Gender-specific factors associated with the Japanese version of the trail making test among Japanese workers.

[Purpose] The Trail Making Test is a valuable tool for predicting the transition from mild cognitive impairment to dementia. This cross-sectional study aimed to investigate gender-specific factors associated with the Trail Making Test using body composition and motor function among Japanese workers. [Participants and Methods] Demographic data, body composition, motor function, and cognitive and attentional functions (Trail Making Test, Part B) were analyzed among 627 workers who underwent health assessments during the 2019 fiscal year. After conducting univariate analysis, multiple regression analysis was performed. [Results] The presence of metabolic syndrome risk factors was found to significantly prolonged the performance time of the Trail Making Test-B in male workers. In addition, low fat-free mass and the 30-second chair stand test also significantly prolonged the performance time of the Trail Making Test-B in male workers. Among female workers, the presence of metabolic syndrome risk factors affected the performance time of the Trail Making Test-B. Therefore, MetS risk factors affect the performance times of the Trail Making Test-B in both male and female workers. [Conclusion] As male and female workers exhibit different body composition and motor function items in the Trail Making Test-B, gender differences should be considered when formulating measures to prevent cognitive and attentional decline.

Age-Specific Determinants of Brachial-Ankle Pulse Wave Velocity among Male Japanese Workers.

Prevention of cardiovascular disease (CVD) is a public health challenge. Arterial stiffness is an index that indicates the risk of developing CVD. The lifestyle habits of working generations vary greatly with age; however, no study has examined the age-specific determinants of brachial-ankle pulse wave velocity (baPWV), an index of arterial stiffness. In this cross-sectional study, we aimed to identify the age-specific determinants of baPWV. From 2014 to 2017 fiscal years, health measurements were conducted at seven companies. Overall, 1,403 men, aged between 25 and 64 years, were categorized according to age. Their lifestyle habits, body composition, and hemodynamics were recorded. Multiple regression analyses using the stepwise method revealed that higher baPWV was associated with increasing age. baPWV was also increased with increasing systolic and diastolic blood pressure and heart rate across all age groups. The increased baPWV was significantly associated with the presence of metabolic syndrome component factors in the age group of 45-54 years, high smoking index in the age groups of 25-44 years and 55-64 years, low body mass index in the 55-64 age group, and low skeletal muscle index in the 35-54 age group. Total physical activity was inversely associated with baPWV in the two age groups of 45-54 and 55-64 years. In conclusion, hemodynamics significantly affected baPWV across all ages, while smoking index, total physical activity, body mass index, and skeletal muscle index affected baPWV depending on the age group. Thus, age-related strategies should be established for alleviating baPWV increase.

Differences in determinants affecting longitudinal change of brachial-ankle pulse wave velocity due to differences in baseline among Japanese male workers.

[Purpose] No study has examined whether the determinants of longitudinal changes in brachial-ankle pulse wave velocity differ depending on the baseline brachial-ankle pulse wave velocity values. Therefore, this study aimed to extract these determinants in high- and low-value groups based on the FY2014 brachial-ankle pulse wave velocity values. [Participants and Methods] Participants were 97 male workers who underwent continuous health assessments from FY2014 to four years later. Their demographic, lifestyle, body-composition, and hemodynamic data were recorded. First-year data were subtracted from data obtained four years later for each continuous variable item, and the difference divided by the number of years was considered as the annual change. Based on the first-year median brachial-ankle pulse wave velocity, participants were classified into high- and low-brachial-ankle pulse wave velocity groups, i.e., high- and low-value groups, respectively. Multiple regression analysis was performed with the annual change in brachial-ankle pulse wave velocity serving as the dependent variable for both groups. [Results] In comparison with the values obtained in the first year, brachial-ankle pulse wave velocity obtained four years later increased significantly in the low-value group and tended to increase in the high-value group. Increased visceral fat area in the high-value group and increased diastolic blood pressure and heart rate in the low-value group were associated with worsening brachial-ankle pulse wave velocity. [Conclusion] The determinants of longitudinal changes in the brachial-ankle pulse wave velocity differed depending on the baseline brachial-ankle pulse wave velocity values.

