The relationship between self-reported difficulty with hearing in the worse ear and the better ear.

OBJECTIVES: To investigate the relationship of self-reported hearing difficulty with hearing in the worse ear and the better ear at 1 and 4 kHz. DESIGN: Receiver-operating characteristic (ROC) curve analysis in community-residing population. SETTINGS: The Settsu City Health Center (Osaka, Japan). PARTICIPANTS: A total of 919 consecutive participants who were provided health check-ups. MAIN OUTCOMES MEASURES: Comparison is based on the measurement of the area under the curve (AUC) of ROC. RESULTS: At 1 kHz, the area under the curve (AUC) of the worse ear (0.625 +/- 0.021) was significantly larger than that of the better ear (0.570 +/- 0.021) (P < 0.01). At 4 kHz, the AUC of the worse ear (0.665 +/- 0.019) was significantly larger than that of the better ear (0.622 +/- 0.020) (P < 0.01). Excluding the subjects with noise exposure, tinnitus and ear disease, at both frequencies, the AUC of the worse ear was not significantly larger than that of the better ear at both 1 and 4 kHz. Hearing in the worse ear was significantly more related to self-reported hearing difficulty than in the better ear without excluding those with noise exposure, tinnitus and ear disease. CONCLUSIONS: ROC curve analysis would provide a method to help us judge the difference between the worse hearing ear and the better hearing ear on the subject of hearing loss.

Haematocrit and risk of development of Type 2 diabetes mellitus in middle-aged Japanese men.

AIMS: To investigate the association between haematocrit and risk of development of diabetes. Methods The study enrolled 2953 normoglycaemic [fasting plasma glucose (FPG) < 6.1 mmol/l and taking no hypoglycaemic medication] Japanese men aged 35-59 years and free of medication for hypertension and history of cardiovascular disease. FPG was measured at periodic annual health examinations from May 1994 through May 2001. Men in whom Type 2 diabetes mellitus (FPG > or = 7.0 mmol/l or receiving hypoglycaemic medication) was found during repeated surveys were classified as having Type 2 diabetes. RESULTS: The estimated incidence rates for Type 2 diabetes during 7 years of follow-up were 3.1% [[95% confidence interval (CI) 1.6, 4.6]], 4.6% (2.8, 6.4), 5.0% (3.2, 6.9), 6.4% (4.4, 8.5), and 11.5% (8.9, 14.2) for respective haematocrit levels of < 42.6, 42.6-44.0, 44.1-45.3, 45.4-46.8, and >/= 46.9% (the log-rank test: P < 0.001). After controlling for potential predictors of diabetes, the respective relative risks for Type 2 diabetes were 1.0 (reference), 1.52 (95% CI 0.81, 2.86), 1.24 (0.66, 2.31), 1.57 (0.86, 2.88), and 2.30 (1.30, 4.08) (P for trend = 0.002). From stratified analyses by presence or absence of a risk factor, a linear association of haematocrit level with risk of development of Type 2 diabetes was also observed. CONCLUSION: These results indicate that haematocrit contributes to the risk of developing Type 2 diabetes.

Serum gamma-glutamyltransferase and development of impaired fasting glucose or type 2 diabetes in middle-aged Japanese men.

OBJECTIVE: To investigate the association between serum gamma-glutamyltransferase (GGT) and risk for development of diabetes. DESIGN: Longitudinal study (followed from 1994 to 2001). SETTING: A work site in Japan. SUBJECTS: A total of 2918 Japanese male office workers aged 35-59 years who did not have impaired fasting glucose (IFG) (a fasting plasma glucose concentration of 6.1-6.9 mmol L-1), type 2 diabetes (a fasting plasma glucose concentration of >/=7.0 mmol L-1 or receipt of hypoglycaemic medication), medication for hypertension or hepatitis, alanine aminotransferase concentrations higher than three times the upper limit of the reference range or a history of cardiovascular disease at study entry. MAIN OUTCOME MEASURE: Incidence of IFG or type 2 diabetes over a 7-year period. RESULTS: With adjustment for potential risk factors for diabetes, the relative risk for IFG compared with serum GGT <16 U L-1 was 1.23 (95% CI, 0.79-1.90), 1.50 (CI, 0.97-2.32) and 1.70 (CI, 1.07-2.71) with serum GGT of 16-24, 25-43 and >/=44 U L-1, respectively (P for trend = 0.014). The respective relative risks for type 2 diabetes compared with serum GGT <16 U L-1 were 2.54 (CI, 1.29-5.01), 2.64 (CI, 1.33-5.23) and 3.44 (CI, 1.69-6.70) (P for trend = 0.002). From stratified analyses by body mass index (BMI) and alcohol intake, a stronger linear association between serum GGT and development of IFG or type 2 diabetes was found in men with a BMI >/=23.2 kg m-2 in both those who drank <46 and >/=46 g day-1 of ethanol. CONCLUSIONS: The risk for development of IFG or type 2 diabetes increased in a dose-dependent manner as serum GGT increased in middle-aged Japanese men. The increased relative risk for IFG or type 2 diabetes associated with serum GGT was more pronounced in obese men.

