[Association between working in small-scale cultivated land as a daily-life task and the physical and cognitive functions among elderly people in hilly and mountainous areas].

AIM: This study aimed to verify whether working in cultivated land as a daily-life task contributes to the maintenance and improvement of physical and cognitive functions. METHODS: The participants were 91 elderly people of ≥65 years of age who owned cultivated land in the mountainous Koyadaira district in Tokushima Prefecture. Sex, age, body mass index (BMI), walking speed as a physical function, and the mini-mental status examination (MMSE) score as a cognitive function were measured and analyzed in addition to the total working hours per week (WH) in cultivated land. RESULTS: The participants were 31 males and 60 females (mean age 78.5±6.6 years). The average values of the evaluated variables were as follows: WH, 18.0±13.2; BMI, 23.4±3.0 kg/m2; walking speed, 0.95±0.28 m/s; and MMSE score, 26.6±3.1 points. In addition, the Mann-Whitney U test and the Chi-square test showed no significant differences between sexes for each item. A logistic regression analysis showed that WH was significantly associated with MMSE (1, ≥28 points; 0, <28 points), and the odds ratio was 1.054 (p=0.010) in the model adjusted for age and BMI, while it was not significantly associated with walking speed (1, ≥1 m/s; 0, <1 m/s). CONCLUSIONS: Working on small-scale cultivated land was significantly associated with the cognitive function but not the physical function. Routine work on small-scale cultivated land as a daily-life task would contribute to the suppression of cognitive decline in older people living in hilly and mountainous areas.

[Severe neuropsychiatric disorder developing during busulfan-containing regimen for stem cell transplantation].

Here we describe two patients that required interruption of a busulfan (BU) containing conditioning regimen due to severe mental disorder before stem cell transplantation. The first patient was a 66-year-old man scheduled for unrelated peripheral blood stem cell transplantation with fludarabine/BU conditioning for myelodysplastic syndrome. He received 9.6 mg/kg BU and developed hallucinations that worsened the next day. BU was stopped on the final day, but the patient became comatose (grade 4). He recovered the next day. The second patient was a 69-year-old man scheduled for autologous peripheral blood stem cell transplantation with thiotepa (TT)/BU conditioning for cerebral nervous system relapse of mantle cell lymphoma. He received 12.8 mg/kg BU and developed hallucinations. His mental symptoms worsened on the next day, and thus administration was stopped on the second day of TT. His symptoms improved the next day. Both patients were over 65 years old, and their psychiatric symptoms worsened 1-2 days after the final dose of BU. Our findings suggest that BU may cause psychiatric disorders in elderly patients. When performing BU conditioning, it may be necessary to avoid azole antifungal medication and acetaminophen and to reduce the dose or perform therapeutic dose monitoring for elderly patients.

High-density lipoprotein size distribution can differ between subjects with alcoholic and non-alcoholic fatty liver disease.

BACKGROUND: While alcohol consumption is associated with levels of high-density lipoprotein (HDL)-cholesterol (HDL-C), a cardiovascular risk marker, HDL size distribution has yet to be characterized in subjects with alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). METHODS: The present study compared HDL subfractional characteristics between subjects with AFLD (36 men, age 61 +/- 14) and NAFLD (35 men, age 65 +/- 13), recruited during general health check-ups. Serum HDL subfractions were measured with the electrophoretic separation of lipoproteins employing the Lipoprint system. RESULTS: The subjects with AFLD had a significantly greater proportion of small-sized HDL part (6.6 +/- 5.7%) than those with NAFLD (3.8 +/- 4.9%, p = 0.029). CONCLUSIONS: More percentages of small-sized HDL part were observed in the subjects with AFLD than in those with NAFLD in Japanese general population. Whether the difference of HDL size is associated with cardiovascular manifestations should be studied further.

Social frailty as a predictor of all-cause mortality and functional disability: a systematic review and meta-analysis.

