Masaji Tabata

Trends in stroke incidence and acute case fatality in a japanese rural area: The oyabe study

BACKGROUND AND PURPOSE Stroke mortality in Japan has significantly declined during recent decades. To determine the cause of this decrease, we studied the trends in stroke incidence and case fatality within 28 days after stroke in a rural area in Japan. METHODS We used a population-based registry during 1977-1991 in Oyabe, a rural area in the central part of Japan. The average population aged 25 years and older numbered 32 859 persons. Changes in age-standardized stroke incidence rate were calculated and compared between the 3 periods 1977-1981, 1982-1986, and 1987-1991. The 28-day case fatality rate was evaluated and also compared between the 3 periods by onset year. RESULTS The total number of strokes was 2068. The age-standardized incidence rate of all strokes decreased during the 15-year period, from 605 to 417 per 100 000 in men and from 476 to 329 per 100 000 in women. A marked decline was found during 1977-1986 but was not apparent during 1987-1991. Moreover, there was an increase in the group aged 75 years and older. The 28-day case fatality rates for all strokes improved from 18.0% to 14.2% in men and from 26.8% to 19.1% in women during the observation period. CONCLUSIONS These data indicate that declines in the stroke incidence and the 28- day case fatality have been associated with a marked decrease in stroke-related mortality in Japan.

Organizational justice, psychological distress, and work engagement in Japanese workers

PurposeTo investigate the cross-sectional association between organizational justice (i.e., procedural justice and interactional justice) and psychological distress or work engagement, as well as the mediating roles of other job stressors (i.e., job demands and job control, or their combination, effort–reward imbalance [ERI], and worksite support).MethodsA total of 243 workers (185 males and 58 females) from a manufacturing factory in Japan were surveyed using a self-administered questionnaire including the Organizational Justice Questionnaire, Job Content Questionnaire, Effort–Reward Imbalance Questionnaire, K6 scale, Utrecht Work Engagement Scale, and other covariates. Multiple mediation analyses with the bootstrap technique were conducted.ResultsIn the bivariate analysis, procedural justice and interactional justice were significantly and negatively associated with psychological distress; they were significantly and positively associated with work engagement. In the mediation analysis, reward at work (or ERI) significantly mediated between procedural justice or interactional justice and psychological distress; worksite support significantly mediated between procedural justice or interactional justice and work engagement.ConclusionThe effects of organizational justice on psychological distress seem to be mediated by reward at work (or ERI) while those regarding work engagement may be mediated by worksite support to a large extent, at least in Japanese workers.

Urinary β2-microglobulin Concentration and Mortality in a Cadmium-polluted Area

A 9-y follow-up study of 3,178 persons who lived in a cadmium-polluted area was conducted to assess the influence of environmental cadmium exposure on long-term outcome. The standardized mortality ratios of the urinary beta 2-microglobulin-positive subjects (> 1,000 micrograms/g creatinine) of both sexes were higher than those of the general Japanese population, whereas the cumulative survival curves were lower than those of the urinary beta 2-microglobulin-negative group. A significant association was also found between urinary beta 2-microglobulin and mortality, using a Coxs proportional hazards model. Moreover, mortality rates increased in proportion to increases in the amount of urinary beta 2-microglobulin excreted. These results suggest that the prognosis for cadmium-exposed subjects with proximal tubular dysfunction is unfavorable. The mortality rate tended to become higher as the severity of renal dysfunction progressed.

High mortality and shortened life-span in patients with itai-itai disease and subjects with suspected disease

A follow-up study was conducted from 1967 to 1987 for patients diagnosed as having itai-itai disease, subjects who were suspected of having the disease, and controls. Ninety-five subjects per category were selected after matching for age, sex, and residential area. The cumulative survival rate of the patients who had a definite diagnosis of itai-itai disease was significantly lower than that of the control group in every period after the first 3 y. The cumulative survival rate of the subjects who were suspected of having itai-itai disease and who had severe renal dysfunction due to cadmium pollution was significantly lower than that of the control group. These results demonstrate (1) the enduring negative influence of itai-itai disease on prognosis and (2) that the cadmium pollution-induced renal disorder adversely affects the health of the inhabitants of a cadmium-polluted area.

Relationship between urinary cadmium and mortality among inhabitants living in a cadmium polluted area in Japan.

A 15 year follow-up study of 3119 inhabitants living in a cadmium polluted area was conducted to investigate the influence of environmental cadmium exposure on the mortality. The cumulative survival curves of the subjects with urinary cadmium concentration > or = 10 microg/g creatinine was lower than that of the subjects with < 10 microg/g creatinine in the men aged 50-59 and 60-69 years and in the women aged 60-69 and 70-79 years. In the men aged 50-69 years and the all aged women, the cumulative survival curves became lower in proportion to the increase of urinary cadmium concentration, when the subjects were divided into four groups according to the amount of urinary cadmium concentration (< 5, 5-9.9, 10.1-19.9, > or = 20 microg/g creatinine). These results suggested a dose response relationship between cadmium exposure and mortality.

