In this paper, we first evaluated the distribution of blood pressure (BP) using a dataset containing 113,979 measurements in 48,022 individuals with the cooperation of one health insurance society in Japan from April,...In this paper, we first evaluated the distribution of blood pressure (BP) using a dataset containing 113,979 measurements in 48,022 individuals with the cooperation of one health insurance society in Japan from April, 2013 to March, 2016. The means of the systolic BP (SBP) and diastolic BP (DBP) were 125.4 and 77.6 mmHg with standard deviations of 16.5 and 11.7 mmHg, respectively. Under the 140/90 criterion, 21.6% of the measurements showed hypertension. According to the World Health Organization/International Society of Hypertension criterion, 16.4%, 4.2% and 0.96% were classified as grades 1, 2 and 3, respectively. The factors affecting BP were evaluated by a regression analysis and were found to include age, gender, some eating habits, daily activities, smoking, drinking alcohol, sleeping and wages. Age was a very important factor, and the age cohorts from the previous study might be revised based on these findings. Among factors that individuals can control, the influence of drinking alcohol is very large. Comparing to an individual who does not drink, SBP and DBP of a heavy drinker are more than 5.0 mmHg higher on the average.展开更多
Background: Many people take medicines to control high blood pressure (BP), or hypertension. Randomized clinical trials (RCT) are usually used for the evaluation of effects of medicines. However, RCT have some serious...Background: Many people take medicines to control high blood pressure (BP), or hypertension. Randomized clinical trials (RCT) are usually used for the evaluation of effects of medicines. However, RCT have some serious problems. Data and Methods: We evaluated the effects of BP medicines in Japan using a dataset containing 113,979 cases. We employed four statistical methods in the analysis. First, we simply compared the systolic blood pressure (SBP) of individuals with and without BP medicines. We then used a regression model with a dummy variable, representing taking medicines or not. We replaced the dummy variable by its expected value, and estimated the regression model again. Finally, we selected individuals who had both taken and not taken medicines at different times. The effect of sample selection was also considered in the estimation. Results: For the simple comparison, SBP with BP medicines was 11 mmHg higher than without medicines. In the next regression analysis, SBP with BP medicines was still 5 mmHg higher. When the dummy variable was replaced by its expected value, SBP with medicines decreased by 7 mmHg. For individuals taking medicines at some times and not at others, SBP decreased by 9 and 8 mmHg in models with and without a sample bias correction, respectively. Conclusion: The methods eliminated some problems of RCT and might be attractive. However, we obtained contradictory conclusions depending on the statistical methods employed, despite using the identical dataset. Statistical methods must be selected carefully to obtain a reliable evaluation. Limitations: The dataset was observatory, and the sample period was only 3 years.展开更多
Background: The cost and economic burden of diabetes are a serious worldwide issue. In this study, we evaluated medical payments for persons diagnosed with diabetes and the factors that led to a person having diabetes...Background: The cost and economic burden of diabetes are a serious worldwide issue. In this study, we evaluated medical payments for persons diagnosed with diabetes and the factors that led to a person having diabetes to reduce its prevalence. Methods: A dataset containing 113,979 medical checkups and 3,671,783 monthly medical, dental, care-giving and pharmacy payment records of one health insurance society was used. The dataset contains information of normal and healthy persons. The sample period ran from April, 2013 to March, 2016. The medical payments for persons diagnosed with diabetes were calculated. The regression analysis was used to remove the effects of age and gender. The probit analysis was used to analyze the factors that led to a person having diabetes. Results: In 2.9% of