Andropause symptoms and sickness absence in Japanese male workers: a prospective study.

OBJECTIVE: The purpose of the study was to investigate the association between andropause symptoms and sickness absence in Japanese male workers over 2 years. METHODS: A baseline survey asking about andropause symptoms, along with blood sampling for testosterone level, was conducted in June 2009. A total of 418 men (mean age = 52.4 years, SD = 8.6) participated and were followed through 2011. Hazard ratios (HRs) and 95% confidence intervals (CIs) for sickness absence were calculated using Cox proportional hazard models. RESULTS: During the follow-up period, 31 of 35 participants who took sickness absences had physical illnesses. A higher andropause symptom score was associated with an increased risk of sickness absence. Testosterone deficiency (<350 ng/dL) was not associated with sickness absence. Among the subscales of andropause symptoms, the somatic symptom score was positively associated with sickness absence, whereas testosterone deficiency combined with high sexual symptoms was not associated with sickness absence. Results were similar when limited to sickness absence because of physical illness. No significant interaction between andropause symptoms and testosterone deficiency was found. CONCLUSIONS: Non-specific andropause symptoms unrelated to testosterone deficiency were positively associated with sickness absence.

Association Between Cortisol to DHEA-s Ratio and Sickness Absence in Japanese Male Workers.

PURPOSE: This study aimed to investigate the association between serum levels of cortisol and dehydroepiandrosterone sulfate (DHEA-s) and sickness absence over 2 years in Japanese male workers. METHOD: A baseline survey including questions about health behavior, along with blood sampling for cortisol and DHEA-s, was conducted in 2009. In total, 429 men (mean ± SD age, 52.9 ± 8.6 years) from whom blood samples were collected at baseline were followed until December 31, 2011. The hazard ratios (HR) and 95% confidence intervals (CI) for sickness absence were calculated using a Cox proportional hazard model, adjusted for potential confounders. RESULTS: Among 35 workers who took sickness absences, 31 had physical illness. A high cortisol to DHEA-s ratio increased the risk of sickness absence (crude HR = 2.68, 95% CI 1.12-6.41; adjusted HR = 3.33, 95% CI 1.35-8.20). The cortisol to DHEA-s ratio was linearly associated with an increased risk of sickness absence (p for trend < .050). Single effects of cortisol and DHEA-s levels were not associated with sickness absences. This trend did not change when limited to absences resulting from physical illness. CONCLUSION: Hormonal conditions related to the hypothalamus-pituitary-adrenocortical axis and adrenal function should be considered when predicting sickness absence. The cortisol to DHEA-s ratio may be more informative than single effects of cortisol and DHEA-s levels.

Modification Effects of Changes in Job Demands on Associations Between Changes in Testosterone Levels and Andropause Symptoms: 2-Year Follow-up Study in Male Middle-Aged Japanese Workers.

PURPOSE: The purpose of this longitudinal study was to ascertain if changes in job demands modify associations between changes in testosterone levels and andropause symptoms in male Japanese workers. METHOD: A baseline survey including job demands and the Aging Males' Symptoms scale, lifestyle factors, and blood levels of testosterone was conducted in 2007. Among 192 men (mean age ± SD 52.2 ± 7.6 years) who completed all relevant questionnaires and provided blood at baseline, 104 men (50.9 ± 7.2 years) were followed up in 2009. Changes of variables in 2 years were calculated (data of follow-up minus those of baseline). RESULTS: Testosterone levels were increased significantly, whereas job demands and somatic symptoms were reduced significantly, at follow-up. Changes in testosterone levels were negatively associated with changes in total andropause symptoms, psychological symptoms, and sexual symptoms (standardized ß = -0.27, -0.24, and, -0.29, p < 0.05, respectively), after adjustment for confounders. Changes in job demands were positively associated with changes in somatic symptoms (standardized ß = 0.21, p < 0.05). Significant interactions of changes in testosterone levels and job demands were noted for changes in psychological symptoms (standardized ß = 0.26, p < 0.05). For men with a 1-SD reduction in job demands, negative associations between changes in testosterone levels and psychological symptoms were intensified, but not for men with a 1-SD increase in job demands. CONCLUSION: Andropause symptoms may be affected by changes in testosterone levels and job demands. Change in job demands may modify associations between changes in testosterone levels and andropause symptoms.

