Isao Ohsawa

A clinical survey on the compliance of exercise therapy for diabetic outpatients

To clarify the present state of exercise therapy for diabetes mellitus, we conducted a survey of 570 diabetic outpatients by written questionnaires. The results revealed that approximately 30% of the patients did not implement the prescribed exercise regimen. The principal reasons for low compliance were lack of time to do and lack of mind to do. Lack of time to do was particularly numerous in male patients. Other reasons were lack of guidance by physician, lack of interest, lack of understanding of procedure. These findings indicated that the patients should be motivated adequately when they are diagnosed as having diabetes and subsequently encouraged to reinforce their intentions by the physician and co-medical staff. Furthermore, they showed that specific approaches suitable for each individual patient and not standardized guidelines should be devised. As regards the daily environment of patients, the cooperation of the patients family would be effective and the exercise facilities and the exercise guidance personnel should be augmented.

Low level of parental bonding might be a risk factor among women with prolonged depression: A preliminary investigation

Aims:u2002 The aim of the present study was to determine whether or not the effect of parenting by the father and mother on outcomes for depression may be different between male and female subjects.

Subjective health values of individuals with diabetes in Japan: comparison of utility values with the SF-36 scores.

To investigate the characteristics of utility values for current health states and the Medical Outcome Study Short Form 36 (SF-36) scores in terms of patients preferences, we performed the utility assessment using the visual analog scale (VAS) and the standard gamble (SG) techniques, and the SF-36 questionnaires on 68 hospitalized individuals with diabetes. Sixty patients responded appropriately. The SG value, 0.93 +/- 0.12 (mean +/- S.D.), was significantly higher than the VAS value, 0.65 +/- 0.21 (P<0.001). A tendency for the SF-36 subscale scores to decrease compared to national normative data for Japan was observed. Diabetic conditions such as glycated hemoglobin level and daily insulin injection were not significant predictors of either utility or SF-36 scores, while diabetic complications affected two subscales of the SF-36. The VAS values were somewhat related to the SF-36 subscale scores but the SG values had no relation to any SF-36 scores. These results suggest the difficulty of estimating the subjective health values of the patients only through the traditional clinical indicators and the SF-36 scores.

Additive effects of estrogen deficiency and diabetes on bone mineral density in rats.

We investigated the combined effects of estrogen deficiency and diabetes on bone mineral density (BMD) and bone metabolism in rats. Ten-week-old, female rats were randomly divided into four groups: controls (C), an ovariectomized group (O), a streptozotocin-induced diabetic group (S), and a combined ovariectomy and streptozotocin-induced diabetic group (OS). The BMD of the lumbar spine and the femur were measured before grouping and at 23 weeks old. At the end of the experiment, blood samples were obtained via cardiac puncture, and bone gla protein (BGP), tartrate-resistant acid phosphatase (TRAP) and 1,25-dihydroxyvitamin D levels were measured. The rats in the C, O, S, and OS groups, in that order, had higher levels of BMD of the lumbar spine and femur at 23 weeks of age. The BGP levels in the S and OS groups were significantly lower than in C and O groups. Significantly higher 1,25-dihydroxyvitamin D was observed in the O group compared with the C, S and OS groups. No differences were obtained in TRAP among four groups. Our data suggest that the combined effects of estrogen deficiency and diabetes on BMD are not synergistic or counteractive but additive.