Serum uric acid and risk for development of hypertension and impaired fasting glucose or Type II diabetes in Japanese male office workers.

We examined the association of serum uric acid (SUA) with development of hypertension (blood pressure > or = 140/90 mmHg and/or medication for hypertension) and impaired fasting glucose (IFG) (a fasting plasma glucose level 6.1-6.9 mmol/l) or Type II (non-insulin-dependent) diabetes (a fasting plasma glucose level > or = 7.0 mmol/l and/or medication for diabetes) over a 6-year follow-up among 2310 Japanese male office workers aged 35-59 years who did not have hypertension, IFG, Type II diabetes, or past history of cardiovascular disease at study entry. After controlling for potential predictors of hypertension and diabetes, the relative risk for hypertension compared with quintile 1 of SUA level was 1.27 [95% confidence interval (CI): 1.00-1.62] for quintile 2, 1.34 (95% CI: 1.08-1.74) for quintile 3, 1.48 (95% CI: 1.18-1.89) for quintile 4, and 1.58 (95% CI: 1.26-1.99) for quintile 5 (p for trend <0.001). The respective multivariate-adjusted relative risks for IFG or Type II diabetes compared with quintile 1 of SUA level were 1.55 (95% CI: 0.95-2.63), 1.62 (95% CI: 0.98-2.67), 1.61 (95% CI: 1.01-2.58), and 1.78 (95% CI: 1.11-2.85) (p for trend = 0.030). The association between SUA level and risk for hypertension and IFG or Type II diabetes was stronger among men with a body mass index (BMI) <24.2 kg/m2 than among men with a BMI > or = 24.2 kg/m2, although the absolute risk was greater in more obese men. These results indicate that SUA level is closely associated with an increased risk for hypertension and IFG or Type II diabetes.

Association of alcohol consumption with white blood cell count: a study of Japanese male office workers.

OBJECTIVES: To investigate the association of alcohol consumption with white blood cell (WBC) count. DESIGN: Cross-sectional study. SETTING: A work site in Japan. SUBJECTS: A total of 5218 Japanese male office workers aged 23-59 years who participated in annual health examinations. MAIN OUTCOME MEASURES: Subjects were classified as nondrinkers, or current drinkers who averaged <12, 12-22, 23-34, 35-45, 46-68 or > or = 69 g day(-1) of ethanol. The association between alcohol consumption and WBC count was examined by smoking status. RESULTS: After controlling for age, body mass index, systolic blood pressure, and levels of total cholesterol, high-density lipoprotein (HDL) cholesterol and fasting plasma glucose, WBC count showed a negative dose-response relation with alcohol consumption in each smoking status. The WBC count increment per category of alcohol intake (x10(9) cells L(-1)) was -0.07 [95% confidence interval (CI), -0.11 to -0.04] for never smokers, -0.11 (95% CI, -0.15 to -0.06) for ex-smokers, and -0.04 (-0.08 to -0.00) for current smokers. For current smokers, additional adjustment for cigarettes smoked per day heightened the magnitude of these associations [the respective WBC count increment (x10(9) cells L(-1)), -0.07 (95% CI, -0.11 to -0.03)]. The risk for high WBC count (fifth quintile) also showed a negative linear trend related to alcohol intake in each smoking status. CONCLUSIONS: The WBC count was inversely associated with alcohol consumption in both nonsmokers and smokers. In view of the firm association of WBC count with the increased risk of coronary heart disease, alcohol consumption seems to have a favourable impact on the link between WBC count and the risk of cardiovascular disease.

