Association between the interval of worksite dental check-ups and dental and medical expenditures: a single-site, 12-year follow-up study in Japan.

OBJECTIVES: The purpose of this study was to identify the effective intervals of worksite dental check-ups to reduce cumulative dental expenditures (CDEs) and cumulative medical expenditures (CMEs), based on 12 years of follow-up dental check-ups. SETTING, DESIGN AND PARTICIPANTS: A longitudinal study was conducted between 2002 and 2014 fiscal years. A total of 2691 full-time employees (2099 males and 592 females) aged 20-59 years in a manufacturing company in Japan were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES: Based on the follow-up of 12-year dental check-ups, the interval of dental check-ups visits was classified into the following categories: 'Once per year' as the regular group, 'At least once per 2 years' as the subregular group and others as the irregular group. CDEs and CMEs per capita were examined by the three groups of dental check-ups interval after adjustment for sex, age, occupation and total CMEs at baseline. For sensitivity analysis, decayed teeth, missing teeth and Community Periodontal Index were added as adjustment factors. RESULTS: Compared with the irregular group, the pooled CDEs (including dental check-ups fee) per capita in the subregular group (OR 0.91, 95% CI 0.85 to 0.98) and regular group (OR 0.87, 95% CI 0.81 to 0.93) were significantly lower overall. The younger adults in the subregular group and younger-aged and middle-aged adults in the regular group had significantly lower CDEs. Sensitivity analysis confirmed these findings. CONCLUSIONS: Our findings suggest that regular and subregular worksite dental check-ups were related to reduction of CDEs. It is important to promote a yearly interval between dental check-ups.

[Association between periodontal pockets and health-related behaviors of workers].

OBJECTIVE: Periodontal disease is a chronic disease caused by bacterial infection, and frequently develops in adulthood. As the disease is closely related to lifestyle, it is important to clarify its relationship with health-related behaviors to provide effective health instructions targeting its prevention. In this study, we focused on periodontal pockets with advanced periodontal disease to clarify the health-related behaviors associated with the presence or absence of periodontal pockets. METHODS: The subjects were 3,142 employees (male: N=2,429, female: N=713; 42.4 ± 10.5 years, Range 20-59 years) of one company, which had provided all employees with an oral health program in 2002. Participants with a Community Periodontal Index code of ≤2 and ≥3 were classified as those without and with periodontal pockets, respectively. To clarify the health-related behaviors associated with the presence or absence of periodontal pockets, we conducted multivariate logistic regression analysis, with presence/absence of periodontal pockets as the dependent variable, and items of health-related behavior investigated in 2002 as independent variables, and calculated the odds ratios (OR) and 95% confidence intervals (95%CI) adjusted for sex, age group and occupation. RESULTS: The factor most strongly correlated with the presence of periodontal pockets was non-use of dental floss (OR=1.95 (95%CI: 1.57-2.41)), followed by smoking (OR=1.71 (95%CI: 1.44-2.03)), and tooth-brushing habits (≤once a day: OR=1.33 (95%CI: 1.10-1.61)). CONCLUSIONS: Our results suggest that, to promote oral health program at the worksite, it is important to provide health education and instructions to encourage the use of dental floss, a daily tooth-brushing habit, and smoking cessation.

The impact of breast cancer on employment among Japanese women.

OBJECTIVES: Breast cancer (BC) is a cancer that affects working age women in Japan. The aim of this study was to examine the impact that BC has on the work-related life of Japanese women and identify factors that correlate with job resignation. METHODS: A cross-sectional Internet survey of cancer survivors in Japan was conducted from December 2011 to February 2012. The questionnaire included questions regarding demographic characteristics, impact of cancer diagnosis and treatment on job resignation and consultation behavior of respondents regarding work-related issues. This study reports results obtained from 105 respondents with BC. RESULTS: The mean age of respondents at diagnosis was 42.5 ± 6.4 years, and the median time since diagnosis was 40 months. Thirty-one respondents (29.5%) lost their jobs, and 12 could not find another job after BC diagnosis. Nearly half of the respondents (47.6%) reported a decrease in personal income after diagnosis. Multiple logistic regression analysis revealed that contract or part time workers were significantly more likely to lose their jobs compared with regular, full time workers (odds ratio, 2.52; 95% confidence interval, 1.39 to 4.55; p<0.001). Seventy-nine respondents (75.2%) consulted someone regarding work-related issues. The most frequently consulted person was the boss at the workplace. CONCLUSIONS: Our findings suggest that women with BC experience various job-related problems. In order to create a supportive work environment for BC survivors, focus should be placed on facilitating communication and coordination between BC survivors, healthcare providers and coworkers.

