Complementary and Alternative Medicine Use, Cancer Screening, and Medical Checkups in Japan from 2001 to 2013: A Repeated Cross-Sectional Study.

Introduction: The association between complementary and alternative medicine (CAM) use and other health-related behaviors is an important issue. A previous study reported that complementary medicine use is related to greater use of cancer screening, whereas alternative medicine use is related to lower use of cancer screening. Given the sparse evidence from Japan, we aimed to examine the association of CAM use with cancer screening and medical checkups. We used a repeated cross-sectional survey of a nationally representative sample of Japanese people and conducted age-period-cohort analysis. Methods: The study population was 68,217 of 83,827 individuals observed from 2001 to 2013 who received cancer screening. CAM users were defined as individuals who received acupuncture, moxibustion, anma/massage/shiatsu, or judo therapy for their most worrisome symptom. The outcomes of interest were receiving stomach, lung, colorectal, uterine, and breast cancer screenings and medical checkups. Using crossclassified multilevel logistic regression models, we estimated odds ratios (ORs) and 95% credible intervals (CIs) for cancer screening and medical checkups. Results: For CAM users of complementary medicine, the adjusted ORs for stomach, lung, and colorectal cancer screening were 1.40 (95% CI: 1.35-1.44), 1.37 (95% CI: 1.34-1.40), and 1.52 (95% CI: 1.49-1.54), respectively. We found similar results for uterine and breast cancer screening, and medical checkups. Conclusions: Irrespective of whether they use CAM, CAM users in Japan tend to receive a variety of cancer screenings and medical checkups.

Do Complementary and Alternative Medicine Users Also Use Conventional Medicine? A Repeated Cross-Sectional Study in Japan from 1995 to 2013.

Introduction: It is recommended that users of complementary and alternative medicine (CAM) also seek conventional medical care to prevent the loss of access to appropriate medical care. However, the status of such use is unknown. The aim of this study was to examine the time trends in the proportion of CAM users who also receive conventional medical care for the same symptoms. Methods: This is a repeated cross-sectional study. Of data for 753,978 respondents to the Comprehensive Survey of Living Conditions, which was conducted seven times between 1995 and 2013, data from 17,707 individuals who used acupuncture, moxibustion, anma-massage-shiatsu, or judo therapy were analyzed. Cross-classified multilevel logistic regression models with individuals as level 1 and survey year and cohort as level 2 were used to calculate odds ratios (ORs) and 95% credible intervals (CIs) for combined use of CAM and conventional medical care. Age was entered as an individual-level variable. The period effect after 2003 was entered as a survey year-level variable because the number of eligible persons providing CAM treatments has increased since 2003. Results: Among the 17,707 CAM users, 11,567 (65.3%) were women. When age was entered as an explanatory variable, the results showed that both older men and women tended to receive conventional medical care (women, OR: 1.04, 95% CI: 1.03-1.04; men, OR: 1.03, 95% CI: 1.02-1.04). Additional examination of the possible period effect after 2003 showed a positive (although nonsignificant) association (women, OR: 1.36, 95% CI: 0.89-1.99; men, OR: 1.37, 95% CI: 0.94-1.91). Conclusions: As patient age increased, patients combined CAM use with conventional medicine. The findings also suggested that the combined use of CAM and conventional medicine has increased since 2003.

Trends in geographic distribution of nursing staff in Japan from 2000 to 2010: a multilevel analysis.

The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types:public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PHN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased;the RRs per 1-year increment were 1.022 (95% CI:1.020-1.023), 1.021 (95% CI:1.019-1.022), and 1.037 (95% CI:1.037-1.038), respectively. In contrast, AN significantly decreased;the RR per 1-year increment was 0.993 (95% CI:0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.

Green tea consumption and mortality among Japanese elderly people: the prospective Shizuoka elderly cohort.

PURPOSE: To investigate the association between green tea consumption and mortality from all causes, cancer, and cardiovascular disease (CVD) among elderly people. METHODS: In a population-based, prospective cohort study, a total of 14,001 elderly residents (aged 65-84 years), randomly chosen from all 74 municipalities in Shizuoka, Japan, completed questionnaires that included items about frequency of green tea consumption. They were followed for up to 6 years, from December 1999 to March 2006. Consequently, 12,251 subjects were analyzed to estimate the hazard ratios (HRs) for all-cause mortality, cancer, and CVD. RESULTS: Among 64,002 person-years, 1,224 deaths were identified (follow-up rate, 71.6%). The multivariate HRs and 95% confidence intervals (CIs) for CVD mortality compared those who consumed seven or more cups per day with those who consumed less than one cup per day, were 0.24 (0.14-0.40), 0.30 (0.15-0.61), and 0.18 (0.08-0.40) for total participants, men, and women, respectively. Although green tea consumption was not inversely associated with cancer mortality, green tea consumption and colorectal cancer mortality were inversely associated with a moderate dose-response relationship. CONCLUSIONS: Green tea consumption is associated with reduced mortality from all causes and CVD. This study also suggests that green tea could have protective effects against colorectal cancer.