Multicenter study on finger systolic blood pressure test for diagnosis of vibration-induced white finger.

OBJECTIVE: A multicenter study (six Rosai hospitals around Japan) was performed to investigate the diagnostic value of changes in finger systolic blood pressure (FSBP) after segmental local cooling for vibration-induced white finger (VWF). METHODS: Subjects were 154 men without exposure to vibration and 135 men with occupational vibration exposure. They were classified into four groups: Group A, 154 unexposed control cases; Group B, 21 exposed cases without VWF; Group C, 31 cases with a history of VWF but without any signs of VWF within the last year; and Group D, 83 cases with active VWF within the last year. FSBP% measurements were taken at room temperatures of 23 +/- 1 and 21 +/- 1 degrees C, using a strain-gauge Digimatic 2000 plethysmograph (Medimatic). RESULTS: At a room temperature of 23 +/- 1 degrees C, there was a significant difference between Groups A and D, and B and D. At a room temperature of 21 +/- 1 degrees C, there was a significant difference between Groups A and C, A and D, and B and D. The values in Group D were the lowest at both room temperatures. Assuming a cut-off value of 75% at 23 +/- 1 degrees C, the sensitivity and specificity were 65.2 and 87.5%, respectively. Assuming the same cut-off value at 21 +/- 1 degrees C, the sensitivity and specificity were 73.9 and 82.5%, respectively. These values were not too high. Most of the subjects with WVF in this study were retired and had not used vibratory tools for many years. The situation of the subjects may affect the results of the FSBP test. Our data did not confirm a difference in diagnostic accuracy between room temperatures of 23 +/- 1 and 21 +/- 1 degrees C. CONCLUSIONS: Our study showed that the sensitivity and specificity of the FSBP test with a cut-off value of 75% at 23 +/- 1 degrees C, were 65.2 and 87.5%, respectively, and at 21 +/- 1 degrees C, they were 73.9 and 82.5%, respectively.

Japanese study to organize proper lifestyle modifications for metabolic syndrome (J-STOP-MetS): design and method.

Prevalence of the metabolic syndrome is now a very serious health problem in Japan and a public preventive strategy is essential to reduce morbidity. A systematic interventional strategy for the metabolic syndrome remains to be established. In order to address this issue, a multi-center study; Japanese Study to Organize Proper lifestyle modification for the metabolic syndrome (J-STOP-MetS), has been established by nine preventive medical centers among Rosai hospital groups. This study comprises a cross-sectional study (J-STOP-MetS 1) and a prospective randomized control study (J-STOP-MetS 2). J-STOP-MetS 1 examines the causes of the metabolic syndrome by means of a questionnaire in a large cohort of patients with the metabolic syndrome and control subjects matched for age and sex. J-STOP-MetS 2 examines the hypothesis that guidance on lifestyle modifications will help at risk patients to reduce abdominal fat and cardiovascular risk factors. The metabolic syndrome patients are randomly assigned either to a single visit to a guidance group or multiple visits every two months. The individualized guidance is provided by the coordination of physician, trained nurse, dietician and exercise trainer. Several parameters are measured before and six months after the first guidance session, including, body weight, waist circumference, blood pressure, several blood markers and arterial stiffness. The J-STOP-MetS is the first large-scale clinical study of the metabolic syndrome in Japan and should provide important evidence for the practical management of the metabolic syndrome.

Repeated counselling improves the antidiabetic effects of limited individualized lifestyle guidance in metabolic syndrome: J-STOP-METS final results.

The aim of this study was to examine whether additional repeated counselling further improves the health effects of limited, highly individualized lifestyle guidance in metabolic syndrome. One hundred and nine previously untreated metabolic syndrome patients received highly standardized and individualized lifestyle guidance for weight loss. A tentative goal of 5% weight reduction over the course of 2 months was set. Patients were then randomly assigned to either the multiple guidance group who received further counselling every 2 months (n = 52) or the single guidance group who received no further guidance until the final assessment 6 months later (n = 57). Baseline data between the multiple guidance and single guidance groups were similar. Body weight and waist circumference were significantly reduced, and liver function, lipid profiles and glucose metabolism were significantly improved in both groups. After adjustment for baseline data, the multiple guidance group showed considerably higher reduction in waist circumference and fasting blood sugar concentration than the single guidance group. These data suggest that additional counselling further improved the antidiabetic effects of limited individualized lifestyle guidance in metabolic syndrome.