Rationale and Descriptive Analysis of Specific Health Guidance: the Nationwide Lifestyle Intervention Program Targeting Metabolic Syndrome in Japan.

AIM: All health insurers in Japan are mandated to provide Specific Health Checkups and Specific Health Guidance (SHG) focusing on metabolic syndrome (MetS) in middle-aged adults, beginning in 2008; intensive HG for individuals who have abdominal obesity and two or more additional MetS risk factors, and motivational HG for individuals with one risk factor. The aim of this study is to describe medium-term changes in health indexes for intensive and motivational HG groups using the National Database. METHODS: We compared changes of risk factors and initiation of pharmacological therapy over 3 yr between participants (n=31,790) and nonparticipants (n=189,726) who were eligible for SHG in 2008. RESULTS: Body weight reduction in intensive HG was 1.98 kg (participants) vs 0.42 kg (nonparticipants) in men (p＜0.01) and 2.25 vs 0.68 kg in women (p＜0.01) after 1 yr. In motivational HG, the respective reduction was 1.40 vs 0.30 kg in men (p＜0.01) and 1.53 vs 0.42 kg in women (p＜0.01). Waist circumference reduction was also greatest among participants in intensive HG (2.34 cm in men and 2.98 cm in women). These reductions were fairly unchanged over 3 yr and accompanied greater improvements in MetS risk factors in participants. We also detected significantly smaller percentages of SHG participants who initiated pharmacological therapy compared with nonparticipants. CONCLUSION: Participants in SHG showed greater improvements in MetS profiles with proportionally smaller pharmacological treatment initiations than did nonparticipants for 3 yr. Although selection bias may be present, this study suggests SHG would be a feasible strategy to prevent MetS and its sequelae.

Errata: Public health activities in Osaka: A way of implementing collective medicine.

Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH), Vol. 64 (2017) No. 4 p. 179-189: p189(Ref. 16).

Estimating numbers of persons with persistent hepatitis B virus infection transmitted vertically and horizontally in the birth cohort during 1950-1985 in Japan.

AIM: We estimated numbers of persons, born between 1950 and 1985 in Japan, who were persistently infected with hepatitis B virus (HBV) through vertical and horizontal infections. METHODS: HBV carrier rates with vertical and horizontal infections were computed using sex- and age-specific prevalence rates of hepatitis B surface antigen (HBsAg) and hepatitis B e-antigen (HBeAg) by mathematical model. Probabilities of vertical HBV transmission in babies born to carrier mothers with and without HBeAg were presumed to be 90% and 10%, respectively. RESULTS: HBV carrier rates with vertical infection stayed contrast at approximately 0.3% in birth cohorts through 36 years (1950-1985), both in men and women. By a remarkable constant, HBV carrier rates with horizontal infection decreased steadily from 1.43% to 0.10% in men and from 0.95% to 0.03% in women. The estimated total number of HBV carriers born between 1950 and 1985 was 522 500 (355 488-693 606). Of them, the numbers of HBV carriers with vertical and horizontal infections were 197 574 (149 505-288 709) and 324 926 (205 983-404 896); they accounted for 37.81% and 62.19%, respectively, with a ratio of 1:1.64. The ratio between vertical and horizontal infections was 1:2.20 in men and 1:1.06 in women. CONCLUSION: Vertical HBV infection had stayed constant until immunoprophylaxis of mother-to-baby transmission was implemented in 1986 in Japan. In contrast, horizontal HBV infection decreased over years. The decrease would be due to many factors, including improved socioeconomic environments, advanced medical maneuvers and equipment, and careful vaccination procedures.

Japan: health system review

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Japan’s health system provides universal coverage of the populationthrough health insurance system for employees and their families (60% of the population) and National Health Insurance (NHI) system for the self-employed, retired and unemployed (40%). Annual expenditure is around 8% of gross domestic product (GDP) according to OECD estimates, and the main funding mechanisms are health insurance (50% of total spending), taxation (36%) and out-of-pocket payments (14%). Population health in Japan is among the best in the world, with the longest life expectancy and lowest infant mortality. The population has aged considerably, with over 21% aged 65 years or older. Recent health system reforms are related in large part to this demographic challenge, such as the introduction of an independent financingsystem for the oldest-old population cross-subsidized by all health insurers, better integration of preventive services into the insurance system, reforming the methods of paying hospitals and the introduction of a new system of long-term care financed through insurance and administered by municipal governments.

Factors associated with "Ikigai" among members of a public temporary employment agency for seniors (Silver Human Resources Centre) in Japan; gender differences.