White blood cell count and clustered features of metabolic syndrome in Japanese male office workers.

We assessed the association of white blood cell (WBC) count with different components of metabolic syndrome (MS)-obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol levels, hypertriglyceridemia, high fasting plasma glucose levels and hyperuricemia-in 5275 Japanese male office workers aged 23-59 years. After controlling for age, smoking and alcohol intake, the relative risks for the presence of 1, 2, 3, 4 and > or =5 features of MS compared with the lowest quintile of WBC count increased in a dose-dependent manner as WBC count increased (P for trend < 0.001 for all) and the increased relative risks for clustered features of MS were more pronounced as the number of features of MS increased. The WBC count increments in subjects with 1, 2, 3, 4 and > or =5 features of MS were 0.28, 0.45, 0.68, 0.76 and 1.40 x10(9) cells/l, respectively, compared with the subjects without features of MS (P for trend < 0.001). These findings indicate a strong association between WBC count and clustered features of MS in middle-aged Japanese men.

Plasma levels of natriuretic peptide and echocardiographic parameters in patients with Duchenne's progressive muscular dystrophy.

We investigated the relationship between plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels and systolic and diastolic cardiac function, determined by echocardiography, in 63 patients with Duchenne's progressive muscular dystrophy (DMD) (age range 8-21 years). The relationship between shortening fraction of the left ventricle and ANP and BNP levels was curvilinear rather than linear: When the shortening fraction was >15%, increases in ANP and BNP levels were minimal. However, if the shortening fraction was <15%, both natriuretic peptide levels increased dramatically. Stepwise regression analysis revealed that only the deceleration time of the early diastolic filling wave predicted plasma BNP concentration among various diastolic echocardiographic parameters determined by mitral flow. Three patients died of cardiac dysfunction during a 2-year follow-up period. These patients had a severely decreased deceleration time (<65% of normal) in association with increases in both natriuretic peptide levels. In conclusion, plasma ANP and BNP levels are not sensitive markers for the early detection of cardiac systolic dysfunction in patients with DMD. However, in patients with systolic dysfunction, an increase in the concentrations of these peptides, associated with a decrease in the deceleration time of early diastolic filling, suggests poor prognosis.

White blood-cell count and the risk of impaired fasting glucose or Type II diabetes in middle-aged Japanese men.

AIMS/HYPOTHESIS: To investigate the association between white blood-cell (WBC) count and the development of diabetes, independent of cigarette smoking. METHODS: We examined 2953 Japanese men who were office workers and between 35 and 59 years of age and who did not have impaired fasting glucose (IFG) (a fasting glucose concentration of 6.1-6.9 mmol/l), Type II (non-insulin-dependent) diabetes mellitus (a fasting glucose concentration of > or =7.0 mmol/l or more or receipt of hypoglycaemic medication), medication for hypertension, and a history of cardiovascular disease. Fasting glucose concentrations were measured at annual health examinations from May 1994 through May 2000. RESULTS: After controlling for potential predictors of diabetes, the relative risk for IFG or Type II diabetes mellitus compared with a WBC count of less than 5.3-10(9) cells/l was 1.2 (95 %-CI, 0.6-2.3), 1.6 (CI, 0.8-3.1), and 2.5 (CI, 1.2-5.1) among non-smokers (p for trend = 0.009): and 1.0 (CI, 0.4-2.5), 2.3 (CI, 1.0-5.1), and 3.1 (CI, 1.4-7.1) among ex-smokers (p for trend = 0.001) with WBC counts of 5.3-6.1, 6.2-7.2, and 7.3-10(9) cells/l or more, respectively. Among current smokers, the respective multivariate-adjusted relative risks for IFG or Type II diabetes mellitus were 1.1 (CI, 0.6-2.1), 1.4 (CI, 0.8-2.4), and 1.2 (CI, 0.7-2.1) (p for trend = 0.460). CONCLUSION/HYPOTHESIS: Although the selection of a rigorously normoglycaemic cohort might have had an influence on these observations, higher WBC counts seem to predict the development of IFG or Type II diabetes mellitus, primarily in non-smokers.

