Kazuo Inoue

Associations of brachial-ankle pulse wave velocity and carotid atherosclerotic lesions with silent cerebral lesions.

Silent cerebral lesions are increasingly found in mass screenings using MRI and magnetic resonance angiography (MRA). The purpose of this paper is to assess the usefulness of two non-invasive clinical tests—carotid ultrasound examination and brachial-ankle pulse wave velocity (baPWV) measurement—for predicting silent cerebral infarction (SCI) and silent intracranial arterial stenosis. Data were collected on 480 asymptomatic adult subjects who participated in a brain screening program at a single hospital between April 2003 and March 2006. All participants underwent baPWV measurement, B-mode ultrasonography of carotid arteries, MRI, and MRA. Data on 476 (99.1%) subjects were included in the analysis. Among these, 273 (57.4%) were male and the mean age was 51.5 years; 161 (33.8%) had carotid plaque; 33 (6.9%) had increased intima-media thickness (IMT); 99 (20.8%) had SCI; and 7 (1.5%) had intracranial arterial stenosis. The multivariate analysis showed that age (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.08–1.17), carotid plaque (OR: 2.69; 1.59–4.56), increased IMT (OR: 2.40; 1.02–5.65), and a history of hypertension treatment (OR 2.22; 1.11–4.43) were significantly associated with SCI. Also, increased IMT (OR 9.70: 1.48–63.71) was related to intracranial arterial stenosis. Brachial-ankle PWV was related to SCI (p<0.01) and intracranial stenosis (p=0.01) in univariate analysis but not in multivariate analysis. The presence of carotid plaque and that of increased IMT on ultrasound examination are useful for assessing the risk of SIC. Increased IMT is also predictive of intracranial arterial stenosis.

A Contract-Based Training System for Rural Physicians: Follow-Up of Jichi Medical University Graduates (1978-2006).

CONTEXT The number of studies on long-term effects of rural medical education programs is limited. Personal factors that are associated with long-term retention of physicians in rural areas are scarcely known. PURPOSE The authors studied the outcomes of Jichi Medical University (JMU), whose mission is to produce rural doctors, and analyzed the characteristics of its graduates who engaged in rural practice even after their 9-year obligation of rural practice. METHOD A retrospective cohort study was conducted including 2,988 JMU students who graduated between 1978 and 2006. Baseline data were collected at matriculation and graduation. Workplace addresses were surveyed in 2000, 2004, and 2006. Follow-up rates were 98.7%, 98.2%, and 98.0% respectively. FINDINGS After their obligation period, JMU graduates were 4 times more likely than non-JMU graduates to work in rural areas. The higher proportion of JMU graduates in rural areas did not change significantly between 1994 and 2004. The rural recruitment rate of post-obligation JMU graduates was somewhat lower than rates reported for top rural medical education programs in the United States. In multivariate analyses, rural upbringing and primary care specialty were positively associated with having a rural address in at least one post-obligation study year (OR 1.89 [95% CI 1.27-2.81]; and 7.63 [4.37-13.34], respectively) and settlement (ie, having a rural address over multiple years) after the contract (1.90 [1.04-3.48]; and 32.07 [4.43-232.24], respectively). Graduation from a private high school had a negative association with recruitment (0.56 [0.33-0.96]). CONCLUSIONS JMU was successful in increasing the number and retention of rural physicians. Rural origin and primary care specialty have a positive impact on both recruitment and retention after the rural obligation.

Characteristics of medical students with rural origin: Implications for selective admission policies

OBJECTIVES Selective admission policies of medical schools favoring students of rural origin have been implemented in many countries in hope of increasing rural physicians. This study evaluated the characteristics of medical students from rural origins and their choice of future practice location. METHODS Personal, familial, and academic information of 1929 graduates of Jichi Medical University (JMU), a Japanese medical school with a special mission to produce rural doctors, was collected on admission and graduation between 1972 and 1997, and follow-up information on workplace addresses were collected in 2000, 2004, and 2006. Jichi Medical University has a unique contract system under which all the graduates have the obligation to work in rural areas in exchange for having their tuition fee during their 6 years of undergraduate medical education waived. RESULTS Subjects with rural origin were more likely to have parents with lower academic background, improve their academic standing throughout undergraduate medical education, and engage in rural practice than those from urban origins. Positive linear relationships between places of upbringing and workplaces were recognized in various geographic/demographic indicators. CONCLUSIONS The selective admission policy seems to be a reasonable way of increasing the number of rural physicians without placing an undue burden on medical schools.