BACKGROUND: "Ikigai" is culturally defined in the society of Japan as a comprehensive concept describing subjective well-being. It is considered to be related to life-satisfaction, self-esteem, morale, happiness as well as evaluation towards meaning of one's life. Although previous studies examined factors associated with Ikigai with smaller samples, consistent results have not been obtained, especially from the viewpoint of gender differences. Identification of gender-specific factors related with Ikigai among the elderly, may be of value to enhance subjective well-being. METHODS: Self-administered questionnaires were distributed among 4,737 randomly selected members of the Silver Human Resources Centre (SHRC), a public temporary employment agency for seniors, in Osaka, Japan. This represents about 10% of all registered members (n = 41,593) in the 38 SHRC centres in Osaka. A total of 4,376 subjects (male: 2,913; female: 1,463) provided a satisfactory response to the questionnaire (response rate: 92%). The status whether they have "Ikigai" or not was evaluated by self-anchoring scale ranging from 0 to 5 (0 = lowest rate and 5 = highest rate of having "Ikigai"). Also, self-rated life-change score through work (-3 to 3) was evaluated by three items, i.e.) changes in (1) the number of friends through work, (2) social interests and (3) the quantity of conversation with others (1 = increase, 0 = no change, and -1 = decrease). RESULTS: The factors associated with "Ikigai" for total subjects were the number of rooms in one's residence, annual income, healthy life style score (Breslow), the number of working days through SHRC, satisfaction with one's life history and life-change sore through work. The multivariable odds ratio (95% CI) of having "Ikigai" was 1.9 (1.1-3.3) for persons with no change in life thorough work compared with subjects with a score of < or = -1. Moreover, the multivariable odds ratios were 3.5 (1.9-6.6) for a life-change score = 1, 3.1 (1.7-5.7) for a score = 2 and 7.8 (4.0-15.2) for a score = 3 compared with persons with a score of < or = -1. For male subjects, other factors associated with having "Ikigai" were the number of rooms in their residence, annual income, the number of working days through SHRC, subjective assessment of health condition, and degree of satisfaction with their life history. For female, the corresponding factors were the presence of a spouse and degree of satisfaction with their life history. CONCLUSION: Scores for life-changes through work were associated with a higher prevalence of having "Ikigai" for both male and female. For male, "Ikigai" tended to be associated with physical condition and socioeconomic factors such as the size of their residence or annual income, while for female, family relations such as having spouse and psychological factors such as satisfaction with one's life history were significant factors. In spite of the design limitations of this study, it is possible to conclude that the recognition of life change through obtaining work may enhance "Ikigai" among people who wish to engage in productive activities in their later stages of life for both male and female. SHRC has a potential to provide resources for fulfilling one's "Ikigai" through supporting working opportunities to realize life changes for both elder male and female.

Relationship between self-assessed masticatory disability and 9-year mortality in a cohort of community-residing elderly people.

OBJECTIVES: To examine the relationship between self-assessed masticatory disability and mortality. DESIGN: Prospective. SETTING: Community based. PARTICIPANTS: Total of 1,405 randomly selected people aged 65 and older living in Settsu, Osaka Prefecture, in October 1992. MEASUREMENTS: Data on health status as indicated by disability scores, history of health management, self-assessed masticatory ability, and psychosocial conditions were collected by means of interviews during home visits at the time of enrollment. Nine-year follow-up was completed for 1,245 (88.6%; 398 deceased and 847 alive). RESULTS: Self-assessed masticatory disability was significantly associated with being 75 and older, having overall disability, not using dental health checks or general health checks, not participating in social activities, not feeling that life is worth living (no ikigai), and finding relationships with people difficult. As for the association between self-assessed masticatory disability and mortality, the estimated survival rate for those with self-assessed masticatory disability was lower than that for those without for each group stratified by sex and age (65-74 and >or=75), and the equality of survival curves according to self-assessed masticatory disability was significant for each group. After controlling for potential predictors of mortality, self-assessed masticatory disability remained as a significant predictor of mortality (adjusted hazard ratio=1.63, 95% confidence interval=1.30-2.03, P<.001). CONCLUSION: These results indicate that self-assessed masticatory disability may be associated with a greater risk of mortality in community-residing elderly people.

Age-related change in relationship between white blood cell count and some features of the metabolic syndrome.

