Randomized Controlled Trial of Two Forms of Self-Management Group Education in Japanese People with Impaired Glucose Tolerance

The aim of this study was to determine the effectiveness of education on diabetes prevention in subjects with impaired glucose tolerance. A total of 100 subjects of impaired glucose tolerance with hemoglobin A1c (HbA1c) levels ≥5.5 to <6.1% were assigned randomly to either support or control groups. All subjects received education in 8 sessions over a 6-month period. The support group consisted of 10 members collaborating with a dietitian or a nurse who learned coping skills by employing a participant-centered approach. Participants in the support group were required to keep a diary that monitored weight, food intake and blood glucose levels, while the control group attended several lectures. Subjects assigned to the support group had a reduction in mean HbA1c levels from 5.77 ± 0.36% at baseline to 5.39 ± 0.24% at the endpoint (p<0.01). Weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels also decreased (p<0.01) in the support group, whereas subjects in the control group had no observable reduction in these indices. After intervention, participants of the support group had improvements in their 2-h post-meal blood glucose levels. Support group education can be effective for improving glycemic control in participants when carried out in collaboration with educators and other team members

血清ペプシノゲン検査に基づく胃がん発生率と有効性に関する15年間のコホート研究

Objectives : The incidence of and mortality from gastric cancer in Japan have remained high and prophylaxis is important. However, the number of the individuals undergoing gastric mass radiography has decreased in recent years because the examination has a big burden at the time of the consultation. Many studies have reported the ease and effectiveness of the pepsinogen test and a higher incidence of gastric cancer in positive groups. However, the longest survey period was 10 years. Therefore, we conducted a 15-year cohort study to examine the validity of the testing period and the incidence of gastric cancer in serum pepsinogen positive and negative groups at a private company utilizing pepsinogen test. Methods : Subjects were 4383 employees who received a pepsinogen test. Subjects were followed for 15 years. For the purpose of examining the three periods over five-, 10-, and 15-year periods, we analyzed the validity of testing during each period, carried out a log-rank test, and analyzed hazard ratio in the Cox proportional hazard model. Results : The number of individuals who developed gastric cancer during the survey was nine in the five-year negative group, 18 in the five-year positive group, 16 in the 10-year negative group, 27 in the 10-year positive group, 31 in the 15-year negative group, and 29 in the 15-year positive group. The sensitivity of testing was 0.667 over the first five years, 0.628 over 10 years, and 0.483 over 15 years, and the specificity was 0.744 over the first five years, 0.745 over 10 years, and 0.745 over 15 years. The five-year incidence of gastric cancer was 57 per 100,000 person years in the negative group and 350 per 100,000 person years in the positive group. The ten-year incidences were 53 per 100,000 person years in the negative group and 279 per 100,000 person years in the positive group. The 15-year incidence was 75 per 100,000 person years in the negative group and 231 per 100,000 person years in the positive group. The hazard ratio of the positive group toward the negative group was 4.98 over the first five years, 4.71 over 10 years, and 2.76 over 15 years (p＜0.001). Conclusions : This study clarified that the first five years after the testing showed the highest hazard ratio and validity, therefore, the validity of testing was approximately 10 years. 【目的】我が国の胃がんの死亡率及び罹患率は現在も上位であり、その予防対策は重要で ある。けれども、近年X線の胃集団検診の受診者は、受診時の負担が大きいことから減少 している。一方職域の胃がん予防対策は、法的義務が無いため、企業により様々であるが 地域同様減少している。多くの先行研究では、血清ペプシノゲン検査法が簡便で有益とし ており、陽性群に発症率が高いとしているが、調査期間は最長10年であり、15年間の調査 はなかった。そこで、一企業において15年間の“陽性群”と“陰性群”での発症率の違い と検査の有効性の期間を検討することを目的にコホート調査を行った。 【方法】ペプシノゲン検査を受診した4,383名を15年間追跡した。５年間、10年間、15年間の ３期間に区切って各期間の検査の有効性を算出し、発症率をLog-rankで検定し、発症危険 度をCox比例ハザードで分析した。 【結果】追跡期間中に陰性群と陽性群のそれぞれの胃がん発症数は、５年間で９人と18人、 10年間で16人と27人、15年間で31人と29人であった。検査の感度は５年間で0.667、10年間 で0.628、15年間で0.483であり、特異度は、５年間で0.744、10年間で0.745，15年間で0.745 であった。発症率では、５年間の陰性群と陽性群で57、350per 100,000 person yearsであり、 10年では53、279 per 100,000 person years であり、15年では 75、231 per 100,000 person yearsであった。陰性群に対する陽性群の発生危険度は、５年間4.98、10年間4.71、15年間 2.76であった (p＜0.001)。 【結論】胃がんの発症率及び発症危険度や検査の有効性が最も高かったのは、2000年まで の５年間であり、検査の有効性は、約10年であることが明らかになった。Thesis of Takami Okuno / 奥野 敬生 博士論文 金沢大学医薬保健学総合研究科（保健学専攻

