Changes in mental health and quality of life with dental implants as evaluated by General Health Questionnaire (GHQ) and Health Utilities Index (HUI).

OBJECTIVES: The purpose of this study was to assess and compare the improvement in oral and systemic conditions and health-related quality of life in patients with missing teeth receiving dental implants and conventional treatment. METHODS: A total of 97 patients with missing teeth, of whom 59 received dental implants and 38 received conventional treatment, were included in this study. The patients were divided into two age groups for a more detailed analysis: a 30- to 59-year age group (young) and a >60-year age group. The changes in oral condition, mental health, and health utility level before and after (pre- and post-, respectively) the procedures were assessed using an original questionnaire, the General Health Questionnaire 12 (GHQ12), and Health Utilities Index Mark 3. RESULTS: Responses to the GHQ12 indicated that treatment with implants significantly improved the oral health of patients in all treatment groups, except for the young group receiving partial dentures (PD). The mental state improved with a lower GHQ score; in terms of pre- versus post-procedure, mental state improved after the procedure in the young group receiving full dentures (FD) (1.75 ± 2.12 vs. 0.88 ± 2.10, p < 0.05), in the old group receiving PD (2.61 ± 3.91 vs. 0.72 ± 1.71, p < 0.05), and in the old group receiving FD (2.63 ± 3.12 vs. 0.44 ± 0.27, p < 0.05). The sleep score also improved by implant in FD of the old group (2.00 vs. 1.00, p < 0.05); it also is better with a lower score. CONCLUSIONS: Recovery of oral function and oral stability in middle-aged people who did not receive implants was possible with PD. However, the results suggest that implant treatment in edentulous denture cases and particularly in elderly people with dentures has a certain efficacy on the physical condition mediated through an improvement in aspects of the mental state.

Long-term pioglitazone therapy improves arterial stiffness in patients with type 2 diabetes mellitus.

Pioglitazone, a peroxisome proliferator-activated receptor gamma agonist, not only improves insulin resistance and glycemic control, but may also have additional beneficial vascular effects in patients with type 2 diabetes mellitus. We investigated whether pioglitazone had an influence on arterial stiffness, which is an independent predictor of cardiovascular events, in 204 patients with type 2 diabetes mellitus. A prospective, nonrandomized, open-label trial was performed that involved 41 patients treated with pioglitazone, 46 patients receiving sulfonylureas, 67 patients on insulin, and 50 patients on diet/exercise only. The follow-up period was 56 +/- 3 months. Arterial stiffness was evaluated by using the arterial stiffness index (ASI), which was based on analysis of the pulse wave amplitude pattern obtained during automated blood pressure measurement in the upper limb. The 4 groups had a similar baseline ASI, which was greater than the reference range in each group. Although antidiabetic therapies improved hemoglobin A(1c) and low-density lipoprotein cholesterol, ASI only decreased significantly in the pioglitazone group. Thus, pioglitazone improved abnormal arterial stiffness in patients with type 2 diabetes mellitus via a mechanism beyond the metabolic improvement. These findings may have important clinical implications in the use of pioglitazone in patients with type 2 diabetes mellitus.

An occupational health study of emergency physicians in Japan: health assessment by immune variables (CD4, CD8, CD56, and NK cell activity) at the beginning of work.

This study was conducted to evaluate the occupational health of Japanese physicians in emergency medicine. Subjects participating in this study were eighty-nine physicians working at 12 medical facilities (10 critical care emergency centers) in Japan. Participants were asked to complete a questionnaire of work conditions and to provide blood samples for immune variable measurements (CD4, CD8, CD56 and natural killer cell (NK cell) activity) before commencing their work. The data collected from seventy-four of 89 participating physicians were analyzed. The traditional work group comprised of 39 emergency physicians, who were significantly overworked compared to other two groups: the shift work group and the day work group. Among these three groups, no immune variable was significantly different except lymphocyte, number of CD4, and NK cell activity; and the NK cell activity of the shift work group was significantly lower than those of the traditional work group (p<0.01) and the day work group (p<0.01) in terms of Bonferroni's multiple comparison, probably due to circadian rhythm. It was indicated that NK cell activity was significantly lower in samples collected at night versus in the morning (OR=8.34, 95%CI: 1.95-35.6, p<0.01) through multiple logistic regression analyses. NK cell activity was significantly lower in individuals taking 0-3 days off per month, as compared to those taking 4 or more days off (OR=4.65, 95%CI: 1.27-17.0, p=0.02), according to multiple logistic regression analyses. Therefore, the low NK cell activity appears to have reflected the extent of fatigue arising from physicians' overwork. Overwork would have been a potential risk for the physicians' health, resulting in a lower quality of Japanese emergency medical services than that which could have been achieved otherwise. This study suggests that it would be better for the Japanese emergency physicians to take 4 or more days off per month for their health and the quality of their services.

The relationship between long-term changes in plasma B-type natriuretic peptide levels and electrocardiographic findings.

