Periodontal disease and incident diabetes: a seven-year study.

Diabetes is associated with a high prevalence of periodontal disease, but little is known about the effects of periodontal disease on incident diabetes. In total, 5848 non-diabetic individuals aged 30-59 yrs who completed a health examination were analyzed in this study. They were divided into three categories: no pathological pockets, moderate periodontitis, or severe periodontitis. Incident diabetes was defined as newly diagnosed cases with fasting plasma glucose > 125 mg/dL. Cox proportional hazards models estimated the effect of periodontitis on incident diabetes during a seven-year follow-up period. Moderate and severe periodontitis was significantly associated with an increased risk of diabetes in unadjusted analyses, but the magnitude of the association decreased after full adjustment [hazard ratio (HR) = 1.00, 95% confidence interval (95% CI) = 0.77-1.30 and HR = 1.28, 95% CI = 0.89-1.86, respectively]. Our findings do not indicate an apparent association between periodontitis and incident diabetes, although there was a tendency for increased risk.

The effects of smoking on dental care utilization and its costs in Japan.

Smoking has been established as an important risk factor for periodontal disease and tooth loss. The purpose of this study was a prospective evaluation of the effects of smoking on dental care utilization and its costs, based on data from 5712 males aged 20-59 yrs. Age, dental health behavior, and history of diabetes were adjusted in a multivariate analysis. Current smokers accrued 14% higher dental care costs than never-smokers over a five-year period. This difference in annual dental care costs was mainly attributable to the increased percentage of participants in the 'higher dental care cost' category among current smokers. There was no clear trend identified for the dose-dependent effects of smoking on dental care utilization and its costs. Past smokers incurred lower dental care costs compared with current smokers. Smoking may have played a key role in the increment of dental care utilization and its costs via deterioration in oral conditions.

[A report on symposium, "protection for personal information in epidemiological research and cancer registry"].

A symposium on protection of personal information in epidemiological research and the compilation of a cancer registry was held at the National Cancer Center, Japan, on March 16, 2000. Participants discussed the use of personal health information in epidemiological research activities such as the compiling of a cancer registry to protect personal information. Legislation in Japan is pending in the near future. A total of thirteen domestic and foreign speakers and commentators shared opinions from various viewpoints and discussed the issue. It was proposed that protection regarding personal information should be legislated as soon as possible for the development of cancer registry; patients could be exempted from informed consent for utilization of personal health information, in particular, in public health activities such as the complication of a cancer registry and epidemiological research with the approval of an ethics review board; ethical guidelines including these steps should be established in Japan. An appropriate system of protection of personal information should be established through constructive discussion at frequent meetings and symposia which are open to the citizenry.

[Impact of indirect factors on the growing prevalence of workers with abnormal findings in periodic general health examinations: a survey on the definition and detection of such abnormal workers by occupational health organizations].

The prevalence of workers with abnormal findings in periodic general health examinations (PGHEx) has been growing recently in Japan and reached 41.2% in 1998. To clarify the indirect factors related to such an increase in workers with abnormal findings in the PGHEx, we carried out a questionnaire survey on the content of the statutory notification form of results of the PGHEx among a representative sample of 136 Occupational Health Organizations (OHOs). Questions on how those workers with abnormal findings were defined and detected and when the definition and the reference intervals for total cholesterol became available were included. Of the 107 OHOs which answered the questionnaire, 85 were included in the analyses because they actually calculated the number of workers with abnormal findings in each company and helped the employer fill out the notification form. The results revealed that there was no standardized definition of workers with abnormal findings in the PGHEx. Both reference intervals of items in the PGHEx and algorithm in detecting workers with abnormal findings in the PGHEx varied among the OHOs. When detecting the workers, 13 OHOs (15.3%) selected them taking into consideration medical background factors such as previous results of the PGHEx and current medical treatment. From the late 1980s to the early 1990s, many OHOs modified the definition of workers with abnormal findings, and have tended to reduce the upper limit of the reference interval for serum cholesterol. This is mainly due to amendment of the Industrial Safety and Health Law and a new recommendation for a reference interval/value proposed by the related scientific society. Although the prevalence of workers with abnormal findings in the PGHEx has continuously increased, it is not valid to compare the prevalence over the years because of modification in the definition of such workers. The prevalence of workers with abnormal findings in the PGHEx, which is one of the most important indices of the state of occupational health, should be measured by using an objective definition and be compatible with the future system of health examination for Japanese workers.