cases, the person undergoing the checkup was diagnosed with diabetes, and the medical payments for these patients were 2.7 times as much as the average medical payment per person. This result did not change significantly even if age and gender were considered. The results of the probit analysis suggested that body mass index, high systolic blood pressure, low diastolic blood pressure, eating habits, physical activities, smoking, drinking alcohol and sleeping were important factors for diabetes. Conclusion: The diabetes might be a costlier disease than previously thought in Japan. By the estimation, 8% of all medical payments were made for these persons with diabetes, which is much higher than the result shown by national survey data. However, overall prevalence could be recused by efforts such as prevention of overweight and obesity.展开更多
Objective:To appraise the effectiveness of HbA_(1c) and fasting plasma glucose(FPG) on screening diabetes in health check-up.Methods:A total of 1 337 individuals(male 850,female 487),aged 27 to 91 years with HbA_(1c) ...Objective:To appraise the effectiveness of HbA_(1c) and fasting plasma glucose(FPG) on screening diabetes in health check-up.Methods:A total of 1 337 individuals(male 850,female 487),aged 27 to 91 years with HbA_(1c) test were included.Participates with HbA_(1c)≥6.0%or FPG≥6.1 mmol/ L underwent oral glucose tolerance test(OGTT).Diabetes mellitus was diagnosed according to the criteria of WHO in 1999,FPG≥7.0 mmol/L and/or OGTT 2 h-postload plasm glucose(2 h-PG)≥11.1 mmol/L.The sensitivity and specificity of HbA_(1c) thresholds and FPG or combination test on screening of diabetes were analyzed.Results:A total of 842 subjects had HbA_(1c)<6.0%,in which 32 had isolated FPG≥6.1 mmol/L,of 495 had HbA_(1c)≥6.0%.Subjects with HbA_(1c)≥6.0% had significant increased disorder indexes than those with HbA_(1c)<6.0%.527 subjects who had HbA_(1c)≥6.0%or FPG≥6.1 mmol/L underwent OGTT.A total of 234 subjects were newly diagnosed diabetes,including 123(123/234,52.56%) with FPG≥7.0 mmol/L,and 111 subjects(111/234, 47.43%) with isolated 2 h-PG≥11.1 mmol/L.Among 234 new diabetes,91.88%(215 subjects) had HbA_(1c)≥6.3%,and 77.40%(181 subjects) had HbA_(1c)≥6.5%.HbA_(1c)≥6.3%combined FPG≥7.0 mmol/L increased the positive rate of newly diagnosed diabetes from 91.88%to 96.58%. Conclusions:HbA_(1c) is a practical and convenient tool for screening undiagnosed diabetes in routine health check-up of a large population.Combined use of HbA_(1c)≥6.3%and/or FPG≥7.0 mmol/L is efficient for early detection of diabetes.展开更多
AIM: To identify associated factors of diabetic retinopathy(DR) screening and ey e check-up practice among diabetes mellitus(DM) patients attending Felege Hiwot Specialized Hospital.METHODS: An institution-based cross...AIM: To identify associated factors of diabetic retinopathy(DR) screening and ey e check-up practice among diabetes mellitus(DM) patients attending Felege Hiwot Specialized Hospital.METHODS: An institution-based cross-sectional study was applied from October 4, 2019 to January 12, 2020 at Felege Hiwot Specialized Hospital. A systematic random sampling technique was used to recruit participants and an interviewer-administered questionnaire was employed to collect the data. The collected data were entered into Epi Info version 7 and transposed to SPSS version 24 for statistical analysis. Descriptive statistics were executed and associated factors were identified using binary logistic regression. The strength of association between the independent and the outcome variable was determined using an adjusted odds ratio(AOR) with 95% confidence interval(CI). RESULTS: Four hundred and six participants partake with a response rate of 95.7% and a mean age of 47±11.5y. The magnitude of DR screening was 308(75.9%, 95%CI: 71.5%, 79.8%). Higher educational level(AOR=3.25;95%CI: 1.40, 8.78), good knowledge of DR(AOR=2.50;95%CI: 1.55, 4.46), and family history of DM(AOR=2.15;95%CI: 1.41,3.85) were significantly associated with DR screening. On the other side, rural residence [AOR=3.11(1.89, 5.02)] and undesirable attitudes toward DR [AOR=5.65(3.14, 8.76)] were significantly associated with poor regular eye checkup practice.CONCLUSION: Most of the participants are screened for DR. Higher education, family history, and good knowledge are associated with DR screening. In addition, rural residence and undesirable attitudes toward DR are associated with regular eye checkup practice.展开更多