日本人男性海外勤務者の精神的健康度と職業関連要因との関係

目的：海外勤務者の精神的健康度と職業関連要因の関係と日本国内勤務者の精神的健康度の違いを明らかにすることである。方法：同一の金属製品製造業に勤務する男性海外勤務者450名と男性日本国内勤務者683名を対象に自記式質問紙調査を行った。精神的健康度は日本版気分プロフィール検査を用いて評価した。 結果：日本国内と海外勤務者の精神的健康度の比較では、34－39歳において海外勤務者が日本国内より低く、40代と50代では海外勤務者が日本国内より高かった。 　ロジスティック重回帰分析の結果、精神的健康度の不良に関連していたものは、ヨーロッパに対して東アジア（e.g. オッズ比 : 7.548, 95%信頼区間［以下CI］: 2.912－22.293［抑うつ－落込み〔以下D〕］）、東南・南アジア（e.g. オッズ比 : 4.675, 95% CI : 1.679－14.433［D］）、北米（e.g. オッズ比 : 3.997, 95% CI : 1.495－11.895［D］）。管理職に対してエンジニア（e.g. OR : 2.328, 95% CI : 1.168－4.679［緊張－不安〔以下T－A〕］）と生産管理（OR: 5.268, 95% CI : 1.520－18.013［T－A］）。労働時間10－11時間未満に対して12－13時間未満（e.g. OR : 2.063, 95% CI : 1.007－4.283［D］）、13時間以上（e.g. OR : 2.651, 95% CI :1.227－5.814［D］）。休日日数 8 日以上に対して 5 日未満（e.g. OR : 2.285, 95% CI : 1.276－4.129［疲労〔以下F〕］）、5－7日以下（e.g. OR : 2.219, 95% CI: 1.246－4.000［F］）であった。結論：海外勤務者の精神保健対策は、地域別ではアジア圏特に東アジア、職種ではエンジニアや生産管理を中心に取り組んでいく必要がある。また実労働時間が12時間を超える者や休日日数が7日以下の者には、就労時間の制限や休日日数を 8 日以上確保することも対策として考えられた。Objectives : The aim of this study was to clarify the relationship between the mental-health status of overseas employees and work-related factors, and also to determine the difference between the mental-health status of these employees and their counterparts in Japan. Method : Four hundred and fifty male overseas employees and 683 male employees in Japan were surveyed using a self-assessment questionnaire, namely the Japanese version of the Profile of Mood States, which is used to assess mental-health status. Result: The mental-health status of overseas employees in the age range 34－39 years was worse, and that for those in their forties and fifties better, than those o employees in Japan. A multiple logistic regression analysis showed that employees in East Asia Southeast & South Asia and North America were positively associated with poor ental-health status compared with employees in Europe (e.g. odd ratio [OR] : 7.548, 95% confidence interval [CI] : 2.912－22.293, OR : 4.675, 95% CI : 1.679－14.433 and OR: 3.997, 95% CI : 1.495－11.895 in depression/dejection, respectively). Engineers and production controllers were positively associated with poor mental-health status compared with those in managerial posts (e.g. OR : 2.328, 95% CI : 1.168－4.679 and OR : 5.268, 95% CI : 1.520－18.013 in tension/anxiety, respectively). As regards average daily working hours, those employees working for between 12 and less than 13 hours and 13 hours or more were positively associated with poor mentalhealth status compared with those working for between 10 and less than 11 hours (e.g. OR : 2.063, 95% CI : 1.007－4.283 and OR : 2.651, 95% CI : 1.227－5.814 in depression/dejection, respectively). In terms of number of days’ holiday in the last month, those employees who had taken less than five days and between five days and seven days were positively associated with poor mental-health status comparison with those who had taken eight days or more (e.g. OR : 2.285, 95% CI : 1.276－4.129 and OR : 2.219, 95% CI : 1.246－4.000 in fatigue, respectively). Conclusion : Mental-health protection measures in overseas bases need to focus on Asia, especially East Asia and employees who work as engineers or production controllers. Furthermore, average daily working hours should be shortened as much as possible and employees should take at least eight days’ holiday per month

Polycystic Kidney Disease in the Medaka (Oryzias latipes) pc Mutant Caused by a Mutation in the Gli-Similar3 (glis3) Gene