The association between social frailty and adverse health outcomes, especially mortality and functional disability, which are essential health outcomes, has not been systematically summarized or meta-analyzed. In this study, we conducted a systematic review and meta-analysis of the impact of social frailty on all-cause mortality and functional disability, while addressing the components of social frailty. In this study, social frailty was operationally defined in alignment with the previous literature, as follows: "a state of increased vulnerability to the interactive back-and-forth of the community, including general resources, social resources, social behaviors, and needs." Hazard ratios or odds ratios described in each selected literature were used as the meta-analytic results. Considering the impact of social frailty on all-cause mortality, the hazard ratio was 1.96 (95% CI 1.20-3.19), indicating a significant association between the two but high heterogeneity. The hazard and odds ratios for the impact of social frailty on functional disability were 1.43 (95% CI 1.20-1.69) and 2.06 (95% CI 1.55-2.74), respectively. A significant association was found between social frailty and functional disability; both hazard and odds ratios were found, and low heterogeneity between these articles was observed. These results highlight the importance of assessing social frailty using more standardized methods and examining its effects on various health outcomes.

Biopsychosocial Consideration of Ikigai in Older Adults in Japan through a Cross-Sectional Study.

Ikigai-a Japanese concept that includes elements such as life's purpose and meaning-has been reported to be associated with various systemic health conditions, such as the risk of developing physical dysfunction or death in older adults. However, there are no reports that comprehensively examine the psychological and social aspects of Ikigai. We attempted to clarify the characteristics of Ikigai by examining it from a biopsychosocial model using physical, psychological, and social perspectives through a cross-sectional study on sarcopenia, frailty and healthy life expectancy in a hilly and mountainous area of Japan. Koyadaira in Mima City, which is located in a hilly and mountainous region on Shikoku Island in Japan, was targeted. This cross-sectional study included 105 outpatients aged 65 and over, with an average age of 79.02 ± 6.91 years. Ikigai (self-rating score on a scale of 0 (no Ikigai) to 5 (the highest Ikigai)) participants' level of physical activity (the Physical Activity Scale for the Elderly, PASE), degree of depression (the Geriatric Depression-15 Scale, GDS-15), cognitive function (the Mini-Mental State Examination, MMSE) and social isolation (the abbreviated Lubben Social Network Scale, LSNS-6) was assessed. Significant positive correlations were found between PASE and MMSE. The LSNS-6 significantly correlated with the MMSE and GDS-15. In a path model, out of four paths from PASE, GDS-15, MMSE, and LSNS-6 to Ikigai, the path from the GDS-15 alone was significant (correlation coefficient -0.271, p < 0.01). The adaptability of this model was good. This study indicates that depressive status has a large impact on Ikigai, along with physical, cognitive, and social conditions; thus, it is appropriate to consider that an affective psychological status, such as depressive symptoms, is a fundamental condition for having Ikigai.

Clinical characteristics of anti-GBM disease with thrombotic microangiopathy: a case report and literature review.

The coexistence of anti-glomerular basement membrane (anti-GBM) disease with thrombotic microangiopathy (TMA) is rarely encountered, and the clinical characteristics of this phenomenon are not well known.A 76-year-old Japanese woman with a history of idiopathic pulmonary disease was diagnosed with anti-GBM disease due to rapidly progressive glomerulonephritis and a positive anti-GBM antibody test result. We treated the patient with hemodialysis, glucocorticoids, and plasmapheresis. During treatment, the patient suddenly became comatose. TMA was then diagnosed because of thrombocytopenia and microangiopathic hemolytic anemia. The activity of a disintegrin-like and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS-13) was retained at 48%. Although we continued the treatment, the patient died of respiratory failure. An autopsy revealed the cause of respiratory failure to be an acute exacerbation of interstitial pneumonia. The clinical findings of the renal specimen indicated anti-GBM disease; however, there were no lesions suggestive of TMA. A genetic test did not reveal an apparent genetic mutation of the atypical hemolytic uremic syndrome.We conducted a literature review of past case reports of anti-GBM disease with TMA. The following clinical characteristics were obtained. First, 75% of the cases were reported in Asia. Second, TMA tended to appear during the treatment course for anti-GBM disease and usually resolved within 12 weeks. Third, ADAMTS-13 activity was retained above 10% in 90% of the cases. Fourth, central nervous system manifestations occurred in more than half of the patients. Fifth, the renal outcome was very poor. Further studies are required to understand the pathophysiology of this phenomenon.