Paradoxical weight loss with extra energy expenditure at brown adipose tissue in adolescent patients with Duchenne muscular dystrophy.

We examined the energy expenditure in patients with Duchenne muscular dystrophy(DMD) to evaluate the cause of the paradoxical weight loss observed in large numbers of adolescent patients before any obvious impairment of their swallowing function. In the morning, resting energy expenditure (REE)/m(2) was almost the same as that in normal controls despite a reduction in fat-free mass (FFM); thus, REE/m(2)/FFM was significantly increased in patients (median, 21.2 kcal/m(2)/FFM kg; range, 17.7 to 44.2, P =.012). A thermographic examination in the morning showed an obvious elevation of the body surface temperature on the back. This phenomenon was consistent with a paradoxical fall in the low frequency (LF)/high frequency (HF) ratio at night analyzed using the inter-RR spectrum by 24-hour electrocardiogram, which indicated relative activation of the sympathetic nervous system. The urinary secretion of norepinephrine at night was also significantly greater in patients (median, 0.119 microg/kg/h; range, 0.061 to 0.219, P =.011). These results suggest that paradoxical activation of the sympathetic nervous system may accelerate the production of heat in brown adipose tissue (BAT) and increase the level of energy consumption in patients, and that adolescent DMD patients may require greater caloric intake than expected to maintain body weight, which is important to improve the prognosis of their respiratory function.

Hours of work and the risk of developing impaired fasting glucose or type 2 diabetes mellitus in Japanese male office workers.

OBJECTIVE: To investigate the association between duration of overtime and the development of impaired fasting glucose (IFG) or type 2 diabetes mellitus (DM). METHODS: A cohort of 1266 Japanese male office workers aged 35-59 years and free of IFG (fasting plasma glucose concentration 6.1-6.9 mmol/l), type 2 DM (fasting plasma glucose concentration of 7.0 mmol/l or more or taking hypoglycaemic medication), history of diabetes, or medication for hypertension were re-examined over 5 successive years after their initial examinations in 1994. RESULTS: 138 men developed IFG or type 2 DM during the 5736 person-years of follow up. After controlling for potential predictors of diabetes, the relative risks of IFG or type 2 DM, compared with those who worked <8.0 hours a day, were 0.82 (95% confidence interval (95% CI) 0.54 to 1.26), 0.69 (95% CI 0.38 to 1.26), 0.63 (95% CI: 0.37 to 1.09), and 0.50 (95% CI: 0.25 to 0.98) for those who worked 8.0-8.9, 9.0-9.9, 10.0-10.9, and of 11.0 hours or more a day, respectively (p for trend=0.020). 87 and 54 men developed IFG and type 2 DM during the 5817 and 5937 person-years of follow up, respectively. The multivariate adjusted relative risks of IFG tended to decrease with an increase in hours of overtime work a day, but did not reach significance (p for trend=0.202). On the other hand, the multivariate adjusted relative risks of type 2 DM significantly decreased with an increase in hours of overtime work a day (p for trend=0.014). CONCLUSION: Longer overtime is a negative risk factor for the development of IFG or type 2 DM in Japanese male office workers.

Alcohol consumption and risk for increased aortic pulse wave velocity in middle-aged Japanese men.

A 9-year longitudinal study was performed to prospectively examine the association of alcohol consumption with development of increased aortic pulse wave velocity (PWV) in 1,358 Japanese men aged 35 to 59 years with a PWV less than 8.0 m/sec and without antihypertensive medication. Three hundred fifty-nine men developed increased aortic PWV of 8.0 m/sec or more during 10,598 person-years follow-up. After controlling for potential predictors of aortic PWV, the relative risk for increased aortic PWV compared with that in nondrinkers was 1.05 (95% confidence interval [CI], 0.70 to 1.58) for those who drank 0.1 to 22.9 g/day of ethanol, 1.58 (95% CI, 0.89 to 1.91) for those who drank 23.0 to 45.9 g/day of ethanol, 1.77 (95% CI, 1.24 to 2.53) for those who drank 46.0 to 68.9 g/day of ethanol, and 1.81 (95% CI, 1.23 to 2.66) for those who drank 69.0 or more g/day of ethanol (p for trend <0.001). The relative risk for increased aortic PWV in current drinkers vs nondrinkers was stronger among men with a body mass index (BMI) less than 24.2 kg/m2 and nonsmokers than among men with a BMI 24.2 kg/m2 or more and current smokers, respectively. These results suggest that alcohol consumption is closely associated with risk for increased aortic PWV in middle-aged Japanese men.