Background: Caries detection in school oral examinations insufficient accuracy. Objective: To evaluate advantages of introducing quantitative light-induced fluorescence-digital (QLF-D) in school oral examinations. Met...Background: Caries detection in school oral examinations insufficient accuracy. Objective: To evaluate advantages of introducing quantitative light-induced fluorescence-digital (QLF-D) in school oral examinations. Methods: Experiment No. 1. Early demineralized lesions in the upper and lower incisors and canines were visually inspected by three dentists and by QLF-D. The numbers of tooth planes with early demineralized lesions were compared between the methods. Experiment No. 2. Approximal demineralized lesions in molars were assessed by visual inspection, x-ray imaging, and QLF-D. The numbers of tooth planes with demineralized lesions were compared among the methods. Experiment No. 3. Plaque distribution was evaluated by QLF-D and a traditional staining method. The ratio of the diameter of plaque to tooth crown in the tooth axis direction in each method was calculated. The results were evaluated by Pearson’s correlation coefficient analysis and Bland-Altman plot. Results: Experiment No. 1. The three dentists found 0.67 tooth planes on average. QLF-D found 22 tooth planes with early demineralized lesions in the same samples. Experiment No. 2. Fourteen approximal tooth planes of molars were found to have demineralized lesions by x-ray imaging. QLF-D detected 71.4% of the tooth planes out of the 14, whereas visual inspection found 7.1%. Experiment No. 3. The Pearson’s correlation coefficient for the evaluations of plaque distribution between the QLF-D and traditional staining methods was 0.77 (P Conclusion: The results support introduction of QLF-D for use in school dental examinations.展开更多
To prevent the development of metabolic syndrome among adult members of the community, improving the participation rate in the specific medical checkup (a medical examination focused on factors associated with metabol...To prevent the development of metabolic syndrome among adult members of the community, improving the participation rate in the specific medical checkup (a medical examination focused on factors associated with metabolic syndrome prior to the onset of lifestyle-related disease) is an important public health issue. This study used claim data and health checkup data and aimed to detect those community-dwelling adults who were least likely to participate in the specific medical checkup. Analysis included the medical and health checkup chart data of 61,753 adults aged 60 - 69 years (as of April 2011) who lived in Fukui prefecture, Japan. The chi-squared interaction was used to analyze data. If a person did not participate in the specific medical checkup, individual was categorized as “absent.” Between April 2012 and March 2013, 66.3% of subjects were absent from the specific medical checkup. Those most likely to be absent included those who were also absent at the previous year’s checkup, those who were men, and those who did not have an examination for hypertension;87.9% of patients who met all of these criteria were absent. Among women who were absent at the previous year’s checkup, the absentee rate differed by about 10.0% between those whose municipalities did (74.8%) or did not (84.2%) have a free checkup program. Our findings may help public health professionals detect those who require intervention and to effectively and efficiently improve participation in the specific medical checkup.展开更多
