九州大学 研究者情報
論文一覧
馬場園 明(ばばぞの あきら) データ更新日:2021.11.11

教授 /  医学研究院 基礎医学部門 医学研究院医療経営管理学講座


原著論文
1. 田中 達士、馬場園 明, 地域包括ケアシステムを中核としたまちづくり~山口県萩市で地域包括ケアシステムの構築を図る~ , 医療福祉経営マーケティング研究, 1, 1-12, 2021.11.
2. Shiomoto K, Babazono A, Harano Y, Fujita T, Jiang P, Kim S, Nakashima Y, Effect of body mass index on vertebral and hip fractures in 0lder people and differences according to sex: A retrospective Japanese cohort study , BMJ Open, in press., 2021.10.
3. Ishihara R, Babazono A, Liu N, Yamao R, Impact of income and eating speed on new-onset diabetes among men: a retrospective cohort study
, BMJ Open , 2021;11:e048855, 2021.10.
4. Fujita T, Babazono A, Jiang P, Jamal A, Li Y, Cost-effectiveness analysis of treatment with varenicline for nicotine dependence compared with smoking cessation without pharmacotherapy in the real world, Pharmacoepidemiology and Drug Safety, in press, 2021.09.
5. Li Y, Babazono A, Jamal A, Liu N, Yamao R, Population-based multilevel models to estimate the management strategies for acute myocardial
infarction in older adults with dementia, Clinical Epidemiolog, in press., 2021.09.
6. Nishi T, Maeda T, Katsuki S, Babazono A, Impact of the 2014 coinsurance rate revision for the elderly on healthcare resource utilization in Japan, Health Economics Review, org/10.1186/s13561-021-00324-0, 2021.07.
7. Jamal A ,Babazono A, Li Y, Fujita T, Yoshida S, Kim, SA, Elucidating variations in outcomes among older end-stage renal disease patients on hemodialysis in Fukuoka Prefecture, Japan, PloS one, org/10.1371/journal.pone.0252196, doi.org/10.1371/journal.pone.0252196, 2021.05.
8. Li Y, Babazono A, Ohmori T, Jamal A, Yoshida S, Kim S, , Health inequality among older adults with percutaneous coronary intervention living in universal health coverage in Japan, Popul Health Manag, 10.1089/pop.2021.0070, 2021 Jun 1. doi: , 2021.06.
9. Kim SA, Babazono A, Jamal A, Li Y, Liu N, , Comparison of Care Utilization and Medical Institutional Death among Older Adults by Home Care Facility Type: A Retrospective Cohort Study in Fukuoka, Japan, BMJ Open, 2021 Apr 14;11(4):e041964., 2021.04.
10. Liu N, Babazono A, Kim SA, Li Y, , The Effect of Care Rehabilitation on Medical Expenses, Care Costs and Total Costs of Elderly Individuals of Parkinson’s Disease, Popul Health Manag, 10.1089/pop.2020.0316., . 2021 Mar 9. doi: 10.1089/pop.2020.0316., 2021.03.
11. Jamal A, Babazono A, Li Y, Yoshida S, Fujita T, , Quantifying regional and health care variations to identify improvement areas for quality hemodialysis services and survival outcomes, ,American Journal of Medical Quality, 10.1097/01.JMQ.0000735484.44163.ce., 2021 May 18. doi: 10.1097/01.JMQ.0000735484.44163.ce., 2021.03.
12. Li Y , Babazono A, Jamal A, Fujita T,Yoshida S, Kim S,, Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan, International Journal for Equity in Health (2021) 20:80, 10.1186/s12939-021-01415-4., (2021) 20:80, 2021.01.
13. 曽我いずみ, 馬場園明, 「介護医療院いなつき」を中心とした地域包括ケアシステムの構築に向けた検討, 医療福祉経営マーケティング研究, 15, 1, 7-16, 15、1、7-16、2020, 2020.10.
14. #梅木駿太, @馬場園明, 急性期病院における非薬物的せん妄予防に関する試み-心血管術後患者を対象とした横断研究, 医療福祉経営マーケティング研究, 15, 1, 1-6, 15、1、1-6、2020, 2020.10.
15. Yunfei Li, Akira Babazono, Aziz Jamal, Peng Jiang, Takako Fujita, Cost-Sharing Effects on Hospital Service Utilization Among Older People in Fukuoka Prefecture, Japan, International Journal of Health Policy and Management, 10.34172/ijhpm.2020.190, 2020.10, [URL], BACKGROUND: The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system.
METHODS: The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization.
RESULTS: For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level.
CONCLUSION: The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced..
16. 來島 裕太, 馬場園 明, 医療マネジメントに向けた入院患者数の将来予測 : 将来的な診療体制の検討, 日本診療情報管理学会誌, 32、7、51-57, 2020.07.
17. Aziz Jamal, Akira Babazono, Yunfei Li, Shinichiro Yoshida, Takako Fujita, Multilevel analysis of hemodialysis-associated infection among end-stage renal disease patients
results of a retrospective cohort study utilizing the insurance claim data of Fukuoka Prefecture, Japan, Medicine, 10.1097/MD.0000000000019871, 99, 18, e19871, 2020.05, [URL], The presence of comorbid conditions along with heterogeneity in terms of healthcare practices and service delivery could have a significant impact on the patient's outcomes. With a strong interest in social epidemiology to examine the impact of health services and variations on health outcomes, the current study was conducted to analyse the incidence of hemodialysis-associated infection (HAI) as well as its associated factors, and to quantify the extent to which the contextual effects of the care facility and regional variations influence the risk of HAI.A total of 6111 patients with end-stage renal disease who received hemodialysis treatment between 1 October 2015 and 31 March 2016 were identified from the insurance claim database as a population-based, close-cohort retrospective study. Patients were followed for one year from April 1, 2016 to March 31, 2017. A total of 200 HAI cases were observed during the follow-up and 12 patients died within 90 days of the onset of HAI. Increased risks for HAI were associated with moderate (HR 1.73, 95% confidence interval [CI] 1.00-2.98) and severe (HR 1.87, 95% CI 1.11-3.14) comorbid conditions as well as malignancy (HR 1.36, 95% CI 1.00-1.85). Increased risk was also seen among patients who received hemodialysis treatment from clinics (HR 2.49, 95% CI 1.1-5.33). However, these statistics were no longer significant when variations at the level of care facilities were statistically controlled. In univariate analyses, no statistically significant association was observed between 90-day mortality and baseline patients, and the characteristics of the care facility.The results of the multivariate, multilevel analyses indicated that HAI variations were only significant at the care facility level (σ 2.07, 95% CI 1.3-3.2) and were largely explained by the heterogeneity between care facilities. The results of this study highlight the need to look beyond the influence of patient-level characteristics when developing policies that aim at improving the quality of hemodialysis healthcare and service delivery in Japan..
18. Takako Fujita, Akira Babazono, Yumi Harano, Peng Jiang, Influence of Occupational Background on Smoking Prevalence as a Health Inequality among Employees of Medium- and Small-Sized Companies in Japan, Population Health Management, 10.1089/pop.2019.0021, 23, 2, 183-193, 2020.04, [URL], Tobacco smoking is a major public health problem. In addition, the influence of socioeconomic status on health inequalities has received great attention worldwide. The authors used insurance data of beneficiaries employed in medium- and small-sized Japanese companies to investigate the influence of occupational background on smoking prevalence as a health inequality among workers in Japan. Participants were aged 35-74 years and underwent health examinations in 2015. Smoking prevalence was estimated for each occupational group according to sex, age, and income. Logistic regression analysis was used to assess the association between smoking status and occupational groups. A total of 385,945 participants were included. Overall smoking prevalence was 36.3%, higher than average in Japan. Smoking prevalence was lowest among workers in the education and learning support category; all other occupational groups had significantly high prevalence, with the highest for transport and postal services (odds ratio 2.69, 95% confidence interval 2.53-2.86). There were few differences in smoking prevalence at higher income levels among female participants, but differences were remarkably significant at lower income levels. For health inequalities related to smoking, occupational background was associated with smoking prevalence. In particular, there was high smoking prevalence in workplaces not covered by smoke-free policies. These results also demonstrated differences between the sexes; smoking prevalence among female workers with lower income levels was strongly associated with occupational background whereas there were no large differences among male workers by income. These findings suggest that the government should encourage companies to adopt smoke-free policies in the workplace..
19. Fumiko Murata, Akira Babazono, Haruhisa Fukuda, Effect of income on length of stay in a hospital or long-term care facility among older adults with dementia in Japan, International Journal of Geriatric Psychiatry, 10.1002/gps.5248, 35, 3, 302-311, 2020.03, [URL], Objective: We aimed to ascertain the degree of influence of income disparity among older people with newly developed dementia on the probability and duration of stay in a hospital or long-term care facility and the degree of influence on medical expenses for hospitalization and care costs. Methods: This was a retrospective cohort study. Study participants included 12 829 individuals aged 75 years or older not diagnosed with dementia between April 2012 and March 2013 but newly diagnosed with dementia between April 2013 and March 2014. Participants were categorized according to income. We evaluated the associations of income with the probability and duration of stay in a hospital or long-term care facility and the costs for hospitalization and care. Results: In the adjusted analyses, high-income individuals had a lower probability of admission to a hospital or long-term care facility than middle- and high-income individuals. In all hospitals, low-income individuals had the longest duration of stay, but in long-term care facilities, income categories varied by facility type. Medical expenses for hospitalization and care costs were highest in the low-income group. Conclusion: Income category affects the probability and duration of stay in the hospital or a long-term care facility, as well as expenses for hospitalization and care. It is necessary to consider a policy to enable low-income older patients with dementia to continue living at home..
20. Takumi Nishi, Toshiki Maeda, Takuya Imatoh, Akira Babazono, Comparison of regional with general anesthesia on mortality and perioperative length of stay in older patients after hip fracture surgery, International Journal for Quality in Health Care, 10.1093/intqhc/mzy233, 31, 9, 669-676, 2019.11, [URL], Objective: The aim of this study was to examine whether anesthetic technique is associated with 30-or 90-day mortality and perioperative length of stay (LOS). Design: We used a retrospective cohort design using a healthcare insurance claims database. Setting: The Fukuoka Prefecture’s claims database of older patients who underwent hip fracture surgery under general or regional (spinal or epidural) anesthesia from April 2012 to March 2016 was used for analyses. Participants: The database under analyses contained 16 125 participants of hip fracture surgery under general or regional anesthesia. Main Outcome Measure: We measured 30- and 90-day mortalities and perioperative LOS. Results: In a propensity score-matched cohort, we found no significant differences in 30- and 90-day mortalities after adjusting for confounding factors. The reconverted perioperative LOS for the general and regional anesthesia groups was, respectively, 29.7 (29.1–30.4) and 28.0 (27.4–28.6) days in the matched cohort. Therefore, the perioperative LOS in the regional anesthesia group was significantly shorter by 1.7 days than in the general anesthesia group (P < 0.001). Conclusions: This study demonstrated that the use of regional anesthesia was not associated with 30-or 90-day mortality, but it was associated with slightly shorter perioperative LOS. Since Japan has much longer LOS than other countries, our findings have implications for more efficient healthcare resource utilization and quality assurance in geriatric care..
21. 古賀大一郎、馬場園明, 訪問リハビリテーションの仕組みであるKAKOシステムの開発と検証, 医療福祉経営マーケティング研究, 2019.10.
22. Peng Jiang, Akira Babazono, Takako Fujita, Health Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan, Population Health Management, 10.1089/pop.2019.0141, 2019.10, [URL], The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013-2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium- and high-income males, respectively, were 1.35 (95% CI: 1.27-1.43) and 1.41 (95% CI: 1.30-1.54); females: 1.17 (95% CI: 1.11-1.23) and 1.24 (95% CI: 1.13-1.35). Adjusted hazard ratios (AHRs) for male hospitalization were 0.88 (95% CI: 0.80-0.96) and 0.88 (95% CI: 0.79-0.99); females: 1.00 (95% CI: 0.93-1.07) and 0.95 (95% CI: 0.83-1.08). AHRs for male in-hospital death were 0.83 (95% CI: 0.75-0.91) and 0.62 (95% CI: 0.54-0.70); females: 0.94 (95% CI: 0.87-1.02) and 0.77 (95% CI: 0.65-0.92). Results revealed sex-specific health inequalities among older Japanese diabetes patients. Subjects with worse SES had significantly poorer OHA medication adherence (both sexes), higher hospitalization risk for diabetes complications (males), and higher in-hospital death risk (both sexes)..
23. 亟々美香、馬場園明, 市町村における認知症対策の戦略について, 医療福祉経営マーケティング研究, 2019.09.
24. 吉田真一郎、姜鵬、藤田貴子、馬場園明, 福岡県後期高齢者医療制度における集中治療受療率の地域差, 日本医療・病院管理学会誌, 2019.09.
25. Takako Fujita, Akira Babazono, Yumi Harano, Peng Jiang, Risk of depressive disorders after tobacco smoking cessation:a retrospective cohort study in Fukuoka, Japan, BMJ open, 10.1136/bmjopen-2018-025124, 9, 3, e025124, 2019.03, [URL], OBJECTIVE: We sought to examine the effect of smoking cessation on subsequent development of depressive disorders.
DESIGN: This was a retrospective cohort study.
METHODS: We used administrative claim and health check data from fiscal years 2010 to 2014, obtained from the largest health insurance association in Fukuoka, Japan. Study participants were between 30 and 69 years old. The end-point outcome was incidence of depressive disorders. Survival analysis and Cox proportional hazards models were conducted. The evaluated potential confounders were sex, age, standard monthly income and psychiatric medical history.
RESULTS: The final number of participants was 87 255, with 7841 in the smoking cessation group and 79 414 in the smoking group. The result of survival analysis showed no significant difference in depressive disorders between the two groups. The results of Cox proportional hazards models showed no significant difference by multivariate analysis between participants, including users of smoking cessation medication (HR 1.04, 95% Cl 0.89 to 1.22) and excluding medication use (HR 0.97, 95% Cl 0.82 to 1.15).