Degree of agreement between weight perception and body mass index of Japanese workers: MY Health Up Study.

Degree of Agreement between Weight Perception and Body Mass Index of Japanese Workers: MY Health Up Study: Mariko Inoue, et al. Department of Public Health, Graduate School of Medicine, University of Tokyo—The objective of this study was to assess the degree of agreement between body mass index (BMI) and weight perception of Japanese office workers between the ages of 20 and 65. We sent 43,064 self‐administered health‐related questionnaires to all employees of a financial firm in Japan in October 2004. The questionnaire asked the respondents for their height, weight, and their weight perception. The kappa coefficient was calculated to investigate the degree of agreement between the BMI calculated using the self‐reported data and weight perception for three categories. Of the questionnaires, 34,921 (81.1%) were returned and 33,514 responses (77.8%) were used for the analysis. Based on Japanese obesity criteria, 2,202 men (31.2%) and 5,145 women (19.5%) were obese; and 179 men (2.5%) and 2,769 women (10.5%) were underweight. The kappa coefficient was 0.374 for men and 0.297 for women. The kappa coefficients for different age groups—twenties, thirties, forties, fifties, and sixties (up to 65)—were respectively as follows: 0.315, 0.355, 0.374, 0.406, and 0.425 for men; and 0.194, 0.275, 0.285, 0.334, and 0.355 for women. In conclusion, the degree of agreement between BMI and weight perception differed by age and sex. The degree of agreement was smaller among women than among men and the degree of agreement among younger women was weaker than among older women.

Association of periodontitis with increased white blood cell count and blood pressure.

This study aimed to examine the association of periodontitis with white blood cell (WBC) count and blood pressure (BP). In 2002, 424 subjects (manufacturing workers) were investigated for periodontitis by a general dentist. All were Japanese. Among them, 364 subjects (269 men and 95 women) who also attended the next years (2003) screening were enrolled for this study. Of the 364 subjects, 55 (15.1%) had periodontitis. We also measured the BP and WBC count in periodontitis and non‐periodontitis subjects at baseline and 1‐year later follow‐up. The WBC count was higher in subjects with periodontitis than in subjects without periodontitis, both at baseline [mean±standard error (SE) 6.6×103±0.2×103/ml vs 5.8±0.3×103/ml; p<0.001] and follow‐up (7.0±0.3×103/ml vs 6.5±0.1×103/ml; p = 0.03). The systolic BP was higher in subjects with periodontitis than in subjects without periodontitis, both at the baseline (128.8±2.1 mmHg vs 120.8±0.8 mmHg; p<0.001) and follow‐up (129.2±2.3 mmHg vs 123.0±0.8 mmHg; p = 0.011), and so was the diastolic BP both at baseline (76.1±1.5 mmHg vs 71.2±0.6 mmHg; p = 0.003) and follow‐up (80.5±1.7 mmHg vs 75.4±0.7 mmHg; p = 0.004). Periodontitis is associated with increased BP and WBC count. This finding may provide one underlying pathway linking periodontitis and cardiovascular disease.

Gender difference in physician workforce participation in Japan.

OBJECTIVE To investigate changes in Japanese physician workforce participation over time, with a focus on gender differences in career patterns. METHODS Subjects were Japanese physicians who had participated in the biennial national physician survey at least once between 1980 and 2002. Two cohorts of physicians were traced: those who were between 25 and 64 years old and were already on the physician registry as of 1980 (Cohort 1980), and those on the registry as of 1990 (Cohort 1990). Workforce participation rates, as measured by the proportion of physicians working in the field of health care, were calculated for every other year until 2002. Then, 10-year averages for workforce participation rates were calculated and compared by cohort and gender. RESULTS In both cohorts, the workforce participation rates of female physicians revealed a marked decline in their late 20s and 30s; in contrast, those of male physicians remained at a high level until the age of 65. The average workforce participation rate of female physicians was significantly lower than that of male physicians, both in Cohort 1980 and Cohort 1990, and both male and female physicians in Cohort 1990 had a significantly lower average than physicians in Cohort 1980. CONCLUSIONS Effective measures should be taken to help physicians continue to work, and especially, to alleviate the decline in workforce participation among young female physicians.