The relationship between social capital and self-rated health in a Japanese population: a multilevel analysis.

OBJECTIVE: The aim of this study was to use a multilevel analysis to examine whether cognitive and structural dimensions of regional social capital were associated with individual health outcomes after adjusting for compositional factors. METHODS: Data from the Japanese General Social Surveys project, a nationwide study with a two-stage stratified random sampling method conducted in 2000, 2001, 2002, 2005, and 2006, were aggregated and used for the multilevel analysis (n = 11,702). We examined whether both cognitive and structural aspects of social capital (social trust, neighborhood safety, and social participation) were associated with the self-rated health (SRH) of residents from 118 regions after adjustment for compositional factors. RESULTS: Social trust and existing neighborhood safety were negatively associated with poor SRH, whereas the effect of social participation was not significant. Social trust was still negatively associated with poor SRH after adjusting for individual demographic factors and socioeconomic status (p = 0.001). In contrast, neighborhood safety and social participation did not reach significance after adjusting for compositional factors. CONCLUSION: Based on the results of this study, social trust was associated with health outcomes. Further study is needed to clarify the path linking regional trust in others to individual health outcomes in the Japanese population.

The relationship between joint pain and climate conditions in Japan.

This study aimed to determine whether there was any association between the regional climate and the proportion of people with joint pain. Regional climate data between 1971 and 2000 were obtained from the Japan Meteorological Agency. The variables used in the cluster analysis included sunlight hours, amount of precipitation, number of days with precipitation, and temperature. The regional proportion of people with joint pain was obtained from the National Survey for Health in 2001. After performing a cluster analysis, one-way ANOVA and Welch's test were used to determine whether the climate characteristics of the clusters were significantly different. Within each cluster, stepwise multiple linear regression analyses were performed. We found that sunlight hours showed a direct, negative association with the proportion of people with joint pain (adjusted R2=0.532, p=0.016) in cluster 1, which was characterized as the region with the fewest total hours of sunlight, less precipitation, a modest number of rainy days, and low temperature. In the other clusters, the regional female population rate (cluster 2) and the senior population rate (cluster 3, 4) were the primary predictors. We concluded that the degree of exposure to sunlight may play a crucial role in prevention of joint pain. This finding should encourage people to set aside some time for staying outdoors in their daily lives.

Evaluation of pyrogallol-induced cytotoxicity in catalase-mutant escherichia coli and mutagenicity in Salmonella typhimurium.

We evaluated pyrogallol cytotoxicity using Escherichia coli strains that express mammalian catalase gene derived from catalase mutant mice (Cs(b)) and wild-type (Cs(a)), and pyrogallol mutagenicity by Ames test. Pyrogallol was more toxic to Cs(b) rather than to Cs(a) (p < 0.05), while catalase, superoxide dismutase and ascorbic acid decrease the toxic effect. Pyrogallol also showed mutagenic effect (mutagenic index = 3.8 for 10 micromol pyrogallol/plate) while ascorbic acid (19.4% reduction, p < 0.001) and naringin (35.1% reduction, p < 0.001) played a protective role against it. Pyrogallol cytotoxicity and mutagenicity seem to be attributable, at least in part, to reactive oxygen species formation. This study also suggests that newly established catalase mutant E. coli is probably useful in hazard identification of oxidative chemicals.

Health impact of disaster-related stress on pregnant women living in the affected area of the Noto Peninsula earthquake in Japan.