CONCLUSIONS: The present study showed that there were no significant differences with respect to having depressive disorders between smoking cessation and smoking groups. We also showed that smoking cessation was not related to incidence of depressive disorders among participants, including and excluding users of smoking cessation medication, after adjusting for potential confounders. Although the results have some limitations because of the nature of the study design, our findings will provide helpful information to smokers, health professionals and policy makers for improving smoking cessation..
26. Takumi Nishi, Akira Babazono, Toshiki Maeda, Association between income levels and irregular physician visits after a health checkup, and its consequent effect on glycemic control among employees
A retrospective propensity score-matched cohort study, Journal of Diabetes Investigation, 10.1111/jdi.13025, 10, 5, 1372-1381, 2019.01, [URL], Aims/Introduction: The present study aimed to evaluate the effects of income levels on physician visit patterns and to quantify the consequent impact of irregular physician visits on glycemic control among employees’ health insurance beneficiaries in Japan. Materials and Methods: We obtained specific health checkup data of untreated diabetes patients from the Fukuoka branch of the Japanese Health Insurance Association. We selected 2,981 insurance beneficiaries and classified 650 and 2,331 patients into, respectively, the regular visit and irregular visit group. We implemented propensity score matching to select an adequate control group. Results: Compared with those with a standard monthly income <$2,000 (US$1 = ¥100), those with a higher monthly income were less likely to have irregular visits; $2,000–2,999: odds ratio 0.74 (95% confidence interval 0.56–0.98), $3,000–3,999: odds ratio 0.63 (95% confidence interval 0.46–0.87) and ≥$5,000: odds ratio 0.58 (95% confidence interval 0.39–0.86). After propensity score matching and adjusting for covariates, the irregular visit group tended to have poor glycemic control; increased glycated hemoglobin ≥0.5: odds ratio 1.90 (95% confidence interval 1.30–2.77), ≥1.0: odds ratio 2.75 (95% confidence interval 1.56–4.82) and ≥20% relatively: odds ratio 3.18 (95% confidence interval 1.46–6.92). Conclusions: We clarified that there was a significant relationship between income and irregular visits, and this consequently resulted in poor glycemic control. These findings would be useful for more effective disease management..
27. 金晟娥,馬場園明, 後期高齢がん患者における終末期医療費と死亡場所, 医療福祉経営マーケティング研究, 12, 1, 1-10, 2018.10.
28. Toshiki Maeda, Akira Babazono, Takumi Nishi, Hisatomi Arima, Masayoshi Tsuji, Miki Kawazoe, Atsushi Satoh, Effects of gastrostomy fee schedule revision on artificial nutrition routes among older people with dementia in Japan
A time series observational study, Geriatrics and Gerontology International, 10.1111/ggi.13491, 18, 9, 1405-1409, 2018.09, [URL], Aim: The present study aimed to investigate the effects of the 2014 Japanese fee schedule revision on trends in artificial nutrition routes, including gastrostomy, nasogastric tube and parenteral nutrition, among older people with dementia, using time series analysis. Methods: The study used claim data in Japan submitted to Fukuoka Late Elders' Health Insurance from fiscal year 2010 to fiscal year 2016. We identified older people with dementia provided for the first time with artificial nutrition via gastrostomy, nasogastric tube or central venous line and aggregated their data by month. Interrupted time series analyses were used to examine trends in artificial nutrition routes over time. Results: The numbers of older people with dementia receiving nutrition via gastrostomy, nasogastric tube and parenterally declined consistently. The slopes for pre-revision trends in gastrostomy, nasogastric tube and parenteral nutrition procedures were all significantly negative in the interrupted time series analyses. The post-revision trends in gastrostomy and parenteral nutrition continuously had significant negative slopes. In contrast, the significant negative trend in nasogastric tube procedures in the pre-revision period had disappeared during the post-revision period. Conclusions: The study showed that the fee schedule revision had limited impact on gastrostomy and parenteral nutrition. However the trend for nasogastric tube was ambiguous; hence, sustainable surveillance is required for evidence-based health policy. Geriatr Gerontol Int 2018; 18: 1405–1409..
29. Yumi Harano, Akira Babazono, Takako Fujita, Peng Jiang, Efficacy of S-1 monotherapy for older patients with unresectable pancreatic cancer
A retrospective cohort study, Journal of Geriatric Oncology, 10.1016/j.jgo.2018.09.004, 2018.09, [URL], OBJECTIVES: Pancreatic cancer is a fatal malignancy that frequently occurs in older patients. However, limited evidence is available on the effects of chemotherapy on older patients with unresectable pancreatic cancer. Here we explored the efficacy of S-1, an oral fluorouracil drug, compared with gemcitabine, as first-line chemotherapy.
MATERIALS AND METHODS: We conducted a retrospective cohort study of patients with unresectable pancreatic cancer aged ≥75 years. For this purpose, we used the claims and master databases of the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare between April 1, 2010 to March 31, 2017. According to first-line chemotherapy, we divided patients into gemcitabine and S-1 groups to compare three-year survival from the date of diagnosis and time to second-line chemotherapy as a surrogate indicator of progression-free survival. We analyzed the data using multivariate Cox proportional hazards method.
RESULTS: The study comprised 680 patients, of which 92.5% (N = 629) died within three years of diagnosis. The S-1 group had a significantly lower risk of death within three years of diagnosis (hazard ratio (HR) 0.695, 95% CI: 0. 588-0. 821, p < .001). There were no significant differences (HR 0.968, 95% CI: 0.708-1.324, p = .838) in time to second-line chemotherapy. Two sensitivity analyses excluding study subjects who received radiation therapy or second-line chemotherapy yielded consistent results (HR 0.746, 95% CI: 0.622-0.895, p = .002, HR 0.628, 95% CI: 0. 509-0.776, p < .001, respectively).
CONCLUSION: S-1 can serve as a first-line chemotherapeutic option of patients aged ≥75 years with unresectable pancreatic cancer..
30. Takuya Imatoh, Takumi Nishi, Midori Yasui, Toshiki Maeda, Kimie Sai, Yoshiro Saito, Hiroshi Une, Akira Babazono, Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients
A retrospective cohort study, Pharmacoepidemiology and Drug Safety, 10.1002/pds.4560, 27, 8, 931-939, 2018.08, [URL], Purpose: Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of antidiabetic drugs. Although they have been reported to increase the risk of infection, the findings are controversial. Given that urinary tract infections (UTIs) are common in the elderly, we conducted a retrospective cohort study by using health care insurance claims data, to elucidate the association between the DPP-4 inhibitors and the incidence of UTI in latter-stage elderly patients. Methods: We analyzed 25,111 Japanese patients aged 75 years and older between the fiscal years 2011 and 2016. Patients using DPP-4 inhibitors and sulfonylureas (SUs) were matched at a 1:1 ratio using propensity scoring. The Incidence rate ratio (IRR) of UTI was compared between users of SUs and users of DPP-4 inhibitors by Poisson regression. Moreover, subgroup analyses stratified by sex were conducted to evaluate whether the combination of prostatic hyperplasia and DPP-4 inhibitors is associated with the incidence of UTI in male patients. Results: The use of DPP-4 inhibitors was associated with an increased risk of UTI (adjusted IRR 1.23, 95% CI [1.04-1.45]). After propensity score matching, the association remained significant (adjusted IRR 1.28, 95% CI [1.05-1.56]). Moreover, elderly male patients with prostatic hyperplasia who received DPP-4 inhibitors had a higher risk of UTI than SU users without prostatic hyperplasia (Matched: crude IRR 2.90, 95% CI [1.78-4.71]; adjusted IRR 2.32, 95% CI [1.40-3.84]). Conclusions: The long-term use of DPP-4 inhibitors by elderly patients, particularly male patients with prostatic hyperplasia, may increase the risk of UTI..
31. Takumi Nishi, Toshiki Maeda, Akira Babazono, Association between financial incentives for regional care coordination and health care resource utilization among older patients after femoral neck fracture surgery
A retrospective cohort study using a claims database, Population Health Management, 10.1089/pop.2017.0100, 21, 4, 331-337, 2018.08, [URL], The incidence rates of hip fracture have been increasing in Japan. Length of stay among hip fracture patients in Japan is much longer than other developed countries, and the Japanese government introduced financial incentives for regionally coordinated femoral neck fracture care to reduce health care resource utilization. The objective of this study was to evaluate whether the financial incentives reduce health care resource utilization among patients 75 years or older with femoral neck fracture in Japan. Claims data from the Fukuoka Prefecture Regional Association for Late-Stage Healthcare for Older People were analyzed for the period from April 2010 to March 2016. The authors identified 4641 eligible subjects after femoral neck fracture surgery, and categorized them into groups based on care pathways: Coordinated care, integrated care, and other. Length of stay by care phase and total charges were used as measures of health care resource utilization. The models showed that coordinated and integrated care were significantly associated with shorter length of stay during perioperative care: Coordinated care, multiplicative effect, 0.90 (P < 0.001); integrated care, 0.77 (P < 0.001). However, only integrated care was associated with shorter rehabilitation and overall length of stay: 0.66 (P < 0.001) in rehabilitation; 0.70 (P < 0.001) in overall duration. Integrated care also was associated with lower total charges: 0.70 (P < 0.001). Current financial incentives for regionally coordinated femoral neck fracture care do not affect health care resource utilization. Further health care reforms should be implemented to promote effective regional care coordination in Japan..
32. Takako Fujita, Akira Babazono, Yumi Harano, Peng Jiang, Secondhand Smoke and Streptococcal Infection in Young Children Under Japan's Voluntary Tobacco-Free Policy, Population Health Management, 10.1089/pop.2018.0053, 2018.08, [URL], Tobacco-free policy in Japan lags behind those of most developed countries. Evidence is required to promote strong implementation of existing policies. This study aimed to assess whether exposure to secondhand smoke (SHS) influences the incidence of streptococcal infection in young children, to further support the need for effective tobacco-free policies in Japan. This study used medical administrative claim and health check data from the Japan Health Insurance Association Fukuoka branch. Participants were beneficiaries' dependents younger than age 4 years. Exposure was defined as SHS from beneficiaries' smoking, each year during 2011-2014. The outcome was incidence of streptococcal infection, diagnosed with and without laboratory testing. Logistic regression analysis was performed to yield odds ratios (ORs) of associations with the outcome and 95% confidence intervals (CIs). This study included a total of 5743 children. The proportion of all participants with a record of streptococcal infection was 4.2% (n = 244). The results of logistic regression analysis between streptococcal infection and SHS exposure showed a significantly higher association (OR 1.39, 95% CI 1.07-1.80, P < 0.05) if all cases were included and an insignificant association with diagnoses using testing (OR 1.20, 95% Cl 0.80-1.80, P = 0.39). This study showed that 60% of streptococcal infections in young children were diagnosed without testing, and SHS increased this incidence regardless of testing. It reports new findings regarding the effect of SHS on infection in young children to support implementation and promotion of tobacco-free policies by the Japanese government not only in public spaces, but also at home..
33. Toshiki Maeda, Akira Babazono, Takumi Nishi, Surveillance of First-Generation H1-Antihistamine Use for Older Patients with Dementia in Japan
A Retrospective Cohort Study, Current Gerontology and Geriatrics Research, 10.1155/2018/3406210, 2018, 2018.01, [URL], Background. This study aimed to investigate the rate of first-generation H1-antihistamines use for older adults with dementia in Japan. Methods. The study design was retrospective cohort using claims data between fiscal years 2010 and 2013. Subjects were 75 years or older, diagnosed with dementia, and given H1-antihistamines orally during the study period after being diagnosed with dementia. We investigated the cumulative number of oral H1-antihistamines administered and the relationship between first-generation H1-antihistamine use and each explanatory variable using crude and adjusted odds ratio. Results. The cumulative total for use of first-generation H1-antihistamine for older adults with dementia accounted for 32.1% of all antihistamine medication. The majority of first-generation H1-antihistamine prescriptions were indicated for cold treatment. Those with upper respiratory infection or asthma had a significantly positive relationship with first-generation H1-antihistamine use. Conclusion. The study showed that first-generation H1-antihistamine drugs were highly prescribed in older adults with dementia in Japan..
34. 藤田貴子, 安井みどり, 原野由美, 姜鵬, 馬場園明, 全国健康保険協会福岡支部の加入者を対象とした虚血性心疾患における二次医療圏の設定に関する研究, 日本医療・病院管理学会誌, 54、2017., 2017.10.
35. 竹山 由子, 馬場園明, 九州がんセンターにおける訪問看護ステーションの医療モデルの構築, 医療福祉経営マーケティング研究, 12、1、7-17、2017, 2017.10.
36. 豊田 史郎, 馬場園明, 精神科救急医療の効果に関する研究, 医療福祉経営マーケティング研究, 12、1、1-5、2017, 2017.10.
37. 藤田貴子, 原野由美, 姜鵬, 馬場園明, レセプトデータを使用した虚血性心疾患における保険者別入院受療行動と二次医療圏の設定に関する研究, 厚生の指標, 2017.09.
38. Takumi Nishi, Toshiki Maeda, Akira Babazono, Impact of financial incentives for inter-provider care coordination on health-care resource utilization among elderly acute stroke patients, International Journal for Quality in Health Care, 10.1093/intqhc/mzx053, 29, 4, 490-498, 2017.01, [URL], Objective: To examine the impact of inter-provider care coordination on health-care resource utilization among elderly acute stroke patients. Design: A retrospective cohort study using health-care insurance claims data. Setting: Claims data of the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare. Participants: About, 6409 patients aged 75 years or older admitted for acute stroke and moved to rehabilitation wards from 1 April 2010 to 30 September 2015. Main outcome measure: Lengths of stay (LOS) and total charge (TC) were evaluated according to three groups of care pathways (coordinated care, integrated care and other pathways). Results: Compared with the other care pathway, the coordinated care groups had significantly shorter LOS of 2.0 days in acute ischemic stroke care; they had 2.5 days shorter LOS in hemorrhagic stroke care. However, there were no significant differences in rehabilitation care LOS and TC. Conclusions: Our findings suggest that a payment system for care coordination is inappropriate since it was not associated with a reduction in overall health-care resource utilization. Further, health-care system reform is necessary to improve care continuity across multiple health-care institutions in Japan..