Non-work-related personal events contribute to depressive symptoms in Japanese discretionary workers.

In Japan, the number of workers with depressive symptoms has increased recently, and long working hours are considered one of the main contributing factors. Currently, the number of workers engaging in discretionary work is small but is expected to increase, as a diverse method of employment is believed to contribute to workers' well-being. However, the factors related to discretionary workers' depressive symptoms are unclear. This study aimed to identify the factors associated with depressive symptoms in discretionary workers. The subjects were 240 male discretionary workers in a Japanese insurance company. A cross-sectional study was performed using a questionnaire that includes demographic characteristics, living and working conditions, work-related and non-work-related stressful events, and the Center for Epidemiologic Studies Depression Scale (CES-D). Depressive symptoms were assessed as more than 16 points on the CES-D. Multiple logistic regression models were employed to estimate odd ratios (OR) with 95% confidence intervals (95% CI) of depressive symptoms in relation to possible factors. Thirty-six subjects (15.5%) showed depressive symptoms. The depressive symptoms were significantly related to age (p = 0.04), presence of child(ren) (p = 0.02), and length of employment (p = 0.01), but unrelated to working hours. Subjects who reported "financial matters" (OR = 4.50, 95% CI = 1.89-10.72) and "own event" such as divorce or illness (OR = 2.93, 95% CI = 1.13-7.61) were more likely to show depressive symptoms. In conclusion, mental health measures for discretionary workers should focus on addressing financial difficulties and consultations and assistance in personal health and family issues.

Concise synthesis and biological assessment of (+)-neopeltolide and a 16-member stereoisomer library of 8,9-dehydroneopeltolide: identification of pharmacophoric elements.

We describe herein a concise synthesis of (+)-neopeltolide, a marine macrolide natural product that elicits a highly potent antiproliferative activity against several human cancer cell lines. Our synthesis exploited the powerful bond-forming ability and high functional group compatibility of olefin metathesis and esterification reactions to minimize manipulations of oxygen functionalities and to maximize synthetic convergency. Our findings include a chemoselective olefin cross-metathesis reaction directed by H-bonding, and a ring-closing metathesis conducted under non-high dilution conditions. Moreover, we developed a 16-member stereoisomer library of 8,9-dehydroneopeltolide to systematically explore the stereostructure-activity relationships. Assessment of the antiproliferative activity of the stereoisomers against A549 human lung adenocarcinoma, MCF-7 human breast adenocarcinoma, HT-1080 human fibrosarcoma, and P388 murine leukemia cell lines has revealed marked differences in potency between the stereoisomers. This study provides comprehensive insights into the structure-activity relationship of this important antiproliferative agent, leading to the identification of the pharmacophoric structural elements and the development of truncated analogues with nanomolar potency.

Evaluation of participatory training in managing mental health for supervisory employees in the financial industry.

Industry-specific primary prevention measures for promoting mental health of workers were undertaken in 2008 and 2009 as a result of participatory training involving 130 supervisory employees in workplaces of the financial industry. These measures included the following five points suggested to be effective in the industry: 1) proper opportunities for training and career building, 2) control of work time and improving work organization, 3) standardization of tasks, 4) job rotation for sharing work responsibilities, and 5) increasing communication and mutual support. A post-training follow-up survey revealed that participatory, action-oriented training facilitated sharing of feasible measures and mutual support, leading to the development of measures easily introduced and established at each workplace. We concluded that mutually supportive group work of teams composed of members who held similar duty positions and were engaged in similar operations, using the Mental Health Action Checklist as a guiding tool, was effective for realizing implementation of optimally practical and specific measures.

The effectiveness of acceptance and commitment therapy bibliotherapy for enhancing the psychological health of Japanese college students living abroad.

