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Diabetes causes complications and collateral diseases, reducing quality of life and increasing medical costs. The Japanese government has promoted measures for the prevention of diabetes aggravation. Although glycemic control is reported to prevent the development of complications, assessment of the effects on overall medical cost is insufficient. We examined the medical cost by the analysis of hemoglobin A1c (HbA1c) level.
A Japanese employee-based health insurance claims database with annual medical check-up data was analyzed. Excess medical cost was calculated as the difference between medical cost and standard medical cost (defined as the average medical cost for individuals of same age and sex). Percentage of excess medical cost was calculated by dividing excess medical cost by standard cost, and compared between individuals with or without treatment for diabetes.
Of 4,307,184 individuals with HbA1c data, four percent of them received treatment for diabetes. For treatment of 6.5 percent of HbA1c, excess medical cost increased to 124 percent. The medical cost increased by an additional 20.4 percent (95% CI: 17.1–23.8) when the HbA1c level increased one percent. Treatment for less than six percent of HbA1c caused an increase consistent with the HbA1c level. The relative risk of iron deficiency anemia, unspecified of those with less than six percent of HbA1c against those with seven to eight percent was the highest, 2.15.
An increase of medical cost for individuals with treatment for high HbA1c is likely associated with diabetic complication. The raise for individuals with lower HbA1c level may be related to anemia. Despite the younger age and healthier life of the analyzed individuals, since they were insured by employee-based health insurance who took regular medical check-ups, more expensive medical cost was observed for those having higher HbA1c level.
Self-reported outcomes are considered to be useful to understand physical and mental conditions in daily life. Sleep quality is an important factor related to healthy lifestyle and work productivity, as well as to diseases. We examined the relationship of sleep condition with lifestyle and diseases based on self-reported sleep.
A Japanese employee-based health insurance claims database with annual medical check-up data was used. Individuals were questioned about sleep quality as: “Do you get enough rest by sleeping?” during the medical check-up. The prevalence of diseases and medical check-up data were compared between those who answered “Yes” or “No”.
Among 1,310,157 individuals who answered about sleep quality, 540,564 (41.3 percent) answered “No”. The female ratio was around 38 percent for both answers, and the average age was lower for those who answered “No” (45.3) than “Yes” (47.3). Matched individuals for same examination year, sex, and age were 536,218 in each group. Individuals diagnosed with sleep disorder were 8.7 percent of those who answered “No”, representing the highest relative risk (RR=1.64), followed by other anxiety disorders (RR = 1.47), and depressive episode (RR = 1.45), with statistical significance. Other diseases diagnosed in more than 200,000 patients, and which had significantly higher RRs in patients who answered “No”, included vasomotor and allergic rhinitis (RR = 1.09), disorders of refraction and accommodation (RR =1.02), acute upper respiratory infections (RR = 1.11), gastritis and duodenitis (RR = 1.17), and acute bronchitis (RR = 1.13). The RR of other diseases of the liver (RR = 1.13), diabetes (RR = 1.12), hypertension (RR = 1.08), and disorders of lipoprotein metabolism and other lipidaemias (RR = 1.06) were also significantly higher for those who answered “No”.
Sleep quality is suggested to be associated with various chronic diseases as well as mental disorders. Therefore, self-reported outcomes should be a useful tool to understand health-condition, prevent the onset and progression of diseases, and evaluate patient-centered care.
Past studies suggest that, across nations, the average cognitive ability of a population is negatively associated with income inequality; societies with higher average cognitive ability tend to have lower levels of income inequality. However, it is not clear why. This paper proposes that social transfers from the wealthy to the poor may be a major mechanism by which some societies achieve lower income inequality than others, because more intelligent individuals may be more likely to have a preference for such transfers. Publicly available societal-level data were analysed in a series of multiple regression models. The empirical results in this study replicate the earlier finding that societies with higher cognitive ability have lower levels of income inequality, but the association is entirely mediated by social transfers. Social transfers therefore appear to be the primary mechanism by which societies with higher levels of cognitive ability achieve lower income inequality.