AIMS: The present study assessed the health impact of stress on women who were pregnant during, or immediately after, a major earthquake and were living in the disaster area. Inherent resistance against the stress induced by the earthquake was also assessed. METHODS: The panel study consisted of 99 women who provided responses before and after delivery (response rate, 77.9%). Psychological impact was assessed on the Edinburgh Postnatal Depression Scale (EPDS), and stress resistance was assessed on the Sense of Coherence Scale (SOC). RESULTS: In adjusted multivariate models, the significant earthquake factor that predicted postnatal depression (EPDS) was 'existing anxiety about an earthquake' (beta = 0.27, P = 0.01) and 'parity' (beta = -0.26, P = 0.02). The SOC during pregnancy significantly moderated between 'existing anxiety about an earthquake' and 'EPDS' (beta = -0.21, P = 0.02). During pregnancy the EDPS was a significant predictor of a physical abnormality during pregnancy or childbirth (odds ratio, 1.21; 95% confidence interval: 1.04-1.41). The SOC during pregnancy did not moderate between a physical abnormality and earthquake-related stress. CONCLUSIONS: Provision of an adequate support system and improvement of the SOC of young women affected by a disaster may be two ways of reducing the deleterious effects of disaster-related stress on maternal well-being.

Relationship of psychological factors with physical activity stage of change in prime-and middle-aged Japanese.

The present study aimed to investigate the status of physical activity and the differences in psychological factors associated with physical activity from the perspective of transtheoretical model stages between prime- and middle-aged Japanese. The study involved 375 prime-aged volunteers (175 men, 200 women) and 557 middle-aged volunteers (247 men, 310 women) living in Kuse, a town in Okayama Prefecture, Japan. We found that the prime-aged men at the preparation stage had significantly higher self-efficacy scores than at the contemplation stage (p<0.01). Middle-aged men had significantly higher self-efficacy scores at the contemplation stage than at the precontemplation stage (p<0.001). Middle-aged women, meanwhile, had significantly higher self-efficacy scores at the maintenance stage than at the action stage (p<0.01), and at the contemplation stage than at the precontemplation stage (p<0.001). The present findings provide valuable information about the differences in psychological factors affecting physical activity between prime-aged and middle-aged community-dwelling Japanese. This information may be useful to health professionals as they develop effective community-based intervention programs for target populations.

Oxidative stress biomarkers and lifestyles in Japanese healthy people.

The urinary concentrations of 8-isoprostane and 8-hydroxy-2'-deoxyguanosine (8-OHdG), which are biomarkers of oxidative stress, were measured in 677 Japanese people without any diseases, and their correlations with lifestyle facotrs, lifestyle-related blood biochemical parameters, and dietary intake of antioxidative vitamins were investigated. The mean urinary concentration of 8-isoprostane and 8-OHdG was 0.58 ng/mg creatinine and 8.43 ng/mg creatinine, respectively. Mean urinary 8-isoprostane was significantly different in terms of age, gender, smoking and alcohol consumption but not different in terms of body mass index (BMI) and exercise. By multiple regression analysis, urinary 8-isoprostane was significantly influenced by smoking and age. On the other hand, mean urinary 8-OHdG showed differences only by age group. Multiple regression analysis revealed that urinary 8-OHdG was significantly influenced by age, smoking, body weight, levels of high-sensitivity C-reactive protein (Hs-CRP) and low density lipoprotein-cholesterol in females, although it was significantly influenced by body weight in males. The present study shows that urinary 8-isoprostane is associated with lipid peroxidation related-lifestyles such as smoking, and urinary 8-OHdG is associated with arteriosclerosis related-factors such as Hs-CRP. Our findings suggest that 8-isoprostane and 8-OHdG appear to be prospective biomarkers for early prediction of lifestyle related-disease risk at the population level.

Development of a new assay for evaluation of l-3,4-dihydroxyphenylalanine cytotoxicity in catalase-mutant Escherichia coli.

