6%), and the improvement rate of MetS was the highest (70.7%). Furthermore, the weight reduction target after 3 months to arrive at a ≥ 3% body weight reduction at 6 months was 2.0% weight reduction. Those who reduced weight ≥ 2.0% had better prevalence and improvement rates of MetS than those who reduced weight < 2.0%. CONCLUSIONS: Our findings indicated that the objective of losing ≥ 3% of body weight at 6 months in male workers after completing specific health guidance was effective and that assessment after 3 months based on setting a 2.0% weight reduction target was applicable.

Lifestyle and subjective musculoskeletal symptoms in young male Japanese workers: A 16-year retrospective cohort study.

This longitudinal study was conducted from 2002 to 2018 and aimed to investigate predictive lifestyle factors for the occurrence of subjective musculoskeletal symptoms. The participants came from several employers in Japan. Setting 2002 as the baseline, we performed logistic regression analyses using lifestyle questionnaire items as explanatory variables and Stiff neck/shoulders (SN/S) and Lower back pain (LBP) as objective variables (n = 16,748). Workers who responded positively to good lifestyle items with an odds ratio < 1.0 and those who did not were classified in the Good (GL) and Poor lifestyle groups (PL), respectively. The survival period between the groups was compared using the log-rank test and Cox hazard regression analysis with propensity score matching (n = 3,593). Based on the Cox hazard regression analysis results, the risk of SN/S was about 2.54 (95% confidence interval [CI]: 1.80-3.59) times higher for PL than for GL (p < 0.001). Similarly, after propensity score matching, the risk was about 2.33 (95% CI: 1.07-5.10) times higher for PL than for GL (p < 0.05). Further, LBP risk was about 2.45 (95% CI: 1.67-3.58) times higher for PL than for GL (p < 0.001). Similarly, after propensity score matching, the risk was about 3.50 (95% CI: 1.60-7.68) times higher for PL than for GL (p < 0.01). This study highlighted that workers with four good lifestyle factors (life satisfaction, hours of sleep, exercise habits, and physical fitness) presented reduced risk of subjective musculoskeletal symptom occurrence. To prevent musculoskeletal symptoms, physicians and occupational health staff should advise on workers' individual lifestyle.

Can self-monitoring mobile health apps reduce sedentary behavior? A randomized controlled trial.

OBJECTIVE: To examine whether the self-monitoring interventions of a mobile health app reduce sedentary behavior in the short and long terms. METHOD: We designed a double-blind randomized control trial. Participants were selected from among the staff of a medical institution and registrants of an online research firm. Forty-nine participants were randomly assigned to either a control group (n = 25) or an intervention group (n = 24). The control group was given only the latest information about sedentary behavior, and the intervention was provided real-time feedback for self-monitoring in addition to the information. These interventions provided for 5 weeks (to measure the short-term effect) and 13 weeks (to measure the long-term effect) via the smartphone app. Measurements were as follows: subjective total sedentary time (SST), objective total sedentary time (OST), mean sedentary bout duration (MSB), and the number of sedentary breaks (SB). Only SST was measured by self-report based on the standardized International Physical Activity Questionnaire and others were measured with the smartphone. RESULTS: No significant results were observed in the short term. In the long term, while no significant results were also observed in objective sedentary behavior (OST, MSB, SB), the significant differences were observed in subjective sedentary behavior (SST, ßint  - ßctrl between baseline and 9/13 weeks; 1.73 and 1.50 h/d, respectively). CONCLUSIONS: Real-time feedback for self-monitoring with smartphone did not significantly affect objective sedentary behavior. However, providing only information about sedentary behavior to users with smartphones may make misperception on the amount of their subjective sedentary behavior.

[A case study of tailor-made exercise for preventing decrease in physical function: Analyzing the effect of tailor-made exercise from a motion study, motor function test, and questionnaire].

OBJECTIVE: This study aimed to verify the effect of tailor-made exercise depending on the characteristics of a certain food manufacturing industry on the physical function and subjective symptoms of employees. METHODS: For the development of tailor-made exercise, work analysis was carried out at each factory to comprehend the physical burden due to work load. The motor function test and questionnaire survey for subjective symptoms were conducted before and after exercise during 3 months. The motor function tests included the 30-s chair-stand test and two-step test. RESULTS: There were significant improvements in the 30-s chair-stand test after tailor-made exercise intervention for men and women (men: 20.9±4.8 vs 27.9±5.1 counts/30 s, p < 0.01; women: 19.4±3.1 vs 23.7±2.7 counts/30 s, p < 0.01) but not in the two-step test. In addition, as a result of comparing the questionnaire survey for subjective symptoms before and after intervention, there was a significant difference (p < 0.05) in "stumbling and staggering within 1 month," "feeling of fatigue in the back," "feeling of fatigue in the right foot/ankle," and "feeling of fatigue in the left foot/ankle." CONCLUSIONS: It is thought that the leg muscle strength increased due to tailor-made exercise, and the stumbling and staggering improved. In addition, feeling of fatigue in the back and in the right and left foot/ankle was improved. It was suggested that tailor-made exercise intervention can significantly affect the physical function of employees.