International students often experience significant psychological distress but empirically tested programs are few. Broadly distributed bibliotherapy may provide a cost-effective approach. About half of the Japanese international students in a western university in the United States (N=70) were randomly assigned to a wait-list or to receive a Japanese translation of a broadly focused acceptance and commitment therapy (ACT) self-help book. Although recruited without regard to health status, the sample was highly distressed with nearly 80% exceeding clinical cutoffs on one or more measures. After a 2-months period for the first treatment group to read the book and a 2-month follow up, wait-list participants also received the book. Students receiving the book showed significantly better general mental health at post and follow up. Moderately depressed or stressed, and severely anxious students showed improvement compared to those not receiving the book. These patterns were repeated when the wait-list participants finally received the book. Improvements in primary outcomes were related to how much was learned about an ACT model from the book. Follow-up outcomes were statistically mediated by changes in psychological flexibility, but not vice versa and were moderated by level of initial flexibility. Overall, the data suggest that ACT bibliotherapy improved the mental health and psychological flexibility of Japanese international students.

Occupational health and safety services for immigrant workers in Japanese workplaces.

The objective of this study was to clarify the status of occupational health and safety services for immigrant workers, the barriers to employing immigrant workers and the needs of the managers in workplaces to keep immigrant workers healthy and safe. This study was a cross-sectional survey. We sent self-administered questionnaires to 126 workplaces in the western part of Shizuoka Prefecture, Japan in August 2006. The questionnaire included the characteristics of the workplace, barriers to employing immigrant workers, current actions to keep immigrant workers healthy and safe, the implementation rate of health checkups and important issues to keep immigrant workers healthy and safe. Implementation rates of health and safety education, creating job instruction manuals written in their native languages, creating safety signs written in their native languages, and the use of translators were 62.5%, 50.0%, 41.1% and 37.5%, respectively. Implementation rates of general health checkups, special health checkups and follow up after health checkups were 80.8%, 73.6% and 67.3%, respectively. The most important issue which the managers considered kept immigrant workers healthy and safe was health checkups (69.6%). In conclusion, several occupational health and safety services were conducted for immigrant workers without a margin to compare with Japanese workers.

Age-stratified analysis of the impact of hypertension on National Health Insurance Medical Expenditures in Ibaraki, Japan.

BACKGROUND: This retrospective cohort study examined the sex- and age-specific impact of hypertension on medical expenditures. METHODS: In 2006, we analyzed the medical expenditure records of 42 426 Japanese National Health Insurance beneficiaries (16 169 men, 26 257 women) who lived in Ibaraki, Japan, were aged 40 to 69 years, and underwent health checkups in 2002. Blood pressure was classified into 4 categories according to the criteria outlined in the seventh report of the Joint National Committee. RESULTS: The difference in median total expenditure between the hypertension categories and the normotension category was 119 585 yen (140 360 yen vs 20 775 yen) for men aged 40 to 54 years, 126 160 yen (204 070 yen vs 77 910 yen) for men aged 55 to 69 years, 125 495 yen (158 025 yen vs 32 530 yen) for women aged 40 to 54 years, and 122 370 yen (208 700 yen vs 86 330 yen) for women aged 55 to 69 years. The median total and outpatient medical expenditures markedly differed between patients with stage 1 hypertension and stage 2 hypertension (which included people on antihypertensive medication) in both sexes and all age subgroups. The median total and outpatient medical expenditures were higher among women than among men in all blood pressure categories. CONCLUSIONS: The impact of hypertension on medical expenditures was similar in all age groups. Therefore, from the perspective of medical economics, prevention of the onset of hypertension seems equally important for all age subgroups.

Hospital safety climate, psychosocial risk factors and needlestick injuries in Japan.

To investigate the interactions between safety climate, psychosocial issues and Needlestick and Sharps Injuries (NSI), a cross-sectional study was undertaken among nurses at a university teaching hospital in Japan (89% response rate). NSI were correlated with various aspects of hospital safety climate including supporting one another at work, the protection of staff against blood-borne diseases being a high management priority, managers doing their part to protect staff from blood-borne disease, having unsafe work practices corrected by supervisors, having the opportunity to use safety equipment to protect against blood-borne disease exposures, having an uncluttered work area, and having minimal conflict within their department. In conclusion, this study has demonstrated the importance of hospital safety climate in Japanese health care practice, particularly its relationship with NSI. Although the provision of safer devices remains critical in preventing injuries, ensuring a positive safety climate will also be essential in meeting these important challenges for nurses' occupational health.

[Study of clarifying incidence of lifestyle-related diseases and related complications and its medical expenses using government-managed health insurance data].