Influence of alcohol intake on risk for increased low-density lipoprotein cholesterol in middle-aged Japanese men.

BACKGROUND: Decreased low-density lipoprotein (LDL) cholesterol in chronic alcoholics is well known. However, the importance of light to moderate alcohol consumption is less certain. METHODS: We investigated the association of alcohol intake with risk for increased LDL cholesterol over 5 years in a cohort of 933 Japanese male office workers aged 35 to 54 years who had LDL cholesterol levels less than 140 mg/dl and were not taking medication for dyslipidemia, hypertension, diabetes, liver disease, or hyperuricemia at study entry. Incident-increased LDL cholesterol was defined by an LDL cholesterol level of 140 mg/dl or more or use of medication for dyslipidemia. Each individual's slope for LDL cholesterol was also calculated with a simple linear regression model. RESULTS: Three hundred twenty-one men developed increased LDL cholesterol during 3785 person-years of follow-up. After controlling for potential predictors of increased LDL cholesterol, the relative risk for increased LDL cholesterol compared with nondrinkers was 0.89 for those who drank 0.1 to 22.9 g/day of ethanol, 0.74 for those who drank 23.0 to 45.9 g/day of ethanol, 0.64 for those who drank 46.0 to 59.9 g/day of ethanol, and 0.54 for those who drank 69.0 g/day or more of ethanol (p < 0.001). Slopes of LDL cholesterol level decreased significantly as alcohol intake increased. From multiple linear regression analyses, alcohol intake remained as an independent negative factor for slopes of LDL cholesterol level. CONCLUSIONS: Alcohol intake is negatively associated with development of increased LDL cholesterol in middle-aged Japanese men.

Alcohol consumption and risk for hypertension in middle-aged Japanese men.

OBJECTIVE: To investigate the association of alcohol intake with development of hypertension. DESIGN: Longitudinal study (followed from 1990 to 1999). SETTING: Work site in Osaka, Japan. PARTICIPANTS: Japanese male office workers (n = 1,310) hypertension-free, with systolic blood pressure (SBP) less than 140 mmHg, diastolic blood pressure (DBP) less than 90 mmHg, no medication for hypertension, and no past history of hypertension, 30 to 59 years of age at study entry. MAIN OUTCOME MEASURE: Incidence of hypertension. RESULTS: After controlling for potential predictors of hypertension, the relative risk for hypertension (SBP 140 mmHg or greater and/or DBP 90 mmHg or greater or receipt of antihypertensive medication) compared with non-drinkers was 1.52 [95% confidence interval (CI), 1.05 to 2.19] for persons who drank 0.1 to 22.9 g/day of ethanol, 1.81 (95% CI, 1.29 to 2.54) for those who drank 23.0 to 45.9 g/day of ethanol, 2.12 (95% CI, 1.53 to 2.94) for those who drank 46.0 to 68.9 g/day of ethanol, and 2.48 (95% CI, 1.75 to 3.52) for those who drank > or = 69.0 g/day of ethanol (for trend, P < 0.001). The relative risk for hypertension in current drinkers versus non-drinkers was stronger among men with a body mass index (BMI) less than 24.2 kg/m2 than among men with a BMI 24.2 kg/m2 or more, although the absolute risk was greater in more obese men. CONCLUSIONS: The risk for hypertension increased in a dose-dependent manner as alcohol intake increased in middle-aged Japanese men. The increased relative risk for hypertension associated with alcohol was more pronounced in leaner men.

Predictors for development of hyperuricemia: an 8-year longitudinal study in middle-aged Japanese men.

