Relationship between serum uric acid levels and chronic kidney disease in a Japanese cohort with normal or mildly reduced kidney function

Background: Some observational studies have shown the relationships between hyperuricemia and chronic kidney disease (CKD); however, the threshold of serum uric acid (SUA) for deterioration of kidney function and the association between SUA and kidney injury by baseline kidney function remains unclear. This study aimed to clarify the relationships between SUA and reduced kidney function. Methods: We analyzed a historical cohort of male Japanese individuals who underwent medical checkup between 1998 and 2007. Participants with baseline data and who were followed up for at least one year were included and stratified according to baseline kidney function. Kidney function was classified as normal [estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m2] or mildly reduced (eGFR 60-89 ml/min/1.73 m2). The outcome measured was kidney impairment defined as a decrease in eGFR to < 60 ml/min/1.73 m2. Associations between SUA and risk for outcome and eGFR slopes were assessed. Results: A total of 41632 subjects with mean age 45.4 years were included. During a mean follow-up of four years, 3186 (7.6%) subjects developed kidney dysfunction. Subjects with SUA ≥ 6.0 mg/dL had a significantly increased risk for kidney impairment compared with subjects with SUA of 4-4.9 mg/dL. SUA threshold levels were different according to baseline kidney function; SUA ≤ 7.0 and ≤ 6.0 mg/dL for normal and mildly reduced kidney function, respectively. Approximately the same trends were observed for eGFR slopes. Conclusion: In the general population, hyperuricemia appears to be a risk factor for kidney impairment in males. For participants with mild kidney dysfunction, even a slight elevation of SUA can be a risk factor. Copyright: © 2015 Toyama et al.This article has a supplementary figure. Please see the last page of the text

Hepatitis B virus strains of subgenotype A2 with an identical sequence spreading rapidly from the capital region to all over Japan in patients with acute hepatitis B

ObjectiveTo examine recent trends of acute infection with hepatitis B virus (HBV) in Japan by nationwide surveillance and phylogenetic analyses.MethodsDuring 1991 through 2009, a sentinel surveillance was conducted in 28 national hospitals in a prospective cohort study. Genotypes of HBV were determined in 547 patients with acute hepatitis B. Nucleotide sequences in the preS1/S2/S gene of genotype A and B isolates were determined for phylogenetic analyses.ResultsHBV genotype A was detected in 137 (25% (accompanied by genotype G in one)) patients, B in 48 (9%), C in 359 (66%), and other genotypes in the remaining three (0.5%). HBV persisted in five with genotype A including the one accompanied by genotype G; another was co-infected with HIV type 1. The genotype was A in 4.8% of patients during 1991-1996, 29.3% during 1997-2002, and 50.0% during 2003-2008 in the capital region, as against 6.5%, 8.5% and 33.1%, respectively, in other regions. Of the 114 genotype A isolates, 13 (11.4%) were subgenotype A1, and 101 (88.6%) were A2, whereas of the 43 genotype B isolates, 10 (23.3%) were subgenotype B1, 28 (65.1%) were B2, two (4.7%) were B3, and three (7.0%) were B4. Sequences of 65 (64%) isolates of A2 were identical, as were three (23%) of A1, and five (18%) of B2, but none of the B1, B3 and B4 isolates shared a sequence.ConclusionsAcute infection with HBV of genotype A, subgenotype A2 in particular, appear to be increasing, mainly through sexual contact, and spreading from the capital region to other regions in Japan nationwide. Infection persisted in 4% of the patients with genotype A, and HBV strains with an identical sequence prevailed in subgenotype A2 infections. This study indicates the need for universal vaccination of young people to prevent increases in HBV infection in Japan

Growth, Sexual Dimorphism, and Geographical Variation of Skull Dimensions of the Brown Bear Ursus arctos in Hokkaido

The growth, sexual dimorphism, and geographical variation in skulls of 596 brown bears (Ursus arctos) hunted in Hokkaido, Japan from 1971 to 1986 were investigated. Most cranial traits continued to increase after the age of sexual maturity, and in particular skulls became progressively wider with age. Skulls of males, even those of cubs and yearlings, were larger than those of females, and the difference became significant after two years of age. Skull dimensions tended to increase from south to north, in Hokkaido, and bears from the north-eastern region possessed higher brain cases and longer mandibles relative to skull length and width, than those in the southern region