39. 廣田りょう, 馬場園明, 大学病院における戦略的経営管理フレームワークの構築, 医療福祉経営マーケティング研究, 11, 1, 1-15, 11、1、1-15、2016, 2016.11.
40. 村田典子, 馬場園明, わが国の市町村における地域包括ケアシステムの構築に向けた評価システムの開発 -福岡県春日市をケースとして-, 医療福祉経営マーケティング研究, 11, 1, 17-24, 11、1、17-24、2016, 2016.11.
41. 尾ノ上美樹夫, 前田俊樹, 西巧, 安井みどり, 馬場園明, 福岡県後期高齢者医療制度の透析患者における医療費の地域差の検討, 医療福祉経営マーケティング研究, 11, 1, 25-30, 11、1、25-30、2016, 2016.11.
42. 安井みどり, 前田俊樹, 原野由美, 馬場園明, レセプ トデータによる後期高齢者の入院医療費の分析, 日本医療・病院管理学会誌, 53, 4, 2016.10.
43. Takumi Nishi, Akira Babazono, Toshiki Maeda, Takuya Imatoh, Hiroshi Une, Effects of Eating Fast and Eating before Bedtime on the Development of Nonalcoholic Fatty Liver Disease, Population Health Management, 10.1089/pop.2015.0088, 19, 4, 279-283, 2016.08, [URL], Few studies have evaluated the effects of lifestyle habits, such as eating behaviors, on the development of nonalcoholic fatty liver disease (NAFLD). It is known that NAFLD increases the risk of type 2 diabetes, prediabetes, cardiovascular disease, and chronic kidney disease. Therefore, a retrospective cohort study was conducted to evaluate the effect of eating behaviors and interactions between these behaviors on the development of NAFLD among health insurance beneficiaries without NAFLD. Study subjects were 2254 male and female insurance beneficiaries without NAFLD who had attended specific health checkups during fiscal years 2009 and 2012 among health insurance societies located in Fukuoka and Shizuoka Prefectures (Japan). The incidence of NAFLD was defined as Fatty Liver Index scores ≥60 or visiting medical organizations for fatty liver disease treatment according to claims data. Eating behaviors, including eating speed and eating before bedtime, were evaluated by a self-administered questionnaire. During the study period, 52 (2.3%) subjects progressed to NAFLD. Subjects who ate before bedtime but did not eat fast had a higher risk of NAFLD (adjusted odds ratio [AOR] = 2.15; 95% confidence interval [CI]: 1.03-4.46). Those with both negative eating habits had a significantly higher risk of NAFLD (AOR = 2.48; 95% CI: 1.09-5.63). Subjects who habitually ate before bedtime, and those who ate fast and before bedtime, tended to have an increased risk of NAFLD. Earlier intervention to modify these poor eating behaviors could be useful to prevent NAFLD..
44. Toshiki Maeda, Akira Babazono, Takumi Nishi, Hiroki Miyazaki, Kazumitsu Tamaki, Masashi Fujii, The effect of diabetes with pharmacotherapy for breast cancer on care resource use, Journal of Cancer Research and Therapeutics, 10.4103/0973-1482.172119, 12, 2, 876-880, 2016.04, [URL], Introduction: The aim of this study was to quantify the effects of diabetes with pharmacotherapy-treated breast cancer on care resource use. Materials and Methods: The study was designed as a single institutional retrospective cohort study using hospital administrative data. The subjects were 152 patients admitted to a hospital from 2008 to 2012 diagnosed with breast cancer, and who underwent pharmacotherapy. We identified diabetes group and nondiabetes group in addition to other variables and quantified the effects of diabetes with breast cancer patients undergoing pharmacotherapy on care resource use, using a multilevel linear regression model. Results: Diabetes was significantly correlated to both longer length of stay (coefficient standard error: 0.75 [0.19], P < 0.001) and higher total hospital charge (0.72 [0.18], P < 0.001), controlled for age, pharmacotherapeutic agent, steroid use, admission route, procedures, and postpharmacotherapy events. Conclusion: This study showed that diabetes itself is a risk factor for greater care resource use after controlling for confounding factors. Pharmacotherapy for breast cancer may influence poor glycemic control, thus leading to greater care resource use. Early detection and careful monitoring of diabetes are essential in malignancy to eliminate this burden on the health care system..
45. Toshiki Maeda, Akira Babazono, Takumi Nishi, Midori Yasui, Quantification of adverse effects of regular use of triazolam on clinical outcomes for older people with insomnia
A retrospective cohort study, International Journal of Geriatric Psychiatry, 10.1002/gps.4310, 31, 2, 186-194, 2016.02, [URL], Objective Older people are more likely to have insomnia. One of the most prescribed hypnotics in Japan is triazolam. Although some studies showed the possibility of adverse effects of triazolam in older people, there have been few studies investigating these effects in a clinical setting. The aim of this study was to determine whether patients who used triazolam regularly had increased risks of pneumonia, trauma, and pressure ulcers. Methods The research design was a retrospective cohort study using claim data. The subjects of the study were patients who were insured by Fukuoka Late Stage Elderly Healthcare Insurance. We defined patients who had received triazolam for 180 days or longer during fiscal year 2011 as the triazolam group, and those who had not received any hypnotics during the period as the non-triazolam group. Each patient in the triazolam group was then matched with a unique control from the non-triazolam group according to propensity score. Multivariate conditional logistic regression analyses were used to obtain adjusted odds ratios for pneumonia, trauma, and pressure ulcer in the triazolam group compared with the non-triazolam group. Results The number of patients in the triazolam and non-triazolam groups in the unmatched cohort was 13,015 and 411,610, respectively. Adjusted odds ratios show that the risks for pneumonia, trauma, and pressure ulcer in the matched cohort increased by approximately 40%, 30%, and slightly less than 30%, respectively (all statistically significant). Conclusions Regular use of triazolam is a risk factor for pneumonia, trauma, and pressure ulcer in older people..
46. Toshiki Maeda, Akira Babazono, Takumi Nishi, Midori Yasui, Yumi Harano, Investigation into the causes of indwelling urethral catheter implementation and its effects on clinical outcomes and health care resources among dementia patients with pneumonia A retrospective cohort study, Medicine (United States), 10.1097/MD.0000000000004694, 95, 35, 2016.01, [URL], There is a possibility that unnecessary treatments and low-quality medical care, such as inappropriate indwelling urethral catheter use, are being provided to older Japanese individuals. The aim of this study was to investigate contextual effects relating to indwelling urethral catheters in older people with dementia and to clarify the effects of indwelling urethral catheter use on patients' mortality, length of stay (LOS), and health care spending. This retrospective cohort study involved 4501 male and female Japanese participants. Those who were aged 75 or older with dementia and had a primary diagnosis of acute lower respiratory disease with antibiotics administered during hospitalization were eligible for inclusion. Patient mortality, LOS, and total charge during hospitalization were the main study outcomes. This study showed that indwelling urethral catheter use was significantly associated with higher mortality, longer LOS, and higher total charge for hospitalization. The pattern of indwelling urethral catheter use was clustered by care facility level. Physician density was significantly associated with indwelling urethral catheter use; the relationship was not linear but U-shaped, such that the approximate median had the lowest rate of urethral catheter use and this increased gradually toward both lower and higher physician densities. Our study found considerable variation in indwelling urethral catheter use between care facilities in older people with dementia. Additionally, indwelling urethral catheter use was related to poor outcomes. Based on these findings, we consider there to be an urgent need for constructing a framework to measure, report on, and promote the improvement of care quality for older individuals in Japan..
47. Toshiki Maeda, Akira Babazono, Takumi Nishi, Midori Yasui, Yumi Harano, Investigation of the existence of supplier-induced demand in use of gastrostomy among older adults a retrospective cohort study, Medicine (United States), 10.1097/MD.0000000000002519, 95, 5, 2016.01, [URL], The aim of this study is to clarify whether there is small area variation in the use of gastrostomy that is explained by hospital physician density, so as to detect the existence of supplier-induced demand (SID). The study design is a retrospective cohort using claim data of Fukuoka Late Elders' Health Insurance, submitted from 2010 to 2013. Study participants included 51,785 older adults who had been diagnosed with eating difficulties. We designated use of gastrostomy as an event. Multilevel logistic analyses were then used to investigate the existence of SID. After controlling for patient factors, we found significant regional level variance in gastrectomy use (median odds ratio [MOR]: 1.72, 1.37-2.51). Hospital physician density was significantly positively related with gastrostomy (adjusted OR of hospital physician density: 1.75, 1.25-2.45; P<0.001).MORs were largely reduced for the input variable of hospital physician density. We found that the small area variation in use of gastrostomy among older adults could be explained by hospital physician density, which might indicate the existence of SID..
48. 大久保浩一, Babazono A, 呼吸器感染症で急性期病院に入院した高齢者の栄養状態が在院日数及び入院医療費に与える影響, 医療福祉経営マーケティング研究, 10, 1, 2-9, 10、2-9、2015, 2015.09.
49. Hiroki Miyazaki, Akira Babazono, Takumi Nishi, Toshiki Maeda, Takuya Imatoh, Masayoshi Ichiba, Hiroshi Une, Does antihypertensive treatment with renin-angiotensin system inhibitors prevent the development of diabetic kidney disease?, BMC Pharmacology and Toxicology, 10.1186/s40360-015-0024-y, 16, 1, 2015.09, [URL], Background: Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease worldwide. Renin-angiotensin system (RAS) inhibitors are the first-line treatment for diabetic patients with hypertension. However, whether RAS inhibitors prevent the development of DKD remains controversial. We conducted a retrospective cohort study quantifying the preventive effect of antihypertensive treatment with RAS inhibitors on DKD, using data from specific health check-ups and health insurance claims. Methods: The study subjects were 418 patients with diabetes and hypertension, drawn from health insurance societies located in Fukuoka and Shizuoka prefectures in Japan. The subjects were divided into three groups, according to the type of antihypertensive treatment they received. They were then compared in terms of the development of DKD, using the diagnostic codes from ICD-10. Results: Thirty subjects (6.2%) developed DKD during the study period between April 2011 and September 2013. RAS inhibitor treated group showed a significantly lower risk of DKD [adjusted odds ratio (AOR) = 0.35; 95% confidential interval (CI): 0.16-0.76] compared with the no treatment group. Conclusion: We conclude that antihypertensive treatment with RAS inhibitors is potentially useful for preventing the development of DKD..
50. Toshiki Maeda, Akira Babazono, Takumi Nishi, Midori Yasui, Shinya Matsuda, Kiyohide Fushimi, Kenji Fujimori, The impact of opportunistic infections on clinical outcome and healthcare resource uses for adult T cell leukaemia, PloS one, 10.1371/journal.pone.0135042, 10, 8, 2015.08, [URL], We examined the impact of opportunistic infections on in-hospital mortality, hospital length of stay (LOS), and the total cost (TC) among adult T-cell leukaemia (ATL) patients. In this retrospective cohort study, we identified 3712 patients with ATL using national hospital administrative data. Analysed opportunistic infections included Aspergillus spp., Candida spp., cytomegalovirus (CMV), herpes simplex virus (HSV), pneumocystis pneumonia (PCP), tuberculosis, varicella zoster virus (VZV), Cryptococcus spp., nontuberculous mycobacteria, and Strongyloides spp. Multilevel logistic regression analysis for in-hospital mortality and a multilevel linear regression analysis for LOS and TC were employed to determine the impact of opportunistic infections on clinical outcomes and healthcare resources. We found ATL patients infected with CMV had significantly higher in-hospital mortality (adjusted odds ratio (AOR) 2.29 [1.50-3.49] p < 0.001), longer LOS (coefficient (B): 0.13 [0.06-0.20] p < 0.001) and higher TC (B: 0.25 [0.17-0.32] p < 0.001) than those without CMV. Those with CAN and PCP were associated with a lower in-hospital mortality rate (AOR 0.72 [0.53-0.98] p = 0.035 and 0.54[0.41-0.73] p < 0.001, respectively) than their infections. VZV was associated with longer LOS (B: 0.13 [0.06-0.19] p < 0.001), while aspergillosis, HSV, or VZV infections were associated with higher TC (B: 0.16 [0.07-0.24] p < 0.001, 0.12 [0.02-0.23] p = 0.025, and 0.17 [0.10-0.24] p < 0.001, respectively). Our findings reveal that CMV infection is a major determinant of poor prognosis in patients affected by ATL..
51. Takumi Nishi, Akira Babazono, Toshiki Maeda, Takuya Imatoh, Hiroshi Une, Evaluation of the fatty liver index as a predictor for the development of diabetes among insurance beneficiaries with prediabetes, Journal of Diabetes Investigation, 10.1111/jdi.12290, 6, 3, 309-316, 2015.05, [URL], Aims/Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in developed countries, and it was required to monitor patients with prediabetes. However, there have been few reports establishing the risk for diabetes mellitus (DM) among patients with prediabetes. The purpose of the present study was to evaluate the effect of NAFLD on the progression of DM among insurance beneficiaries with prediabetes, using data from specific health check-ups and the fatty liver index (FLI). Materials and Methods: We used a retrospective cohort study that enrolled 967 insurance beneficiaries with prediabetes who had rarely drunk or could not drink alcohol, or whose alcohol consumption was <19 g/day from two health insurance societies. We divided insurance beneficiaries into FLI <30, intermediates FLIs and FLI ≥60, and compared the incidence rate of DM among the groups after 3 years' follow up, using multiple logistic regression models. Results: During 3 years' follow up, progression of diabetes was seen in 65 men (11.5%) and 24 women (6.0%). Logistic regression analyses showed that those with NAFLD had significantly higher risks of developing DM; this was the case in both men (odds ratio 2.68, 95% confidential interval 1.29-5.56) and women (odds ratio 10.35, 95% confidential interval 3.22-33.31). Conclusions: Among insurance beneficiaries with prediabetes, those with NAFLD had a significantly higher risk of DM than those without NAFLD. The FLI might be useful for detecting individuals who have an especially higher risk for DM, and developing more effective guidance for delivering healthcare services in Japan..