The present study aimed to assess whether a newly constructed, catalase-deficient Escherichia coli strain that express mammalian catalase gene could be used to identify oxidative stress-generating chemicals. We tested l-3,4-dihydroxyphenylalanine (l-DOPA), a well-known agent that induces reactive oxygen species. We found that l-DOPA exposure reduced the survival of catalase-mutant E. coli in a dose-dependent manner, especially in the strains with lower catalase activities, implying the usefulness of these strains in assessment of oxidative chemicals.

The half-life of Ascaris lumbricoides prevalence in Japanese school children.

In the present study, we examined the dynamic of school-health-based parasite control and the related socio-economic influences. This is an ecological study based on data from 46 prefectures in Japan. The exponential decay of Ascaris lumbricoides prevalence was calculated by iterative least-squares method. Pearson's correlation and multiple linear regression model analysis were performed to assess the associations between the prevalence of Ascaris lumbricoides in Japanese school children and socio-economic variables such as the prefecture income per capita, the percentage of primary industry, the population density per 1 km2, the diffusion rate of population under water supply, and the percentage of upper secondary school enrollment. The results indicated that the parasite carrier rate was higher in younger students. The half-life of Ascaris lumbricoides prevalence was approximately 3 years with significant variation among prefectures. Multiple regression analyses showed that the decrease of infection in elementary and lower secondary school children had a significant positive association with primary industry and a significant negative association with prefecture income per capita. The school-health-based parasite intervention differs by prefecture and has changed over time according to the respective prefectural stage of economic development.

Effects of mask fitness and worker education on the prevention of occupational dust exposure.

To decrease the incidence of pneumoconiosis, we examined dust protective mask performance and its relation to pulmonary function as well as the effects of worker education on the proper wearing of masks. One hundred and seventy-eight workers from 15 factories subject to dust exposure participated in this study. All participants were interviewed to obtain relevant personal information and underwent both a mask leakage and a pulmonary function test. The mask leakage was expressed as a percentage, with under 10% leakage indicating that the dust protective mask worked efficiently. In addition, 23 workers from 2 factories were educated on how to wear masks properly. The average mask leakage was 24.3%, and 58% of workers wore ineffective masks. Though pulmonary function was almost normal, the percent vital capacity (%VC) tended to be lower depending on the mask leakage. Mask education, which was very easy and took only a short time, dramatically decreased average mask leakage from 32.1% to 10.5% (p0.001). Educating workers to wear masks properly might prevent the worsening of pulmonary function in response to dust exposure. Appropriate mask fitness by education could be useful in preventing the development of pneumoconiosis.

The relationship between coping with stress and employment in patients receiving maintenance hemodialysis.

The goal of this study was to assess the relationship between emotion- and task-oriented coping (EOC/TOC) with stress and employment in patients undergoing maintenance hemodialysis. Individuals aged 18 to 64 yr who had uremia and had been undergoing hemodialysis regularly for at least three months were evaluated according to sociodemographic and clinical factors. Work status was defined using the most recent International Labour Organization definitions. Patients were requested to complete the following questionnaires: the Japanese version of the Coping Inventory for Stressful Situations, the Short Form-36 Health Survey, an item on itchiness, the Self-Efficacy on Health-Related Behavior Scale, the Japanese version of the Health Locus of Control Scale, the Social Support Scale, and the Japanese version of the Hospital Anxiety and Depression Scale. A total of 317 individuals participated in this study. Among men, age, physical functioning, EOC, and depression differed significantly (p<0.05) depending on employment. Among women, marital status, household composition, EOC, depression, and anxiety differed significantly (p<0.05) depending on employment. TOC was not significantly associated with employment in either sex. Multiple logistic regression analyses, including possible confounders, indicated that when EOC increased by 10 points, the associated adjusted odds ratio of an unemployed or economically inactive status changed by 1.48 (95% confidence interval, 1.04-2.11; p=0.030) in men and by 1.88 (95% confidence interval, 1.02-3.46; p=0.042) in women. These results suggest that EOC is associated with employment in patients receiving maintenance hemodialysis.

Possible gender differences in the relationships of self-efficacy and the internal locus of control with compliance in hemodialysis patients.