OBJECTIVES: Changes in B-type natriuretic peptide (BNP) and electrocardiographic (ECG) findings in an adult Japanese population were measured over a 5-year period, and the statistical relationships between these were evaluated. METHODS: This was a longitudinal analysis in which data were collected on 353 subjects (135 men and 218 women) who had undergone general health checks in 1998 and 2003. RESULTS: Data were examined by correlation coefficient and one-way analysis of covariance using repeated measurements. The correlation coefficient for BNP between 1998 and 2003 was 0.622 (P < 0.0001) for the men and 0.557 (P < 0.0001) for women. The changes in BNP over the same period were 13.71 +/- 26.06 (P < 0.0001) pg/ml in the men and 20.17 +/- 32.01 (P < 0.0001) pg/ml in the women. In 99 men and 145 women who had undergone ECG tests, with both normal and abnormal findings, visual inspections of changes in the ECG findings with respect to BNP changes were performed over the 5-year period. In men, both age and BNP significantly correlated with changes in ECG findings; however, in women, no significant correlation between BNP and changes in ECG findings was observed. CONCLUSIONS: This regional longitudinal study revealed a gender difference in the relationship between long-term changes in BNP and ECG findings, suggesting that a 10 pg/ml or more increase in BNP in men over a 5-year period may a indicate worsening of cardiac function and the need for intervention.

The relationships of sleep duration and mental health with electrocardiographic findings: a retrospective-cohort study in Okinawa, Japan.

OBJECTIVES: Sleep disorders and psychological stress have become major concerns as health risks in modern Japanese society. Chronic sleep deprivation could lead to physical and mental exhaustion, which could affect the circulatory condition. In this study, we have investigated the effects of long-term sleep problems and mental health conditions on abnormal ECG findings from the standpoint of community health. METHODS: Data were obtained from the records of community physical checkups conducted in a town in Okinawa from 1993 to 2001. Data regarding average sleep duration and the 12-item version of the general health questionnaire (GHQ) were also collected at the community physical checkups. In order to compute the odds ratio of electrocardiographic (ECG) findings according to mental health condition and sleep duration, we conducted multivariate analysis using logistic regression maneuvers. RESULTS: There was a significant difference of average GHQ scores according to sleep duration, with shorter sleep duration (< or =6 h) correlating with poorer GHQ and longer sleep duration (> or =8 h) correlating with healthier GHQ (p < 0.05). In the multivariate logistic regression analysis among subjects with poorer GHQ, shorter sleep duration showed significantly high odds ratio (OR = 7.14) for abnormal ECG findings. CONCLUSIONS: The present study suggested that the mental health condition appears to impact ECG results indirectly through its strong association with sleep duration and provided ground for suggestion that mental health items to be included in community physical checkup examination items.

[A study of factors effecting on an observation time needed for outpatient treatment of acute alcohol intoxication in Japan].

The purpose of this study was to investigate the factors effecting on an observation time needed for outpatient treatment of acute alcohol intoxication. Subjects were 181 patients with acute alcohol intoxication who visited at the Center of Critical Care Medicine of St. Luke's International Hospital from June 1999 to May 2000. One of 181 patients was admitted as an inpatient. The mean observation time of 180 outpatients was about 3 hours. Ninety-nine outpatients (55%) needed observation time less than 3 hours. High level of Blood Alcohol Concentration (BAC), moderate consciousness disorder (Japan Coma Scale; JCS 10-30), and severe consciousness disorder (JCS 100-300) were significant factors to increase observation time more than 3 hours. Gender and age were not significant factors associated with more-than-3-hour observation time. Observation time of mild consciousness disorder (JCS 1-3) was significantly decreased against that of clear consciousness (JCS 0). Effects of acetaldehyde might be related to elongation of the observation time among clear consciousness patients. Medical resources of emergency medicine in Japan are not enough in some cases (such as few beds and small numbers of staffs), and it is occasionally difficult for patients to stay at a emergency unit for a long time. And the number of hospitalization for acute alcohol intoxication is likely to increase in Japan. Consideration on the attributes, such as BAC or patient's consciousness, associated with observation time of outpatient treatment might be useful to reduce the number of hospitalization and the cost of medical care for acute alcohol intoxication in emergency medicine.

Longevity-associated mitochondrial DNA 5178 A/C polymorphism modulates effects of daily drinking and cigarette consumption on serum triglyceride levels in middle-aged Japanese men.

Mitochondrial DNA 5178 adenine/cytosine (mt5178 A/C) polymorphism is one of the longevity-associated mitochondrial DNA polymorphisms. The frequency of the mt5178A genotype is significantly higher in Japanese centenarians than in the general population. We previously reported that serum high-density lipoprotein cholesterol levels were significantly higher in men with mt5178A than in those with mt5178C. However, this significant difference disappeared after adjusting for drinking frequency. To investigate the interaction between mt5178 A/C polymorphism and habitual drinking on serum lipid levels, we performed an association study in 321 healthy middle-aged Japanese men. Interaction between mt5178 A/C polymorphism and daily drinking on serum triglyceride (TG) levels was observed (P=0.019). Moreover, interaction between mt5178 A/C polymorphism and cigarette consumption on serum TG levels was also observed (P=0.022). Multiple regression analysis showed that, in men with mt5178A, daily drinking decreased TG levels (P=0.025), and cigarette consumption increased TG levels (P<0.001), while in men with mt5178C, the effects of daily drinking and cigarette consumption on TG levels were unclear. No interaction was observed on other lipid levels. Longevity-associated mitochondrial DNA 5178 A/C polymorphism thus influences the effects of daily drinking and cigarette consumption on TG levels in middle-aged Japanese men.