Animals, including arthropods, are one health threat that can be affected by disasters. This institution-based study aimed to assess trends in Hymenoptera stings following the 2011 Fukushima nuclear disaster.
We reviewed the medical records of patients with hymenopteran stings who visited Minamisoma Municipal General Hospital, located 23 km from Fukushima Daiichi Nuclear Power Plant, from March 2005 to March 2016. Patient and sting characteristics of post-disaster patients were examined, and the annual incidence of hospital visits for hymenopteran stings was compared with the pre-disaster baseline, calculating an incidence rate ratio (IRR) for each year.
We identified 152 pre-disaster patients (2005-2011) and 222 post-disaster patients (2011-2016). In the post-disaster period, 160 males (72.1%) were identified, with a median age of 59 years (range: 2-89 years). A total of 45 patients (20.3%) were decontamination workers. Post-disaster increases were found in the IRR for hymenopteran stings, peaking first in 2011 (IRR: 2.8; 95% confidence interval [CI]: 1.9-4.2) and later in 2014 (IRR: 3.2; 95% CI: 2.4-4.3) and 2015 (IRR 3.3; 95% CI: 2.5-4.4).
Long-term increases were found in the IRR of hospital visits for hymenopteran stings in an institution affected by the Fukushima nuclear disaster. Decontamination workers appear to have been particularly affected by this phenomenon. Better disaster field worker monitoring and education about potential environmental health hazards may help to identify and prevent worker exposure to insect stings and other vectors in these settings. (Disaster Med Public Health Preparedness. 2017;11:545–551)
Mr. Shinjiro Koizumi and some younger members of Japan's National Diet suggested a new policy, “Health Gold License” which would introduce financial incentives to encourage population health management, with people receiving medical checkups receiving a reduction in coinsurance from the current 30 percent to 20 percent. In this research, to evaluate the policy, we adjusted confounding factors of those insured who receive medical checkups (Medical-Checkup Group) and those who do not (Non-Medical-Checkup Group) using claims data, and estimated the effect of medical checkups on medical costs.
We analyzed Japanese employee-based claims data provided by the Japan Medical Data Center Co. Ltd. for the 3 million insured from January 2005 to December 2015. Two regression models were developed. Under model A, explanatory variables were year, age, dummy variables for various hierarchical condition categories and for medical checkups. Under model B, explanatory variables were estimated medical costs per patient per month (PMPM) in 2012 and a dummy variable for medical checkups. We also simulated the financial impact if Japan introduced Health Gold License for all insured.
The coefficients of medical checkups in model A and in model B were -JPY4,816 PMPM and -JPY8,735 PMPM, respectively. The gap of medical costs between the Medical-Checkup Group and Non-Medical-Checkup Group was JPY4,588 PMPM, without any adjustment. If all of those insured received medical checkups, the breakeven coinsurance would be 27.2 percent.
The Medical-Checkup Group is less expensive than Non-Medical-Checkup Group by at least 30%, therefore, the break-even coinsurance for them would be 0 percent. However, because most of those insured have already gone to medical check-ups every year, if the coinsurance were reduced from 30 percent to 20 percent for all insured, the finance would be largely negative. The break-even as 27.2 percent, we believe, would not incentivize the Non-Medical-Checkup Group to receive medical checkups. Therefore, the coinsurance reduction proposed under Health Gold License is not fully justified financially.
To elucidate the impacts of nuclear plant accidents on neighboring medical centers, we investigated the operations of our hospital within the first 10 days of the Great East Japan Earthquake followed by the Fukushima Daiichi nuclear power plant accident.
Data were extracted from medical records and hospital administrative records covering 11 to 20 March 2011. Factual information on the disaster was obtained from public access media.
A total of 622 outpatients and 241 inpatients were treated. Outpatients included 43 injured, 6 with cardiopulmonary arrest, and 573 with chronic diseases. Among the 241 inpatients, 5 died, 137 were discharged, and the other 99 were transferred to other hospitals. No communication methods or medical or food supplies were available for 4 days after the earthquake. Hospital directors allowed employees to leave the hospital on day 4. All 39 temporary workers were evacuated immediately, and 71 of 239 full-time employees remained. These employees handled extra tasks besides patient care and patient transfer to other hospitals. Committed effective doses indicating the magnitude of health risks due to an intake of radioactive cesium into the human body were found to be minimal according to internal radiation exposure screening carried out from July to August 2011.