Background: The high blood pressure (BP) or hypertension is a widely prevalent disease and its costs are very high, and many studies about the relationships between BP and health conditions have been done. We need to ...Background: The high blood pressure (BP) or hypertension is a widely prevalent disease and its costs are very high, and many studies about the relationships between BP and health conditions have been done. We need to know the precise distributions of BP and factors affecting BP. Data and Methods: The distributions of BP are analyzed using 12,877,653 observations obtained from the JMDC Claims Database. The factors that may affect the BP are analyzed by the regression models using 4,615,346 observations. Results: The averages of systolic BP (SBP) and diastolic BP (DBP) are 120.4 and 74.2 mmHg with standard deviations of 15.9 and 11.3 mmHg, respectively. Among the nonmodifiable factors, age and gender are important factors. Among the modifiable factors, variables related to obesity are important risk factors. Taking antihypertensive drugs makes SBP and DBP 13.4 mmHg and 7.8 mmHg lower. Conclusion: The criteria of BP should be carefully determined considering age and gender. The effects of age may be a little different for SBP and DBP. It is necessary to use the proper model to evaluate the effect of antihypertensive drugs correctly. Limitations: The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.展开更多
To evaluate the impact of behavioral restrictions on perinatal care caused by the COVID-19 pandemic, we conducted a questionnaire survey of 1976 medical institutions handling deliveries across Japan. The survey examin...To evaluate the impact of behavioral restrictions on perinatal care caused by the COVID-19 pandemic, we conducted a questionnaire survey of 1976 medical institutions handling deliveries across Japan. The survey examined changes in the number of antenatal checkups due to behavioral restrictions, visit restrictions at medical institutions, and the acceptance of COVID-19-infected pregnant and nursing mothers. An increased burden was observed at delivery hospitals, irrespective of whether they accepted infected pregnant and nursing mothers. Some medical institutions were unable to manage infected pregnant women and transferred them to other facilities, highlighting the need for role-sharing among institutions. The number of antenatal checkups showed a decreasing trend, indicating that the pandemic negatively affected checkup attendance. However, no clear increase in perinatal deaths was observed during the observation period, despite the reduction in the number of checkups.展开更多
背景颈动脉内中膜增厚是反映动脉粥样硬化早期改变的重要指标,及时发现、积极干预可以得到有效逆转。目的探索非高密度脂蛋白胆固醇(nHDL-C)的动态变化轨迹与成人颈动脉内中膜增厚的关联,预测健康体检人群颈动脉内中膜增厚的风险。方法...背景颈动脉内中膜增厚是反映动脉粥样硬化早期改变的重要指标,及时发现、积极干预可以得到有效逆转。目的探索非高密度脂蛋白胆固醇(nHDL-C)的动态变化轨迹与成人颈动脉内中膜增厚的关联,预测健康体检人群颈动脉内中膜增厚的风险。方法本研究为一项双向性队列研究,纳入2013—2023年在北京大学第三医院参加健康体检的人群为研究对象,收集患者基线资料、体检指标,测量颈动脉内膜中层厚度(CIMT),对基线CIMT正常的研究对象进行随访,直到出现颈动脉内中膜增厚或失访。分别构建男性和女性研究对象nHDL-C随年龄的变化轨迹。纳入结局发生前的所有nHDL-C记录,使用联合潜在类别模型(JLCM)识别异质性nHDL-C变化轨迹并预测不同轨迹与发生颈动脉内中膜增厚的风险差异。采用赤池信息准则(AIC)、贝叶斯信息准则(BIC)、样本调整信息准则(SABIC)、熵值(Entropy>0.5)和满足条件独立假定(Score Test P>0.05)确定最优潜在类别个数。分别使用基线nHDL-C数值和nHDL-C变化轨迹构建Cox模型,比较各模型的受试者工作特征(ROC)曲线下面积(AUC)、一致性指数(C-index)数值,对模型拟合优度进行检验及评估。结果共纳入基线血脂处于正常水平的研究对象5741人,男2487人,女3254人。男性研究对象中发生颈动脉内中膜增厚393例,无颈动脉内中膜增厚和颈动脉内中膜增厚者比较,随访时间、年龄、BMI、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、nHDL-C、高血压占比比较,差异有统计学意义(P<0.05);女性研究对象中发生颈动脉内中膜增厚330例,无颈动脉内中膜增厚和颈动脉内中膜增厚者的随访时间、年龄、BMI、SBP、DBP、TC、TG、LDL-C、nHDL-C、高血压占比比较,差异有统计学意义(P<0.05)。男性人群中,3类别模型的熵值最高,BIC、SABIC最小且满足条件独立假定(Score Test P=0.2079),最终选择3分类作为拟合效果最佳的模型;女性人群4类别模型的熵值、BIC、SABIC与3类别模型相比变化不大,且满足条件独立假定(Score Test P=0.2678),最终选择4分类作为拟合效果最佳的模型。体检人群中男性nHDL-C的3个潜在类别中,类别1的轨迹曲线表现为先缓慢上升后平稳维持在较低水平,为“低水平稳定组”,占比83.80%;类别2表现为快速上升,为“快速升高组”,占比1.09%;类别3表现为缓慢上升,为“缓慢升高组”,占比15.12%;快速升高组风险最高,其次是缓慢升高组,低水平稳定组发生风险最低。相比于低水平稳定组,男性缓慢升高组和快速升高组的HR分别为10.51(95%CI=7.90~13.98)和23.25(95%CI=10.40~51.98)。体检人群中女性nHDL-C的4个潜在类别中,类别1的轨迹曲线表现为稳定的低水平,为“低水平稳定组”,占比93.09%;类别2的轨迹曲线呈现为“U型”,为“低水平稳定-升高组”,占比1.26%;类别3血脂稳定在中等水平,无明显波动,为“中等水平稳定组”,占比4.58%;类别4表现为血脂水平的快速增加,为“快速升高组”,占比1.08%。快速升高组的风险最高,40岁以前,低水平稳定组、低水平稳定-升高组、中等水平稳定组的风险接近,40岁以后中等水平稳定组颈动脉内中膜增厚风险快速增加,50岁以后低水平稳定-升高组风险快速增加。对各个亚组内4个类别人群的颈动脉内中膜增厚累积发生风险进行对比,相比于低水平稳定组,女性低水平稳定-升高组、中等水平稳定组和快速升高组的HR分别为3.69(95%CI=2.27~5.99)、15.48(95%CI=10.56~22.70)和13.93(95%CI=5.44~35.69)。模型拟合优度检验及评估结果显示,在男性及女性人群中,与基线模型相比,Class模型、Class+nHDL-C模型在多个时点的AUC和C-index值均明显增加。结论健康体检人群中,男性和女性nHDL-C水平均存在不同变化轨迹,不同轨迹类别显著影响颈动脉内中膜增厚的发生风险。相比单一基线nHDL-C值,轨迹分类能更精准地预测颈动脉内中膜增厚风险,连续血脂监测对于个体的健康管理具有重要意义。结合轨迹分析的风险评估方法有助于早期识别高危个体,为个体的风险分层和积极干预提供依据。展开更多
