Likelihood ratio-based integrated personal risk assessment of type 2 diabetes.

To facilitate personalized health care for multifactorial diseases, risks of genetic and clinical/environmental factors should be assessed together for each individual in an integrated fashion. This approach is possible with the likelihood ratio (LR)-based risk assessment system, as this system can incorporate manifold tests. We examined the usefulness of this system for assessing type 2 diabetes (T2D). Our system employed 29 genetic susceptibility variants, body mass index (BMI), and hypertension as risk factors whose LRs can be estimated from openly available T2D association data for the Japanese population. The pretest probability was set at a sex- and age-appropriate population average of diabetes prevalence. The classification performance of our LR-based risk assessment was compared to that of a non-invasive screening test for diabetes called TOPICS (with score based on age, sex, family history, smoking, BMI, and hypertension) using receiver operating characteristic analysis with a community cohort (n = 1263). The area under the receiver operating characteristic curve (AUC) for the LR-based assessment and TOPICS was 0.707 (95% CI 0.665-0.750) and 0.719 (0.675-0.762), respectively. These AUCs were much higher than that of a genetic risk score constructed using the same genetic susceptibility variants, 0.624 (0.574-0.674). The use of ethnically matched LRs is necessary for proper personal risk assessment. In conclusion, although LR-based integrated risk assessment for T2D still requires additional tests that evaluate other factors, such as risks involved in missing heritability, our results indicate the potential usability of LR-based assessment system and stress the importance of stratified epidemiological investigations in personalized medicine.

Drop out from out-patient mental healthcare in the World Health Organization's World Mental Health Survey initiative.

BACKGROUND: Previous community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada. AIMS: To explore mental health treatment drop out in the World Health Organization World Mental Health Surveys. METHOD: Representative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted. RESULTS: Overall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/lower-middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit. CONCLUSIONS: Drop out needs to be reduced to ensure effective treatment.

Relationship between serum isoflavone levels and disability-free survival among community-dwelling elderly individuals: nested case-control study of the Tsurugaya project.

BACKGROUND: The longer healthy life expectancy observed in Japan may be partly attributed to the Japanese diet. The researchers sought to examine whether serum isoflavone levels are associated with disability and death. METHODS: The researchers used a nested case-control study to compare serum isoflavones (daidzein, genistein, glycitein, and equol) levels between 165 participants that died or were certificated as disabled (cases) and 177 controls. Disability was defined by certification of long-term care insurance. Conditional logistic regression models were used to calculate the risk of isoflavones for the composite outcome. RESULTS: The proportion of cases was lower in the group with the highest levels of equol (34/91, 37%) compared with equol nonproducers (84/161, 52%). The risk of disability or death among equol producers remained reduced after adjusting for age and sex (odds ratio: 0.55, 95% confidence interval: 0.33-0.93). In a multivariate model, this risk was also unchanged (odds ratio: 0.51, 95% confidence interval: 0.27-0.96). There were no significant associations between daidzein, genistein, and glycitein with the composite endpoint. CONCLUSIONS: Higher serum equol levels, but not any other isoflavones, were inversely associated with the composite endpoint of disability and death. Although it cannot be concluded that equol per se has preventive effects on disability or death, higher equol levels appear associated with better health.

Cost of depression among adults in Japan in 2005.

AIM: Major depression is expected to become the leading contributor to disease burden worldwide by 2020. Previous studies have shown that the societal cost of depression is not less than that of other major illnesses, such as cardiovascular diseases or AIDS. Nevertheless, the cost of depression in Japan has never been examined. The goal of the present study was to estimate the total cost of depression in Japan and to clarify the characteristics of this burden. METHODS: A prevalence-based approach was adopted to measure the total cost of depression. The total cost of depression was regarded as being comprised of the direct cost, morbidity cost and mortality cost. Diagnoses included in this study were depressive episodes and recurrent depressive disorder according to the ICD-10 or major depressive disorder according to the DSM-IV. Data were collected from publicly available statistics and the World Mental Health Japan Survey database. RESULTS: The total cost of depression among adults in Japan in 2005 was estimated to be ¥2.0 trillion. The direct cost was ¥0.18 trillion. The morbidity cost was ¥0.92 trillion, while the mortality cost was ¥0.88 trillion. CONCLUSION: The societal costs caused by depression in Japan are enormous, as in other developed countries. Low morbidity costs and extremely high mortality costs are characteristic in Japan. Effective interventions for preventing suicide could reduce the societal costs of depression.