Sleep status and low-density lipoprotein particle size in a general Japanese female population: the MIMA study.

OBJECTIVE: This study investigated the relationship between sleep adequacy and small dense low-density lipoprotein (sdLDL) in a Japanese population. SUBJECTS AND METHODS: Clinical data, including atherosclerotic risk factors, in addition to the mean LDL particle size (LDL-PS) measured by gel electrophoresis, were evaluated in 136 community-dwelling female subjects (40-80 years old). The sleep status was self-reported and the subjects were divided into those who had inadequate sleep (≤ 6 or ≥ 9 h of sleep) and had adequate sleep (7-8 h). RESULTS: The mean LDL-PS was significantly smaller in subjects with inadequate sleep [n = 68, 26.4 ± 0.4 (SD) nm] than in those with adequate sleep (n = 68, 26.6 ± 0.4 nm, p < 0.05). This difference remained significant and independent after adjusting for confounders (ß = 0.15-0.19, p < 0.05). CONCLUSION: Sleep adequacy was associated with the presence of sdLDL, while the influence of the sleep status on LDL-PS was minor in this population. Further research on the associations among sleep, sdLDL and cardiovascular disease prevention is warranted.

End-of-Life Care of Acute Myeloid Leukemia Compared with Aggressive lymphoma in Patients Who Are Eligible for Intensive Chemotherapy: An Observational Study in a Japanese Community Hospital.

Background: Patients with hematological malignancies (HMs) are reported to receive more aggressive care at the end of life (EOL) than patients with solid tumors. However, the reasons behind this occurrence are not fully understood. Objectives: To examine whether the care at EOL for HMs is mainly because of the disease characteristics or hematologists' attitudes and systems of care, we compared the EOL care of patients with acute myeloid leukemia (AML) and diffuse large B cell lymphoma (DLBCL). Design: We retrospectively analyzed the EOL care of patients with AML and DLBCL younger than 80 years who were receiving combination chemotherapy at a city hospital in Japan. Results: Fifty-nine patients with AML and 65 with DLBCL were included. Those with AML received chemotherapy more often within their last 30 days (48% vs. 19%, p < 0.001) and 14 days (37% vs. 1.5%, p < 0.001) of life, and consulted the palliative team less frequently (5.3% vs. 29%, p < 0.001). In the last 3 years, the mortality rate in hematological wards decreased from 74% to 29% in the DLBCL group, but only from 95% to 90% in the AML group. In multivariate analysis, AML (odds ratio [OR] 0.065) and death before 2018 (OR, 0.077) were significant factors associated with reduced referrals to specialized palliative teams. Conclusion: Patients with AML tend to have lesser access to specialized palliative care and fewer options for their place of death than those with DLBCL. Detailed EOL care plans are needed for these patients, considering the characteristics of the disease.

A Retrospective Analysis of R-MPV Plus Response-adapted Whole-brain Radiotherapy for Elderly Patients with Primary Central Nervous System Lymphoma.

Objective Few reports have described the real-world outcomes of rituximab, methotrexate (MTX), procarbazine, and vincristine (R-MPV) plus response-adapted whole-brain radiotherapy (WBRT) for elderly patients with primary central nervous system lymphoma (PCNSL). We evaluated the outcome of this regimen. Methods We evaluated >60-year-old patients with newly diagnosed PCNSL who received R-MPV plus WBRT from January 2010 to December 2019 at Toyohashi Municipal Hospital. The patients' characteristics, regimen enforcement, response rate, survival, and toxicity were analyzed. Patients Ten patients were consecutively enrolled. Their median age was 69 years old, and 60% had a performance status of 3 or 4 before induction therapy. Results Seven patients achieved a complete response after induction, and all 10 patients achieved a complete response after consolidation. Seven received reduced-dose WBRT at 23.4 Gy, and 2 received WBRT at 45 Gy. The median follow-up was 44.4 months; the 3-year progression-free survival and overall survival rates were 60% and 80%, respectively; and the cumulative incidence of relapse was 40%. The incidence of symptomatic delayed neurotoxicity was 70%. Of the 7 patients who received reduced-dose WBRT, 4 (57%) developed delayed neurotoxicity, including 1 severely affected patient. Only one patient survived without relapse and delayed neurotoxicity. The ratio of patients who developed relapse or delayed neurotoxicity that impaired daily life was 33% and 100% in the MTX high- and low-intensity groups, respectively. Conclusion This regimen in elderly patients is unsatisfactory because of delayed neurotoxicity. We should consider maintaining an adequate MTX intensity, postponing or minimizing WBRT, and choosing high-dose consolidation therapy for select patients.