文摘In this paper, we first evaluated the distribution of blood pressure (BP) using a dataset containing 113,979 measurements in 48,022 individuals with the cooperation of one health insurance society in Japan from April, 2013 to March, 2016. The means of the systolic BP (SBP) and diastolic BP (DBP) were 125.4 and 77.6 mmHg with standard deviations of 16.5 and 11.7 mmHg, respectively. Under the 140/90 criterion, 21.6% of the measurements showed hypertension. According to the World Health Organization/International Society of Hypertension criterion, 16.4%, 4.2% and 0.96% were classified as grades 1, 2 and 3, respectively. The factors affecting BP were evaluated by a regression analysis and were found to include age, gender, some eating habits, daily activities, smoking, drinking alcohol, sleeping and wages. Age was a very important factor, and the age cohorts from the previous study might be revised based on these findings. Among factors that individuals can control, the influence of drinking alcohol is very large. Comparing to an individual who does not drink, SBP and DBP of a heavy drinker are more than 5.0 mmHg higher on the average.
文摘Background: Many people take medicines to control high blood pressure (BP), or hypertension. Randomized clinical trials (RCT) are usually used for the evaluation of effects of medicines. However, RCT have some serious problems. Data and Methods: We evaluated the effects of BP medicines in Japan using a dataset containing 113,979 cases. We employed four statistical methods in the analysis. First, we simply compared the systolic blood pressure (SBP) of individuals with and without BP medicines. We then used a regression model with a dummy variable, representing taking medicines or not. We replaced the dummy variable by its expected value, and estimated the regression model again. Finally, we selected individuals who had both taken and not taken medicines at different times. The effect of sample selection was also considered in the estimation. Results: For the simple comparison, SBP with BP medicines was 11 mmHg higher than without medicines. In the next regression analysis, SBP with BP medicines was still 5 mmHg higher. When the dummy variable was replaced by its expected value, SBP with medicines decreased by 7 mmHg. For individuals taking medicines at some times and not at others, SBP decreased by 9 and 8 mmHg in models with and without a sample bias correction, respectively. Conclusion: The methods eliminated some problems of RCT and might be attractive. However, we obtained contradictory conclusions depending on the statistical methods employed, despite using the identical dataset. Statistical methods must be selected carefully to obtain a reliable evaluation. Limitations: The dataset was observatory, and the sample period was only 3 years.
文摘Background: The cost and economic burden of diabetes are a serious worldwide issue. In this study, we evaluated medical payments for persons diagnosed with diabetes and the factors that led to a person having diabetes to reduce its prevalence. Methods: A dataset containing 113,979 medical checkups and 3,671,783 monthly medical, dental, care-giving and pharmacy payment records of one health insurance society was used. The dataset contains information of normal and healthy persons. The sample period ran from April, 2013 to March, 2016. The medical payments for persons diagnosed with diabetes were calculated. The regression analysis was used to remove the effects of age and gender. The probit analysis was used to analyze the factors that led to a person having diabetes. Results: In 2.9% of cases, the person undergoing the checkup was diagnosed with diabetes, and the medical payments for these patients were 2.7 times as much as the average medical payment per person. This result did not change significantly even if age and gender were considered. The results of the probit analysis suggested that body mass index, high systolic blood pressure, low diastolic blood pressure, eating habits, physical activities, smoking, drinking alcohol and sleeping were important factors for diabetes. Conclusion: The diabetes might be a costlier disease than previously thought in Japan. By the estimation, 8% of all medical payments were made for these persons with diabetes, which is much higher than the result shown by national survey data. However, overall prevalence could be recused by efforts such as prevention of overweight and obesity.