Polycystic kidney disease (PKD) is a common hereditary disease in humans. Recent studies have shown an increasing number of ciliary genes that are involved in the pathogenesis of PKD. In this study, the Gli-similar3 (glis3) gene was identified as the causal gene of the medaka pc mutant, a model of PKD. In the pc mutant, a transposon was found to be inserted into the fourth intron of the pc/glis3 gene, causing aberrant splicing of the pc/glis3 mRNA and thus a putatively truncated protein with a defective zinc finger domain. pc/glis3 mRNA is expressed in the epithelial cells of the renal tubules and ducts of the pronephros and mesonephros, and also in the pancreas. Antisense oligonucleotide-mediated knockdown of pc/glis3 resulted in cyst formation in the pronephric tubules of medaka fry. Although three other glis family members, glis1a, glis1b and glis2, were found in the medaka genome, none were expressed in the embryonic or larval kidney. In the pc mutant, the urine flow rate in the pronephros was significantly reduced, which was considered to be a direct cause of renal cyst formation. The cilia on the surface of the renal tubular epithelium were significantly shorter in the pc mutant than in wild-type, suggesting that shortened cilia resulted in a decrease in driving force and, in turn, a reduction in urine flow rate. Most importantly, EGFP-tagged pc/glis3 protein localized in primary cilia as well as in the nucleus when expressed in mouse renal epithelial cells, indicating a strong connection between pc/glis3 and ciliary function. Unlike human patients with GLIS3 mutations, the medaka pc mutant shows none of the symptoms of a pancreatic phenotype, such as impaired insulin expression and/or diabetes, suggesting that the pc mutant may be suitable for use as a kidney-specific model for human GLIS3 patients

Repeated freeze–thaw cycles reduce the survival rate of osteocytes in bone-tendon constructs without affecting the mechanical properties of tendons

Frozen bone-patellar tendon bone allografts are useful in anterior cruciate ligament reconstruction as the freezing procedure kills tissue cells, thereby reducing immunogenicity of the grafts. However, a small portion of cells in human femoral heads treated by standard bone-bank freezing procedures survive, thus limiting the effectiveness of allografts. Here, we characterized the survival rates and mechanisms of cells isolated from rat bones and tendons that were subjected to freeze–thaw treatments, and evaluated the influence of these treatments on the mechanical properties of tendons. After a single freeze–thaw cycle, most cells isolated from frozen bone appeared morphologically as osteocytes and expressed both osteoblast- and osteocyte-related genes. Transmission electron microscopic observation of frozen cells using freeze-substitution revealed that a small number of osteocytes maintained large nuclei with intact double membranes, indicating that these osteocytes in bone matrix were resistant to ice crystal formation. We found that tendon cells were completely killed by a single freeze–thaw cycle, whereas bone cells exhibited a relatively high survival rate, although survival was significantly reduced after three freeze–thaw cycles. In patella tendons, the ultimate stress, Young’s modulus, and strain at failure showed no significant differences between untreated tendons and those subjected to five freeze–thaw cycles. In conclusion, we identified that cells surviving after freeze–thaw treatment of rat bones were predominantly osteocytes. We propose that repeated freeze–thaw cycles could be applied for processing bone-tendon constructs prior to grafting as the treatment did not affect the mechanical property of tendons and drastically reduced surviving osteocytes, thereby potentially decreasing allograft immunogenecity

Dietary glycemic index and risk of type 2 diabetes mellitus in middle-aged Japanese men

This cohort study investigated the association between dietary glycemic index (GI), glycemic load (GL), and the incidence of type 2 diabetes mellitus in middle-aged Japanese men, and the effect of insulin resistance and pancreatic B-cell function on the association. Participants were 1995 male employees of a metal products factory in Japan. Dietary GI and GL were assessed using a self-administered diet history questionnaire. The incidence of diabetes was detected in annual medical examinations over a 6-year period. The association between GI, GL, and the incidence of diabetes was evaluated using Cox proportional hazards models. During the study, 133 participants developed diabetes. Age- and body mass index-adjusted hazard ratios across the GI quintiles were 1.00 (reference), 1.62, 1.50, 1.68, and 1.80; and those of GL were 1.00 (reference), 1.07, 1.48, 0.95, and 0.98. The hazard ratio for the highest GI quintile was significantly greater than that for the lowest quintile. The influence of GI was more pronounced in the lowest insulin resistance subgroups. GI and pancreatic B-cell function were independently associated with the incidence of type 2 diabetes mellitus; participants with low B-cell function and the highest tertile of GI had the highest risk of diabetes. Dietary GI is associated with the incidence of diabetes in middle-aged Japanese men. GI and B-cell function were independently associated with incidence of diabetes. © 2012 Elsevier Inc. All rights reserved

Self-reported speed of eating and 7-year risk of type 2 diabetes mellitus in middle-aged Japanese men