52. Toshiki Maeda, Akira Babazono, Takumi Nishi, Shinya Matsuda, Kiyohide Fushimi, Kenji Fujimori, Quantification of the effect of chemotherapy and steroids on risk of Pneumocystis jiroveci among hospitalized patients with adult T-cell leukaemia, British Journal of Haematology, 10.1111/bjh.13154, 168, 4, 501-506, 2015.02, [URL], Summary: This study aimed to quantify the risks of Pneumocystis pneumonia (PCP) among adult T-cell leukaemia (ATL) patients without prophylaxis. We used hospital administrative data collected nationwide in Japan over 4 years. The research design was a retrospective cohort study. Subjects were 4369 patients diagnosed with ATL aged 18 years or older. The subjects were categorized into four treatment groups: no agent, chemotherapy, chemotherapy + steroids and steroids. We described the risks of PCP among ATL patients without prophylaxis. Risks of PCP were 3·2% for the no agent group, 9·7% for the chemotherapy group, 10·0% for the chemotherapy + steroids group and 16·6% for the steroids group. Logistic regression analyses showed that the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risk of PCP than did the no agent group [adjusted odds ratio (AOR) 3·30 (1·55-7·02), P = 0·002 for the chemotherapy group; AOR 3·35 (2·18-5·17), P < 0·001 for the chemotherapy + steroids group; AOR 6·12 (3·99-9·38), P < 0·001 for the steroids group]. In conclusion, the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risks of PCP. Prophylaxis for PCP among ATL patients being treated with chemotherapy, chemotherapy + steroids and steroids is highly recommended..
53. 佐藤明宏, 馬場園明, 入院時の血清アルブミン値が後期高齢者誤嚥性肺炎の入院日数、入院医療費に与える影響に関する研究, 医療福祉経営マーケティング研究, 9, 1, 1-8, 9、1-8、2014, 2014.10.
54. Toshiki Maeda, Akira Babazono, Takumi Nishi, Kazumitsu Tamaki, Influence of psychiatric disorders on surgical outcomes and care resource use in Japan, General Hospital Psychiatry, 10.1016/j.genhosppsych.2014.05.014, 36, 5, 523-527, 2014.09, [URL], Objective: The aim of this study was to quantify the effects of psychiatric disorders on major surgery outcomes and care resource use. Methods: This study adopted a retrospective cohort study design. The samples consisted of hospital stays. Subjects were patients who had undergone major surgery. We used multilevel regression analysis to quantify the influence of psychiatric disorders on major surgery outcomes and care resource use. Results: The total number of hospital stays included in the study was 5569, of which 250 were patients with psychiatric disorders. Compared with those without psychiatric disorders, those with schizophrenia had a significantly higher risk of complications, and those with neurotic disorder tended to have fewer complications. Total cost was significantly higher for those with schizophrenia and mood disorder and significantly lower in those with neurotic disorder. Lengths of stay were significantly longer for those with schizophrenia and mood disorder but not for those with neurotic disorder. Post-surgical mortality was equivalent among those with any psychiatric disorder and among those without a psychiatric disorder. Conclusion: The study revealed that surgical outcomes and care resource use are differentiated by psychiatric disorders..
55. Toshiki Maeda, Akira Babazono, Takumi Nishi, Shinya Matsuda, Kiyohide Fushimi, Kenji Fujimori, Regional differences in performance of bone marrow transplantation, care-resource use and outcome for adult T-cell leukaemia in Japan, BMC Health Services Research, 10.1186/1472-6963-14-337, 14, 1, 2014.08, [URL], Background: Japan has a high prevalence of adult T-cell leukaemia (ATL), especially in the Kyushu/Okinawa region. Regional differences in prevalence might cause regional differences in physicians' experiences and the efficiency of care-resource use. This study investigated regional differences in the performance of bone marrow transplantation (BMT), outcome and care-resource use in patients with ATL in Japan. Methods. This was a cross-sectional study using a Japanese hospital administrative database in 2010, with a diagnostic-procedure combination/per diem payment system. We examined the association between BMT performance, resource use, outcomes and region. Results: We analysed data for 712 subjects of whom 60.5% were Kyushu/Okinawa residents. Significantly more patients with ATL underwent BMT in Kanto (p = 0.018) and Kansai (p < 0.001) regions compared with the Kyushu/Okinawa regions. The lengths of hospital stay were longer in Kanto (p = 0.002) and Kansai (p = 0.006) regions than in the Kyushu/Okinawa region. Total health-care costs were higher in Kanto (p = 0.001) and Kansai (p = 0.005) regions than the Kyushu/Okinawa region. The risks of in hospital mortality were not significantly different between regions. Conclusions: There were significant regional differences in BMT performance and resource use within Japan. ATL prevalence was not related to the performance of BMTs, resource use or outcomes. Factors related to regional socioeconomics might affect the performance of BMTs and care resource use within Japan..
56. Takumi Nishi, Akira Babazono, Toshiki Maeda, Risk of hospitalization for diabetic macrovascular complications and in-hospital mortality with irregular physician visits using propensity score matching, Journal of Diabetes Investigation, 10.1111/jdi.12167, 5, 4, 428-434, 2014.07, [URL], Aims/Introduction: The objective of the present study was to evaluate the risk of diabetic macrovascular complications and in-hospital mortality among diabetic patients with irregular physician visits. Materials and Methods: We carried out a health insurance-based retrospective cohort study using claims data from diabetic patients who were newly hospitalized between April 2010 and September 2010 among beneficiaries of the Fukuoka National Health Insurance Organization. Regular visits were defined as physician visits for diabetes mellitus at least every 3 months between April 2009 and March 2010, whereas other visits or no visits were defined as irregular visits. We assigned 5,940 patients to the regular visit or the irregular visit groups using propensity score matching. We compared in-hospital mortality and hospitalization for diabetic macrovascular complications between the two groups by multiple logistic regression models. Results: The irregular visit group had a significantly higher risk of hospitalization for acute myocardial infarction (AMI), ischemic heart diseases (IHDs) except AMI, all IHDs, all strokes and diabetic macrovascular complications than did the regular visit group. Adjusted odds ratios for AMI, IHDs except AMI, all IHDs, all strokes, and diabetic macrovascular complications were 3.52 (95% confidence interval [CI] 1.79-6.96), 1.25 (95% CI 1.02-1.54), 1.37 (95% CI 1.12-1.66), 1.29 (95% CI 1.04-1.60), and 1.28 (95% CI 1.10-1.48), respectively. Conclusions: The present study shows that the irregular visit group had significantly higher risks of hospitalization for IHD and stroke among diabetic patients. Insurers need to motivate diabetic beneficiaries to make regular visits to physicians..
57. Yan Gao, Akira Babazono, Takumi Nishi, Toshiki Maeda, Dulamsuren Lkhagva, Could investment in preventive health care services reduce health care costs among those insured with health insurance societies in Japan?, Population Health Management, 10.1089/pop.2013.0007, 17, 1, 42-47, 2014.02, [URL], This study examined the impact of expenditures for preventive health care services on health care costs among those insured with health insurance societies in Japan using cross-sectional and longitudinal designs. The subjects of the study were those insured with Japan's 1481 health insurance societies belonging to the National Federation of Health Insurance Societies in 2003 and 2007. Multiple regression analyses were conducted using the forced entry method. Case rates, number of service days, and health care costs were used as dependent variables, and preventive health care expenditures, average age, number of the insured, gender ratio, average monthly salary, and dependents ratio were used as independent variables. Expenditures for preventive health care services showed significant negative correlations with both the number of service days and health care costs for inpatient and outpatient services in 2003 and 2007. The results showed that expenditures for preventive health care services had a negative relationship with health care costs. Thus, these findings support the effects of investment in preventive health activities as promoted by health insurance societies to reduce health care costs..
58. 竹口 和江, 荒木 登茂子, 馬場園 明, 労働者における大腸がん検診精密検査の受診行動に関連する要因の検討, 医療福祉経営マーケティング研究, 8, 1, 1-9, 2013.10.
59. 荒巻 悦子, 荒木 登茂子, 馬場園 明, 中小企業労働者の透過性調整力と健康習慣との関連, 医療福祉経営マーケティング研究, 8, 1, 11-17, 2013.10,  荒巻 悦子、荒木 登茂子、馬場園 明:中小企業労働者の透過性調整力と健康習慣との関連、医療福祉経営マーケティング研究、11-17、2013..
60. 菊池 仁志, 原田幸子, 荒木智佳, 宮原美佐, 馬場園 明, 計画的レスパイト入院におけるALS患者の医療保険及び介護保険費用と患者・介護者のQOL評価, 医療福祉経営マーケティング研究, 8, 1, 19-26, 2013.10.
61. Fase Badriah, Takeru Abe, Hidekazu Miyamoto, Megumi Moriya, Akira Babazono, Akihito Hagihara, Interaction effects between rehabilitation and discharge destination on inpatients' functional abilities, Journal of Rehabilitation Research and Development, 10.1682/JRRD.2012.08.0153, 50, 6, 821-833, 2013.09, [URL], A patient's functional ability after hospital discharge may be influenced by in-hospital rehabilitation and discharge destination. However, we know very little about how in-hospital rehabilitation intervention interacts with the type of discharge destination or how this interaction influences patients' functional abilities. Thus, how an interaction between in-hospital rehabilitation and discharge destination influences a patient's subsequent functional ability was examined. This was a cross-sectional study whose participants were inpatients who underwent rehabilitation between February 2008 and December 2010 at a hospital in Japan (n = 835). Participants were categorized into three condition groups (i.e., stroke, orthopedic, disuse syndrome). Then, interaction effects between the rehabilitation therapy and the type of discharge destination on a patient's subsequent functional ability were estimated by hierarchical linear regression analysis in each of the three subgroups. In models where the dependent variable was Functional Independence Measure (FIM) score at 3 mo after hospital discharge, a significant interaction between rehabilitation potential (a measure based on the FIM effectiveness measure) and discharge destination (home or other) was observed in the stroke and orthopedic patients (both p < 0.001). These findings may be useful in deciding on discharge destinations for patients..
62. Dulamsuren Lkhagva, Yan Gao, Akira Babazono, Does co-payment rate influence the relationship between monthly salary and health care service demand among the insured of health insurance societies in Japan?, Population Health Management, 10.1089/pop.2011.0094, 16, 1, 58-63, 2013.02, [URL], The co-payment rate for health care services for insured people increased from 10% to 20% in 1997, and then to 30% in 2003 under the Employed Health Insurance System in Japan. The purpose of this study is to quantify the relationship between average monthly salary and health care service demand by different co-payment rates among the insured of health insurance societies in Japan. Data from the National Federation of Health Insurance Societies from 1996, 2002, and 2007 were analyzed. Indicators of health care service demand included case rates and number of service days per case for inpatient, outpatient, and dental services. The authors evaluated the relationship of average monthly salary with these indicators using multiple regression analyses for each of the 3 years. In the study, the average monthly salary showed a high positive correlation with outpatient and dental case rates for all 3 years. The magnitude of the relationship of average monthly salary to health care service demand was intensified as patient co-payment increased from 10% to 20%. However, it did not change when the co-payment increased from 20% to 30%. The increase in patient co-payment rate from 20% to 30% did not intensify the relationship between average monthly salary and health care service demand among the insured of health insurance societies in Japan..
63. Gao Y, Kuwabara K, Matsuda S, Lkhagva D, Babazono A, Differences in Inpatient care resource use and postoperative complications among insulin-usingdiabetes mellitus patients, non-insulin-using diabetes mellitus patients and patients without diabetes mellitus after partial gastrectomy for gastric cancer, Asian Pacific Journal of Disease Management, 4, 4, 95-101, 2012.12.
64. 西巧、前田俊樹、馬場園明, レセプトデータを活用した医療費適正化計画の指標に関する研究, 医療福祉経営マーケティング研究, 7, 1, 1-8, 2012.11.
65. 猿渡倫治、西巧、馬場園明, 福岡県の透析医療における地域格差の検証, 医療福祉経営マーケティング研究, 7, 1, 9-16, 2012.11.
66. 永本早苗、前田俊樹、馬場園明, 北九州市がん意識調査票を用いたがん検診受診率の推計, 医療福祉経営マーケティング研究, 7, 1, 17-23, 2012.11.
67. 前田俊樹、西巧、馬場園明, がんにおける最適な診療圏城作成のための二次医療圏集約の試み, 日本医療・病院管理学会誌, 49, 3, 133-145, 2012.07.
68. Dulamsuren Lkhagva, Kazuaki Kuwabara, Shinya Matsuda, Yan Gao, Akira Babazono, Assessing the impact of diabetes-related comorbidities and care on the hospitalization costs for patients with diabetes mellitus in Japan, Journal of Diabetes and Its Complications, 10.1016/j.jdiacomp.2011.12.004, 26, 2, 129-136, 2012.03, [URL], Objective: Because diabetes mellitus (DM) has been highlighted in several healthcare sectors, variations in the case mix of DM should be evaluated to promote effective disease management. Using a Japanese administrative database (2003), we investigated the impact of DM-related comorbidities and of their relevant care processes on healthcare costs incurred during hospitalization. Methods: Of 283,771 hospital admissions across 174 acute care hospitals, 27,853 patients with DM were analyzed. The following variables were analyzed according to age (<65 or ≥65 years), the presence of comorbidities, demographic characteristics, procedure-related complications, insulin use, surgical procedures (percutaneous minimally invasive intervention, hemodialysis, ventilation, and rehabilitation), length of stay (LOS), and total charge (TC; US$1=Y90). Multivariate analyses were applied to investigate the effects of DM-related complications and care processes associated with DM on TC. Results: The mortality and procedure-related complication rates were 2.1% and 2.7%, respectively. There were significant differences in the frequencies of comorbidities by age category. Among DM-related comorbidities, peripheral vascular disease had the greatest impact on increasing the LOS or TC. Minimally invasive procedures, hemodialysis, ventilation, and procedure-related complications were significant determinants of TC. Hemodialysis and invasive surgical procedures were independent predictors of procedure-related complications. Conclusions: DM-related comorbidities and care process representative of the DM case mix were responsible for variations in healthcare costs during hospitalization..