OBJECTIVES: In this study, analysis was performed with the objective of clarifying the incidence of lifestyle-related diseases and related complications and its medical expenses. METHODS: A random sample population of people insured under government-managed health insurance in Mie Prefecture, Japan, who had undergone annual health examinations in 1993, 1998, and 2003, and who had incurred medical costs in 2003 was analyzed. The relationship between the results of health examinations in 1993 and medical costs in 2003 was investigated by examining 2,165 individuals whose data were available. The relationship between medical costs and risk factors including diabetes, hypertension, hyperlipemia, cerebrovascular disease, and ischemic heart disease was examined by analysis of covariance adjusted by sex and age. RESULTS: There was a higher doctor consultation rate for diabetes, hypertension, and hyperlipemia after 10 years among people presenting with high Body Mass Index, blood pressure, serum lipid, and plasma glucose. CONCLUSIONS: It was shown that there is a relationship of having lifestyle-related diseases and related complications with doctor consultation rate and medical expenditure.

Changes of subjective stress and stress-related symptoms after a merger announcement: a longitudinal study in a merger-planning company in Japan.

To investigate the influences of a merger on employees in a Japanese company, changes of subjective stress and stress-related symptoms after a merger announcement in a major Japanese financial company were explored using longitudinal study surveys. Seventy-one participants responded to the first and second questionnaires, consisting of stress and symptoms, personal characteristics, lifestyle, medical examination, and work-related factors. After the merger announcement, the prevalence of subjective stress, anxiety, and impatience increased significantly from 46.5% to 78.9%, 18.3% to 40.8%, and 15.9% to 29.0%, respectively. The study suggests that subjective stress and stress-related symptoms may increase after a merger announcement. To reduce the negative impact of mergers, employers are expected to provide mental health-promotion programs in a merger-planning company.

[A study of the association between the results of health examinations and medical costs 10 years thereafter using government-managed health insurance data].

OBJECTIVES: Using a data set combining the results of lifestyle-related disease prevention health examinations with medical fee receipts for individuals insured under government managed health insurance, a study was conducted to evaluate the effect of health examination results on medical costs 10 years thereafter. METHODS: A random sample stratified by sex and age was drawn from people insured under the government managed health insurance in Mie Prefecture, Japan, who had undergone annual health examinations in 1993, 1998, and 2003, and who had incurred medical costs in 2003. By examining a sample of 2,165 individuals for whom data were available, an analysis was performed on the relationship between the results of health examinations in 1993 and medical costs in 2003. Costs were converted to a logarithmic scale and analyzed by one way analysis of variance. The relationship between risks and medical costs was examined through analysis of characteristics adjusted for sex and age. RESULTS: As expected, health examination results and medical costs were related to sex and age. After adjustment for these factors, medical costs were found to be significantly higher in all test categories among individuals with known risk factors, when compared to individuals without such risk factors. Medical costs were approximately four times higher for persons with four risk factors (21,889 points) than for persons with none (5,234 points) (P < 0.001). CONCLUSION: It was shown that an analysis of the relationship between health examination results and medical costs can be applied to better target health guidance and to identify high-priority cases.

Cost-benefit analysis of a worksite oral-health promotion program.

This study was conducted to examine whether oral-health promotion programs provided as an occupational health service for employees were cost-beneficial for employers. The subjects were composed of 357 male workers (20-59 yr of age) who participated in oral-health promotion programs conducted at their workplaces between 1992 and 1997. The design of this study was a quasi-experimental study design in which the three programs (light: 1 visit; medium: 2-4 visits; and heavy: 5-6 visits) were compared through cost-benefit analysis conducted from the viewpoint of the employers. The programs consisted of oral-health checkups by dentists and oral-health education, including that on the proper brushing method, by dental hygienists. The costs of the program included direct costs for the payment of oral-health-care staff and for teaching materials, and indirect costs for the time for employee participation in the program (20 min/employee per visit). The accumulated dental expenses for the seven years were used to calculate benefits, which were determined, based on the differences between 0 visits and each program. The benefit/cost ratios of the three programs were -2.45, 1.46, and 0.73, respectively. These results suggest that a worksite oral-health promotion program of medium frequency is cost-beneficial for employers.

["The paradox of well-being" and "the crisis" in middle and late adulthood: examination from the relationship between aging and self-evaluation].