Assessment of Breast Cancer Risk Based on Mammary Gland Volume Measured with CT.

We investigated the relationship between mammary gland volume (MGV) of the breast as measured with three-dimensional chest computed tomography (CT) and breast cancer risk. Univariate analysis was used to assess the relationship between MGV and known risk factors in 427 healthy women. A case control study (97 cases and 194 controls) was conducted to assess breast cancer risk. MGV was significantly smaller for postmenopausal women than for premenopausal women, and was significantly larger for women with a family history of breast cancer than for women without. MGV, body mass index (BMI), and rate of family history of breast cancer were significantly higher among breast cancer patients than among healthy women, and number of deliveries was significantly lower among breast cancer patients. In postmenopausal women, age at menarche was significantly younger for breast cancer patients. MGV correlated well with breast cancer risk factors. The highest odds ratio was 4.9 for premenopausal women with the largest MGV. Regardless of menopausal status, the greater the MGV, the higher the odds ratio. Our results constitute the first reliable data on the relationship between MGV and breast cancer obtained through exact volume analysis.

Perception of anesthesia safety and postoperative symptoms of surgery patients in Ho Chi Minh City, Vietnam: a pioneering trial of postoperative care assessment in a developing nation.

OBJECTIVES: Vietnamese patients' views on healthcare are changing as surgical interventions become more commonplace, but their views on perioperative care have remained largely unstudied during this period of rapid change. This study assesses Vietnamese patients' impression of anesthesia safety and postoperative pain in relation to clinical outcomes with the aim of improving patient-centered perioperative care. METHODS: The study cohort consisted of 180 hospitalized patients who were followed for 24 h following abdominal surgery. The assessments of these patients on the use of anesthesia and postoperative pain were measured by means of a 5-point Likert scale survey. Perioperative events were recorded on standardized forms by medical staff. The relationship between relevant factors affecting the patients' perceptions of anesthesia safety, postoperative symptoms, and pain was examined using multiple logistic regression analysis. RESULTS: The perception of a low level of anesthesia safety by 105 patients (59%) was associated with a low satisfaction in terms of preoperative anesthesia education [odds ratio (OR) 15.03], poor interaction with family (OR 21.80), and absence of perioperative adverse effects (OR 6.10). The occurrence of three or more postoperative symptoms (59%) was associated with a surgery ≥3 h (OR 2.00). Severe pain at 2 h (25%) post-surgery was associated with male gender (OR 2.08) and open surgery (OR 3.30), no reduction in pain at 24 h (51%) was associated with female gender (OR 2.08), and experiencing as much or more pain than expected (46%) was associated with blood loss ≥100 ml (OR 1.04) and low satisfaction with staff communication (OR 1.90). CONCLUSION: Our results suggest that facilitating patients' communication with staff and families and paying attention to gender differences in pain management are important factors to take into consideration when the aim is to improve perioperative care in the rapidly developing healthcare environment of Vietnam.

Personality and body mass index: a cross-sectional analysis from the Miyagi Cohort Study.

OBJECTIVE: Obesity is an increasingly prevalent public health problem worldwide, and is associated with a higher risk of developing various noncommunicable diseases. To further examine the association between personality and overweight, obesity, or underweight, we conducted a cross-sectional analysis in Japan. We hypothesized that extraversion and psychoticism would have a positive association with overweight, and that neuroticism and lie would have an inverse association with overweight, whereas the association between personality and underweight would be the reverse image of overweight. METHODS: In 1990, 30,722 subjects (40-64 years of age) completed a self-administered questionnaire including body weight and height and the Japanese version of the Eysenck Personality Questionnaire-Revised Short Form. Multivariate logistic regression analysis was used to calculate odds ratios for overweight [body mass index (BMI)> or =25.0 kg/m2] or underweight (BMI<18.5) relative to each category on the personality subscale. RESULTS: In men and women, extraversion and psychoticism had positive associations with overweight, whereas neuroticism had an inverse association. Lie had an inverse association with overweight in men. In men and women, only extraversion had an inverse association with underweight and neuroticism had a positive association with underweight. CONCLUSION: Our findings indicate that personality is associated with both overweight and underweight. These results may provide clues to devising more effective measures for preventing overweight, obesity, or underweight or for weight control intervention.