Body mass index as a predictor of mortality in community-dwelling seniors

Background and aims: The relationship between body mass index (BMI) and mortality remains inconclusive in seniors. This study aimed at assessing this relationship in a community-dwelling elderly population in Japan. Methods: The subjects were 371 Japanese elders, 65 years old and older, who lived in a geographically well-defined rural community and had participated in a general health screening program in 1995. Both height and weight of subjects were measured directly by medical staff. Subjects were classified into three groups according to their BMI values: low, <18.5; normal, 18.5–25.0; and high, >25.0. Univariate analysis was applied to explore potential associations between mortality and possible confounders. Multivariate Cox proportional hazards models were used to analyze the association between mortality and BMI, after adjusting for other risk factors. Results: At baseline, 54 subjects (14.6%) had BMI values in the low range, 280 (75.5%) in the normal range, and 37 (10.0%) in the high range. All 371 subjects were followed prospectively for mortality. Over the next five years, 37 subjects had died. In univariate analysis, male sex, age, BMI and serum creatinine were associated with mortality. The mortality rate in the low BMI group was about twice that in the normal BMI group. No deaths were observed in the higher BMI group. In multivariate analysis, age and low BMI were associated with mortality. Conclusions: BMI may be a useful predictor of mortality among seniors living in the general, non-institutionalized population.

Elevated liver enzymes in women with a family history of diabetes

Both elevated liver enzymes and a family history of diabetes mellitus (FHDM) are independent risk factors for type 2 diabetes. This study evaluates the epidemiological association between elevated liver enzymes and FHDM. Subjects included 3512 women workers without diabetes, hepatitis, a smoking habit, or a history of alcohol intake. Blood samples and personal data were collected from all subjects. Subjects with FHDM had a higher mean body mass index (BMI: 23.9kg/m(2) vs. 23.4kg/m(2); p=0.003). Laboratory testing also revealed higher mean fasting plasma glucose (FPG: 5.67mmol/L vs. 5.22mmol/L; p<0.001), asparate aminotransferase (AST: 20.0IU/L vs. 19.2IU/L; p=0.049), alanine aminotransferase (ALT: 18.4IU/L vs. 16.7IU/L; p=0.004), gamma-glutamyltranspeptidase (GGT: 24.1IU/L vs. 20.5IU/L; p<0.001), and triglycerides (TG: 1.09mmol/L vs. 1.00mmol/L; p=0.011) for FHDM subjects, when adjusted for age and BMI. Multiple linear regression analysis revealed that FHDM, age, BMI, FPG, and TG were correlated with GGT (p=0.004 for FHDM; p<0.001 for age, BMI, FPG, and TG). Elevated liver enzymes were associated with FHDM. In particular, elevated GGT was related to FHDM, independent of the other variables. Elevated liver enzymes, probably due to fat deposition in the liver, may play a role in increasing the risk of diabetes in individuals with FHDM.

Association of periodontitis with blood pressure: Response

We respectfully respond to Professor Bautista’s comments as follows: (a) Antihypertensive treatment clearly has an influence on blood pressure; however, it does not seem to influence periodontitis, at least to the same extent. Moreover, although such treatment should be taken into account, we aimed to examine the association between periodontitis and blood pressure (BP) in the status quo. Nonetheless, we did re-analyze our subject data taking his comments into consideration. At baseline, the systolic and diastolic BP were both significantly higher in subjects receiving antihypertensive treatment than in subjects who were not. We also redid our analysis (ANCOVA, as shown in our Table III; (1)) excluding subjects receiving antihypertensive treatment to see if treatment, itself, had a significant effect. While a similar trend to Table III was obtained, differences both in systolic BP and diastolic BP between subjects with and without periodontitis were slightly decreased throughout the unadjusted, adjusted 1 and adjusted 2 analyses. Consequently, the observed result appears to be contrary to Bautista’s conjectures. (b) We do not feel that our study design should be classified as longitudinal, since measurements were performed only twice, at baseline and at 1year follow-up. (c) Periodontitis is a chronic inflammatory process that may last for years. It is, however, unknown whether BP gradually increases with persistent periodontitis. If it does, the presence of periodontitis likely would slowly affect BP, and increases over a short observation period should be minimal. To examine this hypothesis, a longer observation period than we undertook would be required. Moreover, subjects with periodontitis at baseline generally are counseled to treat this disease early, though this precise information sometimes is unavailable. Such treatment of periodontitis might dilute the association between BP and periodontitis at follow-up. Nevertheless, we found a positive association at follow-up as well as at baseline. This would support the persistent association between periodontitis and BP. We agree with Bautista’s comment that a longer period of observation is warranted and necessary to confirm the long-term association between BP and periodontitis. We wish to thank him sincerely for his thoughtful and practical comments.