[A survey on return to work and fitness for work in Japan: the systems provided in corporate regulations and their application].

We conducted a survey to evaluate the current situation and the application of systems for return to work (RTW) and fitness for work (FFW) in Japanese companies. Self-administered questionnaires were mailed to 351 occupational health (OH) physicians listed in the membership directory of the Japan Society for Occupational Health published in 1990. The item of information sought were the size and industrial type of the company, the organization of OH staff, the process of assessment of RTW, the provision for sick leave in corporate regulations, the FFW criteria, and job training systems for RTW. Of the 145 companies from which questionnaire replies were received from OH physicians (response rate: 41%), 123 (85%) were manufacturing industries. When classified according to the number of employees, 41 (28%) had 3000 or more, 66 (46%) had between 1000 and 2999, 26 (18%) had 999 or fewer and 12 (8%) were unknown. 144 companies (99%) had provisions on temporary retirement in their corporate regulations. As for who makes compensation during temporary retirement, 66 (48%) and 61 (44%) companies answered "both company and health insurance society" and "health insurance society alone," respectively. 136 companies (94%) carried out assessment of RTW, and involved OH professionals and other related staff in the process of assessment. In the majority of cases, the OH physicians were in charge of the decision-making process on RTW and were authorized to make the final decision. In the companies with 3000 or more employees, the cases of longer-term sick leave were assessed in a more complete process than those of shorter-term sick leave. 119 companies (88%) conducted on additional health examination to assess the employee's FFW. Sixty-four companies (47%) had standardized criteria on FFW. One hundred and eighteen companies (83%) had job training systems for employees' RTW, and they mainly introduced restricting one's job and/or reducing one's work-load. It was suggested that complete systems for RTW and FFW were more available among companies with 3000 or more employees than among companies with 2999 or fewer employees.

A bibliometric study of the trend in articles related to epidemiology published in occupational health journals.

OBJECTIVES: To study the role assumed by epidemiology in occupational health literature and characterise its change over the years. METHODS: A bibliometric study was conducted with a MEDLINE search to evaluate 9024 articles published in eight representative occupational health journals for the period 1980-93. Articles related to epidemiology were found by descriptors indexed in the articles and their numbers and proportions among all published articles was tabulated for the study period. RESULTS: The proportion of source items indexed by epidemiology as a descriptor increased over threefold from 7.9% (42/534) in 1980 to over 25% after 1990. Epidemiology was indexed most frequently as a subheading associated with other descriptors-for example, occupational diseases-epidemiology. Cohort studies had the largest increase in the descriptors that indicated epidemiological type of studies during the period studied. CONCLUSION: Epidemiology is assuming increasing importance in occupational health literature. This was shown quantitatively and qualitatively by the use of descriptors in the MEDLINE database.

Return to work after stroke. A follow-up study.

BACKGROUND AND PURPOSE: Few studies have reported the longitudinal trend of return to work after stroke. The purpose of our study was to evaluate the longitudinal trend of proportion of patients who return to work after stroke and further to examine the predictors of return to work while taking follow-up periods into consideration. METHODS: We conducted a retrospective cohort study on the association between characteristics of stroke patients at admission and return to work after first stroke, taking length of follow-up period into consideration (n = 183). The patients were all younger than 65 years and were working at the time of their stroke. A follow-up questionnaire evaluated return to work and related information. Data were analyzed using the Kaplan-Meier method for curves of the proportion of return to work and Cox's proportional hazards model for odds ratios of return to work. RESULTS: The curve of proportion of return to work had two steep slopes, and the proportion was at a maximum at 18 months from patient admission. The adjusted odds ratios of return to work for patients with normal muscle strength versus severe weakness, without apraxia versus with apraxia, and with white-collar versus blue-collar occupations were 5.16 (P < .05), 4.16 (P < .05), and 1.43 (.05 < P < .10), respectively. CONCLUSIONS: The increase of proportion of return to work after stroke was nonlinear, and this trend was referable to the social security systems available to the patients included in this study. Normal muscle strength and absence of apraxia were significant predictors of return to work after stroke. White-collar occupation showed a tendency to promote return to work.