To examine age-related change in the strength of the association of white blood cell count (WBC) with features of the metabolic syndrome (MS), body mass index, blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, fasting plasma glucose, and uric acid were assessed as the components of the MS in 5,218 Japanese male office workers aged 23-59 yr. The subjects were stratified by age into three groups of 23-39, 40-49, and 50-59 yr. WBC count showed a positive crude correlation with the components of the MS, except for HDL cholesterol (negative), in all three age groups. With an increase in age, an association between WBC count and each component of the MS declined, and an interaction with age weakened. After controlling for potential confounders, the largest differences of WBC count for each categorized feature of the MS were found among those aged 23-39 yr. Stratified analyses by smoking status and age showed that in both non-smokers and current smokers the adjusted WBC count increased as the number of features of the MS increased in all three age groups. In each category of the number of clustered features of the MS, differences of WBC count compared with the presence of no features of the MS were the largest in those aged 23-39 yr in both non-smokers and current smokers. The adjusted odds ratios of > or =3 features of the MS also increased with an increase in WBC count in all three age groups in both non-smokers and current smokers. The adjusted odds ratios of > or =3 features of the MS across quartiles of WBC count (lowest to highest) were the largest in the youngest age group. Our results indicate that a variety of features of the MS are associated with WBC count and that these tendencies are more pronounced in younger individuals in both non-smokers and current smokers.

Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men.

OBJECTIVE: To investigate the association between serum gamma-glutamyltransferase (GGT) and risk of metabolic syndrome and type 2 diabetes in Japanese male office workers. RESEARCH DESIGN AND METHODS: This study included 2,957 metabolic syndrome-free men and 3,260 nondiabetic men aged 35-59 years who did not have medication for hepatitis, alanine aminotransferase (ALT) levels higher than three times the upper limit of the reference range, or a history of cardiovascular disease at study entry. Subjects were reexamined at periodic annual health examinations over a 7-year period. We used a modified National Cholesterol Education Program definition of metabolic syndrome with BMI instead of waist circumference and the revised criteria of the American Diabetes Association for type 2 diabetes. RESULTS: With adjustment for age, family history of diabetes, BMI, alcohol intake, cigarette smoking, regular physical activity (fasting plasma glucose for the risk of type 2 diabetes), and white blood cell (WBC) count, the risk of metabolic syndrome and type 2 diabetes increased in correlation with the levels of serum GGT, ALT, aspartate aminotransferase (AST), and alkaline phosphatase. Additional adjustment for all of the other liver enzymes attenuated these associations, but serum GGT remained a significant risk factor for the risk of both metabolic syndrome and type 2 diabetes (P for trend <0.001 for both). Top one-fifth versus bottom one-fifth relative risks of metabolic syndrome and type 2 diabetes were 2.23 (95% CI 1.51-3.30) and 2.44 (1.34-4.46), respectively. CONCLUSIONS: These results indicate that serum GGT may be an important predictor for developing metabolic syndrome and type 2 diabetes in middle-aged Japanese men.

[Factors promoting follow-up services after medical examinations by municipal governments].

OBJECTIVE: All Japanese municipal governments have a responsibility to conduct a medical examination for their residents aged 40 or more under the Health Services for the Elderly Act since 1984. According to the results of the medical examination, municipal governments should give appropriate follow up services to all users. The objective of this study was to find the factors promoting follow up services after medical examinations conducted by municipal governments. SUBJECTS AND METHODS: Mailed questionnaire surveys on follow up services after medical examination were sent out to all 3,255 municipal governments in Japan. The 2,447 municipal governments that answered all items on the questionnaire were enrolled in this study. Follow-up services by municipal government for persons with abnormal findings at medical examinations included "Suggestion to have a more detailed examination", "Confirmation of having had a detailed examination", "Individual health consultation", and "Home visit for medical guidance". These follow-up services were analysed in terms of the number of public health nurses per population and whether a continuous data set was maintained for medical examinations. RESULTS: Follow-up services were conducted more frequently in municipalities that maintained continuous data sets of medical examination than those that did not. They were also carried out more frequently in municipalities with higher numbers of health visitors per population than in those with lower numbers. The percentage of municipal governments that maintained continuous data of medical examinations was higher among those that conducted group medical examinations than those that conducted individual medical examinations at local medical facilities. CONCLUSION: Follow-up services after medical examinations by municipal governments showed a significant relationship with maintenance of a continuous data set of medical examinations and the number of public health nurses.

Components of the metabolic syndrome as predictors of cardiovascular disease and type 2 diabetes in middle-aged Japanese men.