文摘Objective:To appraise the effectiveness of HbA_(1c) and fasting plasma glucose(FPG) on screening diabetes in health check-up.Methods:A total of 1 337 individuals(male 850,female 487),aged 27 to 91 years with HbA_(1c) test were included.Participates with HbA_(1c)≥6.0%or FPG≥6.1 mmol/ L underwent oral glucose tolerance test(OGTT).Diabetes mellitus was diagnosed according to the criteria of WHO in 1999,FPG≥7.0 mmol/L and/or OGTT 2 h-postload plasm glucose(2 h-PG)≥11.1 mmol/L.The sensitivity and specificity of HbA_(1c) thresholds and FPG or combination test on screening of diabetes were analyzed.Results:A total of 842 subjects had HbA_(1c)<6.0%,in which 32 had isolated FPG≥6.1 mmol/L,of 495 had HbA_(1c)≥6.0%.Subjects with HbA_(1c)≥6.0% had significant increased disorder indexes than those with HbA_(1c)<6.0%.527 subjects who had HbA_(1c)≥6.0%or FPG≥6.1 mmol/L underwent OGTT.A total of 234 subjects were newly diagnosed diabetes,including 123(123/234,52.56%) with FPG≥7.0 mmol/L,and 111 subjects(111/234, 47.43%) with isolated 2 h-PG≥11.1 mmol/L.Among 234 new diabetes,91.88%(215 subjects) had HbA_(1c)≥6.3%,and 77.40%(181 subjects) had HbA_(1c)≥6.5%.HbA_(1c)≥6.3%combined FPG≥7.0 mmol/L increased the positive rate of newly diagnosed diabetes from 91.88%to 96.58%. Conclusions:HbA_(1c) is a practical and convenient tool for screening undiagnosed diabetes in routine health check-up of a large population.Combined use of HbA_(1c)≥6.3%and/or FPG≥7.0 mmol/L is efficient for early detection of diabetes.
文摘AIM: To identify associated factors of diabetic retinopathy(DR) screening and ey e check-up practice among diabetes mellitus(DM) patients attending Felege Hiwot Specialized Hospital.METHODS: An institution-based cross-sectional study was applied from October 4, 2019 to January 12, 2020 at Felege Hiwot Specialized Hospital. A systematic random sampling technique was used to recruit participants and an interviewer-administered questionnaire was employed to collect the data. The collected data were entered into Epi Info version 7 and transposed to SPSS version 24 for statistical analysis. Descriptive statistics were executed and associated factors were identified using binary logistic regression. The strength of association between the independent and the outcome variable was determined using an adjusted odds ratio(AOR) with 95% confidence interval(CI). RESULTS: Four hundred and six participants partake with a response rate of 95.7% and a mean age of 47±11.5y. The magnitude of DR screening was 308(75.9%, 95%CI: 71.5%, 79.8%). Higher educational level(AOR=3.25;95%CI: 1.40, 8.78), good knowledge of DR(AOR=2.50;95%CI: 1.55, 4.46), and family history of DM(AOR=2.15;95%CI: 1.41,3.85) were significantly associated with DR screening. On the other side, rural residence [AOR=3.11(1.89, 5.02)] and undesirable attitudes toward DR [AOR=5.65(3.14, 8.76)] were significantly associated with poor regular eye checkup practice.CONCLUSION: Most of the participants are screened for DR. Higher education, family history, and good knowledge are associated with DR screening. In addition, rural residence and undesirable attitudes toward DR are associated with regular eye checkup practice.