Association between location of the lesion and discharge status of ADL in first stroke patients.

We investigated the relationship between the location of the lesion in the brain and discharge status of activities of daily living measured by Barthel index in 112 first-stroke patients who had survived to discharge. Physiatrists and radiologists determined the location of the lesion based on neuroanatomic classification of findings detected by head-computed tomography (CT) of the patients. A stepwise regression analysis showed that only one selected location, the right parietal lobe lesion, was negatively associated with discharge Barthel index (R2 = 0.04). However, low R2 indicated that factors other than CT findings could also influence discharge Barthel index, and thus location of the lesion detected by head CT should be considered as adjunctive on prediction of discharge status.

Factors influencing return to work after stroke in Japan.

BACKGROUND AND PURPOSE: Few studies have identified factors that predict return to work after stroke in Japan. Our aim in this study was to determine the predictors of return to work after stroke in Japan. METHODS: We performed a retrospective cohort study on the association between patients' characteristics at admission and return to work in 230 first-stroke patients, adjusting for potential confounding factors. The patients were all aged younger than 65 years and were working, students, or housewives at the time of their stroke. Return to work was evaluated by a follow-up questionnaire. Data were analyzed using forward logistic regression analysis to compute odds ratios of return to work. RESULTS: The adjusted odds ratios (and 95% confidence intervals) for patients with normal muscle strength vs severe muscle weakness, without apraxia vs with apraxia, and with white-collar vs blue-collar occupation were 4.50 (1.04 to 19.42), 4.87 (1.28 to 18.54), and 3.33 (1.34 to 8.30), respectively. CONCLUSIONS: Significant predictors of return to work after stroke were no muscle weakness, absence of apraxia, and white-collar occupation.

[A descriptive epidemiology on sudden death among workers].

A survey on sudden unexpected death, that is, death within 24 hours from acute onset, among Japanese workers was carried out. Questionnaires were sent to full-time occupational health physicians who were active members of the Japan Association of Industrial Health at the time of the survey. Though 241 doctors answered (response rate: 61.5%), only 53 of them who had had both sudden death cases and the desire to join in this research co-operated in this survey. During the 5 years of observation (from Jan. 1, 1986 to Dec. 31, 1990), 143 cases of sudden death, 141 males and 2 females, were reported. The mean age was 46.5 (S. D. 10.5) for males. The ages of the 2 females were 31 and 44. Onset took place most frequently at home (55%) and most often during sleep (26%). This may be due to the higher rate not only of onset but of death resulting from acute onset at home and during sleep. Similar to the previous findings, a small peak of incidence was found early in the morning (4:00 AM--9:00 AM), although this was not statistically significant. However, the weekly and seasonal variations were a little different from previous reports. In this study, sudden death tended to occur more on Monday, Thursday, Friday, and Saturday (not statistically significant), and as for the seasonal variation, more cases occurred in April, November, and December which were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Involuntary smoking in a workplace situation--discomfort of nonsmokers and interpersonal awareness of smokers].

A questionnaire survey was conducted to examine the socio-behavioral interaction between smokers and nonsmokers in a workplace situation. A socio-behavioral interaction is hypothesized to be centered around the subjective discomfort such as 'bothered feelings' towards involuntary smoking among nonsmokers. Study subjects were 1,134 nonsmokers and 1,457 smokers working in 21 small-scale production companies in Japan. Among nonsmokers, a combined 93.3% reported 'perceived exposure to smoking', 'always', 'often', or 'sometimes' compared to 6.6% reporting 'never'. Similarly, 74.6% experienced 'bothered feelings' 'sometimes', 'always', or 'often' compared to 25.3% reporting 'never'. A combined total of 39.4% expressed their discomfort to smokers 'sometimes', 'often', and 'always' compared to 60.6% who 'never' did. In contrast, 59.1% of smokers responded that they smoked with consideration of nonsmokers' presence (interpersonal awareness) 'sometimes', 'often', and 'always' compared to 41.0% for 'never'. 'Bothered feelings' among nonsmokers was significantly lower among those with past smoking history and correlated positively with 'perceived exposure to smoking' (rs = 0.22, p less than 0.001) and with 'expression of discomfort among both male (rs = 0.32, p less than 0.001) and female nonsmokers (rs = 0.34, p less than 0.001). Among male smokers 'interpersonal awareness' was significantly higher for those with less cigarette consumption and with past history of smoking cessation. A regression analysis was performed using mean scores calculated for smokers and nonsmokers of each workplace. Lower 'bothered feelings' of nonsmokers significantly correlated with higher 'interpersonal awareness' of smokers (r = -0.59, p less than 0.005). These finding imply the presence of socio-behavioral interactions between smokers and nonsmokers and thus suggest the significance of workplace education on involuntary smoking.