Did "Kayoinoba" Prevent the Decline of Mental and Physical Functions and Frailty for the Home-Based Elderly during the COVID-19 Pandemic?

The purpose of this study is to grasp the management situation of "Kayoinoba" under the conditions of self-quarantine due to the COVID-19 pandemic. It is also to clarify the efficacy of "Kayoinoba" using the Kihon Checklist (KCL) for the assessment of mental and physical functions in the elderly. The respondents were 136 elderly people aged 65 years and over who lived in A City, a standard rural area in Japan. The age, gender, living style, affluence for living, and the frequency of participation in "Kayoinoba" were examined by using the KCL as a self-completed questionnaire. Finally, 101 respondents were included in the final analysis. There was no difference in the participation status before and after the spread of COVID-19. The frailty ratio tended to decrease from 23.8% to 19.8% between the two periods, but there was no difference in the frailty ratio. It is suggested that the participants in "Kayoinoba" may have suppressed the deterioration of mental and physical conditions, excluding physical activity. This would prevent the frailty of the elderly, even during self-quarantine due to the spread of COVID-19.

The association of the Clock 3111 T/C SNP with lipids and lipoproteins including small dense low-density lipoprotein: results from the Mima study.

BACKGROUND: The clock molecule plays major roles in circadian rhythmicity and regulating lipid and glucose metabolism in peripheral organs. Disruption of the circadian rhythm can lead to cardiometabolic disorders. The existence of small dense low-density lipoprotein (sdLDL) in the circulation, an abnormality of lipid metabolism, in part associated with lifestyle, is also one of risk parameters for cardiometabolic disorders. The 3111 T/C single nucleotide polymorphism (SNP) of the Clock gene has been reported to be associated with lifestyle including morning/evening preference. We investigated whether the Clock 3111 T/C SNP may affect lipids and lipoproteins including sdLDL. METHODS: In 365 community-dwelling subjects (170 men and 195 women, mean age 63 ± 14 years), the 3111 T/C SNP was genotyped using a fluorescent allele-specific DNA primer assay system. The levels of sdLDL were measured with the electrophoretic separation of lipoproteins employing the Lipoprint system. RESULTS: The frequency of the Clock 3111 C allele was 0.14. The area of sdLDL did not differ between the subjects with obesity and those without. In carriers of T/T homozygotes, the area of sdLDL was significantly higher compared with carriers of the C allele (T/C or C/C) (1.7 ± 3.4 vs. 0.8 ± 1.9%; p < 0.05). A multiple regression analysis showed that the area of sdLDL was significantly and negatively correlated with the Clock 3111 T/C SNP (ß = -0.114, p < 0.05), independently of age, sex, body mass index, and exercise habits. CONCLUSION: Our findings indicated that the Clock 3111 T/C SNP might be associated with the existence of sdLDL.

An association between angiotensin II type 2 receptor gene A/C3123 polymorphism and glycemic control marker in a general Japanese population.

Objective Angiotensin II (Ang II), through the Ang II type 2 receptor (AT2R), may play some roles in the pathogenesis of glucose metabolism and diabetes mellitus (DM). The Adenine/Cytosine 3123 (A/C3123) polymorphism in the AT2R gene has reportedly been associated with metabolic conditions such as blood pressure and body mass index (BMI). The present cross-sectional study was aimed at investigating the association between the AT2R gene A/C3123 polymorphism and glycemic control parameters. Methods Among 286 community-dwelling Japanese subjects (men: women = 126:160; mean age, 65.1 years), AT2R A/C3123 polymorphism, which was detected by polymerase chain reaction methods, and metabolic parameters such as blood pressure, BMI, lipoprotein/lipid, insulin, and glycemic control parameters (fasting plasma glucose and HbA1c) were examined. Results In the whole study population, the proportion of C-allele was 67.0% and A-allele was 33.0%. The A-allele carriers had significantly lower HbA1c levels than the C/C-genotyped subjects in the group of women (5.5 +/- 0.6 vs. 5.8 +/- 1.5%, P = 0.042). The effect on HbA1c persisted to be significant with adjustments to age and BMI. In men, the associations between the polymorphism and glycemic control parameters were non-significantly noted. There were no differences between genotype-based groups in the other metabolic parameters in both sexes. Conclusion These results suggest that the AT2R A/C3123 polymorphism could be a polymorphic marker related to glycemic control, as presented in HbA1c, among general Japanese women.

