[Development of livelihood difficulties assessment scales for clinicians].

Objectives　Poverty is a well-known major social determinant of health. Poverty has been conceptualized as multidimensional livelihood difficulties that include material deprivation, financial difficulties, and social isolation. Through their clinical practice, some health care institutions have tried to address social risks among patients. However, standardized assessment tools that can detect patients' livelihood difficulties are not well established. The aims of this study were to develop brief screening tools to assess patients' livelihood difficulties, and to examine the validity and reliability of these tools in Japanese health care institutes.Methods　We used secondary data from a cross-sectional questionnaire survey. The respondents of the survey were adult patients from five hospitals belonging to Japan Health Promoting Hospitals and Service Networks. The questionnaire included 25 questions that assessed patients' poverty. An iterated principal factor analysis with Promax rotation was performed and scales to assess patients' livelihood difficulties were developed. This was followed by an examination of the scales' validity and internal consistency using standardized Cronbach's alpha. Further, we built brief assessment tools by selecting questions that showed high factor loading.Results　A total of 265 participants were included in the study. The response rate was 75.1%. The results of factor analysis suggested that data was affected by patients' financial difficulties and social isolation. Eight questions on the financial difficulty scale and five questions on the social isolation scale showed factor loadings greater than 0.40. The standardized Cronbach's alpha coefficient was 0.88 for the financial difficulty scales and 0.74 for the social isolation scales. Finally, a brief assessment tools that included two questions from each scale was developed.Conclusion　This tool may be used as a screening tool for patients' livelihood difficulties in the health records of each clinic/hospital, and may help patients effectively receive integrated medical and social care. In order to use this scale in practice, under a well-established community-based integrated care system, it may be necessary to establish a standardized scoring system and diagnostic threshold to verify the generalizability of the scale at healthcare institutes with different characteristics.

Long working hours and skipping breakfast concomitant with late evening meals are associated with suboptimal glycemic control among young male Japanese patients with type 2 diabetes.

AIMS/INTRODUCTION: To assess the associations of working conditions, eating habits and glycemic control among young Japanese workers with type 2 diabetes. MATERIALS AND METHODS: This hospital- and clinic-based prospective study included 352 male and 126 female working patients with diabetes aged 20-40 years. Data were obtained from June to July 2012 and June to July 2013. Logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for suboptimal glycemic control (glycosylated hemoglobin level of ≥7%) obtained from June to July 2013. RESULTS: Multivariable logistic regression analysis showed that disease duration of ≥10 years (OR 2.43, 95% CI 1.02-5.80), glycosylated hemoglobin level of ≥7% in 2012 (OR 8.50, 95% CI 4.90-14.80), skipping breakfast and late evening meals (OR 2.50, 95% CI 1.25-5.00) and working ≥60 h/week (OR 2.92, 95% CI 1.16-7.40) were predictive of suboptimal glycemic control in male workers, whereas a glycosylated hemoglobin level of ≥7% in 2012 (OR 17.96, 95% CI 5.93-54.4), oral hyperglycemic agent therapy (OR 12.49, 95% CI 2.75-56.86) and insulin therapy (OR 11.60, 95% CI 2.35-57.63) were predictive of suboptimal glycemic control in female workers. CONCLUSIONS: Working ≥60 h/week and habitual skipping breakfast concomitant with late evening meals might affect the ability of young male workers with type 2 diabetes to achieve and maintain glycemic control.

Potential asbestos exposure among patients with primary lung cancer in Japan.

OBJECTIVE: To investigate the extent of asbestos exposure among patients with primary lung cancer in Japan. METHODS: A retrospective estimation of potential asbestos-exposed individuals, as determined by the presence of pleural plaques identified on chest computed tomography (CT), was conducted on 885 pathologically confirmed primary lung cancer patients (mean age 71.3 years, 641 males). All patients were diagnosed at 29 hospitals across Japan between 2006 and 2007. Since these hospitals belong to the Japan Federation of Democratic Medical Institutions (MIN-IREN), an organization of medical institutions for workers, the study subjects may contain a higher proportion of workers than the general population. RESULTS: Pleural plaques were identified in 12.8% of subjects (15.8% in males and 4.9% in females), consisting exclusively of cases older than 50 years. They were found most frequently on the chest wall pleura (96.5%), followed by the diaphragm (23.9%) and mediastinum (9.7%). Calcifications were seen in 47 cases (41.6%). The highest prevalence of pleural plaques was seen among workers from construction-related fields (37.7%). No distinct lung cancer histology was observed in patients with pleural plaques. Coexistence of pleural plaques and small irregular opacities was observed in 2.5% of subjects. CONCLUSION: In a Japanese population representing more workers than general Japanese, 12.8% of patients with primary lung cancer may have experienced asbestos exposure at some time in the past. Special medical attention should be paid to individuals with a history of employment in construction-related occupations, as workers in this sector showed the highest prevalence of pleural plaques.

Socioeconomic status and type 2 diabetes complications among young adult patients in Japan.

