An Empirical Study of Alcoholic Consumption and Labor Productivity in Japan

This paper examines the relationship between labor productivity and alcohol consumption based on research conducted with a limited sample of workers who drink alcohol. Estimation results show that in the case of males, the amount of alcohol consumed significantly raises labor productivity, with an elasticity of approximately 0.13. In females, we cannot reach the firm conclusion. Conversely, the reverse relationship between labor productivity and alcohol consumption cannot be confirmed. Moreover, an awareness of appropriate alcohol consumption supports the sixth strategy of the Health Japan 21 policy, which is to reduce national alcohol consumption by about 20%.

A crisis of the community health care system in Nakatombetsu, northern Hokkaido

北海道枝幸郡中頓別町で、町内で唯一の入院設備をもつ町立病院の院長の退職願が受理された。地元出身の院長として着任から約6年にわたり地域医療に尽力し、病院の改革や町の保健福祉事業に取り組んできた彼の決断に、町は大騒ぎとなった。気候の厳しい過疎地域、加えて広大な面積のため人口密度が低い不採算地域の自治体病院の経営は確かに厳しく、院長の職責は非常に重い。また、一般病床50床に対して常勤医師が２名という体制では、たとえ病床利用率が５割ほどだとしても医師に対する入院患者の割合は高く、外来患者の対応も考えると過酷な勤務実態とならざるを得ない。院長の辞意の表明をきっかけに、住民が地域医療を巡る環境の厳しさや現状を知り、自分たちでそのあり方を考え、守っていかなければならないという機運が高まった。しかし、いかに状況が厳しいのかは、実はあまり理解されていない。本稿では、保健や福祉との連携や、地域包括医療の取り組みといったこれから目指すべき姿を議論するために、中頓別町を事例として地域医療を考察した

地域医療 : 自治体が医療機関を持つ意味

第187回産業セミナ

Issues in Emergency Response System : For the Correspondence to the Increasing Emergency Demand

第200回記念産業セミナ

Treatment for Osteoporosis among Women in Japan: Associations with Patient Characteristics and Patient-Reported Outcomes in the 2008–2011 Japan National Health and Wellness Surveys

This study was conducted to identify characteristics associated with treatment for osteoporosis among women aged 50 years and older in Japan and to explore differences among patients according to treatment regimen. Data were provided by a large annual survey representative of Japanese aged 18 and older; all measures were by self-report. Women aged 50 and older who reported diagnosed osteoporosis (N=900) were compared based on current treatment status using bivariate statistics and logistic regression. Approximately 1 in 3 women in this study reporting diagnosed osteoporosis were currently untreated. Factors associated with current treatment for osteoporosis included having ≥1 physician visit in the prior 6 months (OR = 5.4, P<0.001), self-rated moderate or severe osteoporosis (OR = 2.8, P<0.001), completion of menopause (OR = 1.6, P<0.05), and family history of osteoporosis (OR = 1.5, P<0.05), while longer duration of osteoporosis diagnosis (OR = 0.9, P<0.05) and arthritis (OR = 0.7, P<0.05) were associated with lower odds of treatment. These findings suggest that diagnosed patients are not being actively managed in the longer term, and efforts need to be made to ensure that patients stay engaged with their healthcare providers

Racial and ethnic disparities in treatment of dementia among Medicare beneficiaries

Objectives—Numerous studies have documented disparities in health care utilization between non-Hispanic White and minority elders. We investigated differences in anti-dementia medication use between non-Hispanic White and minority community-dwelling Medicare beneficiaries with dementia. Methods—Using multivariate analysis with generalized estimating equations, we estimated prevalence ratios (PRs) for anti-dementia medication use by race/ethnicity for 1,120 beneficiaries with dementia from years 2001 through 2003 of the Medicare Current Beneficiary Survey. Results—After adjusting for demographics, socioeconomics, health care access and utilization, comorbidities, and service year, we found that anti-dementia medication use was approximately 30% higher among non-Hispanic Whites compared to other racial/ethnic groups (PR = 0.73, 95% confidence interval [CI] = 0.59, 0.91). As for individual racial/ethnic groups, prevalence disparities remained significant for non-Hispanic Blacks (PR = 0.75, 95% CI = 0.57, 0.99) and non-Hispanic others (PR = 0.50, 95% CI = 0.26, 0.96) but were attenuated for Hispanics (PR = 0.84, 95% CI = 0.59, 1.20). Discussion—Results provide evidence that racial/ethnic disparities in utilization of drugs used to treat dementia exist and are not accounted for by differences in demographic, economic, health status, or health utilization factors. Findings provide a foundation for further research that should use larger numbers of minority patients and consider dementia type and severity, access to specialty dementia care, and cultural factors

Is Adjuvant Chemotherapy Necessary in Patients with Early Endometrial Cancer?

Background: We investigated whether there was a difference in prognosis between patients with stage IA endometrial cancer with and without lymphovascular space invasion. Methods: We enrolled patients with stage IA (pT1aN0M0) endometrial cancer admitted to our hospital from 2009 to 2018. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic lymphadenectomy. We immunopathologically evaluated the presence or absence of lymphovascular space invasion in the tumor tissue using hematoxylin and eosin, Elastica-van Gieson, and podoplanin staining. We analyzed disease-free and overall survival and calculated patients’ survival distribution using the Kaplan–Meier method and log-rank test. The multivariate analysis was performed to determine the prognostic factors. Results: A total of 116 patients were included. The median age of the patients was 57 (range, 30–78) years, and the histological subtype revealed 98 and 18 cases of types 1 and 2, respectively. The median follow-up period was 71.9 (range, 10.8–149) months, and the 3-year disease-free and 3-year overall survival rates were 94% and 99%, respectively. The disease-free and overall survival rates were significantly shorter in type 2 patients than in type 1 patients (type 2 vs. type 1; 77% vs. 97%, P < 0.01, 94% vs. 100%, P = 0.014, respectively). The univariate and multivariate analyses showed that there were no significant differences in disease-free survival between the lymphovascular space invasion-positive and -negative groups among type 1 cases. Conclusion: There was no difference in prognosis between patients with stage IA and type 1 endometrial cancer with and without lymphovascular space invasion

Adherence and Persistence with Once-Daily Teriparatide in Japan: A Retrospective, Prescription Database, Cohort Study

Adherence and persistence with osteoporosis treatments are essential for reducing fracture risk. Once-daily teriparatide is available in Japan for treating osteoporosis in patients with a high risk of fracture. The study objective was to describe real-world adherence and persistence with once-daily teriparatide 20 μg during the first year of treatment for patients who started treatment during the first eight months of availability in Japan. This prescription database study involved patients with an index date (first claim) between October 2010 and May 2011, a preindex period ≥6 months, and a postindex period ≥12 months and who were aged >45 years. Adherence (medication possession ratio (MPR)) and persistence (time from the start of treatment to discontinuation; a 60-day gap in supply) were calculated. A total of 287 patients started treatment during the specified time period; 123 (42.9%) were eligible for inclusion. Overall mean (standard deviation) adherence was 0.702 (0.366), with 61.0% of patients having high adherence (MPR > 0.8). The percentage of patients remaining on treatment was 65.9% at 180 days and 61.0% at 365 days. Our findings suggest that real-world adherence and persistence with once-daily teriparatide in Japan are similar to that with once-daily teriparatide in other countries and with other osteoporosis medications