A formation mechanism for 8-hydroxy-2'-deoxyguanosine mediated by peroxidized 2'-deoxythymidine.

The oxidative formation of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in DNA is closely associated with the induction of degenerative diseases, including cancer. However, the oxidant species participating in the formation of 8-OHdG has yet to be fully clarified. On the basis that peroxyl radicals are a strong candidate for this species, we employed 2,2'-azobis(2-amidinopropane) (AAPH) as a peroxyl radical generator. Exposure of calf thymus DNA to AAPH formed 8-OHdG, but the exposure of 2'-deoxyguanosine (dG) alone did not. From the exposure of various combinations of nucleotides, 8-OHdG was formed only in the presence of dG and thymidine (dT). A mix of dG with an oxidation product of dT, 5-(hydroperoxymethyl)-2'-deoxyuridine, produced 8-OHdG, but the amount formed was small. In contrast, 8-OHdG was produced abundantly by the addition of dG to peroxidized dT with AAPH. Thus, the formation of 8-OHdG was mediated by the peroxidized dT. Instead of artificial AAPH, endogenous peroxyl radicals are known to be lipid peroxides, which are probably the oxidant species for 8-OHdG formation mediated by thymidine in vivo.

The common -55 C/T polymorphism in the promoter region of the uncoupling protein 3 gene reduces prevalence of obesity and elevates serum high-density lipoprotein cholesterol levels in the general Japanese population.

Uncoupling protein 3 (UCP3) is considered to be associated with obesity, given its function in the regulation of energy and lipid metabolism. An increased body mass index (BMI) and a decreased level of high-density lipoprotein cholesterol (HDL-C) are risk factors for cardiovascular disease. The purpose of this study was to investigate whether the UCP3 promoter -55 C/T single nucleotide polymorphism (UCP3 -55 C/T SNP) was associated with obesity according to the criteria for Japanese (BMI > or = 25 kg/m2), BMI, and serum HDL-C levels in the general Japanese population. The subjects, numbering 282 and aged 65 +/- 13 years (mean +/- SD), were recruited through an annual health checkup of residents of Mima city, Tokushima, in Japan. Body mass index, blood pressure, biochemical indexes including lipid, and lipoprotein profiles were measured. The UCP3 -55 C/T SNP was determined with a fluorescence-based allele-specific DNA primer assay system. The frequency of the -55 T allele was 30.0%. Subjects with the T/T genotype had significantly higher HDL-C levels than those with the C/C genotype or the C/T genotype. Furthermore, subjects with the T/T genotype had a significantly lower BMI than those with the C/C genotype. A multivariate analysis revealed that the -55 T allele was a significant independent variable contributing to the variance in HDL-C levels and BMI. The T/T genotype was associated with a lower prevalence of obesity than the C/C and C/T genotypes, with an odds ratio of 0.358 (95% confidence interval, 0.132-0.972; P = .037). In conclusion, the UCP3 -55 C/T SNP was associated with elevated HDL-C levels and a reduced BMI, independent of modifiable factors such as lifestyle. Furthermore, this polymorphism, when expressed in its homozygous form, reduced the prevalence of obesity in Japanese.

Oxidative stress, inflammation, and atherosclerotic changes in retinal arteries in the Japanese population; results from the Mima study.