69. 石村晃一、西巧、猿渡 倫治、馬場園明, 急性脳卒中患者におけるリハビリテーションの実施と医療費に関する研究, 医療福祉経営マーケティング研究、6、1-7、2011., 6, 1, 1-7, 2011.10.
70. 山﨑哲男、片岡直、桑原一彰、馬場園明, 医療保障の法的構造, 医療福祉経営マーケティング研究, 6, 1, 9-25, 2011.10.
71. Naoki Ikegami, Byung Kwang Yoo, Hideki Hashimoto, Masatoshi Matsumoto, Hiroya Ogata, Akira Babazono, Ryo Watanabe, Kenji Shibuya, Bong Min Yang, Michael R. Reich, Yasuki Kobayashi, Japanese universal health coverage
Evolution, achievements, and challenges, The Lancet, 10.1016/S0140-6736(11)60828-3, 378, 9796, 1106-1115, 2011.09, [URL], Japan shows the advantages and limitations of pursuing universal health coverage by establishment of employee-based and community-based social health insurance. On the positive side, almost everyone came to be insured in 1961; the enforcement of the same fee schedule for all plans and almost all providers has maintained equity and contained costs; and the co-payment rate has become the same for all, except for elderly people and children. This equity has been achieved by provision of subsidies from general revenues to plans that enrol people with low incomes, and enforcement of cross-subsidisation among the plans to finance the costs of health care for elderly people. On the negative side, the fragmentation of enrolment into 3500 plans has led to a more than a three-times difference in the proportion of income paid as premiums, and the emerging issue of the uninsured population. We advocate consolidation of all plans within prefectures to maintain universal and equitable coverage in view of the ageing society and changes in employment patterns. Countries planning to achieve universal coverage by social health insurance based on employment and residential status should be aware of the limitations of such plans..
72. Shinichi Tanihara, Takuya Imatoh, Motonobu Miyazaki, Akira Babazono, Yoshito Momose, Michie Baba, Yoko Uryu, Hiroshi Une, Retrospective longitudinal study on the relationship between 8-year weight change and current eating speed, Appetite, 10.1016/j.appet.2011.04.017, 57, 1, 179-183, 2011.08, [URL], Most of the studies that have examined the relationship between the speed of eating and obesity have been cross-sectional. We investigated 529 male workers who received health check-ups provided by the employer in 2000 and 2008. We obtained information on the subjects' alcohol consumption, smoking status, self-reported speed of eating, and exercise in 2008, and height and weight in both 2000 and 2008. We compared weight change from 2000 to 2008 between 2 groups classified according to the speed of eating: a group of fast eaters, and a combined group of medium and slow eaters. The fast-eating group had a higher average weight gain (1.9. kg) than the medium and slow eating group (0.7. kg). Although statistically significant only for the 20-29-year age group, weight gain was greater in the fast-eating group for all age groups and was statistically significant when the age groups were combined. The relationship between eating fast and weight change was statistically significant even after adjusting for age and body mass index in 2000, drinking, smoking, and exercise. Our results suggested that the speed of eating is related to the rate of weight gain..
73. Akira Babazono, Kazuaki Kuwabara, Akihito Hagiihara, Jun Nagano, Reiko Ishihara, Do interventions to prevent lifestyle-related diseases reduce healthcare expenditures? A randomized controlled clinical trial, Journal of epidemiology, 10.2188/jea.JE20100095, 21, 1, 75-80, 2011.01, [URL], Background: In 2008, the Japanese government implemented a program of health lifestyle interventions to reduce health care expenditure. This study evaluated whether these interventions decreased health care expenditures. Methods: The study enrolled 99 participants insured by Japanese National Health Insurance, who, in our previous study conducted in 2004, were allocated by random sampling into an intervention group (50 participants) and a control group (49 participants). In the intervention group, we used a health support method that facilitated the attainment of goals established by each participant. The control group received instruction in exercise, as well as health support using publically available media. Although 3 participants in the intervention group and 9 participants in the control group did not participate in a follow-up health examination 1 year after the intervention, the health care expenditures of all initial participants were assessed. Expenditures before and after the intervention were compared within and between groups. Data on health care expenditures were obtained from inpatient, outpatient, pharmacy, and dental health insurance claims. Results: After the intervention, the pharmacy and dental expenditures were significantly higher in the intervention group, while the pharmacy expenditure was significantly higher in the control group. However, there was no significant difference in any medical expenditure item between the intervention and control groups before or after the intervention. Conclusions: No significant differences were observed in short-term medical expenses for any medical expenditure item after a lifestyle intervention..
74. 久保伸子, 馬場園明, 乳がん及び子宮がん検診における受診行動に関する研究, 医療福祉経営マーケティング研究, 4, 1, 13-22, 4、13-22、2010., 2010.10.
75. 中司元、藤原昌彦、深田光敬、安田潮人、小田代敬太、丸山徹、赤司浩一、馬場園明, 不整脈疾患におけるホルター心電図に対するイベントレコーダーの費用対効果分析, 心電図、30、216-224、2010., 30, 3, 216-223, 2010.08.
76. Tasaki K, Kuwabara K, Babazono A, Soejima, Visualization Model for Medical Care Processes vy Utilizing Japanese Case-mix Classification and its Application to the Variance Analysis of Clinical Pathway, Asian Pacific Journal of Disease Management, , 4, 77-82, 2010., 77-78, 4, 77-82, 2010., 2010.07.
77. Yan Gao, Akira Babazono, Estimates of reduction in prevalence of diabetes mellitus and health care costs reduced through the intervention program for obese people in Japan, Nippon eiseigaku zasshi. Japanese journal of hygiene, 10.1265/jjh.65.53, 65, 1, 53-59, 2010.01, [URL], OBJECTIVES: In the structural reform bill of health care, which passed the Diet in fiscal year 2006, the number of patients with lifestyle-related diseases and the number of those who will potentially develop such diseases in 2015 should be reduced by 25% from the number in 2008 through the national intervention program against obesity. We estimated the reduction in prevalence of diabetes mellitus, as a representative lifestyle-related disease, and the health care costs reduced by controlling obesity. METHODS: Firstly, we estimated the prevalence (95% confidence interval) of obese people by conducting the National Health and Nutrition Examination Survey in 2005. Secondly, we estimated the proportion of obese people that should be reduced in order to reduce diabetes prevalence by 25% using the data from the National Diabetic Patients Survey in 2002. Thirdly, we estimated changes in prevalence of diabetes mellitus when the proportion of obese people was reduced by 20%, 40%, 60%, 80%, and 100%. Finally, we estimated how much health care costs would be reduced if the number of obese people was reduced by 20%. RESULTS: It is extremely difficult to reduce the prevalence of diabetes mellitus by 25% by only reducing the proportion of obese people. From our estimation of changes in the prevalence of diabetes mellitus when the proportion of obese people was reduced, the intervention for people aged from 40 years to 59 years was more effective than that for people in other age groups for both male and female. The health care costs of diabetes mellitus can be reduced by yen 841,210,000,000 for male and by yen 75,930,000,000 for female. CONCLUSION: It is almost impossible to reduce the prevalence of diabetes mellitus by 25% although it is cost-effective to target on people aged from 40 to 59 years against obesity to reduce the prevalence of diabetes mellitus..
78. 今岡節子、馬場園 明, 訪問看護ステーションの経営・管理改善モデルの構築とその評価, 医療福祉経営マーケティング研究, 4, 1, 1-12, 2009.09.
79. 馬場園明、桑原一彰、荒木登茂子、萩原明人、山口裕幸、山口結花, 患者・医師コミュニケーション支援ツール「つたえるくん」の開発と評価, 医療福祉経営マーケティング研究, 4, 1, 13-22, 13-22, 2009.09.
80. 荒木登茂子、馬場園明、桑原一彰、萩原明人、山口裕幸、山口結花, 医師と病気に関する患者のイメージを可視化する「サークルドローイング」の開発と実践, 医療福祉経営マーケティング研究, 4, 1, 23-32, Development and Practice of the Circle Drawing to Visualize Patient’s image of
the Doctor and the Illness, 2009.09.
81. Toshihide Tsuda, Takashi Yorifuji, Soshi Takao, Masaya Miyai, Akira Babazono, Minamata disease
Catastrophic poisoning due to a failed public health response, Journal of Public Health Policy, 10.1057/jphp.2008.30, 30, 1, 54-67, 2009.04, [URL], We present the history of Minamata disease in a chronological order from the public health point of view. Because the appropriate public health response - to investigate and control the outbreak - as set out in the Food Sanitation Act was not conducted, no one knew how many became ill following the outbreak. Exposure could not be stopped. In our discussion, we offer two reasons as to why the Japanese public health agencies did not apply the Act: social circumstances in the 1950s and 1960s that placed emphasis on industrial development, and the Japanese medical communitys lack of knowledge about the Act. The history of Minamata disease shows us the consequences when public health responses are not implemented. Minamata disease should be an invaluable lesson for future public health responses..
82. 谷原真一、板並智子、渡辺美野子、北島純子、馬場園明、今任拓也、百瀬義人、畝博, 介護保険主治医意見書に記載された診断名の解析, 厚生の指標、, 56、3、24-29, 2009.03.
83. 三好亜美、岩尾由希子、児玉満、白石 美恵、馬場園明、沖田千代, 痩せの改善を目的とした栄養教育に関する研究, 福岡女子大学人間環境学部紀要, 40、7-10、2009., 2009.03.
84. Ishihara R, Kame C, Babazono A, Relationship between the change in mental health
and indicators of medical expenses in the prevention of lifestyle-related disease
, Disease Management & Health Outcomes, 2008.12.
85. Reiko Ishihara, Chihoko Kame, Akira Babazono, Relationship between the change in mental health and indicators of medical costs in the prevention of lifestyle-related disease, Disease Management and Health Outcomes, 10.2165/0115677-200816060-00009, 16, 6, 439-447, 2008.12, [URL], Background: Mental health influences the need for health consultations, and mental healthcare is often required in the prevention of lifestyle-related disease. We investigated the relationship between indicators of medical costs and changes in mental health before and after interventions to prevent lifestyle-related disease. Methods: The study was conducted using data from participants of a lifestyle intervention program who did not have inpatient medical claims (n = 110; 46 men, 64 women). The results of a General Health Questionnaire (GHQ)-30, completed before the intervention in August 2003 and after 1 year, were used as indicators of mental health, while diagnoses based on the International Classification of Diseases (ICD)-10 from medical claims in the 2003 fiscal year were used to classify diseases using the proportional disease magnitude (PDM) method. Subjects were classified into four groups based on their change in mental health: change from good to good (GG; n = 72); change from good to poor (GP; n = 9); change from poor to good (PG; n = 16); and change from poor to poor (PP; n = 13).The indicators of medical costs were compared among four groups by analysis of variance (ANOVA) and analysis of co-variance (ANCOVA). We classified patients according to the frequency of consultations as follows: (i) those of at least two clinics per month; (ii) those of at least three clinics per month; and (iii) those of at least two clinics for the same disease per month. This frequency was used as an indicator of medical costs. Results: Patients in the GG and PG groups required significantly fewer consultations than those in the PP group. The GG group had significantly fewer patients who had at least two outpatient medical claims per month than the PP group, following adjustment for age and sex. Patients in the GG and PG groups had significantly fewer consultations for ICD-10 diagnosis codes for 'certain infectious and parasitic diseases,' 'disease of the digestive system,' and 'injury, poisoning, and certain other consequences of external causes' than those in the PP group; however, the GP group had a significantly greater number of consultations for 'endocrine, nutritional, and metabolic disease' than the PP group. Conclusion: Individuals with mental health issues both before and after intervention required more outpatient consultations than those without. The importance of considering mental health in preventing lifestyle-related diseases was confirmed..
86. 中園博美、西田大介、中島直樹、馬場園明, 行動変容支援における支援者の会話デザインに関する研究, 医療福祉経営マーケティング研究, 3、1-8, 2008.11.
87. 金子美幸、馬場園明, わが国における2003年度の患者自己負担変更による受診行動への影響, 医療福祉経営マーケティング研究, 3、9-16, 2008.09.
88. 波多敬子、波多英寛、馬場園明, Interactiveなお出かけセンサー開発のための基礎的研究, 医療福祉経営マーケティング研究, 3、17-30, 2008.09.
89. Akira Babazono, Hiroyuki Kitajima, Shigeru Nishimaki, Tomohiko Nakamura, Seigo Shiga, Masahiro Hayakawa, Tahei Tanaka, Kazuo Sato, Hideki Nakayama, Satoshi Ibara, Hiroshi Une, Hiroyuki Doi, Risk factors for nosocomial infection in the neonatal intensive care unit by the Japanese Nosocomial Infection Surveillance (JANIS), Acta medica Okayama, 62, 4, 2008.08, We evaluated the infection risks in the neonatal intensive care unit (NICU) using data of NICU infection surveillance data. The subjects were 871 NICU babies, consisting of 465 boys and 406 girls, who were cared for between June 2002 and January 2003 in 7 medical institutions that employed NICU infection surveillance. Infections were defined according to the National Nosocomial Infection Surveillance (NNIS) System. Of the 58 babies with nosocomial infections, 15 had methicillin-resistant Staphylococcus aureus (MRSA) infection. Multiple logistic regression analysis demonstrated that the odds ratio for nosocomial infections was significantly related to gender, birth weight and the insertion of a central venous catheter (CVC). When the birth weight group of more than 1, 500 g was regarded as the reference, the odds ratio was 2.35 in the birth weight group of 1,000-1,499 g and 8.82 in the birth weight group of less than 1,000 g. The odds ratio of the CVC (+) for nosocomial infection was 2.27. However, other devices including artificial ventilation, umbilical artery catheter, umbilical venous catheter, and urinary catheter were not significant risk factors. The incidence of MRSA infection rapidly increased from 0.3% in the birth weight group of more than 1,500 g to 2.1% in the birth weight group of 1,000-1,499 g, and to 11.1% in the birth weight group of less than 1,000 g. When the birth weight group of more than 1,500 g was regarded as the reference, multiple logistic regression analysis demonstrated that the odds ratio was 7.25 in the birth weight group of 1,000-1,499 g and 42.88 in the birth weight group of less than 1,000 g. These odds ratios were significantly higher than that in the reference group. However, the application of devices did not cause any significant differences in the odds ratio for MRSA infection. Copyright.