In this study, the authors assessed gender differences between the relationships of self-efficacy and the internal health locus of control with compliance in hemodialysis patients. Using a self-efficacy scale for health-related behavior and the Japanese version of the Health Locus of Control Scale, the authors studied individuals who had been regularly undergoing hemodialysis for longer than 1 year. Blood urea nitrogen, serum potassium, and interdialytic weight gain were used to measure compliance. In men, self-efficacy and the internal health locus of control were negatively correlated with all compliance measures. In women, all the correlations were positive, except for that between self-efficacy and interdialytic weight gain. The authors constructed regression lines for the significant interactions. On the basis of blood urea nitrogen or serum potassium levels, the authors found that female patients who had higher self-efficacy or internal health locus of control were less compliant. The decrease of interdialytic weight gain accompanying increased self-efficacy was more significant in men than it was in women.

Confirmation of Maslow's Hypothesis of Synergy: Developing an Acceptance of Selfishness at the Workplace Scale.

This study aimed to develop a new Acceptance of Selfishness at the Workplace Scale (ASWS) and to confirm Maslow's hypothesis of synergy: if both a sense of contribution and acceptance of selfishness at the workplace are high, workers are psychologically healthy. In a cross-sectional study with employees of three Japanese companies, 656 workers answered a self-administered questionnaire on paper completely (response rate = 66.8%). Each questionnaire was submitted to us in a sealed envelope and analyzed. The ASWS indicated high internal consistency (Cronbach's alpha = 0.86). Significant (p < 0.001) positive moderate correlations between ASWS scores and job control scores support the ASWS's convergent and discriminant validity. Significant (p < 0.001) associations of ASWS scores with psychological distress and work engagement supported the ASWS's criterion validity. In short, ASWS was a psychometrically satisfactory measure. Significant (p < 0.05) interactions between a sense of contribution and acceptance of selfishness at the workplace in linear regression models showed that when those two factors are low, psychological distress becomes high. However, when a sense of contribution and acceptance of selfishness are high, work engagement also becomes high. Thus, Maslow's hypothesis of synergy was confirmed.

Associations of workplace bullying and harassment with stress reactions: a two-year follow-up study.

The purpose of this prospective study was to investigate the effect of the patterning of workplace bullying and harassment over two time points (chronic, remission, onset, and never) on psychological and physical stress reactions. The subjects were 543 workers at welfare facilities for the elderly in Japan who completed a self-administered questionnaire at Time 1 (from August to September, 2009) and at Time 2 (from September to October, 2011). Workplace bullying and harassment were assessed using the Negative Acts Questionnaire (NAQ). Stress reactions were assessed using the Brief Job Stress Questionnaire. In the multiple logistic regression analyses, onset of person-related bullying was significantly (p<0.05) positively associated with both psychological and physical stress reactions at Time 2. Chronic form of person-related bullying was significantly (p<0.05) positively associated with psychological stress reaction at Time 2. Onset of sexual harassment was significantly (p<0.05) positively, and remission of sexual harassment was significantly (p<0.05) negatively associated with physical stress reaction at Time 2. Onset and chronic form of person-related bullying and onset of sexual harassment can cause stress reactions. Remission of sexual harassment can terminate physical stress reaction.

Possible interactive effects of demographic factors and stress coping mechanisms on depression and anxiety in maintenance hemodialysis patients.

OBJECTIVE: The aim of this study was to assess the possible interactive effects of age, sex, duration of hemodialysis (HD), educational and income levels, and stress coping mechanisms on depression and anxiety in patients on maintenance HD. METHODS: Uremic patients (N=416), regularly undergoing HD for more than 1 year, who did not have apparent cerebrovascular disease or serious intellectual impairment, were investigated. The interactive effects of age, sex, duration of HD, and educational and income levels, in relation to stress coping mechanisms, on depression or anxiety were assessed by hierarchical multiple regression analyses. RESULTS: Regression lines illustrating significant (P<.05) interactions were constructed. The decrease in depression accompanying the increase in task-oriented stress coping was greater in highly educated patients than it was in the other patients. Anxiety levels decreased when patients had both high income and demonstrated a range of task-oriented stress coping mechanisms. For patients undergoing HD for long duration, or with a relatively high income, the decrease of depression and anxiety accompanying a decrease of emotion-oriented stress coping was greater, as compared with other patients. The decrease of depression accompanying an increase of avoidance-oriented stress coping was greater in patients with low income and in older patients than it was in the other patients. CONCLUSIONS: These findings may lead to the development of specific and focused interventions for depression or anxiety in maintenance HD patients.

Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis.

BACKGROUND: The pathogenesis of restless legs syndrome (RLS) is still unclear. The purpose of this study is to determine relationships of the presence of RLS in uremic patients regularly undergoing hemodialysis (HD) with demographic, clinical, and psychological factors. METHODS: In 490 uremic patients on HD therapy in Japan, RLS was diagnosed based on diagnostic criteria established by the International Restless Legs Syndrome Study Group. Data were compared between patients with and without RLS. RESULTS: There were univariately significant (P < 0.05) differences in serum phosphorus levels, anxiety levels determined using the Hospital Anxiety and Depression Scale, and degrees of emotion-oriented and avoidance-oriented coping determined using the Coping Inventory for Stressful Situations. In multivariate analyses, low hemoglobin levels, high serum phosphorus levels, high anxiety levels, and a great degree of emotion-oriented coping were independently related to the presence of RLS in uremic patients on HD therapy, with statistical significance (P < 0.05). CONCLUSION: Hyperphosphatemia, anxiety, and a great degree of emotion-oriented coping with stress were independently related to the presence of RLS in uremic patients on HD therapy. The pathogenesis of RLS seems to involve more than one mechanism, which leads to restless legs as the final common pathway. These findings may provide new clues to the pathogenesis of RLS.

Possible variances of blood urea nitrogen, serum potassium and phosphorus levels and interdialytic weight gain accounted for compliance of hemodialysis patients.

OBJECTIVES: The aim of this study was to assess the possible variances of blood urea nitrogen (BUN), serum potassium (SK) and serum phosphorus (SPO(4)) levels and interdialytic weight gain (IWG) accounted for compliance of uremic patients on hemodialysis (HD). METHODS: BUN, SK and SPO(4) levels and IWG of uremic patients (n=310) regularly undergoing three HD sessions per week for more than 1 year in Japan were assessed. Patients suffering from problems influencing dietary intake and those with malnutrition were excluded. The variances accounted for self-efficacy for health-related behavior and avoidance-oriented coping (AOC) with stress were assessed by hierarchical multiple regression analyses. RESULTS: BUN and SPO(4) levels were not significantly (P<.05) associated with self-efficacy or AOC. SK levels and IWG were significantly (P<.05) associated with self-efficacy and/or AOC. The variances of SK levels and IWG accounted for self-efficacy and/or AOC, independent of age, sex, duration of HD and facilities, were 1.6% and 5.0%, respectively. CONCLUSIONS: Although the variances of SK levels and IWG accounted for self-efficacy and/or AOC were rather small, the significance of their relationships may suggest that intervention for self-efficacy or AOC could improve compliance and reduce SK levels and IWG of uremic patients on HD.

Interactions among a stressor, self-efficacy, coping with stress, depression, and anxiety in maintenance hemodialysis patients.

The authors' purpose in this study was to assess the interactive effects of stressors, coping with stress, and self-efficacy on depression and anxiety in maintenance hemodialysis (HD) patients. Patients (n = 453) undergoing HD for more than 1 year in Japan were investigated. The regression lines illustrating significant (p < .05) interactions predict that itching HD patients with low self-efficacy will be more depressive and anxious than nonitching patients. In HD patients who report a high degree of emotion-oriented coping, itching patients will be more anxious than nonitching patients. These new findings may lead to the development of specific and focused interventions for depression or anxiety in maintenance HD patients.