Oxidative stress and inflammation are known to play roles in the pathogenesis of vascular events. The aim of this study was to investigate the relationship between oxidative stress, inflammation, and atherosclerosis in the general population. A population-based, cross-sectional study was made of 282 people (126 men and 156 women, mean age; 65 13, mean BMI; 25.4 2.7 kg/m (2) ) recruited from the Mima study in Tokushima Prefecture. Risk factors included age, sex, body mass index (BMI), cigarette smoking, systolic and diastolic pressure, fasting blood glucose, serum lipids, and high-sensitive C-reactive protein (hs-CRP). Oxidative stress in blood samples was measured by the diacron reactive oxygen metabolites (ROMs) test. The degree of sclerotic change was determined from fundus photographs according to Scheie's classification. After adjustment for age and sex, ROM levels positively correlated with hs-CRP levels, but not with ghrelin, leptin and adiponectin levels. Furthermore, ROM and hs-CRP levels positively and individually correlated with the grade of sclerotic change in the fundus oculi independent of age in a multiple regression analysis. These results suggest that oxidative stress and chronic inflammation promote atherosclerosis in the retinal arteries in the general population.

Isolation of recombinant human antithrombin isoforms by Cellufine Sulfate affinity chromatography.

Human antithrombin (hAT) is a major serine protease inhibitor that regulates blood coagulation in human plasma, and it has been applied for the treatment of antithrombin (AT) deficiency and disseminated intravascular coagulation (DIC). In the past, hAT for therapeutic use has been obtained from human plasma; however, hAT can now be sourced from transgenic animals and Chinese hamster ovary (CHO) cells by recombinant technology. The dominant form of hAT in plasma is the α form, which is glycosylated with four oligosaccharides and sialylated at its terminals. However, it would be preferable to remove the poorly sialylated α form of hAT, the minor ß form with unoccupied glycosylation sites, and the inactive forms. Cellufine Sulfate, a heparin-mimic affinity resin made of cellulose and modified with sulfate groups, has an affinity for heparin-binding proteins and can be used in cation exchange chromatography. Based on these properties, the α and ß forms of hAT could be separated and purified depending on the rate of sialylation. Consequently, Cellufine Sulfate was used to enrich the highly sialylated α form with a considerably higher step yield than that obtained using conventional heparin-immobilized resins. Furthermore, subsequent hydrophobic interaction chromatography could eliminate the inactive forms. These results suggested that Cellufine Sulfate was more effective than heparin-immobilized resins in purifying the highly sialylated α form of hAT for therapeutic applications.

The Trp64Arg polymorphism of the beta3-adrenergic receptor gene is associated with increased small dense low-density lipoprotein in a rural Japanese population: the Mima study.

The presence of small dense low-density lipoprotein (sdLDL) is closely associated with an increased risk of developing coronary artery disease. The Trp64Arg polymorphism of the beta(3)-adrenergic receptor (beta(3)-AR) gene is a genetic marker for obesity-related traits. However, any possible association between this polymorphism and sdLDL profiles is unclear. The objective of this study is to investigate the effects of the polymorphism of the beta(3)-AR gene on LDL particle size and sdLDL in a rural Japanese population. Among 277 subjects, body mass index, blood pressure, fasting serum insulin levels, and insulin resistance index (fasting glucose x fasting insulin/405) were determined. The polymorphism of the beta(3)-AR gene was assessed by polymerase chain reaction-restriction fragment length polymorphism using buccal samples. Low-density lipoprotein particle size and sdLDL were measured with the electrophoretic separation of lipoproteins on the LipoPrint System (Quantimetrix, Redondo Beach, CA). The frequency of the beta(3)-AR allele was 0.19. In Arg carriers (Trp/Arg or Arg/Arg), the mean value of LDL particle size was smaller than that of non-Arg carriers (Trp/Trp) (P < .05). The area percentage of sdLDL was higher in Arg carriers (P < .05) than in non-Arg carriers. A multiple regression analysis showed that the area percentage of sdLDL was correlated with the polymorphism of the beta(3)-AR gene (P < .05), independently of age, sex, body mass index, smoking, and insulin resistance index. The present findings suggest that the beta(3)-AR gene polymorphism plays a role in the genetic predisposition to increased sdLDL, independently of insulin resistance.

[Factors related to municipality expectations of retaining physicians in public medical facilties].

