Relationship between low evaluation by recipients under 40 years old of health interviews by occupational health nurses and deterioration in health checkup results over one year.

Improvement of an unhealthy lifestyle decreases the risk of incidence and mortality from lifestyle-related disease. One method for the improvement of an unhealthy lifestyle is interviewing for health and consultation regarding a healthy lifestyle to recipients of health checkups by public health nurses. Original articles in occupational health for recipients' evaluation in health checkups as longitudinal studies are rare. The purpose of the present study was to investigate in a longitudinal study the relationship between recipients' evaluation of interviews by public health nurses in a health checkup and variations in health checkup results for one year. Data on 750 male white collar workers who underwent a company health checkup in 1999 and 2000 were analyzed. The variation in health checkup results for one year from 1999 to 2000 was studied by computing odds ratios in a conditional logistic analysis of the recipients who set a low value on the interview for health by occupational health nurses in the health checkup in 1999 and those who did not. It was found that among the subjects who set a low value on the usefulness of the interview by the occupational health nurses, the numbers of the subjects whose body mass index (BMI) and triglyceride value (TG) were healthy (normal) in 1999 and unhealthy (abnormal) in 2000 were significantly greater than those of the subjects whose values were unhealthy in 1999 and healthy in 2000, while such a finding was not detected in the subjects who set a high value on the interview. The differences for BMI and TG between (i) differences between deterioration and improvement of health checkup results in the subjects who evaluated the interview lowly and (ii) those in the subjects who did not were statistically significant as interactions. It can be supposed that some of the subjects who set a low value on the usefulness of the interview by the occupational health nurses may be indifferent to their health status, indicating that low recipient evaluation of the interview for health in health checkup may be regarded as a risk factor of metabolic syndrome from the viewpoint of prevention.

Comparing medical expenditures of smokers and nonsmokers in studies using direct methodology in Japan.

Numerous epidemiologic studies have revealed that smoking is a significant risk factor of many diseases. Some studies reported increase in medical expenditure by smoking using odds or hazard ratios between smoking and diseases in epidemiologic studies. The purpose of the present study is to investigate the ratios of mean medical expenditures between smokers and nonsmokers from studies conducted observing medical expenditure directly in Japan. We collected 11 published articles of studies conducted observing medical expenditures of smokers and nonsmokers directly in Japan. The weighted geometric mean of ratios between age-adjusted mean medical expenditures for smokers and nonsmokers of National Health Insurance and Government-Managed Health Insurance beneficiaries which included many elderly individuals was somewhat greater than 1.0, while the value of Society-Managed Health Insurance that included a small number of elderly people was less than 1.0. Smoking and smokers' indifference to health increase the medical expenditure of the smokers, especially elderly smokers. It was not determined, however, whether the mean medical expenditure of smokers is actually greater than that of nonsmokers.

Estimating cadmium absorption rate in digestive organs calculated from information of studies on cadmium conducted in Japan.

The absorption rate of cadmium (Cd) in the digestive organs is reported to be 0.5-8% in Friberg's textbook. This value was obtained from experimental studies. The object of the present study is to obtain the value from the Cd intake amount by ingestion, the Cd absorption amount by respiration and smoking, and the total Cd absorption amount calculated from the Cd accumulation amount in organs reported in articles including not only experimental but also epidemiologic studies conducted in Japan. The oral intake amounts of Cd in Japan were obtained from a published article to be 48 micrograms/day for males in the 1970s. The total Cd absorption amount that was calculated from the Cd accumulation amount in organs of 223 male subjects autopsied following sudden death was found to be 6.8 micrograms/day for male adults in the 1970s. The Cd exposure before the 1970s reflected the Cd absorption amount calculated from the Cd accumulation amount in the 1970s. The Cd absorption amount by respiration and smoking for males in the 1960s was 1.0 microgram/day, and the difference of 5.8 micrograms/day between the above two corresponds to the Cd absorption amount in digestive organs before the 1970s. The rice intake amount for Japanese in 1955-1965 was reported to be about 1.4 times as much as that in 1975. Therefore the Cd absorption rate in digestive organs was estimated to be about 10% from these values, assuming that most of the change in Cd intake from food is derived from the amount of rice eaten in Japan. This value is somewhat greater than the values published in the literature.

[Evaluation of intractable diseases].

OBJECTIVE: The aim of this study was to determine priorities for specific intractable disease from the viewpoint of countermeasures. METHODS: A significance evaluation to provide a priority framework for intractable disease was performed with a questionnaire distributed to the staff of preventive medicine and public health departments of medical schools in Japan. To determine the actual conditions of these intractable diseases question were directed at the chairmen of individual clinical study groups. The priority to be assigned countermeasures for such diseases was obtained from the two questionnaires. RESULTS: When the 4 factors "rare nature of diseases," "level of clarity of causes and pathology," "unestablished curative treatment", and "influence on daily life" were evaluated using 100 point as a full score, the mean scores were 14.5, 27.1, 28.5 and 29.9 points, respectively. In attaching importance to the various items, regarding the "rare nature of disease" the elements of "few patients nationwide" and "few specialist doctors nationwide" proved important; for the "level of clarity of causes and pathology," this was the case for the elements of "unclear triggering mechanism" and "diagnostic criteria not established." With the "unestablished curative treatment," the "no efficacious treatment available" and "low 5-year survival rate elements were important; and with the factor of "influence on daily life," the two most significant were "high proportion of patients needing assistance in daily life" and "high percentage of patients impeded from attending school or obtaining a job (playing a role in society)". CONCLUSION: When the priority among the 118 intractable diseases was evaluated by combining the overall results of the questionnaire survey with preventive medicine and public health staffs, and actual condition data from survey investigation of the intractable diseases among chairmen of clinical study groups, it was suggested that some intractable diseases whose medical expenses are covered by the medical aid program have a low ranking.

Difference between consciousness of intervention for improving lifestyle by public health nurses and recipients of a company health check.

Improving an unhealthy lifestyle decreases risk of incidence and death of lifestyle-related diseases. Consultation about a healthy lifestyle to recipients of health checkups conducted by public health nurses is one method for such improvement. The objective in the present study was to investigate the difference between consciousness of intervention by (1) the public health nurses who conducted consultations with recipients of health checkups and (2) the recipients who were consulted by the public health nurses. Data on 1,370 male white collar workers who underwent health checks were analyzed. When public health nurses determined that recipients required health consultation regarding lifestyle from the health checkup, they consulted with the recipients regarding improvement of lifestyle. The consultation regarding lifestyle included abstinence from smoking, drinking in moderation, exercise, and eating. The results of the analysis regarding difference in consciousness of the intervention by the public health nurses and the recipients show that (1) most drinkers did not think they were being discouraged to drink despite intervention by the public health nurses and (2) the smokers and the subjects with no habitual physical exercise tend to think that they were being consulted even though the public health nurses did not intervene regarding smoking and exercise.