Effect of the Japanese medical office system on job satisfaction, loyalty, engagement, and organizational commitment of medical practitioners: a survey of cardiologists in the acute care setting

Abstract Background In Japan, medical doctors have traditionally been assigned from university medical offices, under the medical office system. The present study examined the effects of the medical office system on job satisfaction, engagement, loyalty, and organizational commitment among cardiologists. Methods In this study, a survey of 156 cardiologists was conducted, from April 22, 2023, to May 21, 2023, to examine the effect of the medical office system on employee job satisfaction, employee engagement, and organizational commitment. Results Compared with the group that belonged to a medical office system (affiliated group, n = 117), the group that did not belong to a medical office system (non-affiliated group, n = 39) was affiliated to hospitals with a smaller number of beds. The results of the factor analysis showed that four types of hospital management styles were generated, namely, environment-, loyalty-building-, treatment-, and philosophy-oriented hospitals. There is an indication that the philosophy-oriented management style was adopted at the workplaces of the non-affiliated group. The treatment-oriented style also tended to be higher in the non-affiliated group than in the affiliated group. Furthermore, the non-affiliated group had higher organizational commitment, indicating that they were more likely to agree with the management philosophy set forth by hospital executives. Conclusion Although the medical office system did not affect job satisfaction, compared with medical doctors with the affiliated group, those with the non-affiliated group tended to work in hospitals that emphasized philosophy-oriented management, and they received moderate compensation while practicing in an environment suitable for their specialty. These results suggest that the medical office system makes it difficult for medical doctors to have high workplace loyalty, engagement, and commitment to the hospital to which they are dispatched

The concept of healthcare management theory: positioning by the discipline of economics and management theory

publisher多摩　環境変化への対応を抜きにしては、医療機関をマネジメントすることができない時代になってきた。それは、本格的な医療経営学が必要になってきたことを意味する。本論文では、医療という財の特徴を前提にして、医療経営学に対してどのようなアプローチが取られているのかを概観する。なお、アプローチとしては、紙面の制約もあり、「マネジリアルエコノミクスとしての医療経済」「マーケティング」「経営戦略」ついての考察にとどめ、組織論も敢えて「経営戦略」の1 部として扱った。「経営戦略」については、この考え方を使い、実際の医療分野の分析をも行った。 The time has come when healthcare service providers must consider the response to the environment, meaning that the healthcare management theories are necessary. In this paper, based on the characteristics of healthcare as economical goods, the overview of the approach to the healthcare management theory in the field of managerial economics, marketing, strategy. Furthermore, the analysis about the healthcare service provider was done by using strategic theory

Economic consideration about how to provide medical information

publisher多摩　本稿では、非対称情報下で成立する可能性がある「レモン市場」が医療という財において成立するかどうかを考えたい。医療情報は三種類あると考えられる。それは１）「診療情報」、２）「疾患治療法や薬剤などについての医学情報」（狭義の医療情報）、３）「医療機関情報（経営情報も含む）」、の３つである。本論文では、３）「医療機関情報（経営情報も含む）」を中心に考察する。３）の医療情報には、Ａ）「個別医療の質の評価に役立つもの」、Ｂ）「平均的な医療の質の評価に役立つもの」、Ｃ）「医療の質の評価に役立たないもの」の3 種類があり、多くの情報はＢ）かＣ）である。Ｂ）の情報の多くは「レモン市場」を形成する。 In this paper, author would consider whether the lemon market theory could be adapted to health care market. The author divided medical information into three categories; that is 1) medical record&information, 2) narrowly defined medical information (such as information about diseases and drugs), and 3) information about healthcare provider. The author tried to consider how to provide medical information, especially type 3 information. Type 3 information is consisted of A) useful for evaluation of each health care quality, B) useful for evaluation of average health care quality, C) useless for health care quality. Much information is type B or C and much of type B information may form lemon market.