OBJECTIVE: To assess the relationship between socioeconomic status (SES) and complications of type 2 diabetes among young adults in Japan. DESIGN: A cross-sectional study. SETTING: Outpatient wards of 96 member hospitals and clinics of the Japan Federation of Democratic Medical Institutions. PARTICIPANTS: A total of 782 outpatients with type 2 diabetes (525 males, 257 females), aged 20-40 years as of March 31, 2012. After excluding 110 participants whose retinopathy diagnosis was in question, 672 participants were analyzed. MEASUREMENTS: We examined the relations between SES (educational level, income, type of public healthcare insurance, and employment status) and diabetes complications (retinopathy and nephropathy) using a multivariate logistic regression analysis. RESULTS: The prevalence of type 2 diabetic retinopathy was 23.2%, while that of nephropathy was 8.9%. The odds of having retinopathy were higher among junior high school graduates (OR 1.91, 95% CI 1.09-3.34), patients receiving public assistance (OR 2.19, 95% CI 1.20-3.95), and patients with irregular (OR 1.72, 95% CI 1.03-2.86) or no employment (OR 2.23, 95% CI 1.36-3.68), compared to those with a higher SES, even after covariate adjustment (e.g., age, gender, body mass index). Similarly, the odds of having nephropathy were higher among patients with middle (OR 3.61, 95% CI 1.69-8.27) or low income levels (OR 2.53, 95% CI 1.11-6.07), even after covariate adjustment. CONCLUSIONS: Low SES was associated with a greater likelihood of type 2 diabetes complications in young adults. These findings suggest the necessity of health policies that mitigate socioeconomic disparity and thereby reduce the prevalence of diabetic complications.

Measurement of whole-body vibration in taxi drivers.

In a previous epidemiological study we reported that the prevalence (45.8%) of low-back pain (LBP) and the two-year incidence (25.9%) of LBP in 284 male taxi drivers in Japan was comparable with rates reported for other occupational drivers in which LBP frequently occurs. LBP was significantly related with the level of uncomfortable road vibrations, and, importantly, increased with total mileage. The aim of this study was to measure whole-body vibration (WBV) on the driver's seat pan of 12 taxis operating under actual working conditions. The results were evaluated according to the health guidelines in International Standard ISO 2631-1:1997. Finally, the relation between total mileage and WBV was investigated. The majority of the frequency-weighted r.m.s. accelerations of the taxis fell into the "potential health risks" zone, under ISO 2631-1:1997. It was clear that the taxi drivers were exposed to serious WBV magnitudes. Therefore, occupational health and safety management should be carried out to help prevent adverse health effects in taxi drivers. In particular, reduction of WBV in taxis and shortening of driving time to reduce duration of WBV exposure should be considered. Moreover, because many taxi drivers work 18 h every other day, the shortening of working hours and taking of rest breaks while working should be considered. Frequency-weighted r.m.s. accelerations of taxis had a tendency to decrease as total mileage increased. The relation between total mileage and WBV should be investigated by taking measurements on the floor and the back rest in addition to the seat pan.

[Work-relatedness of asthma among outpatients].

The American Thoracic Society (ATS) issued a statement in 2002 that approximately 15% of adult asthma was likely to be work related and emphasized the importance of prevention for occupational asthma. However, the occupational contribution of the burden of asthma has been not understood, because there are very few epidemiological studies in the general population in Japan that examined the population attributable risk (PAR) of asthma due to occupational exposures. Assessing this component of the burden of asthma can better inform preventive strategies. Therefore, we examined the PAR of adult asthma due to occupational exposures among outpatients by using the National Institute for Occupational Safery and Health (NIOSH) criteria. Additionally we examined characteristics of cases of work-related asthma. The results indicate that the PAR of asthma due to occupational exposures is 22.7%, a value comparable to previous reports in Western countries. Therefore, we thought that it suggested that the prevalence of work-related asthma in Japan is similar to Western countries. Five patients met the criteria for having "probable OA", and their occupations were pest control industry, florist, hairdresser and pet groomer. Two patients (40%) changed their jobs due to asthma, which suggests that work-related asthma materially affects continuation of employment. Four patients (80%) had asthma despite leaving their jobs, which suggests that it is crucial to prevent work-related asthma.

[Risk factors for low back pain among taxi drivers in Japan].

We conducted a questionnaire study on low back pain (LBP) and working conditions among male taxi drivers employed in the company in Fukuoka city in order to investigate the occurrence of LBP and occupational factors related to LBP among taxi drivers. The study was undertaken through two questionnaires, the first conducted in 1999 (n = 280, first cross-sectional study), the second conducted in 2001 (n = 284, second cross-sectional study). The questionnaire results were used to conduct two analyses: 1) the one-year prevalence of LBP and the relationship between LBP and occupational factors in the second cross-sectional study, and 2) the incidence of LBP and the relationship between LBP and occupational factors from the first to the second cross-sectional study in the longitudinal study. The incidence cases were defined as subjects who met the following conditions: those who had never experienced LBP at the time of the first study but had experienced LBP during the previous year at the time of the 2nd study. The one-year prevalence (45.8%) of LBP among taxi drivers was comparable to rates reported for other occupational drivers in which LBP occurs frequently. This result indicates that LBP is an important health problem for taxi drivers, and an urgent occupational safety and health management issue. The two-year incidence of LBP among the taxi drivers was estimated at 25.9%. LBP was significantly related with the suitability of the driver's seat pan, total mileage on the taxi (total mileage), the level of uncomfortable vibrations on the road, job stress and time employed as a taxi driver. Importantly, the prevalence of LBP increased with increasing total mileage, a finding which had not previously been reported. The findings of this study also suggest that ergonomic problems with the driver's seat pan, whole-body vibration (WBV) and job stress may contribute to LBP among taxi drivers. Further study is needed to confirm how total mileage contributes to LBP. Furthermore, WBV during normal use of taxies should be measured in order to evaluate the association between WBV and LBP.