After the disaster, hospitals located within the evacuation zone of a 30-km radius of the nuclear power plant were isolated. Maintenance of the health care system in such an event becomes difficult. (Disaster Med Public Health Preparedness. 2014;8:471-476)
Revision laryngeal framework surgery is usually performed for medialisation laryngoplasty failure, rather than for failure after arytenoid adduction. We describe a new method for revision arytenoid adduction surgery, performed by directly pulling the lateral cricoarytenoid muscle (‘lateral cricoarytenoid muscle pull surgery’).
We describe a case of revision laryngeal framework surgery, present a literature review and describe the advantages of lateral cricoarytenoid muscle pull surgery over the original method of arytenoid adduction using a posterior approach.
Medialisation laryngoplasty combined with arytenoid adduction was performed following unilateral vocal fold paralysis from mediastinal surgery, resulting in severe glottic insufficiency. The patient's voice improved after the initial surgery, but had deteriorated 18 months later. Revision surgery was performed using lateral cricoarytenoid muscle pull surgery, and her voice recovered normally in terms of perceptual impression. The post-operative course was uneventful for 10 months following revision surgery.
To our knowledge, this is the first case of revision arytenoid adduction performed using a lateral cricoarytenoid muscle pull approach. Lateral cricoarytenoid muscle pull surgery should therefore be considered as a new fenestration approach for arytenoid adduction.
In this paper, Schlieren photography technique has been applied for the visualization of the pressure field of a single-shot underwater pulsed discharge. A needle-to-plane electrode configuration submerged in distilled water was used. The detailed time- and space-resolved images of both streamers and pressure waves were captured. As a result, several phenomena, such as the phase change prior to the initiation of the discharge, primary and secondary streamers propagation, shock wave generation, and the bubble formation, were observed. From these observations, a scenario of multiple events from prebreakdown to post-discharge was proposed. The gas bubbles generated in discharge were used to visualize the electrohydrodynamic flow induced by the discharge.
Laminaria japonica is traditionally eaten in Japan as a beneficial food for thrombosis. The alga contains two specific ingredients, a xanthophyll fucoxanthin (FX) and a polysaccharide, F-fucoidan (FD). The aim of the present study was to investigate whether FX or FD exhibited anti-thrombotic effects. For this purpose, three types of capsules, containing 1 mg FX, 400 mg fucoidan, and both, were prepared from the alga and administered to volunteers for 5 weeks. The dose of FD or FD+FX significantly shortened lysis time (LT) of the thrombus measured by a global thrombosis test in the blood, but FX did not. Examining the mechanism, dietary FD increased H2O2 and the secretion of prostacyclin (PGI2), a potent inhibitor of platelet aggregation, in the blood, although FD was under the detection limit in the blood, determining with its monoclonal antibody. Furthermore, in mouse experiments, dietary FD was totally excreted into the faeces and was not incorporated into the blood. We then employed a co-culture system of a Caco-2 cell monolayer with fresh human blood. The addition of FD to Caco-2 cells stimulated the expression of NADPH oxidase 1 (NOX1) and dual oxidase 2 (DUOX2) mRNA and secreted H2O2 onto the blood side accompanied by a significant increase in serum PGI2 production. These effects were invalidated by the combined addition of FD with its monoclonal antibody. The results suggested that dietary FD stimulated the expression of H2O2-producing enzymes in intestinal epithelial cells and released H2O2 into the blood, which played a signalling role to increase PGI2 production and then shortened LT for thrombi.
This study aimed to investigate the function of tissue plasminogen activator in the olfactory epithelium of mice following neural injury.
Transmission electron microscopy was used to study the changes in the morphology of the olfactory epithelium 1–7 days after surgical ablation of the olfactory bulb (bulbectomy).