文摘Background: Caries detection in school oral examinations insufficient accuracy. Objective: To evaluate advantages of introducing quantitative light-induced fluorescence-digital (QLF-D) in school oral examinations. Methods: Experiment No. 1. Early demineralized lesions in the upper and lower incisors and canines were visually inspected by three dentists and by QLF-D. The numbers of tooth planes with early demineralized lesions were compared between the methods. Experiment No. 2. Approximal demineralized lesions in molars were assessed by visual inspection, x-ray imaging, and QLF-D. The numbers of tooth planes with demineralized lesions were compared among the methods. Experiment No. 3. Plaque distribution was evaluated by QLF-D and a traditional staining method. The ratio of the diameter of plaque to tooth crown in the tooth axis direction in each method was calculated. The results were evaluated by Pearson’s correlation coefficient analysis and Bland-Altman plot. Results: Experiment No. 1. The three dentists found 0.67 tooth planes on average. QLF-D found 22 tooth planes with early demineralized lesions in the same samples. Experiment No. 2. Fourteen approximal tooth planes of molars were found to have demineralized lesions by x-ray imaging. QLF-D detected 71.4% of the tooth planes out of the 14, whereas visual inspection found 7.1%. Experiment No. 3. The Pearson’s correlation coefficient for the evaluations of plaque distribution between the QLF-D and traditional staining methods was 0.77 (P Conclusion: The results support introduction of QLF-D for use in school dental examinations.
文摘To prevent the development of metabolic syndrome among adult members of the community, improving the participation rate in the specific medical checkup (a medical examination focused on factors associated with metabolic syndrome prior to the onset of lifestyle-related disease) is an important public health issue. This study used claim data and health checkup data and aimed to detect those community-dwelling adults who were least likely to participate in the specific medical checkup. Analysis included the medical and health checkup chart data of 61,753 adults aged 60 - 69 years (as of April 2011) who lived in Fukui prefecture, Japan. The chi-squared interaction was used to analyze data. If a person did not participate in the specific medical checkup, individual was categorized as “absent.” Between April 2012 and March 2013, 66.3% of subjects were absent from the specific medical checkup. Those most likely to be absent included those who were also absent at the previous year’s checkup, those who were men, and those who did not have an examination for hypertension;87.9% of patients who met all of these criteria were absent. Among women who were absent at the previous year’s checkup, the absentee rate differed by about 10.0% between those whose municipalities did (74.8%) or did not (84.2%) have a free checkup program. Our findings may help public health professionals detect those who require intervention and to effectively and efficiently improve participation in the specific medical checkup.
文摘Background: The high blood pressure (BP) or hypertension is a widely prevalent disease and its costs are very high, and many studies about the relationships between BP and health conditions have been done. We need to know the precise distributions of BP and factors affecting BP. Data and Methods: The distributions of BP are analyzed using 12,877,653 observations obtained from the JMDC Claims Database. The factors that may affect the BP are analyzed by the regression models using 4,615,346 observations. Results: The averages of systolic BP (SBP) and diastolic BP (DBP) are 120.4 and 74.2 mmHg with standard deviations of 15.9 and 11.3 mmHg, respectively. Among the nonmodifiable factors, age and gender are important factors. Among the modifiable factors, variables related to obesity are important risk factors. Taking antihypertensive drugs makes SBP and DBP 13.4 mmHg and 7.8 mmHg lower. Conclusion: The criteria of BP should be carefully determined considering age and gender. The effects of age may be a little different for SBP and DBP. It is necessary to use the proper model to evaluate the effect of antihypertensive drugs correctly. Limitations: The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.
文摘To evaluate the impact of behavioral restrictions on perinatal care caused by the COVID-19 pandemic, we conducted a questionnaire survey of 1976 medical institutions handling deliveries across Japan. The survey examined changes in the number of antenatal checkups due to behavioral restrictions, visit restrictions at medical institutions, and the acceptance of COVID-19-infected pregnant and nursing mothers. An increased burden was observed at delivery hospitals, irrespective of whether they accepted infected pregnant and nursing mothers. Some medical institutions were unable to manage infected pregnant women and transferred them to other facilities, highlighting the need for role-sharing among institutions. The number of antenatal checkups showed a decreasing trend, indicating that the pandemic negatively affected checkup attendance. However, no clear increase in perinatal deaths was observed during the observation period, despite the reduction in the number of checkups.