Reliability and Validity of the Japanese Version of the Organizational Justice Questionnaire

Reliability and Validity of the Japanese Version of the Organizational Justice Questionnaire: Akiomi Inoue, et al. Department of Mental Health, Graduate School of Medicine, The University of Tokyo

Ten-year follow-up study on the relation between the development of non-insulin-dependent diabetes mellitus and occupation.

To investigate the relation between occupation and the development of non-insulin-dependent diabetes mellitus (NIDDM), we undertook a 10-year follow-up survey of male employees of a zipper and aluminum sash factory in Japan. Of 1,218 employees we followed 1,087 subjects. We classified the subjects into five occupations: managers, technical workers, clerical workers, workers in transport, and laborers. NIDDM incidence was 3.1% for 10 years. The age-adjusted incidence of the workers in transport was the highest and that in laborers was the lowest. We used a multiple logistic analysis for adjustment with baseline characteristics such as age, BMI, fasting plasma glucose, and family history of diabetes mellitus. Adjusted relative risk of the workers in transport compared with the laborers was significantly high (3.95). Our work suggests that occupation is related to the development of NIDDM.

Burnout and Related Factors among Hospital Nurses

Burnout and Related Factors among Hospital Nurses: Kazuyo Higashiguchi, et al. Department of Nursing, Kanazawa Medical University—The overall goal of this study is to examine the relationship between burnout in hospital nurses and three parameters: occupational factors, individual attributes, and workplace stressors. Two hundred and sixty‐eight female nurses from two public general hospitals were surveyed. Three forms were used: first, a demographic data form to ascertain personal attributes; second, the Japanese version of the Maslach Burnout Inventory (MBI) to assess burnout; and third, the Japanese version of the Job Content Questionnaire (JCQ) to assess workplace stressors. The Japanese version of MBI consists of three subscales: Physical Exhaustion (PE), Emotional Exhaustion/ Depersonalization (EE + DP), and Personal Accomplishment (PA). The results were as follows: 1. There was a significant correlation between both PE and EE+DP and years of nursing experience, as well as the age of children. 2. There was a significant correlation between PE and the work schedule or workplace. 3. There was no significant correlation between the Japanese MBI subscales and job rank, marital status, or the number of children. 4. There was a significant correlation between the three subscales of Japanese MBI and the Japanese JCQ scales. These findings are discussed.

Significance of elevated urinary human intestinal alkaline phosphatase in Japanese people exposed to environmental cadmium

Urinary human intestinal alkaline phosphatase (IAP), beta 2-microglobulin (beta 2-MG) and N-acetyl-beta-D-glucosaminidase (NAG) were analyzed in 40 Japanese environmental-cadmium (Cd)-exposed and 40 non-exposed subjects to evaluate early biological markers for Cd-induced renal damage. All urinary indicators were significantly higher in the Cd-exposed subjects than non-exposed subjects. A fourth-order function was fitted for the relationship between beta 2-MG and IAP or NAG. The beta 2-MG concentration corresponding to the inflexion point for IAP was smaller than that for NAG. This result may support the contention that the cells containing IAP are damaged earlier than those containing NAG, and that IAP is a useful marker for detecting renal tubular dysfunction in people moderately exposed to Cd. However, in the stage of severe renal damage, the combination of IAP and beta 2-MG is considered to be more useful.

Microalbuminuria and hypertension in nondiabetic Japanese men.

To investigate the relationship between microalbuminuria and hypertension in nondiabetic subjects, we selected 245 Japanese men aged 35 to 69 years on the basis of the results of a 75 g oral glucose tolerance test. Prevalence of hypertension (blood pressure levels > or =140/90 mm Hg or treatment of hypertension) in microalbuminuria-positive (0.03 to 0.3 g/d) subjects was significantly higher than that in microalbuminuria-negative (<0.03 g/day) subjects. Also, the significant increase of levels of triglycerides, serum uric acid, and area of plasma insulin were recognized in microalbuminuria-positive subjects. Urinary albumin was significantly related to both systolic and diastolic blood pressure in a manner independent of these relevant factors, including area of insulin. With regard to renal functions, creatinine clearance of microalbuminuria positive subjects was significantly increased and fractional excretion of sodium of microalbuminuria-positive subjects was significantly decreased as compared with those of microalbuminuria-negative subjects. In normotensive subjects, serum uric acid, which is known to be related to sodium handling at renal tubules of microalbuminuria-positive subjects, was significantly higher than those of microalbuminuria negative subjects as well as triglycerides and area of insulin, without the differences of the levels of blood pressure and BMI. Therefore, it is suspected that microalbuminuria is a renal facet of insulin resistance, and a predictor value of hypertension.