Prior to bulbectomy, a uniformly fine material was observed within some regions of the olfactory epithelium of mice deficient in tissue plasminogen activator. At 2–3 days after bulbectomy, there were degenerative changes in the olfactory epithelium. At 5–7 days after bulbectomy, we noted drastic differences in olfactory epithelium morphology between mice deficient in tissue plasminogen activator and wild-type mice (comparisons were made using findings from a previous study). The microvilli seemed to be normal and olfactory vesicles and receptor neuron dendrites were largely intact in the olfactory epithelium of mice deficient in tissue plasminogen activator.
The tissue plasminogen activator plasmin system may inhibit the regeneration of the olfactory epithelium in the early stages following neural injury.
It is shown that various spectroscopic methods based on measurements of X-ray spectra radiated from cluster targets can be used for estimation of the destruction degree of clusters by laser prepulses. These methods allow insight to be gained regarding the important issue of preservation of the dense cluster core at the moment of the arrival of the main laser pulse. In addition, they can be used for quantitative estimation of the size of the undestroyed parts of the clusters and also for measuring the temperature and density of the preplasmas produced by the laser prepulses.
This book contains papers arising from a symposium held during a combined meeting of The International Union of Anthropological and Ethnological Sciences (IUAES), The Australian Anthropological Society (AAS) and The Association of Social Anthropologists of Aotearoa New Zealand at the University of Western Australia from July 5-8th, 2011. It follows on from a recently published Special Issue Supplement of Archives of Oral Biology, Volume 54, December 2009 that contains papers from an International Workshop on Oral Growth and Development held in Liverpool in 2007 and edited by Professor Alan Brook. Together, these two publications provide a comprehensive overview of state-of-the-art approaches to study dental development and variation, and open up opportunities for future collaborative research initiatives, a key aim of the International Collaborating Network in Oro-facial Genetics and Development that was founded in Liverpool in 2007.
The aim of the symposium held at The University of Western Australia in 2011 was to emphasise some of the powerful new strategies offered by the science of dental anthropology to elucidate the historical lineage of human groups and also to reconstruct environmental factors that have acted on the teeth by analysing dental morphological features. In recent years, migration, as well as increases and decreases in the size of different human populations, have been evident as a result of globalisation. Dental features are also changing associated with changes in nutritional status, different economic or social circumstances, and intermarriage between peoples. Dental anthropological studies have explored these changes with the use of advanced techniques and refined methodologies. New paradigms are also evolving in the field of dental anthropology.
A study of non-metric dental traits in people in the Papua New Guinea (PNG) Highlands was carried out and the results were compared with other Asian and Pacific peoples. Dental impressions were obtained of young adults from Kasi village, Wabag, Enga Province, PNG. Frequencies of 13 dental traits were recorded using the Arizona State University Dental Anthropology System. Conspicuous characteristics in PNG Highlanders included: low frequencies of shoveling and double-shoveling of maxillary incisors, 6th cusp in mandibular first molar and Carabelli's trait, but in contrast high frequencies of hypocone reduction in maxillary second molars, 5th cusp in maxillary first molars and 4-cusped mandibular second molars. A principal coordinate plot including 39 Asian and Pacific populations for scores of these 13 traits, based on Smith's MMDs and standard deviations, showed that the PNG Highlanders belonged to the Sunda-Pacific group, but occupied an extreme position on the first axis. Many of dental characteristics of Wabag were related to morphological reduction of the molar dental crowns, especially their distal components. This suggests that their dental morphologies have changed from the original Australian type of dental characteristics to a peculiar type of morphology associated with nutritional conditions and complex genetic factors.
Recent discoveries of archaeological site in highland Papua New Guinea (PNG) demonstrate that this area was colonized by humans almost 49,000 years ago (Gasden, 2010; Summerhays, 2010).
In recent years, migration, as well as increases and decreases in the size of different human populations, have been evident as a result of globalisation. Dental features are also changing associated with changes in nutritional status, different economic or social circumstances, and intermarriage between peoples. Dental anthropological studies have explored these changes with the use of advanced techniques and refined methodologies. New paradigms are also evolving in the field of dental anthropology.