[Predictors of functional status among independent and homebound community dwelling elderly: physical, psychological, and social parameters].

PURPOSE: The purpose of this study was to determine changes in functional status of Japanese community-dwelling elderly, and to identify physical, psychological, and social factors that predict functional change in a 1-year longitudinal study. METHODS: A cohort of people 65 years of age and over living in two cities in Yamagata Prefecture were followed for one year. The employed degree of independent criteria developed by the Ministry of Health and Welfare had nine levels. Subjects were classified as independent (rank J) and homebound (rank A) and numbered 112 and 53, respectively. Data on demographic, physical, psychological, and social variables were collected in 1997 by mail and interview during house visits. Death and change in functional status were checked in 1998. RESULTS: At follow-up, 1.0% of independent elders had died. Likewise, of the homebound elderly 7.7% had died. Change in functional status between the baseline and follow-up surveys were similar for both sexes and all age groups. According to nine levels criteria, rates for a good and a poor functional status of independent elderly were much the same at the baseline. Among homebound elders, 35.4% demonstrated improvement in the functional status and 14.6% deterioration. Among independent elderly, worsening of the functional status was significantly displayed, particularly with regard to hearing deficits, hospitalization within the past one year, loss of self-efficacy, fair or poor subjective health and poor functional ability. Among homebound elderly, worsening was significantly displayed in term of incontinence and poor self-efficacy. CONCLUSIONS: When functional status at baseline was poor, deterioration was evident at follow-up survey, independent of the sex or age group. Transition in functional status can be dynamic, and improvement was more usual than worsening among homebound elderly. Our results show that increase in self-efficacy can be an effective target in programs for improvement of functional status and for prevention of functional deterioration among the independent and homebound elderly of both sexes.

Factors associated with unintended pregnancy in Yamagata, Japan.

Data on unintended pregnancy are scarce in Japan. The purpose of this study is to examine the association of sociodemographic, reproductive, and other health behavioral factors with unintended pregnancy. A survey was conducted from May through November 1999 in Yamagata, Japan. We distributed anonymous self-administered questionnaires to cervical and breast cancer screening participants aged 35-49 years. There were 564 eligible women, and the number of respondents was 421 (74.6%). The proportion of women who had experienced unintended pregnancy was 46.2%, and 40.1% of them had repeated experiences. Among 312 pre-menopausal married women who did not want to become pregnant, 15.4% were not using any contraception. Factors that were significantly associated with the experience of unintended pregnancy were age of husband being 4 or more years older [Odds ratio (OR) = 1.83], and age at initiation of sexual intercourse (OR = 1.86) and marriage during teens (OR = 11.14). Analysis of 1255 pregnancies that the subjects had experienced showed that 51.2% and 25.9% of mistimed and unwanted pregnancies occurred as a result of no contraceptive use, and 39.5% and 71.1% of these ended in abortions. The number of past unintended pregnancies was significantly (p < 0.001) correlated with the number of pregnancies (r(s) = 0.49), live births 0.20) and abortions (r(s) = 0.63). This is the first epidemiological study in Japan to examine factors associated with unintended pregnancy, and also contraceptive use and pregnancy outcome for each of the unintended pregnancy women had experienced. Unintended pregnancy is not a rare event among our target population, and many unintended pregnancies leading to abortion could be prevented by effective contraceptive use. Results suggest that Yamagata's family planning strategies need to target both the younger and older generations, and address the role of men. A woman's pregnancy history reflecting her past experience of unintended pregnancy could be used as an indicator for recognizing the woman's need for appropriate contraceptive counseling for the prevention of repeated unintended pregnancies.