To determine whether the clustered features of the metabolic syndrome precede the 7 year incidence of cardiovascular disease (CVD) and type 2 diabetes, we examined 6182 Japanese male office workers aged 35-59 years without any history of CVD. The 5588 subjects without type 2 diabetes also constituted the nondiabetic cohort, and were re-examined over seven successive years. Components of the metabolic syndrome included glycemic disorder (type 2 diabetes for the risk of CVD and impaired fasting glucose for the risk of type 2 diabetes), systemic obesity, hypertension, dyslipidemia, proteinuria, and elevated white blood cell (WBC) count. After controlling for age, family history of diabetes, alcohol intake, and cigarette smoking, the multivariate-adjusted relative risk of incidence of CVD compared with absence of components was 3.18, 3.48, 12.55, and 14.15 (P for trend <0.001), for the presence of 1,2,3, and > or =4 components, respectively. The corresponding relative risks of incidence of type 2 diabetes were 1.92, 4.36, 6.44, and 15.08 (P for trend <0.001). In both non-smokers and current smokers, the multivariate-adjusted relative risks of incidence of CVD and type 2 diabetes increased as the number of components increased (P for trend <0.001 for all). Our findings indicate that clustered features of the metabolic syndrome are closely associated with development of CVD and type 2 diabetes in middle-aged Japanese.

Self-reported hearing difficulty and hearing impairment in Japanese people living in a community.

Nine hundred and eighteen people aged 40 years and over were examined to assess the relationship between self-reported hearing difficulty and hearing impairment at 1 kHz and 4kHz during annual health check-ups. After adjustment for potential confounding factors of self-reported hearing difficulty such as age, sex, noise exposure, ear disease and tinnitus. the odds ratios for self-reported hearing difficulty at 1 kHz compared with a hearing threshold of 30 dB were 1.74. 3.37 and 4.97 for hearing thresholds of 40 dB, 50 dB, and over 50 dB, respectively (p-value for trend = 0.003). At 4 kHz, the respective odds ratios for self-reported hearing difficulty were 1.53, 2.59 and 1.83 (p-value for trend = 0.012). These results suggest that self-reported hearing difficulty is closely associated with the severity of hearing impairment at 1 kHz and 4 kHz in a community-residing population and that people with hearing impairment at 1 kHz would be more sensitive to their hearing difficulty than those with hearing impairment at 4 kHz.

Clustering of components of the metabolic syndrome and risk for development of type 2 diabetes in Japanese male office workers.

To investigate the effects of the clustering of components of the metabolic syndrome (MS) on development of diabetes, we examined 3298 Japanese male office workers aged 35-59 years who did not have type 2 diabetes (a fasting plasma glucose level of > or =7.0 mmol/l or receipt of hypoglycemic medication) or a history of cardiovascular disease. Fasting plasma glucose levels were measured at periodic annual health examinations from May 1994 through May 2001. After adjustment for potential risk factors for diabetes, the multivariate-adjusted relative risk of type 2 diabetes compared with the subjects without components of the MS was 1.58 (95% CI: 1.08-2.32), 2.48 (95% CI: 1.69-3.63), 3.10 (95% CI: 2.05-4.68), and 5.22 (95% CI: 3.49-7.83) (P-value for trend <0.001) for those with 1, 2, 3, and > or =4 components, respectively. Even after the subjects were stratified according to fasting plasma glucose level, the clustering of components of the MS was associated with an increased risk of type 2 diabetes for subjects in all three categories of low-normal fasting glucose (a fasting plasma glucose level of <5.1 mmol/l), high-normal fasting glucose (a fasting plasma glucose level of 5.0-6.0 mmol/l), and impaired fasting glucose (a fasting plasma glucose level of 6.1-6.9 mmol/l). These results indicate that clustering of components of the MS associated with diabetes precedes an increase in the risk of type 2 diabetes in Japanese men.

Effects of socioeconomic indicators on coronary risk factors, self-rated health and psychological well-being among urban Japanese civil servants.

In Japan, the effects of socioeconomic indicators on coronary risk factors and subjective well-being in an urban population have not been compared. The subjects of this study were 1361 civil servants (968 men and 393 women, aged 35-64 years) working in an urban area of Japan. Screening examinations were conducted from April 1997 to March 1998, and a questionnaire survey was conducted in February 1998. The effects of two socioeconomic indicators, education level (junior high school, high school and university education) and employment grade (manual, low-level nonmanual and high-level nonmanual work), on behavioral and biological coronary risk factors, self-rated health and affect balance were investigated using multivariate logistic regression analyses. Smoking was found to be inversely associated with level of education; compared to university graduates, the odds ratios for subjects who had only graduated from high school and those for subjects who had only graduated from junior high school were 1.96 and 2.07 in men and 3.44 and 5.48 in women, respectively. As for alcohol drinking and physical inactivity, relationships were inconsistent in terms of direction by the two indicators. Among biological risk factors, diabetes was inversely associated with education level in men. Self-rated health, however, was inversely associated with employment grade both in men and women, and affect balance was inversely associated with employment grade in men. In summary, different effects of two socioeconomic indicators, education and employment grade, were seen in some coronary risk factors and subjective well-being in an urban Japanese population. Our findings should contribute to the elucidation of mechanisms of the socioeconomic gradients of risk factors and mortality from coronary heart disease in Japan.