90. Akira Babazono, Kazuaki Kuwabara, Akito Hagihara, Eiji Yamamoto, Alan Hillman, Does income influence demand for medical services despite Japan's "Health Care for All" policy?, International Journal of Technology Assessment in Health Care, 10.1017/S0266462307080166, 24, 1, 125-130, 2008.01, [URL], Objectives: We examined the impact of household income on the use of medical services in Japan, where there is a "health care for all" policy, with important, centralized influence by the national government designed to ensure universal access. Methods and Subjects: All healthcare societies operating in 2003 were included in the study, representing 14,776,193 insured adults and 15,496,752 insured dependents. The mean case rate (the average number of monthly bills per patient), the mean number of service days per person, and the mean medical cost per person served as indicators of medical service use. Multiple regression analysis was performed by the forced entry method using case rate, the number of service days, and medical cost as outcome variables, and average monthly salary, dependent ratio, average age, and premium rate as the explanatory variables. Results: In the multiple regression analyses, average monthly salary showed a high positive correlation of outpatient and dental indicators, including case rate, the number of service days, and medical cost. If the average monthly salary were reduced 20 percent lower than the mean, the estimated changes (95 percent CI) in case rate for the insured were -7.49 (-8.14 ∼ -6.84) percent for outpatient visits and -8.16 (-8.77 ∼ -7.56) percent for dental services. Conclusions: Average monthly salary intensifies the effects of copayments on the case rate, the number of service days, and medical cost in the "Employees Health Insurance" in Japan. Thus, a low salary appears to discourage patients from seeking medical and dental services..
91. Taichiro Tanaka, Tomonori Okamura, Zentaro Yamagata, Toru Takebayashi, Unai Tamura, Yukinori Kusaka, Sumio Urano, Yuji Miyoshi, Akira Okayama, Hirotsugu Ueshima, Kiyomi Sakata, Keiko Tsuji, Katsushi Yoshita, Yuriko Kikuchi, Hideaki Nakagawa, Katsuyuki Miura, Hiroshi Yamato, Nagako Chiba, Masahiko Yanagita, Kazunori Kodama, Fumiyoshi Kasagi, Nobuo Nishi, Shigeyuki Saitoh, Hideo Tanaka, Masakazu Nakamura, Yoshihiko Naito, Yasuyuki Nakamura, Makoto Watanabe, Yoshikazu Nakamura, Akira Babazono, Zentaro Yamagata, Sumio Urano, Fujihisa Kinoshita, Isao Saitoh, Shinichi Tanihara, Junko Tamaki, Osamu Tochikubo, Takeo Nakayama, Shunichi Fukuhara, Yoshiharu Fujieda, Mariko Naito, Shunsaku Mizushima, Yuji Miyoshi, Takayo Tada, Takashi Kadowaki, Toshimi Yoshida, Mami Ide, Awareness and treatment of hypertension and hypercholesterolemia in Japanese workers
The High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study, Hypertension Research, 10.1291/hypres.30.921, 30, 10, 921-928, 2007.10, [URL], The objective of this study was to clarify the awareness and treatment status of hypertension in Japanese workers, comparing with those of hypercholesterolemia. The subjects were 6,186 workers (age 19 to 69 years), who worked at 12 workplaces in Japan and who continuously participated in the High-risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study at the baseline (1999 or 2000) and the subsequent year (2000 or 2001). No Intervention was performed during the study period. Blood pressure and total cholesterol level were measured at baseline. Awareness and treatment status were examined by a self-administered questionnaire in the following year. Untreated subjects were defined as those were not aware of hypertension (or hypercholesterolemia) or those not taking medication and not undergoing lifestyle modification. The percentages of subjects with hypertension defined as aware were 65.7% in men and 72.7% in women, respectively. The percentages of subjects with hypercholesterolemia defined as aware were 55.7% in men and 58.6% in women, respectively. In subjects 40 years and older, the awareness rate for hypertension was significantly higher than the awareness rate for hypercholesterolemia (75.0% vs. 59.2%, p<0.001). The percentage of untreated subjects with hypertension was significantly lower than the percentage of untreated subjects with hypercholesterolemia (41.0% vs. 57.1%, p<0.001). Although Japanese workers ≥40 years old have a higher awareness of and are more often treated for hypertension than for hypercholesterolernia, there are still many unaware and untreated individuals with either disease in all age groups. It is important to increase the awareness of risk factors in individuals with positive findings for these conditions..
92. 松園美貴、戸田美紀子、中山博子、山尾玲子、丸山徹、上園慶子、馬場園明, 肥満学生を対象とした生活習慣の行動変容支援プログラム「ウエルカムホームベース型健康支援プログラム, 厚生の指標, 54(9)、31-37, 2007.09.
93. 重田尊子、荒木登茂子、馬場園明, 新人看護職員が抱える主観的ストレスおよび早期離職行動に与える職業性ストレスの影響, 医療福祉経営マーケティング研究, 2, 1-12, 2007.09.
94. 川添希,馬場園明, 健康保険組合被保険者の医療受診における所得効果, 厚生の指標, 54(6)、14-19, 2007.06.
95. Akira Babazono, Chihoko Kame, Reiko Ishihara, Eiji Yamamoto, Alan L. Hillman, Patient-motivated prevention of lifestyle-related disease in Japan
A randomized, controlled clinical trial, Disease Management and Health Outcomes, 10.2165/00115677-200715020-00007, 15, 2, 119-126, 2007.05, [URL], Background: Preventing lifestyle-related disease requires realistic, cost-effective programs that patients will embrace. We sought to determine whether patient-motivated lifestyle changes would better enhance healthcare outcomes compared with usual care. In addition, we performed an incremental cost-identification analysis of the intervention. Methods: Participants were members of the National Health Insurance in Umi Town, Fukuoka Prefecture, Japan. Ninety-nine patients consented to participate in the study and were then randomized into the Patient-motivated Health Promotion Program group (intervention group) or the conventional support group (control group). The intervention group had a support team - consisting of qualified dietitians, health exercise instructors, and public health nurses - who encouraged patients to set their own goals and to select their own lifestyle improvements. Follow-up support was performed twice during the first year. These follow-up interventions were made in the patients' homes. The control group received the results of their health examinations and instructions on how to enhance exercise via leaflets only. The control group did not receive services from support staff or have the benefit of the two home visits. All patients underwent health center visits for blood testing and reindoctrination, which were conducted at the end of 4, 6, and 12 months. Main outcome measures included changes in vegetable intake and physical activity (measured as number of steps taken per day). Other health measures included bodyweight, body mass index, blood pressure, cholesterol levels, and General Health Questionnaire. Results: The intervention program significantly increased the number of steps per day, increased the likelihood of consuming ≥2 servings of any type of vegetable, and increased the likelihood of consuming green and yellow vegetables after 1 year compared with the control group. However, there were no significant differences between groups with respect to measures of bodyweight, body mass index, blood pressure, cholesterol levels, and General Health Questionnaire score after 1 year. The incremental cost per person-year and the adjusted incremental cost per person-year were ¥27 495 ($US250) and ¥25 819 ($US235), respectively. Conclusions: Health-oriented lifestyle changes can be achieved at nominal additional cost by targeting patient motivation. Patient self-determination in goal-setting should be included in lifestyle-related health programs and program activities should take place, when possible, in patients' homes..
96. 亀千保子、馬場園明、石原礼子、西岡和男, 生活習慣病予防事業による医療費への影響, 厚生の指標, 54,29-35, 2007.04.
97. 山尾玲子、戸田美紀子、松園美貴、中山博子、能登裕子、上園慶子、永野純、馬場園明, ウエルカムホームベース型健康支援プログラムの開発とその評価, Campus Health, 45、115-120
, 2007.04.
98. 亀千保子, 馬場園明, 山本英二, 総コレステロール高値の治療者データを利用した高脂血症治療薬の死亡率への影響とその経済評価, 日本衛生学雑誌, 62,39-46, 2007.01.
99. Chihoko Kame, Akira Babazono, Eiji Yamamoto, Estimation of effect of lipid lowering treatment on total mortality rate and its cost-effectiveness determined by intervention study of hypercholesterolemia, Nippon eiseigaku zasshi. Japanese journal of hygiene, 10.1265/jjh.62.39, 62, 1, 39-46, 2007.01, [URL], OBJECTIVES: Total cholesterol (TC) level reduction decreases coronary heart disease (CHD) risk, but it is also associated with an increase in non-CHD mortality rate. Our objectives are to estimate the effect of TC level reduction on total mortality and other mortalities in the Japanese population using published data and to analyze the cost-effectiveness of drug therapy. METHODS: We analyzed three data sets for the estimation. The first data set comprised Japanese mortality rates of cardiac diseases, cerebrovascular/other vascular diseases, malignancy, and all causes according to sex and age. The second data set comprised the distributions of serum TC levels in the Japanese population. The third data set comprised the relative risks of mortality rates for the above causes according to the TC level classified into discrete intervals of 20 mg/dl from an intervention study. We estimated the mortality rates of people aged 30-69, with each TC level classification group on the basis of each cause. On the assumption that TC level decreases from 240-259 mg/dl to 160-179 mg/dl or 180-199 mg/dl with drug therapy, we calculated the differences between the mortalities of the classification. When we found a positive effect of TC level reduction, we performed cost-effectiveness analyses of Number Needed to Treat (NNT). RESULTS: TC level reduction increased the mortality rates except for that of cardiac diseases, and the NNT for cardiac diseases was in the range of 4,202-17,533. The cost of simvastatin, for example, was 0.25-1.05 billion yen per year. CONCLUSIONS: TC level reduction from 240-259 mg/dl to 160-199 mg/dl leads to an increase in total mortality rate in the Japanese population. The treatment should be reevaluated from both viewpoints of risk benefit and cost-effectiveness..
100. 三根有紀子,馬場園明, 福岡県の周産期死亡率の地域間格差に関する研究, 医療福祉経営マーケティング研究, 1,1-8, 2006.09.
101. 乃美亜維子,馬場園明,荒木登茂子, 看護職員を対象にしたアサーショントレーニングは透過性調整力を向上させるか, 医療福祉経営マーケティング研究, 1,9-17, 2006.09.
102. 党早織,馬場園明,荒木登茂子, 新人看護職員の自我状態と心理的ストレス反応との関連について, 医療福祉経営マーケティング研究, 1,19-29, 2006.09.
103. 定村美紀子,馬場園明, 介護者の視点による保健・医療・福祉のコーディネートにおける課題, 医療福祉経営マーケティング研究, 1, 41-48, 2006.09.
104. Babazono A, Miyazaki M, Une H, Yamamoto E, Tsuda T, Mino Y, Hillman AL, Health care policy-making in Japan: The Impact of the increase co-payments on use of services by patients with chronic illness, Japanese Journal of Health Promotion, 8, 89-96, 2006.09.
105. 石原礼子,馬場園明,亀千保子,西岡和男, メンタルヘルスと医療費の指標との関連に関する研究, 日本衛生学雑誌, 61, 400-406, 2006.09.
106. Reiko Ishihara, Akira Babazono, Chihoko Kame, Kazuo Nishioka, Study of relationships between state of mental health and indicators of medical expenses, Nippon eiseigaku zasshi. Japanese journal of hygiene, 10.1265/jjh.61.400, 61, 4, 400-406, 2006.09, [URL], OBJECTIVE: The purpose of this study is to determine the relationships between the state of mental health and indicators of medical expenses for inpatient, outpatient and dental services. METHODS: This study was conducted using data from 140 people (54 males and 86 females) who participated in a lifestyle intervention program. The result of General Health Questionnaire (GHQ)-30 survey performed in August 2003 was used as the indicator of mental health, whereas diagnoses based on International Classification of Diseases (ICD) 10 from medical expense claims in the 2003 fiscal year were used for disease classification by the Proportional Disease Magnitude (PDM) method. The subjects were classified into two groups by GHQ-30 score: low-score group (n=96) and high-score group (n=44). The differences between the two groups were compared by an unpaired t-test. RESULTS: For outpatient service in the high-score group, the medical expenses and the numbers of consulting days, medical expense claims and consultation cases at least two per month were significantly higher (p < 0.05) than those in the low-score group. However, there were no significant differences in the same indicators between inpatient and dental services. In the high-score group, the medical expenses of the XVIII group (symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified) of ICD10 were also significantly higher (p < 0.05) than those of the low-score group. CONCLUSIONS: The state of mental health is significantly associated with indicators of medical expenses for outpatient service. The medical expenses of a problematic non-mentally healthy group are significantly higher than those of a mentally healthy group..