Relation between respiratory function and arterial stiffness assessed using brachial-ankle pulse wave velocity in healthy workers.

[Purpose] Current studies report that patients with chronic obstructive pulmonary disease (COPD) may also have arteriosclerosis. This study aimed to investigate the relationship between respiratory function and arterial stiffness in healthy workers using the brachial-ankle pulse wave velocity (baPWV). [Subjects and Methods] This study included 104 male Japanese workers without COPD. We collected participant information and measured hemodynamics, body composition, and respiratory function. [Results] In the correlation analysis, baPWV showed a significant positive correlation with age, smoking index, systolic blood pressure, diastolic blood pressure, and heart rate, and a significant negative correlation with height, fat free mass, lower limb muscle mass, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1). In multiple regression analysis using factors other than baPWV and respiratory function as adjustment variables, both FVC and FEV1 showed a significant negative relationship with baPWV (p=0.009 and p=0.027, respectively). FEV1/FVC was not significantly related to baPWV (p=0.704). [Conclusion] The results of this study indicated that FEV1/FVC and the proportion of FEV1 predicted, which are indicators of airflow limitation, are not predictors of baPWV in workers without airflow limitation. However, since baPWV showed a significant negative relationship with FVC and FEV 1, the reduction in respiratory function that does not cause airflow limitation, such as FVC or FEV1 decline, may be related to an increase in the risk of arterial stiffness.

The association between the body composition and lifestyle affecting pulmonary function in Japanese workers.

[Purpose] The purpose of this study was to identify factors related to physical characteristics and lifestyle that affect pulmonary function. [Subjects and Methods] Ninety seven healthy male workers were recruited for this study, and basic information and details about lifestyle were collected. Body composition analyzer and visceral fat measuring device were conducted as measurements. Pulmonary function was measured using spirometer. A multiple stepwise linear regression analysis was performed with pulmonary function as the dependent variable. Variables with a significant association with pulmonary function on univariate analysis were imputed as independent variables. [Results] Height, fat free mass, upper extremity muscle mass, lower extremity muscle mass, and trunk muscle mass had significant positive correlations with FEV1 and FVC. Age, percentage of body fat, and visceral fat area were negatively correlated with FEV1 and FVC. Regarding the association between pulmonary function and lifestyle, a significant difference was found between the smoking index and the presence or absence of metabolic syndrome risk factors and both FEV1 and FVC. The multiple stepwise linear regression analysis with FEV1 as the dependent variable, adjusted for age and height, revealed that visceral fat area and fat free mass were significantly associated with FEV1. A similar analysis, FVC as the dependent variable identified visceral fat area. [Conclusion] FEV1 was independently associated with visceral fat area and fat free mass. FVC was independently associated with visceral fat area. These results may be valuable in preventing the decrease in respiratory function and, hence, in further preventing the onset of COPD.

Functional and occupational characteristics predictive of a return to work within 18 months after stroke in Japan: implications for rehabilitation.

OBJECTIVE: This study examined clinical, functional, and occupational factors associated with return to work within 18 months after stroke, specifically focusing on the impact of higher cortical dysfunction on return to work in the chronic phase. METHODS: This prospective cohort study in 21 hospitals specializing in clinical and occupational health recruited consecutive working-age inpatients receiving acute care for their first stroke (n = 351). A unified database was used to extract patient information from hospital records at the time of admission, discharge, and follow-up at 18 months post-stroke. Cox proportional hazard regression analysis was conducted to determine clinical, functional, and occupational factors influencing return to work within 18 months. RESULTS: Of 351 registered stroke patients (280 males, 71 females, mean age ± SD, 55.3 ± 7.2 years) who met inclusion criteria, 250 responded to the follow-up survey and 101 were lost to follow-up. Half (51%) succeeded in returning to work during the 18-month follow-up after stroke onset. After adjusting for age, gender, and Barthel index at initial rehabilitation, the following factors were identified as significant predictors of a return to work: white-collar versus blue-collar occupation (hazard ratio (HR) 1.5; 95% confidence interval (CI) 1.1-2.2), no aphasia (HR 3.0; 95% CI 1.5-5.9), no attention dysfunction (HR 2.0; 95% CI 1.0-4.0), and walking ability (HR 3.1; 95% CI 1.3-7.1). CONCLUSIONS: This study indicated the importance of tailored rehabilitation to alleviate the impact of higher cortical dysfunction and to support return to work by stroke survivors.