[Relationship between utilization of health notebooks and the elderly population rate among Japanese municipal governments].

OBJECTIVE: Health conditions are changing rapidly in aging societies and an essential health service by municipal governments is to promote the utilization of health notebooks in support of the health of individuals. The objective of this study was to clarify the relationship between utilization of health notebooks and rates for elderly among Japanese municipal governments. SUBJECTS AND METHODS: Questionnaires on the utilization of health notebooks were mailed to all 3,255 municipal governments in Japan. The 2,445 that filled in all items on the questionnaire were enrolled in this study. Questions concerned opportunities for utilizing health notebooks when residents received health education/guidance, health examinations, home visits, or welfare service. If they answered "Frequent use" for these opportunities, one point was given. Furthermore, if they answered that they filled in the results of residents' health examination into health notebooks, one point was given. If a municipal government got 4 points or more, this municipality was classified as "health notebooks frequently used". RESULTS: The percentage of municipalities defined as "health notebooks frequently used" was higher among municipal governments with a high rate of elderly residents than with a lower rate. The odds ratio for being classified as "health notebooks frequently used" was higher among municipal government with high rates for the elderly and public health nurses per elderly person than with low rates. CONCLUSION: With increase in the percentage of elderly residents, municipal governments need to promote their health services in support of residents' health. To improve the utilization of health notebooks, municipalities should increase the number of public health nurses.

Multiple risk factor clustering and risk of hypertension in Japanese male office workers.

Major risk factors associated with hypertension (a family history of hypertension, obesity, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and increased white blood cell counts) were assessed in 5275 Japanese male office workers aged 23-59 years. After controlling for potential risk factors of hypertension, the odds ratio of hypertension compared with the absence of risk factors was 1.91, 2.65, 3.88, 6.54, and 8.18 for the presence of 1, 2, 3, 4, and > or = 5 risk factors, respectively (P for trend < 0.001). Systolic and diastolic blood pressure levels also increased in a dose-dependent manner as the number of risk factors increased. Among men not taking antihypertensive medication, the adjusted mean differences in systolic and diastolic blood pressures (mmHg) were 11.2 and 9.2 between men with the presence of > or = 5 risk factors and men without risk factors, respectively. These results indicate that the accumulation of risk factors is highly associated with the increased risk of hypertension in Japanese men.

Clustered features of the metabolic syndrome and the risk for increased aortic pulse wave velocity in middle-aged Japanese men.

The association between different features of the metabolic syndrome (MS) (obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol level, hypertriglyceridemia, high fasting plasma glucose level, and hyperuricemia) and the risk for increased aortic pulse wave velocity (PWV) of > or = 8.0 m/sec was examined in 2431 Japanese men aged 35 to 54 years who were not taking antihypertensive medication. After controlling for age, cigarette smoking, and alcohol intake, the odds ratios for increased aortic PWV in subjects with 1, 2, 3, and > or = 4 features of the MS, compared with those without features of the MS, were 1.35 (95% CI, 0.86 to 2.11), 1.90 (95% CI, 1.18 to 3.06), 1.57 (95% CI, 0.89 to 2.76), and 2.38 (95% CI, 1.26 to 4.49), respectively (p for trend = 0.003). A 9-year longitudinal study was also performed to prospectively examine the association between clustered features of the MS and the development of increased aortic PWV in 2073 men without aortic stiffness with a PWV < 8.0 m/sec and without antihypertensive medication during the follow-up period. The multivariate-adjusted hazard ratios for the incidence of increased aortic PWV in subjects with 1, 2, 3, and > or = 4 features of the MS, compared with those without features of the MS, were 1.39 (95% CI, 1.10 to 1.77), 1.46 (95% CI, 1.1 1 to 1.92), 1.75 (95% CI, 1.27 to 2.40), and 2.22 (95% CI, 1.52 to 3.25), respectively (p for trend < 0.001). These results suggest that clustered features of the MS are closely associated with the risk for increased aortic PWV in middle-aged Japanese men.