107. Takuya Imatoh, Motonobu Miyazaki, Ken Kadowaki, Akira Babazono, Masuyuki Sato, Hiroshi Une, Interaction of low serum adiponectin levels and smoking on coronary stenosis in Japanese men, International Journal of Cardiology, 10.1016/j.ijcard.2005.11.039, 110, 2, 251-255, 2006.06, [URL], Background: The relationship between serum adiponectin levels and coronary stenosis and the interaction of low serum adiponectin levels and smoking on coronary stenosis have not been clarified. Methods: We conducted a hospital-based case-control study to examine serum adiponectin levels and smoking in 86 male patients with coronary stenosis and 145 male controls, using multiple logistic regression analyses. Serum adiponectin levels were grouped into quartiles for the analysis of the relationship between serum adiponectin levels and coronary stenosis, and into dichotomy for the analysis of the interaction of low serum adiponectin levels and smoking status. Results: Decreasing serum adiponectin levels were significantly associated with increased risk of coronary stenosis in a dose-dependent manner. As for the interaction of low serum adiponectin levels and smoking on coronary stenosis, adjusted odds ratios were 14.00 (95% Confidence Interval 5.45-37.48) among ever-smokers with low serum adiponectin levels, 3.84 (95% CI: 1.44-10.21) among ever-smokers with high serum adiponectin levels and 3.79 (95% CI: 1.38-10.45) among never-smokers with low serum adiponectin levels, compared with the reference group of never-smokers with high serum adiponectin levels. Conclusions: The interaction of low serum adiponectin levels and smoking on coronary stenosis was likely to be a synergic effect. This study suggests that the combination of low serum adiponectin levels and smoking is the most useful predictor for coronary stenosis among Japanese men..
108. Yoshio Mino, Akira Babazono, Toshihide Tsuda, Nobufumi Yasuda, Can stress management at the workplace prevent depression? A randomized controlled trial, Psychotherapy and Psychosomatics, 10.1159/000091775, 75, 3, 177-182, 2006.04, [URL], Background: Stress, mental health and depression at the workplace have emerged as common and significant problems. The effectiveness of a stress-management program at the workplace was investigated. Methods: The effectiveness of a stress-management program was examined in workers at a highly stressful workplace using a randomized controlled trial. The 58 workers in the office were randomly assigned into a stress-management group (n = 28) and a control group (n = 30). The stress-management program included lectures on the perception of stress, measures to cope with it, stress-management recording sheets, and e-mail counseling. This program was based on the cognitive behavioral approach. The stress-management program was carried out for 3 months, and perceived work-related stress and psychological symptoms were evaluated using: General Health Questionnaire (GHQ)-30, Center for Epidemiologic Study for Depression (CES-D), the Questionnaire of Work-Related Stress and the Effort-Reward Imbalance Questionnaire. Twenty-one out of the 28 in the stress-management group and all in the control group were successfully followed up. Results: In the stress-management group, a significant improvement in the depressive symptoms was observed, compared with the control group in CES-D (p = 0.003 by two-tailed paired t-test, and p = 0.042 by repeated measure analysis of variance). In the multiple regression analysis, the effect of stress management on depressive symptoms at follow-up was significant (p = 0.041), controlling for potential confounding factors. However, the alleviation of perceived occupational stress was limited. Conclusions: A stress-management program based on the cognitive behavioral approach at the workplace may have potential for the prevention of depression..
109. Babazono A, Miyazaki M, Une H, Yamamoto E, Tsuda T, Mino Y, Hillman AL, Understanding the Impact of Health Policy: 10% Co-payments for Medical Services Reduce Compliance with Necessary Care Among Elderly Patients with Chronic Disease in Japan, Journal of Health Sciences, 28, 15-23, 2006.03.
110. A. Babazono, Securing access to medical services and patient co-payment, Fukuoka igaku zasshi = Hukuoka acta medica., 97, 3, 43-52, 2006.03.
111. 馬場みちえ、馬場園明、畝博, 健康保険組合の男性被保険者を対象とした喫煙状況と医療費に関する研究, 健康支援, 8、1-8, 2006.02.
112. Motonobu Miyazaki, Akira Babazono, Ken Kadowaki, Masumi Kato, Tohru Takata, Hiroshi Une, Is Helicobacter pylori infection a risk factor for acute coronary syndromes?, Journal of Infection, 10.1016/j.jinf.2005.04.009, 52, 2, 86-91, 2006.02, [URL], Objectives: To elucidate risk factors for acute coronary syndromes (ACS), the present study examined whether Helicobacter pylori infection is a risk factor for patients with ACS. Methods: We studied 33 male patients with acute coronary syndromes (ACS). All patients were incidence cases of ACS that they did not have a past history of IHD and were at the first onset of ACS. A control group was consisted of 66 males. Controls were at random selected from outpatients. All controls had normal resting electrocardiogram and had no history of IHD. H. pylori seropositivity was determined by an IgG-specific enzyme linked immunosorbent assay (ELISA). We serologically confirmed the presence of antibodies specific to the antigen CagA of H. pylori, using CagA ELISA. Results: Seropositive rate of IgG antibodies in patients with ACS was 87.9%. A rate of in controls was 66.7%. After adjustment for age, a statistically significant association was found in H. pylori seropositivity between ACS and controls (OR, 3.74; 95% CI, 1.15-12.13). This relation was also significant after adjusted for potential confounding factors (OR, 4.09; 95% CI, 1.10-15.17). Anti-CagA positive H. pylori were significantly recognized in ACS (adjusted OR, 3.58; 95% CI, 1.08-11.82). However, this significant association was disappeared after adjusted for potential confounding factors (P=0.054). Conclusions: We confirmed a significant link between H. pylori infection and ACS. H. pylori infection is likely to be a risk factor for ACS..
113. 馬場みちえ、今任拓也、馬場園明、谷原真一、宮崎元伸、西岡和男、畝博, 福岡県における長期入院高齢者の介護保険法施行後の動向, 厚生の指標, 53、13-19, 2006.01.
114. 石原礼子,馬場園明,亀千保子,八尋玄徳,西岡和男, 生活習慣病予防事業におけるメンタルヘルスの変化と生活習慣改善および身体的健康度改善との関連, 日本衛生学雑誌, 60,442-449, 2005.11.
115. Babazono A, Mino Y, Nagano J, Tsuda T, Araki T, A prospective study on the influences of workplace stress on mental health, Journal of Occupational Health, 10.1539/joh.47.490, 47, 6, 490-495, 47,490-495, 2005.11.
116. Reiko Ishihara, Akira Babazono, Chihoko Kame, Motonori Yahiro, Kazuo Nishioka, Relationship between the change of mental health and the improvement of lifestyle and physical health, Nippon eiseigaku zasshi. Japanese journal of hygiene, 10.1265/jjh.60.442, 60, 4, 442-449, 2005.11, [URL], OBJECTIVES: The purpose of this study was to clarify the relationship between the change of mental health and the improvement of lifestyle and physical health in the lifestyle intervention program. METHODS: The study was conducted using data from 126 persons (50 males and 76 females) who participated in the 6-month lifestyle intervention program. We used the result of the General Health Questionnaire (GHQ)-30 as the indicator of mental health, the number of steps, surveys concerning caloric intake, and sleeping hours as the indicator of lifestyle, and body weight, BMI, blood pressure, triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol and HBA1c. The subjects were classified into four groups based on the change of mental health: Group-GG, change from good to good (n = 80); Group-PG, change from poor to good (n = 25); Group-PP, change from poor to poor (n = 13); and Group-GP, change from good to poor (n = 8). The changes between pre-intervention and post-intervention were compared for each group by the paired t-test, and among the 4 groups by ANCOVA. RESULTS: In Group-GG, the number of steps (p < 0.01), calorie intake (p < 0.05) and sleeping hours (p < 0.01) were significantly improved, triglyceride was significantly decreased (p < 0.01), and total and HDL cholesterol were significantly increased (p < 0.01). However there were no significant changes in Group-GP. CONCLUSION: The state and change of mental health were found to be significantly associated with the improvement of lifestyle and physical health..
117. 八尋玄徳, 馬場園明, 西岡和男, 石原礼子, 亀千保子, 精神的健康度と受診行動との関連について—レセプト情報を活用した保健事業の推進—, 厚生の指標, 21-26,52, 2005.09.
118. Akira Babazono, Motonobu Miyazaki, Takuya Imatoh, Hiroshi Une, Eiji Yamamoto, Toshihide Tsuda, Kiyoshi Tanaka, Shinichi Tanihara, 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, International Journal of Technology Assessment in Health Care, 21, 2, 228-233, 2005.03, 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..
119. 定村美紀子、馬場園明, 介護保険制度による介護資源の指標と死亡場所との関連, 厚生の指標, 52, 8-14, 2005.01.
120. 一宮厚、福盛英明、馬場園 明、峰松修, 大学生の入学時の精神状態と留年・休学・退学との関連, 精神医学、46,1185-1192, 46,1185-1192, 2004.11.
121. 山下順子、馬場園明, 入院患者のソーシャルサポートスケールSSSHP-20(Social Support Scale for Hospitalized Patients-20)の開発とソーシャルサポートと心理的ストレスとの関連, 健康支援, 6、145-155, 2004.09.
122. 三根有紀子、馬場園明, 日本の周産期死亡率の地域間格差に関する研究—人口動態統計を用いた調査—, 日本衛生学雑誌, 59, 342-348, 2004.07.
123. Yukiko Mine, Akira Babazono, Regional differences in perinatal mortality rates in Japan--an investigation based on vital statistics, Nippon eiseigaku zasshi. Japanese journal of hygiene, 10.1265/jjh.59.342, 59, 3, 342-348, 2004.07, [URL], OBJECTIVE: This study investigated whether regional differences in perinatal mortality rates are related to distances to medical resources for perinatal care, such as the Neonatal Intensive Care Unit (NICU). METHODS: Using the census for Japan in 2000, all municipalities in Japan were classified into four groups based on population size: municipalities of 1,000,000 people or more (Group 1), municipalities between 350,000 and 1,000,000 people (Group 2), municipalities between 10,000 and 350,000 people (Group 3), and municipalities of less than 10,000 people (Group 4). Then, using the vital statistics, perinatal mortality rates for all groups were calculated. In addition, setting the perinatal mortality rate in Group 1 as a referent, we calculated the differences in the rates to detect regional differences in perinatal mortality in Japan. Finally, we compared the distances between the municipality center and the closest NICU among the four groups by one-way ANOVA. RESULTS: The perinatal mortality rates of Groups 1, 2, 3 and 4 were 5.38, 5.58, 5.88 and 6.31, respectively. The perinatal mortality rate ratios (95%CI) were 1.04 (0.96-1.12), 1.09 (1.03-1.16), and 1.17 (1.05-1.31), respectively. The perinatal mortality rate differences (95%CI) were 0.20 (-0.24-0.64), 0.50 (0.15-0.84), and 0.93 (0.23-1.62), respectively. The distances (95%CI) between the center of the municipalities and the closest NICU for Groups 1, 2, 3 and 4 were 2.61 (1.56-3.66) km, 4.23 (2.74-5.72) km, 20.79 (17.68-23.90) km and 38.07 (31.65-44.48) km, respectively. All of the differences among the groups were significant (p < 0.001), except for the difference between Group 1 and Group 2. CONCLUSION: There are regional differences in perinatal mortality rates in Japan. This study suggests that the difference is associated with the uneven distribution of NICUs..
124. T. Okamura, T. Tanaka, Akira Babazono, Katsushi Yoshita, Nagako Chiba, Toru Takebayashi, Hideaki Nakagawa, Hiroshi Yamato, Katsuyuki Miura, J. Tamaki, T. Kadowaki, Akira Okayama, Hirotsugu Ueshima, Nobuo Nishi, Keiko Tsuji, Yuriko Kikuchi, Masahiko Yanagita, Kazunori Kodama, Fumiyoshi Kasagi, Yukinori Kusaka, Shigeyuki Saitoh, Kiyomi Sakata, Hideo Tanaka, Masakazu Nakamura, Yoshihiko Naito, Yasuyuki Nakamura, Makoto Watanabe, Yoshikazu Nakamura, Unai Tamura, Junko Minai, Zentaro Yamagata, Sumio Urano, Fujihisa Kinoshita, Isao Saitoh, Shinichi Tanihara, Junko Tamaki, Osamu Tochikubo, The high-risk and population strategy for occupational health promotion (HIPOP-OHP) study
Study design and cardiovascular risk factors at the baseline survey, Journal of human hypertension, 10.1038/sj.jhh.1001680, 18, 7, 475-485, 2004.07, [URL], In order to establish the methodology of a population strategy for improving cardiovascular risk factors, we have planned the High-risk and Population Strategy for Occupational Health Promotion Study (HIPOP-OHP study). This study is a nonrandomized control trial in approximately 6500 participants in six intervention and six control companies. Our population strategy is based on three factors, nutrition, physical activity, and smoking. For each factor, a researcher's working team was organized and has been supporting the intervention. A standardized method to obtain comparable data has also been established. In the baseline survey, urinary sodium excretion in male subjects was higher, and urinary potassium excretion was lower in both genders in the intervention group compared to the control group. The prevalence of hypertension for both genders was also higher in the intervention group. Male subjects in the intervention group had higher serum total cholesterol than controls, while high-density lipoprotein cholesterol was lower in both genders in the intervention group compared to the control group. These differences were reflected by our finding that the predicted relative risk of coronary heart disease for male subjects was significantly higher in the intervention group (relative risk, RR: 1.17; 95% confidence interval, 95% CI.: 1.09, 1.25) and significantly lower in the control group (RR: 0.93; 95% CI.: 0.89, 0.98) compared to a model Japanese population. Similar results were observed in the female subjects. Taken together, these findings indicate that it is possible to compare trends of predicted relative risk for coronary heart disease between two groups..
125. Akira Babazono, Motonobu Miyazaki, Hiroshi Une, Eiji Yamamoto, Toshihide Tsuda, Yoshio Mino, A Study on A Reduction in Visits to Physicians after Introduction of 30% Co-payments in the Employee Health Insurance in Japan, Industrial health, 10.2486/indhealth.42.50, 42, 1, 50-56, 2004.01, [URL], The purpose of the study is to evaluate influences of the introduction of 30% co-payments on potential visit behavior using a questionnaire in order to determine whether "employment state of the spouse" and "number of dependent children", as indicators of economic backgrounds, affect visits to physicians in a health insurance society. The subjects were 1,674 insured consisting of 1,165 males and 509 females, who underwent a regular health examination in July 2002, in a health insurance society. In the survey, they were asked whether the subject "will reduce" or "will not reduce" visits to physicians due to the increase in co-payments in the health insurance system scheduled in 2003. Multivariate analyses showed that "employment state of the spouse" was significantly related to the reduction in visits for myocardial infarction or stroke, cancer or heart disease, and hypertension and diabetes mellitus. Concerning "number of dependent children", it was related to the risk of reducing visits to physicians for myocardial infarction or stroke, trauma or fracture, cancer or heart disease, and low back pain or knee pain. Finally, upper limit expenditures of co-payments of physicians to visits due to hypertension and diabetes mellitus were related to "number of dependent children". The study results suggest that "employment state of the spouse" and "number of dependent children" are significant factors to affect potential visits to physicians after the introduction of 30% co-payments..