Functional and occupational characteristics associated with very early return to work after stroke in Japan.

OBJECTIVES: To examine clinical, functional, and occupational factors associated with very early return to work after stroke, and to identify factors manageable through occupational arrangements, patient education, and other welfare programs. DESIGN: Prospective cohort study. SETTING: Acute care of the first stroke event in 21 acute care hospitals specializing in clinical and occupational health. PARTICIPANTS: Consecutive patients with stroke in working age (N=335). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data pertaining to demographic, clinical, functional, and occupational factors were collected from hospital records. Multiple logistic regression analysis with backward stepwise selection was used to obtain a final model to predict the likelihood of patients returning very early to work. RESULTS: The sample was predominantly men (80%) with a mean age ± SD of 55.2±7.2 years; 30% succeeded in very early return to work. After adjusting for age, sex, and modified Rankin scale at discharge, white-collar versus blue-collar occupation (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.00-4.21), Barthel Index at onset (OR, 1.02; 95% CI, 1.01-1.03), and employment status at discharge (OR, 17.36; 95% CI, 3.15-95.72) were selected in the final model as significant predictors of very early return to work. Patients with mild physical disability and higher cortical dysfunction found it more difficult to return to work very early compared with those without these conditions. CONCLUSIONS: We found that patients with stroke who had mild disability at onset, were in a white collar occupation, and were employed at discharge were more likely to return to work very early, even after adjusting for functional levels at discharge. Cognitive rehabilitation is needed for those with mild physical disability and higher cortical dysfunction.

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.

Determinants of early return to work after first stroke in Japan.

OBJECTIVE: To examine the time to return to work after first stroke and identify determinants of early return to work in Japan. DESIGN: A multicentre, prospective cohort study on the association between characteristics at admission and early return to work after first stroke. SUBJECTS: Among 464 patients after first stroke, 325 were registered in this study. All participants were younger than 65 years and engaged in paid work at the time of the stroke. METHODS: Data collected prospectively for 18 months were analysed using the Kaplan-Meier method for time trends, and then a multiple logistic regression model for odds ratio of early to late return to work was conducted. RESULTS: Of the 325 registered patients (mean age 55.1, standard deviation (SD) 7.4 years), 253 (78%) were available for follow-up, and 138 (55%) returned to work. The curve of proportion of return to work was non-linear. Significant determinants of early return to work were gender, function of hemiplegic hand, and ability to perform activities of daily living independently. CONCLUSION: The curve of time to return to work was influenced by the follow-up days. Patients after stroke who were male and/or had milder physical disabilities tended to return to work earlier.

Association of pain with employment status and satisfaction among amputees in Japan.

OBJECTIVE: To assess the relationship between residual and phantom limb pain and working life among persons with limb amputation. DESIGN: Cross-sectional study in which amputee patients completed a mailed questionnaire about their residual limb and phantom limb pain, employment status, and satisfaction with working life. SETTING: Department of rehabilitation medicine of a major hospital in Japan. PARTICIPANTS: All participants were registered at the industrial rehabilitation center of a general hospital in Japan. Responses were received from 101 of the 147 patients (response rate, 68.7%) who were sent the questionnaire. INTERVENTION: An amputation pain and employment status survey that included a standardized pain measure. MAIN OUTCOME MEASURES: A self-report questionnaire, with 1 part concerning employment status and satisfaction with working life, and the other regarding amputation-related pain, which the participant described according to the Chronic Pain Grade (CPG). RESULTS: We found (1) no statistically significant association between types of pain and the return to work rate, (2) no statistically significant association between the pain severity as graded by the CPG and return to work rate, and (3) satisfaction with working life was significantly related to the CPG categories. CONCLUSION: The severity of pain does not appear to be associated with return to work among limb amputees. However, it is associated with satisfaction with working life. Appropriate treatment of pain may therefore improve work-related satisfaction.