The present study focused attention on "the paradox of well-being" and "the crisis" of aging discussed in the previous studies, and examined the developmental characteristics of middle and late adulthood regarding the relationship between subjective experiences of aging and domain-specific self-evaluation. A questionnaire survey was conducted to 2,026 thirty through 75-year-old participants. Within a cross-sectional model, "the paradox of well-being" was verified. It was suggested that aging is a pivotal component of well-being for the middle-aged and elderly. "Leeway and maturation," a positive aspect of subjective aging experience, showed positive and far-reaching impacts on self-evaluation. Its function to limit and minimize the negative effect caused by decline was also suggested. The crisis, for men, found in early and post middle-age, was explained as the accumulation of negative effect of aging, mainly relating to the socioeconomic changes. For women, the crisis was inferred to be elicited as a negative impact of aging that spilled over to most facets of self throughout middle and late adulthood.

Characteristics of lifestyle and health status of workers in small-scale enterprises in Japan.

This study was conducted to clarify the characteristics of small-scale enterprises (SSEs) with fewer than 50 workers, which employ 62.2% of all Japanese workers. Subjects were 71,183 workers employed at 1,761 workplaces in Tochigi, Japan, in 2002. Frequencies of abnormal lifestyle and health check-up data were described according to the category of the enterprise. Adjusted odds ratios (ORs) of the abnormal findings were calculated by logistic regression analysis. Dose-response relationships were calculated by trend tests. The frequency of abnormal findings was higher in SSEs than in other categories of enterprises. The ORs of work intensity, alcohol consumption, current smoker, and the Brinkmann index were higher in SSEs than in large-scale enterprises (LSEs) and were also significant in trend tests. The ORs of audiometry, hypertension, glucose in urine and ECG in males and females, BMI, liver function, lipid metabolism, and blood sugar in females, chest X-ray, and anemia in males were higher in SSEs. Audiometry, hypertension, anemia, ECG in both males and females; chest X-ray, and glucose in urine in males, and liver function, lipid metabolism and blood sugar in females showed significant results in trend tests. Overall health and healthy lifestyle in SSEs were worse than in LSEs.

Metabolic syndrome in Japanese men and women with special reference to the anthropometric criteria for the assessment of obesity: Proposal to use the waist-to-height ratio.

BACKGROUND: Obesity is one of the criteria for defining metabolic syndrome. However, overt obesity in Asians is relatively low despite high prevalence of metabolic risks. METHODS: We investigated the effectiveness of various anthropometric indices {body mass index (BMI), waist circumference, waist-to-height ratio (W/Ht)} for the evaluation of coronary risk factors (hypertension, hyperglycemia, hypertriglyceridemia, and low HDL cholesterol) and as one of the criteria for metabolic syndrome (clustering of three or more from one obesity and four coronary risk factors) in Japanese on 6141 men and 2137 women. RESULTS: (1) The areas under the receiver operating characteristic curves for the different anthropometric indices to identify any one and two or more coronary risk factors were highest for W/Ht. (2) The sensitivities for the identification of any one and two or more coronary risk factors were greater for W/Ht > or =0.5 than BMI > or =25, > or =23, and indices of waist circumference (Adult Treatment Panel III and Japan Society for the Study of Obesity). (3) The prevalence of metabolic syndrome varied greatly by different anthropometric indices, and the percentages of obesity risk factors in metabolic syndrome were highest for W/Ht > or =0.5 in both genders (approximate 95%). CONCLUSIONS: W/Ht >/=0.5 may be the most effective anthropometric index for screening Japanese people for metabolic syndrome.

Characteristics of an external employee assistance programme in Japan.

BACKGROUND: Mental health care is now a major occupational health issue in Japan. Although realizing effective use of external employee assistance programmes (EAPs) has been identified as crucial for mental health care, few scientific papers describe or analyse the characteristics of EAPs in Japan. AIMS: This study sought to clarify the characteristics of an external EAP in Japan. METHODS: The characteristics of an external EAP were clarified in terms of programme description and utilization. A total of 10,260 counselling sessions from 1996 to 2000 were used for utilization analysis. RESULTS: The EAP studied had contracts with 133 organizations, half of which were health insurance societies. The EAP provided employees and family members with free, confidential counselling. Annual mean utilization rate per 1000 individuals increased from 1.3 in 1996 to 2.7 in 2000. Less than one-third of counselling sessions were for work-related mental health issues, and male users (30%) consulted significantly more often than female users (14%) for such problems. Among men, career development issues were most common, while job dissatisfaction was highest among women. Absenteeism, depression and fatigue were the most frequently observed problems in both sexes. CONCLUSIONS: EAP use in Japan is rising. The majority of its use is for non-work-related health issues. Male users were more likely to consult for work-related mental health problems.

[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.