To identify the factors responsible for increases in serum uric acid (SUA), a cohort of 1,312 hyperuricemia-free (SUA < 7.5 mg/dL and no medication for hyperuricemia or hypertension) male office workers aged 30 to 52 years were examined annually for 8 successive years. Subjects who were found to have become hyperuricemic (SUA > or = 7.5 mg/dL) or who started medication for hyperuricemia during repeat surveys were defined as incidence cases. The SUA trend was also examined in 1,062 subjects for whom 9 consecutive SUA values were available and who did not start medication for hyperuricemia or hypertension during the observation period. Multivariate analyses, excluding the baseline SUA level as a factor in the Cox proportional-hazards model, indicated that age (negative), body mass index (BMI), log triglyceride level, hemoglobin A(1c) (HbA(1c)) level (negative), white blood cell count, and alcohol intake at study entry were significantly associated with the incidence of hyperuricemia. In the model including the baseline SUA level, baseline SUA level was the strongest factor for the incidence of hyperuricemia, and BMI, white blood cell count, and alcohol intake at study entry remained as independent factors. From stepwise linear regression analyses for SUA slope, excluding the baseline SUA level as a factor, significant correlates with SUA slope were, in order of their relative importance, slopes of BMI, HbA(1c) (negative), blood urea nitrogen, log triglyceride level, total protein, and baseline levels of hematocrit (negative), white blood cells, and HbA(1c) (negative). In stepwise linear regression analyses, including the baseline SUA level as a factor, SUA level (negative) and alcohol intake at study entry emerged as significant factors for SUA slope. The cumulative percentage of variation for SUA slope was 25.6%. In conclusion, obesity, alcohol intake, and multimetabolic disorders were determined to be independent predictors for the development of hyperuricemia. In addition, the white blood cell level may be a contributory factor.

[Analysis on the relationship between use of health check ups and medical care by elderly patients. A study on urban cities with high health check-up rates].

The aim of this study was to evaluate the influence of health examination provided by municipalities in Japan on the use of medical care by elderly patients aged 70 and above. The study was carried out to compare health indicators of cities with high and low usage rates for health check ups over 14 years. The indicators of health service utilization included mean bed days, mean inpatient fees, and mean outpatient fees in 1983, 1988, 1993 and 1996. The data for these indicators were collected from all 12 Japanese cities, where more than 50% of the target population had annual health check-ups in 1983, 1986, 1989 and 1992, as the subjects of high rate cities. All other 134 cities belonging to the same prefectures with the 12 cities were included as the control low rate cities. The correlation coefficients for all the 146 cities showed that usage rates of health check ups had an inverse relationship with mean bed days and mean inpatient fees for the elderly population in all the fiscal years 1983, 1988, 1993 and 1996. In nine out of the ten prefectures, mean bed days and mean inpatient fees were lower in the high rate cities as compared to the low rate cities for all the fiscal years compared. The bed days in the 12 high rate cities were 72% of those in 134 low rate cities in 1983, and the percentages were 66%, 72%, and 78% in 1988, 1993 and 1996 respectively. No remarkable differences in mean outpatient fees were observed between the high and low rate cities. The differences in use of medical care by inpatients suggest that providing preventive health services would decrease the demand by the elderly and result in a more efficient use of health resources.

Medical malpractice and legal resolution systems in Japan.

Medical malpractice claims and dispute resolution systems have been examined in Western societies for their impact on the quality of care and efficient compensation for injured patients. However, little is known about the Japanese malpractice environment because claim information has been closely guarded. Based on data from the Japanese Supreme Court, the Ministry of Health, Labor, and Welfare (formerly the Ministry of Health and Welfare), and the Japan Medical Association (JMA), which provides malpractice insurance to 43.5% of Japan's 250 000 physicians, we review Japanese malpractice liability systems and the frequency of claims during the last 30 years. Annual premiums for physician professional liability insurance are relatively low (454 dollars-491 dollars). Although the frequency of claims in Japan is lower than that reported in the United States, England, and Germany, the number of claims is increasing in Japan. According to publicly available data from the Japanese Supreme Court, the annual number of medical malpractice suits filed in district courts has increased from 102 in 1970 to 629 in 1998 (from 0.09 to 0.25 per 100 physicians). The proportion of awards greater than 89 dollars 300 increased from 13.6% in 1976 to 65.4% in 1987. Among JMA members, claims increased 31% from 1987 to 1999, but the frequency of claims has remained at approximately 0.3 per 100 JMA members. The JMA's professional liability program offers a nonbinding out-of-court review of claims that is faster and less expensive than judicial resolution (a few months with no attorney required vs 35 months and attorney fees), but is a poor means of deterrence or discipline. Since JMA data represent only 43.5% of Japanese physicians, generalizations cannot be made about all Japanese physicians and institutions. The lack of data on all claims hinders adequate evaluation of dispute resolution methods, development of appropriate risk management activities, and proactive education for Japanese physicians.