Objective: This cohort study investigated the association between eating speed and the incidence of type 2 diabetes in middle-aged Japanese men. Materials/Methods: Participants were 2,050 male employees of a metal products factory in Japan. We measured self-reported categorical eating speed. The incidence of diabetes was determined in annual medical examinations over a 7-year period. The association between eating speed and the incidence of diabetes adjusted for multiple variables (age, family history of diabetes, smoking, alcohol drinking, habitual exercise, and presence of hypertension and hyperlipidemia) was evaluated using Cox proportional hazards models. Results: The prevalence of obesity (BMI ≥ 25 kg/m 2) across the categories of eating speed (slow, medium, and fast) was 14.6, 23.3, and 34.8%, respectively, and a faster eating speed was associated with a higher prevalence of obesity. During the study, 177 participants developed diabetes. Crude incidence rates (/1,000 person-years) across the three categories of eating speed were 9.9, 15.6, and 17.3, respectively. Multivariate-adjusted hazard ratios (95% CI) across the categories were 1.00 (reference), 1.68 (0.93-3.02), and 1.97 (1.10-3.55), respectively, and eating speed was associated with the risk of diabetes (p for trend = 0.030). After further adjustment for BMI, a significant association was not observed. Conclusions: Eating speed was associated with the incidence of diabetes. Since these associations were not significant after adjusting for BMI, eating speed may act via its effect on body weight. Eating speed is a controllable risk factor, and eating slowly could be an acceptable lifestyle intervention for the prevention of diabetes mellitus. © 2012 Elsevier Inc. All rights reserved

Family history of diabetes, lifestyle factors, and the 7-year incident risk of type 2 diabetes mellitus in middle-aged Japanese men and women

Aims/Introduction: This cohort study of middle-aged Japanese participants investigated the relationship between family history of diabetes, the incident risk of type 2 diabetes and the interaction of these variables with other factors. Materials and Methods: Study participants were 3,517 employees (2,037 men and 1,480 women) of a metal products factory in Japan. Baseline health examinations included questions about medical history, physical examination, anthropometric measurements, questions about lifestyle factors, such as smoking, alcohol consumption and habitual exercise, and a self-administered diet history questionnaire. Family history of diabetes was defined as having at least one-first-degree relative with diabetes. The incidence of diabetes was determined in annual medical examinations over a 7-year period. Hazard ratios (HRs) for type 2 diabetes were estimated by Cox proportional hazards analysis. Results: Of the 3,517 participants, 630 (18%) had a family history of diabetes mellitus. During the study, 228 participants developed diabetes. The age and sex-adjusted HR for type 2 diabetes in participants with a family history of diabetes was 1.82 (95% confidence interval 1.36-2.43) as compared with those without a family history of diabetes. HRs did not change after adjustment for body mass index and lifestyle factors. We found no interactions with body mass index, insulin resistance, pancreatic β-cell function or lifestyle factors. Conclusions: Family history of diabetes was associated with the incident risk of diabetes, and these associations were independent of other risk factors, such as obesity, insulin resistance, and lifestyle factors in Japanese men and women. © 2013 Asian Association for the Study of Diabetes and Wiley Publishing Asia Pty Ltd

Sugar-sweetened beverage and diet soda consumption and the 7-year risk for type 2 diabetes mellitus in middle-aged Japanese men

Purpose: This cohort study investigated the association between sugar-sweetened beverage (SSB) and diet soda consumption and the incidence of type 2 diabetes in Japanese men. Methods: The participants were 2,037 employees of a factory in Japan. We measured consumption of SSB and diet soda using a self-administered diet history questionnaire. The incidence of diabetes was determined in annual medical examinations over a 7-year period. Hazard ratios (HRs) with 95 % confidence intervals (CIs) for diabetes were estimated after adjusting for age, body mass index, family history, and dietary and other lifestyle factors. Results: During the study, 170 participants developed diabetes. The crude incidence rates (/1,000 person-years) across participants who were rare/never SSB consumers, <1 serving/week, ≥1 serving/week and <1 serving/day, and ≥1 serving/day were 15.5, 12.7, 14.9, and 17.4, respectively. The multivariate-adjusted HR compared to rare/never SSB consumers was 1.35 (95 % CI 0.80-2.27) for participants who consumed ≥1 serving/day SSB. Diet soda consumption was significantly associated with the incident risk of diabetes (P for trend = 0.013), and multivariate-adjusted HRs compared to rare/never diet soda consumers were 1.05 (0.62-1.78) and 1.70 (1.13-2.55), respectively, for participants who consumed <1 serving/week and ≥1 serving/week. Conclusions: Consumption of diet soda was significantly associated with an increased risk for diabetes in Japanese men. Diet soda is not always effective at preventing type 2 diabetes even though it is a zero-calorie drink. © 2013 Springer-Verlag Berlin Heidelberg