OBJECTIVES: This study was conducted to investigate the association between municipality expectations of retaining physicians in public medical facilities and their evaluation of the physicians from key aspects considered important for practicing community medicine. METHODS: A cross-sectional study using a self-reported postal questionnaire survey was conducted with all 3,152 local governments in Japan from July to September, 2000. Three thousand and fifty-nine (94%) local governments responded. Of the responders, 1,315 (42%) operated public medical facilities. These local governments evaluated their expectations of retaining physicians in medical facilities and the physicians themselves focusing on the following aspects considered important for practicing community medicine: degree of government satisfaction with the physician's involvement in public health and welfare services; primary care for emergency patients; human relationships between the physician and the population, staff of the facility or the municipal officials; public estimation of the facility; income and expenditure of the facility; understanding of the local government's system. RESULTS: The subjects were 1,092 local governments (83.0%) that responded to all of the questions. The proportion of municipalities expecting to retain physicians was 56% overall, 61% in rural areas and 44% in urban areas (P<0.001). The proportion of governments satisfied with the physicians' human relationships was higher than the other factors and the proportion satisfied about income and expenditure of facilities was the lowest. Multiple logistic regression analysis revealed that the degree of local government expectation of retaining physicians was significantly associated with the physicians' involvement in public health and welfare services (Odds ratio (OR) 1.8; 95% confidential interval (95%CI) 1.3-2.5), their human relationship with the population and public estimation of facilities (OR 1.6; 95%CI 1.1-2.2), and income and expenditure (OR 1.3; 95%CI 1.01-1.8 in all, OR 1.7; 95%CI 1.7-2.4 in rural areas). Primary care for emergency patients demonstrated a significant association in rural areas (OR 1.6; 95%CI 1.1-2.3). CONCLUSIONS: Municipal expectation of retaining physicians in public medical facilities was significantly associated with factors related to the integration of medical, public health and welfare systems, human relationship with the population, public estimation and income and expenditure of the facilities overall. In rural areas, there was a closer association with income and expenditure and a significant association with emergency care. These findings suggest that the local governments' thought related with the expectation of retaining physicians are influenced by their different needs for medical services in community healthcare.

[Community healthcare activities of physicians in public medical facilities and their evaluation by municipalities].

OBJECTIVES: In order to practice appropriate community healthcare activities, it is essential for healthcare providers to integrate medical, public health, and welfare systems into one comprehensive healthcare body. In Japan, local governments are obliged to provide their entire population with public health and welfare services And physicians who work as government employees at public medical facilities play an important role in combining the three systems. It has been reported that the level of subjective evaluation by the municipality of the degree of involvement by physicians in the region's public health activities and welfare services is associated with the standardized mortality rates for strokes in the area's population. However, little is known about which specific public health and welfare services are more important as factors contributing to the level of evaluation of physicians by the people or municipality. The present study was therefore conducted to determine associations between levels of participation by community physicians in each specific public health or welfare service and the respective levels of evaluation by their municipalities. METHODS: A cross-sectional study design using a self-reported postal questionnaire survey was conducted with all 3,152 local governments in Japan from July to September, 2000. A total of 3,059 local governments (94%) responded, and 1,315 (42%) that operated a public medical facility were analyzed. The aspects from which local governments evaluated the physicians working for their public medical facilities were: the frequency of involvement in each of 13 services related to public health and welfare; the degree of satisfaction of governments with the physicians' involvement in each of the services; and the relationship between the physicians and the municipal healthcare officials. RESULTS: The services in which the local governments responded that they 'always' appreciated the physicians involved was significantly associated with the degree of municipal satisfaction. In the multiple logistic regression analysis, the degree of municipal satisfaction was significantly associated with their perception of consistent involvement by the physicians in case conferences on homecare management, health counseling, health education, life style instruction after basic health screening (odds ratio > 2.0 respectively), and school healthcare, vaccination, school health screening, and basic health screening (0 < odds ratio < 1.5 respectively). There was no significant difference in the level of satisfaction between large and small municipalities. CONCLUSIONS: The findings showed that high levels of municipal appreciation of consistent participation by physicians in certain public health and welfare services is associated with a higher degree of local government satisfaction with the physicians. It is noteworthy that services found to be highly associated with municipal satisfaction were concerned with individual affairs or education, and with activities that do not entail any legal obligation.