A case-control study on occupational lung cancer risks in an industrialized city of Japan.

A hospital-based case-control study was conducted to evaluate occupational risks of lung cancer in an industrialized city of Japan. The lung cancer cases were obtained from 3 major hospitals in the city. The control group consisted of patients with a variety of diseases hospitalized in the same wards of the same hospitals as the cases. After matching on sex, 5-year age category and hospital, 144 cases and 676 controls comprised the study group. A self-administered questionnaire was used to obtain lifetime job histories and smoking status. The conditional logistic regression model was used to estimate relative risks after controlling for smoking and employment in other jobs. The workers in shipbuilding, ironworks and other plants (mostly chemical plants) showed statistically significant increases in lung cancer risk with relative risks of 6.18, 2.02, and 2.66, respectively. An increase in risk with the duration of employment was also observed in the "other plants" category. Building and road construction workers also showed increased relative risks, 1.95 and 1.79, but they were not significant. When the risk was evaluated on the exposure chemicals, the workers exposed to inorganic acids and bases had significantly increased risk. The workers exposed to asbestos, dust or organic chemicals also showed increased risk but the effects were not significant. The combined effect of smoking and employment in ironworks showed a good fit to an additive model, while that in the "other plants" category was closer to a multiplicative model.

[Remarkable improvement of anemia by administration of recombinant human erythropoietin in a patient with aplastic anemia].

A 69-year-old female was admitted for pancytopenia. The hematological examination showed leukocytes 1,800/microliters, hemoglobin 5.3 g/dl and platelets 9.6 x 10(4)/microliters. A bone marrow aspiration revealed hypoplasia, but no abnormal cells. Serum erythropoietin titer was 5,100 mU/ml. Diagnosis of aplastic anemia was made. She received 400 ml of blood transfusion twice, and was then treated with recombinant human erythropoietin (rHuEPO) (12,000 U/day) three times a week for eight weeks. Hemoglobin level gradually increased to the level of 12.0 g/dl. This case suggests that there are some cases of aplastic anemia which can respond to treatment with rHuEPO.

[Non-Hodgkin's lymphoma with marked infiltration in calf muscle].

A 64-year-old male developed pain and marked swelling of his left calf muscle in September, 1989. Deep-vein thrombophlebitis was suspected, and therapy with warfarin sodium followed by urokinase was instituted. Because of unsatisfactory effect of the therapy, the patient was referred to another hospital on January 3rd 1990. A CT scan of the left leg showed a soft-tissue mass adjacent to the fibula. A biopsy of the mass revealed non-Hodgkin's lymphoma of diffuse medium-sized cell type. Immunohistologic examination confirmed B cell type. He was admitted to our hospital on January 31st 1990. A chest roentgenogram showed right pleural effusion. A CT scan of the abdomen revealed a space-occupying lesion in the liver. A Gallium scintigraphy showed markedly increased isotope uptake in the left calf and liver. He was classed as a Stage IV B. He responded well to combination chemotherapy with cyclophosphamide, THP-adriamycin, VP-16, and prednisolone and achieved a complete remission. Although prominent infiltration of lymphoma cells in skeletal muscles is rarely reported, it is important to perform the biopsy promptly when the mass is found in a muscle. In this case report, we describe a rare case of non-Hodgkin's lymphoma with muscle invasion presented as marked calf muscle swelling.