Effects of the increase in co-payments from 20 to 30 percent on the compliance rate of patients with hypertension or diabetes mellitus in the Employed Health Insurance System

Objectives: How to contain medical expenditures is a universal problem. The Japanese government has increased patient co-payments to control it. The purpose of this study is to clarify whether the increase in co-payments to 30 percent prevented patients with hypertension or diabetes mellitus from receiving necessary care in the Employee Health Insurance System. Methods: The subjects were 211 patients with hypertension and 66 patients with diabetes mellitus who regularly visited physicians from October 2001 to March 2002 and were defined as a cohort that needed health care, and their medical indicators were examined between April and September 2002 (prestage) and between April and September 2003 (poststage). Results: In the hypertensive patients with no complications, the compliance rate was 89.9 percent and 88.0 percent in the prestage, and poststage, respectively, showing no significant change. In the hypertensive patients with complications, the compliance rate was 90.5 percent and 92.1 percent in the prestage and poststage, respectively, showing no significant change. In the diabetic patients with complications, the compliance rate was 77.5 percent and 79.2 percent, in the prestage and poststage, respectively, with no significant change. In the diabetic patients with no complications, however, the compliance rate was 83.7 percent and 66.7 percent, in the prestage and poststage, respectively. A significant decrease was observed among diabetic patients without complications. Conclusions: Increasing co-payments reduced necessary preventive care in diabetic patients without complications.</p

Inverse Correlation between Adiponectin and the Risk of Metabolic Syndrome in Middle-aged Japanese Male Workers

Despite a close association between adiponectin and both hypertension and type 2 diabetes, the relationship between adiponectin and metabolic syndrome has not yet been well-investigated. To examine and evaluate the association between serum adiponectin levels and metabolic syndrome based on Japanese diagnostic criteria, we analyzed adiponectin and anthropometric parameters in 869 male employees aged 40-59 who belonged to a health insurance society in Fukuoka Prefecture and who underwent annual health check-ups from August 2006 to July 2007. Two hundred and thirty-two of the 869 subjects (26.7%) were diagnosed with metabolic syndrome. The serum adiponectin levels were significantly higher in the non-metabolic syndrome group. In a multiple logistic regression analysis, the subjects in the top quartile of serum adiponectin (adjusted odds ratio:0.36;95% confidence interval:0.21-0.63) and the second (adjusted odds ratio:0.51;95% confidence interval:0.31-0.84) quartile had a significantly decreased risk for metabolic syndrome in comparison to the bottom quartile. The dose-response relationship between serum adiponectin levels and metabolic syndrome was significant (p for trend 0.0001) after adjusting for age, body mass index, smoking status, and drinking status. The current findings suggest that hypoadiponectinemia is inversely correlated with the risk of metabolic syndrome in middle-aged Japanese male workers.</p

Helicobacter pylori infection: relationship between seroprevalence and dietary preference in a rural area.

In order to evaluate the relationship between Helicobacter pylori (H. pylori) infection and dietary preference, a cross-sectional study was performed among 626 residents in a rural area of Japan. Seropositive rates were 88.7% in males and 71.4% in females, and these increased with age for both sexes [male P &#60; 0.05 and female P &#60; 0.01]. The relationship between H. pylori-seropositivities and salted-food intake, after adjustment for age, demonstrated a significant result in the &#34;almost every day&#34; group in males with an odds ratio (OR) of 8.39 and with 95% confidence intervals (CI) of 1.02-69.30. As regards an association between seropositivities of H. pylori and levels of serum pepsinogens for the screening of chronic atrophic gastritis (low pepsinogen values used were a pepsinogen I level below 70 ng/ml and a pepsinogen I/pepsinogen II ratio below 3.0), the ORs of H. pylori-seropositivities for low pepsinogen cases were 6.32 [95% CI: 1.42-28.03] in males and 12.72 [95% CI: 4.57-35.46] in females. With regard to the relationship between low pepsinogen cases and light-colored vegetables intake, a significant low OR for the low pepsinogen cases was obtained in the &#34;almost every meal&#34; group in females after adjustment for age and seropositivities of H. pylori with an OR of 0.37 and with 95% CI of 0.15-0.92.</p

Hyperleptinemia is associated with hypertension in Japanese males

Leptin is a hormone which is predominantly secreted by adipose tissue. Recent studies have shown that leptin increases arterial blood pressure. Although data from available animal studies clearly indicate an association between leptin and hypertension, results of human studies have been less definitive. We conducted a case-control study to examine the association between serum leptin levels and hypertension in 111 hypertensive subjects and 222 male controls, using conditional logistic regression analyses. Mean serum leptin levels were found to be marginally higher in the case subjects than in the control subjects (3.3 ng/ml versus 3.0 ng/ml), however, conditional logistic regression analysis revealed that subjects in the highest quartile had a significantly increased risk of hypertension compared with those in the lowest quartile, even after adjusting for drinking status and diabetes mellitus (adjusted OR, 2.11;95% CI, 1.01-4.39). Our findings suggest that leptin plays an important role in the development of hypertension.</p

of lung cancer among Japanese coal miners on hazard risk and interaction between smoking and coal mining

University-This article examines whether an association is found between lung cancer and coal mining and also whether a correlation is found between smoking and coal mining that relates to the risk of lung cancer in Japanese coal miners. A cohort study was performed in former coal mine areas. The survey was carried out between 1987 and 1989, and was extended in a follow-up period to 1995. 5,818 Japanese males (1,796 coal miners and 4,022 non-coal miners) aged from 40 to 69 yr responded to a mail questionnaire that included occupational history and smoking habits. The data were analysed with Cox&apos;s proportional hazards model. Significant differences in hazard ratios for lung cancer were recognized in coal miners with ≥15 yr of work (Hazard ratio=2.08, 95% CI: 1.01-4.27) and current smokers with ≥20 cigarettes/day (Hazard ratio=5.41, 95% CI: 1.26-23.28). As regards the interaction of coal mining and smoking, the hazard ratios were 2.04 (95% CI: 0.13-32.83) for coal miners who had never smoked, 4.71 (95% CI: 0.62-35.56) for non-coal miners who were ex-smokers or current smokers, and 6.88 (95% CI: 0.92-51.65) for coal miners who were ex-smokers or current smokers compared with non-coal miners who had never smoked. The interaction of coal mining and smoking for the risk of lung cancer was likely to be additive rather than synergistic. (J Occup Health 2001; 43: 225-230