Effects of glimepiride on in vivo insulin action in normal and diabetic rats

To evaluate the effects of glimepiride on insulin action in peripheral tissues, we investigated insulin-induced glucose uptake in normal and diabetic rats using the euglycemic clamp procedure (insulin infusion rates: 6 and 30 mU/kg/min). Normal rats: After oral administration of glimepiride (0.1 mg/kg/day; NG) or saline (NC) for 2 weeks, euglycemic clamp procedures were performed. During submaximal hyperinsulinemia (620 +/- 35 pmol/l, mean +/- S.E.M.), metabolic clearance rates of glucose (MCR) in NG were significantly higher than in NC (25.1 +/- 2.1 vs. 18.3 +/- 1.2 ml/kg/min, P < 0.05). During maximal hyperinsulinemia (5235 +/- 270 pmol/l), MCRs in NG were higher than in NC, but there was no statistical significance (43.3 +/- 2.8 and 38.9 +/- 2.8). Diabetic rats: streptozotocin-induced diabetic rats were divided into four groups, GI (glimepiride treatment, 0.1 mg/kg/day p.o., with insulin, 5 U/day s.c.), SI (insulin alone), SG (glimepiride alone), and SC (saline). MCRs in the four groups were similar during 6 mU/kg/min clamps. During 30 mU/kg/min clamps, MCRs in GI were significantly higher than those in SC, SG or SI (23.4 +/- 2.8 vs. 12.2 +/- 1.9 and 8.9 +/- 0.8, P < 0.01, and vs. 17.4 +/- 1.5, P < 0.05). Although MCRs in SI tended to be higher than in SC, there was no significant statistical difference between these two groups. These results suggest that glimepiride enhances insulin action in peripheral tissues, and that glimepiride treatment with insulin improves the insulin resistance observed in streptozotocin-induced diabetic rats.

Analysis of risk factors for dental caries in infants: a comparison between urban and rural areas

ObjectivesThis study investigated the incidence of caries in infants and explored the risk factors related to noteworthy variations between urban and rural areas.MethodsSubjects were 232 infants (111 males and 121 females) aged 1.6 and 3xa0years born in “N” town between the fiscal years of 1997 and 2001. Infants aged 1.6 and 3xa0years had 99.6 and 100% participation in health checkups, respectively. Of the total, 148 and 84 infants were living in the urban and rural areas, respectively, of “N” town.ResultsCaries incidence and the average number of carious teeth (decayed/missing/filled teeth, dmft) for infants aged 1.6xa0years were significantly higher in the rural area than in the urban area, indicating that environmental factors that predispose infants to develop dental caries exist in the rural area. In addition, logistic regression analysis for infants in each of the two areas revealed that risk factors of the child-care environment, for example living with grandparents and brushing by parents, stood in marked contrast with each other. Moreover, the odds ratio of the risk factor dozing off while drinking showed a marked difference between the areas, although this risk factor was common in both areas.ConclusionsThe results of this study indicated that several factors of the child-care environment, for example the daytime caring person, are related with caries development. Scientific elucidation of the risk factors that give rise to high prevalence of caries in specific regions and access to the whole picture of the disease mechanism may have great potential to lead to the development of effective countermeasures and to contribute to the reduction of dental caries in preschool children.

Present situation of exercise therapy for patients with diabetes mellitus in Japan: a nationwide survey

PurposeThis study was performed to investigate the actual situation and problems of exercise therapy in Japan.MethodsA self-recording questionnaire was prepared and sent to 1,200 randomly selected diabetologists and non-specialist physicians of the Japan Medical Association. Responses were obtained from 403 physicians (34% response rate). Two subgroups of the physicians were extracted according to the rate of exercise guidance provided to patients at their initial visit to the clinic: more than 70% [high-rate of exercise guidance (HG) group, Nxa0=xa0212] and less than 50% [low-rate of exercise guidance (LG) group, Nxa0=xa0131].ResultsThe rate of exercise guidance was significantly lower (pxa0<xa00.001) than that of dietary guidance. About 65 and 53% of physicians in both groups responded that their “lack of time” and the “absence of an additional consultation fee,” respectively, were the main problems they faced for implementing exercise guidance to patients. Compared with the HG group, a higher number of physicians in the LG group responded that there were no specialized physical exercise educators in their clinics (pxa0<xa00.001). As to the reasons why patients do not perform exercise, 70% of physicians responded that patients “had no time to exercise” and “were not eager to perform exercise.”ConclusionsThe current survey revealed that, in Japan, the proportion of exercise guidance is low because physicians have no time, they receive no additional consultation fee, and specialized physical exercise educators are lacking. Although an improvement in these factors may lead to higher rates of exercise guidance, we consider that the preparation of specific exercise guidelines for type 2 diabetes patients is essential to effectively implement this therapy in clinical practice.