Long working hours and risk for hypertension in Japanese male white collar workers.

STUDY OBJECTIVE: To evaluate the association of long working hours with the risk for hypertension. DESIGN: A five year prospective cohort study. SETTING: Work site in Osaka, Japan. PARTICIPANTS: 941 hypertension free Japanese male white collar workers aged 35-54 years were prospectively examined by serial annual health examinations. Men in whom borderline hypertension and hypertension were found during repeated surveys were defined as incidental cases of borderline hypertension and hypertension. MAIN RESULTS: 336 and 88 men developed hypertension above the borderline level and definite hypertension during the 3940 and 4531 person years, respectively. After controlling for potential predictors of hypertension, the relative risk for hypertension above the borderline level, compared with those who worked < 8.0 hours per day, was 0.63 (95% confidence intervals (CI): 0.43, 0.91) for those who worked 10.0-10.9 hours per day and 0.48 (95% CI: 0.31, 0.74) for those who worked > or = 11.0 hours per day. The relative risk for definite hypertension, compared with those who worked < 8.0 hours per day, was 0.33 (95% CI: 0.11, 0.95) for those who worked > or = 11.0 hours per day. The multivariate adjusted slopes of diastolic blood pressure (DBP) and mean arterial blood pressure (MABP) during five years of follow up decreased as working hours per day increased. From the multiple regression analyses, working hours per day remained as an independent negative factor for the slopes of systolic blood pressure, DBP, and MABP. CONCLUSIONS: These results indicate that long working hours are negatively associated with the risk for hypertension in Japanese male white collar workers.

Involvement of urban living environments in atopy and enhanced eosinophil activity: potential risk factors of airway allergic symptoms.

BACKGROUND: Airway allergic diseases, such as bronchial asthma and allergic rhinitis, have increased, especially in urban areas. These diseases are characterized by airway inflammation with enhanced eosinophil activity, and the risk of disease development has been shown to increase with the prevalence of atopy. METHODS: Questionnaires were administered to 426 healthy adult women aged 30-74 years, living in an urban area of Osaka, Japan, to survey individual living environments and airway allergic symptoms such as cough, sputum, and wheezing. Moreover, serum house-dust-mite (Dermatophagoides pteronyssinus, [Der p])-specific immunoglobulin E (IgE) and serum eosinophil cationic protein (ECP) were examined by radioimmunoassay, and the atopic status (atopic sensitization) and enhanced eosinophil activity were assessed as Der p-specific IgE RAST scores of 2-6 and ECP levels of more than 10 ng/ml, respectively. RESULTS: Intensive use of electric air conditioners in hot weather (odds ratio: 2.07 [95% CI: 1.11-3.87]) and mold proliferation in the kitchen (2.77 [1.34-5.73]) significantly increased the risk of atopic sensitization. Poor home ventilation and family smoking appeared to be positively but not significantly associated with atopic sensitization. Personal smoking and intensive use of the air conditioner appeared to be positively related to enhanced eosinophil activity. Atopic status showed significant involvement in the development of wheezing, and the development of cough was significantly associated with enhanced eosinophil activity. CONCLUSIONS: The results suggest that some urban styles of living are involved in atopic sensitization and enhanced eosinophil activity in the Japanese urban population, probably due to living conditions, such as indoor dampness and poor home ventilation, caused by tight insulation, which increase exposure to indoor air pollutants, such as respirable mite allergens and tobacco smoke.