文摘背景颈动脉内中膜增厚是反映动脉粥样硬化早期改变的重要指标,及时发现、积极干预可以得到有效逆转。目的探索非高密度脂蛋白胆固醇(nHDL-C)的动态变化轨迹与成人颈动脉内中膜增厚的关联,预测健康体检人群颈动脉内中膜增厚的风险。方法本研究为一项双向性队列研究,纳入2013—2023年在北京大学第三医院参加健康体检的人群为研究对象,收集患者基线资料、体检指标,测量颈动脉内膜中层厚度(CIMT),对基线CIMT正常的研究对象进行随访,直到出现颈动脉内中膜增厚或失访。分别构建男性和女性研究对象nHDL-C随年龄的变化轨迹。纳入结局发生前的所有nHDL-C记录,使用联合潜在类别模型(JLCM)识别异质性nHDL-C变化轨迹并预测不同轨迹与发生颈动脉内中膜增厚的风险差异。采用赤池信息准则(AIC)、贝叶斯信息准则(BIC)、样本调整信息准则(SABIC)、熵值(Entropy>0.5)和满足条件独立假定(Score Test P>0.05)确定最优潜在类别个数。分别使用基线nHDL-C数值和nHDL-C变化轨迹构建Cox模型,比较各模型的受试者工作特征(ROC)曲线下面积(AUC)、一致性指数(C-index)数值,对模型拟合优度进行检验及评估。结果共纳入基线血脂处于正常水平的研究对象5741人,男2487人,女3254人。男性研究对象中发生颈动脉内中膜增厚393例,无颈动脉内中膜增厚和颈动脉内中膜增厚者比较,随访时间、年龄、BMI、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、nHDL-C、高血压占比比较,差异有统计学意义(P<0.05);女性研究对象中发生颈动脉内中膜增厚330例,无颈动脉内中膜增厚和颈动脉内中膜增厚者的随访时间、年龄、BMI、SBP、DBP、TC、TG、LDL-C、nHDL-C、高血压占比比较,差异有统计学意义(P<0.05)。男性人群中,3类别模型的熵值最高,BIC、SABIC最小且满足条件独立假定(Score Test P=0.2079),最终选择3分类作为拟合效果最佳的模型;女性人群4类别模型的熵值、BIC、SABIC与3类别模型相比变化不大,且满足条件独立假定(Score Test P=0.2678),最终选择4分类作为拟合效果最佳的模型。体检人群中男性nHDL-C的3个潜在类别中,类别1的轨迹曲线表现为先缓慢上升后平稳维持在较低水平,为“低水平稳定组”,占比83.80%;类别2表现为快速上升,为“快速升高组”,占比1.09%;类别3表现为缓慢上升,为“缓慢升高组”,占比15.12%;快速升高组风险最高,其次是缓慢升高组,低水平稳定组发生风险最低。相比于低水平稳定组,男性缓慢升高组和快速升高组的HR分别为10.51(95%CI=7.90~13.98)和23.25(95%CI=10.40~51.98)。体检人群中女性nHDL-C的4个潜在类别中,类别1的轨迹曲线表现为稳定的低水平,为“低水平稳定组”,占比93.09%;类别2的轨迹曲线呈现为“U型”,为“低水平稳定-升高组”,占比1.26%;类别3血脂稳定在中等水平,无明显波动,为“中等水平稳定组”,占比4.58%;类别4表现为血脂水平的快速增加,为“快速升高组”,占比1.08%。快速升高组的风险最高,40岁以前,低水平稳定组、低水平稳定-升高组、中等水平稳定组的风险接近,40岁以后中等水平稳定组颈动脉内中膜增厚风险快速增加,50岁以后低水平稳定-升高组风险快速增加。对各个亚组内4个类别人群的颈动脉内中膜增厚累积发生风险进行对比,相比于低水平稳定组,女性低水平稳定-升高组、中等水平稳定组和快速升高组的HR分别为3.69(95%CI=2.27~5.99)、15.48(95%CI=10.56~22.70)和13.93(95%CI=5.44~35.69)。模型拟合优度检验及评估结果显示,在男性及女性人群中,与基线模型相比,Class模型、Class+nHDL-C模型在多个时点的AUC和C-index值均明显增加。结论健康体检人群中,男性和女性nHDL-C水平均存在不同变化轨迹,不同轨迹类别显著影响颈动脉内中膜增厚的发生风险。相比单一基线nHDL-C值,轨迹分类能更精准地预测颈动脉内中膜增厚风险,连续血脂监测对于个体的健康管理具有重要意义。结合轨迹分析的风险评估方法有助于早期识别高危个体,为个体的风险分层和积极干预提供依据。