The factors that affect exercise therapy for patients with type 2 diabetes in Japan: a nationwide survey

PurposeThis study was performed to investigate important factors of exercise therapies for diabetes patients in Japan.MethodsSubjects were 5,100 patients with type 2 diabetes mellitus. Data from 3,685 patients (88.2xa0% effective answer rate) who answered the question whether they are performing exercise therapy or not by the questionnaire were analyzed. We used multiple logistic regression analysis to assess the factors associated with exercise therapy in diabetes patients.ResultsExercise and non-exercise therapy groups had 1,926 and 1,759 patients, respectively. The HbA1c level of the exercise therapy group was significantly lower than that in the non-exercise therapy group. The multivariate odds ratios (ORs) of possible factors affecting the exercise therapy group adjusted for age, gender, BMI and living area were as follows: frequency of exercise therapy guidance [ORxa0=xa01.89, 95xa0% confidence intervalxa0=xa01.40–2.56; reference group (ref.): no exercise therapy guidance], detailed exercise prescription such as type (1.32, 1.08–1.61), frequency (1.60, 1.24–2.06) and duration (1.63, 1.32–2.01; ref.: no exercise prescription), patients who enjoy physical exercise (4.85, 2.97–7.93; ref.: patients who dislike physical exercise) and high level of physical activity (2.31, 1.77–3.03; ref.: low level of physical activity).ConclusionThe results of the current study showed that, concerning exercise therapy education, it is important to maintain the motivation of the patients to participate in exercise therapies, to increase the frequency of guidance, and to provide more detailed exercise prescription such as frequency and duration.

Abdominal circumference should not be a required criterion for the diagnosis of metabolic syndrome.

BackgroundMetabolic syndrome (MetS) is an established concept. However, it is characterized by a number of different definitions as well as different cut-off points (COPs) for waist circumference (WC) and different modes for incorporating WC into the diagnostic criteria.MethodsAbdominal ultrasonography was performed in 2,333 subjects who also underwent comprehensive medical examinations between April and July 2006. The odds ratios for the number of MetS components were calculated by taking central obesity status into account and considering concurrent fatty liver as an independent variable. We compared the areas under the receiver operating characteristic (ROC) curves for fatty liver and MetS using several MetS criteria.ResultsRegardless of the WC criterion selected, we observed a strong linear trend for an association (trend Pxa0<xa00.0001) between MetS and the number of components. The odds ratio (OR) of subjects without central obesity but with all three MetS components was 9.69 (95% confidence interval 3.11–30.2) in men and 55.3 (6.34–483) in women. The COP for the largest area under the curve in men and women was ≥82xa0cm (OR 0.701) and ≥77xa0cm (OR 0.699), respectively, when WC was considered as a component. When WC distribution is taken into consideration, practical and appropriate COPs should be ≥85xa0cm for men and ≥80xa0cm for women.ConclusionWe suggest that a WC of ≥85xa0cm for men and ≥80xa0cm for women would be optimal COPs for the central obesity criteria in the Japanese population. In addition, central obesity should be incorporated as a component of MetS rather than an essential requirement for the diagnosis of MetS.

Cumulative fatigue symptoms among caregivers in Japan

ObjectiveTo investigate the relationship of cumulative fatigue symptoms among caregivers in Japan with work environment issues and lifestyle behaviors.MethodsThe subjects were 376 women (mean age, 54 years) attending professional seminars for caregivers held between 1999 and 2002. After obtaining informed consent, a survey was conducted to ascertain work environment issues, lifestyle behaviors and fatigue levels. Fatigue was quantitatively assessed using the Cumulative Fatigue Symptoms Index (CFSI) developed by Kosugoh et al. Factors related to caregiver fatigue were identified using Pearson’s correlation coefficient, the Mann-Whitney U-test and multiple regression analysis.ResultsCaregivers who felt an xiety or concern regarding care techniques, care content, personal relationships, work conditions, and physical fitness showed higher CFSI scores, while caregivers who exercised regularly and had proper eating behavior displayed lower CFSI scores. Anxiety/concern regarding physical fitness and proper eating behaviors were identified as significant predictors for all CFSI category scores (P<0.001). Regular exercise behavior (P<0.001), age (P<0.001), and years of work experience (P<0.001) also represented significant independent variables for some CFSI categories.ConclusionOur results suggest that upgrading the knowledge and skills of care and nursing and modifying lifestyle behaviors could reduce the level of fatigue experienced by caregivers.