126. Akira Babazono, Motonobu Miyazaki, Hiroshi Une, Eiji Yamamoto, Toshihide Tsuda, Yoshio Mino, Alan L. Hillman, Does seropositivity for Helicobacter pylori antibodies increase outpatient costs for gastric and duodenal ulcer or inflammation?, PharmacoEconomics, 10.2165/00019053-200422150-00002, 22, 15, 975-983, 2004, [URL], Background: Helicobacter pylori is regarded as an important cause of both peptic ulcer and chronic gastritis. In particular, seropositivity is highest in patients with duodenal ulcer. No studies have determined whether there are differences in the direct medical costs associated with gastric/duodenal ulcer or inflammation, between seropositive and seronegative patients. Objective: To examine the relationship between seropositivity for H. pylori and outpatient visits and direct medical costs for gastric/duodenal ulcer or inflammation in Japan from the perspective of the payor and patients. Methods: Participants were males (n = 653) who worked for an agricultural co-operative in Fukuoka Prefecture, attended an annual health examination (including a written lifestyle and medical survey), belonged to the same health insurance society consistently for 4 years from April 1996 to March 2000, and provided a blood sample. The survey asked about lifestyle, including smoking and drinking, and past medical history. We retrospectively analysed the annual number of outpatient visits per person and outpatient medical cost (Yen [¥], 2000 values) per person for visits relating to gastric or duodenal ulcer or inflammation using International Classification of Diseases (9th edition) - Clinical Modification codes. We assessed for potential confounding factors using analysis of covariance and the chi-square test. Results: The annual outpatient incidence of disease, the number of visits to physicians, and the medical costs for gastric or duodenal ulcer or inflammation were about 2-fold greater in individuals with antibodies to H. pylori compared with those without antibodies. Conclusion: Population-based studies and/or randomised controlled clinical trials that target high-risk groups and account for the unique way in which data are collected in Japan are needed to determine whether medical costs for gastric and duodenal ulcer might be reduced by treating asymptomatic patients who have antibodies to H. pylori..
127. 一宮厚、馬場園明、福盛英明、峰松修, 大学新入生の精神状態の変化, 精神医学, 45, 959-966, 2003.09.
128. Motonobu Miyazaki, Akira Babazono, Masumi Kato, Shigeru Takagi, Hiroshi Chimura, Hiroshi Une, Sexually transmitted diseases in Japanese female commercial sex workers working in massage parlors with cell baths, Journal of Infection and Chemotherapy, 10.1007/s10156-003-0257-3, 9, 3, 248-253, 2003.09, [URL], A cross-sectional study of Japanese female commercial sex workers (FCSWs) working in massage parlors with cell baths (MPCBs) was conducted between July 1999 and December 2001. The study subjects were 171 FCSWs aged from 19 to 36 years. A questionnaire included sexual characteristics in addition to working name and date of birth. We serologically or bacteriologically confirmed the prevalence of HIV-1, HIV-2, hepatitis B virus (HBV), hepatitis C virus (HCV), Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and trichomoniasis. There were no differences in the clinical characteristics of FCSWs working in standard-class MPCBs (group A) and those working in expensive-class MPCBs (group B). With respect to sexual characteristics, HIV-1 and HIV-2 were not confirmed in any subjects, but N. gonorrhoeae was detected in 1.2%. Use of condoms was 98.4% in group A and 83.3% in group B (P < 0.01). No HIV infection and an extremely low prevalence of sexually transmitted diseases (STDs) were recognized in Japanese FCSWs working in standard- and expensive-class MPCBs..
129. Akira Babazono, Toshihide Tsuda, Eiji Yamamoto, Yoshio Mino, Hiroshi Une, Alan L. Hillman, Effects of an increase in patient copayments on medical service demands of the insured in Japan, International Journal of Technology Assessment in Health Care, 10.1017/S0266462303000400, 19, 3, 465-475, 2003.06, [URL], Objectives: To examine quantitatively the effects of an increase in patient copayments from 10% to 20% on the demand for medical services in Japan. Methods: The subjects of the study were the employees insured by the 1,797 health insurance societies, belonging to the National Federation of Health Insurance Societies, in 1996 and 1998. Indicators of medical service demands analyzed include the inpatient, outpatient, and dental case rates, the number of serviced days per case, the medical cost per day and the medical cost per insured. Results: When the effects of an increase in patient copayments from 10% to 20% were evaluated, taking into account the average age, the average monthly salary, the total number, the gender (male-to-female) ratio and the dependent ratio of the insured, the estimated change in the case rate was -6. 96% for inpatient, -4.79% for outpatient, and -5.77% for dental care. The estimated change in the number of serviced day per case was -4.66% for inpatient, -5.67% for outpatient, and -1.82% for dental care. The estimated change in the medical cost per day was -3.15% for inpatient, -13.00% for outpatient, and -11.48% for dental care. The estimated change in the medical cost per insured was -14.08% for inpatient, -21.54% for outpatient, and -18.11% for dental care. Conclusions: The increase in patient copayments from 10% to 20% enabled insurers to substantially reduce medical costs by cost shifting from the insurer to the insured, with resultant changes in the case rate and the number of service days per case..
130. Terukazu Kawasaki, Keiko Uezono, Miho Sanefuji, Hiroko Utsunomiya, Takehiko Fujino, Shozo Kanaya, Akira Babazono, A 17-year follow-up study of hypertensive and normotensive male university students in Japan, Hypertension Research, 10.1291/hypres.26.445, 26, 6, 445-452, 2003.06, [URL], The aim of the present study was to determine the disease course of hypertensive male university students followed for 8 to 26 years (average, 17 years) after graduation. Subjects were classified into two groups. 1) A hypertensive group (H-group) consisting of 338 conclusively hypertensive male students followed from 1973 to 1990 at the Institute of Health Science, Kyushu University. Their ages ranged from 20 to 27 years, and all had high blood pressure (BP) of 140 mmHg or greater in systole (SBP) and/or 90 mmHg or greater in diastole (DBP) at a regular health check. This was confirmed by BP measurements for 3 days within 1 week. 2) A normotensive control group (N-group) consisting of 732 normotensive students (110-124 SBP/60-74mmHg DBP) for whom faculty, age, sex, height, weight, and examination period were matched to the H-group as closely as possible. In 1997, each subject was sent a questionnaire with items on height, weight, sitting BP, pulse rate, family history of hypertension, lifestyle habits (such as drinking and smoking), stress and personality type. Completing the questionnaire were 177 (52.4%) of the H-group and 206 (28.1%) of the N-group subjects. Hypertension continued in 44.6% of the H-group subjects, whereas 9.2% of the N-group subjects became hypertensive. The rate of hypertension at the end of the investigation was significantly higher in those subjects who had a family history of hypertension than in those who did not. Weight gain (+15.1%) was the highest in H-group subjects who were initially normotensive. These subjects showed a significantly higher incidence of smoking and drinking than the other subjects. These results confirmed lifestyle to be one of the most important factors in keeping BP normal throughout life and also suggested that fundamental health education should be introduced at an early age..
131. 松園美貴、宇都宮弘子、戸田美紀子、明石久美子、栗巣京子、福田美幸、馬場園明, 大学生におけるライフスタイルと肥満との関連, CAMPUS HEALTH, 40, 61-66, 2003.03.
132. Toshihide Tsuda, Yoshio Mino, Akira Babazono, Jun Shigemi, Tadahiro Otsu, Eiji Yamamoto, Susumu Kanazawa, A case-control study of lung cancer in relation to silica exposure and silicosis in a rural area in Japan, Annals of Epidemiology, 10.1016/S1047-2797(01)00271-X, 12, 5, 288-294, 2002.06, [URL], PURPOSE: In southeast Okayama Prefecture, Japan, there have been reports of a high prevalence of silicosis among refractory brick production workers. Recently, a high mortality rate of lung cancer among the local residents has been observed. Therefore, a population based case-control study was conducted concerning the relationship between silica, silicosis, and lung cancer using multiple cancer controls. METHODS: Cases and controls were restricted to male subjects and information was obtained from death certificates from 1986 to 1993 in the area. Three categories of deceased control groups were selected: a series of deaths from liver cancer, colon cancer, and cancers of other organs, which was assumed not to be related to silica exposure. Age and smoking habits were adjusted by stratified analysis using the Mantel-Haenszel odds ratio estimates. Unconditional logistic regression analysis was also conducted to control potential confounding factors; such as age and smoking habits. RESULTS: The age-, smoking-adjusted odds ratios were 1.94 (0.94-4.43) for the colon cancer control group, 2.13 (1.19-3.85) for the other cancer control group related to silica exposure, and 2.94 (1.30-8.90) and 2.69 (1.43-5.37) related to silicosis, respectively. The direct weighted average using the estimates for colon and the other cancer controls was 2.06 (1.29-3.29) for silica exposure, and 2.77 (1.60-4.77) for silicosis. Histological or cytological types of lung cancer cases were obtained from 64.1% of the subjects (118/184). As for the histologic type of lung cancer, small cell carcinoma was higher among those who had been silica-exposed workers than the unexposed lung cancer cases and the data from the general Japanese population. On chest x-ray findings, elevated lung cancer mortality compared with cancers other than lung cancer was demonstrated among patients without large opacities. CONCLUSIONS: Silica exposure increased the lung cancer mortality in the area. A high lung cancer mortality rate in the area could be explained by silica exposure and silicosis prevalence in this area..
133. 丸山徹、永野純、馬場園明、上園慶子、藤野武彦, 定期学生健康診断における風邪罹患時の心電図ST−T異常, 健康科学, 24, 11-16, 2002.03.
134. 本山帝、上園慶子、馬場園明、一宮厚、丸山徹、藤野武彦、金谷庄蔵、川崎晃位置, 大学生における心胸比と身長・体重・血圧・脈拍との関連, 健康科学, 24, 17-22, 2002.03.
135. Motonobu Miyazaki, Akira Babazono, Toshiya Ishii, Takuya Sugie, Yoshito Momose, Mitsue Iwahashi, Hiroshi Une, Effects of low body mass index and smoking on all-cause mortality among middle-aged and elderly Japanese, Journal of epidemiology, 10.1109/ISSCC.2002.992099, 12, 1, 40-44, 2002.01, [URL], To investigate effects of low body mass index (BMI) and smoking on all-cause mortality among middle-aged and elderly Japanese, we conducted a community-based prospective study. A mail survey was conducted in 1987-1990 in four towns, western Japan. A cohort of 7,301 Japanese men and 8,825 Japanese women was followed up from the date of the mail survey to 1995 in three of the towns and 1998 in the fourth town. We investigated the effect of BMI and smoking on all-cause mortality by using Cox's proportional hazards model. The relationship between BMI and all-cause mortality was a reverse J-shape with minimal mortality in 24 ≤ BMI ≤ 26 in men and a U-shape with minimal mortality in 22 ≤ BMI < 24 in women, after adjusting for age and smoking. The lowest BMI category (BMI < 20) had the highest all-cause mortality in men and also in women. Taking only never-smokers, the highest risk for all-cause mortality was observed in the lowest BMI category for men and for women. This does not seem to be explained by smoking and pre-existing diseases. More attention should be paid to persons with low BMI..
136. 津田敏秀、茂見潤、大津忠弘、馬場園明, 保健医療における因果関係の推論, 3, 87-93, 2001.09.
137. T. Tsuda, A. Babazono, J. Shigemi, T. Otsu, Y. Mino, Causal inference in medicine--decision making, Sangyō eiseigaku zasshi = Journal of occupational health, 10.1539/sangyoeisei.KJ00001991709, 43, 5, 161-173, 2001.09, [URL], In the field of occupational medicine, either when we consider some preventive plans or when we make decisions to compensate for occupational diseases, it has been necessary to discuss causality between work and disease. Furthermore, epidemiologic causality has recently been used in risk assessment in occupational and environmental settings. We have shown that the law of causality in medicine is recognized as probability and continuous variables. Such a law of causality has been recognized in the same way as probability in physics, too, and has been regarded as a model of science. Physicists and mathematicians had claimed the importance of probability in causal inference as well as the principle of uncertainty before it was discovered. We, then, explained Etiologic Fraction (EF), Attributable Proportion for the Exposed Population (APE), Probability of Causation (PC), and so on. The PC has been used to ascertain the conditional probability in an individual case of a disease having been caused by a particular prior exposure, by using the experience of exposed populations to determine the appropriate relative risk, and this has been used for compensation for exposed cases. Next the applicability of information from a population to individuals was presented. Third, we provided a brief historical aspect of epidemiology. The evolutions in Epidemiology have been very rapid, so we pointed out that, in Japan, we could observe many incommensurable phenomena in epidemiologists and physicians depending on the era which was studied by them. Fourth, we discussed judgement and political application based on epidemiologic evidence, using Yanagimoto's classification is also taken or not should be estimated and compared. We presented several examples of reasoning in judgements. Lastly, we discussed several tasks and assignments for the future of epidemiology..
138. 馬場園明、山本英二、津田敏秀、三野善央, 健康保険組合における老人医療費の負担指標に関する研究, 医療経済研究, 9, 5-22, 2001.03.
139. 福盛英明、峰松修、馬場園明、一宮厚、永野純、藤野武彦、上園慶子, 大学生のQOL研究:大学生QOL質問表「大学生活チェックカタログ」の開発, Campus Health, 37, 2, 55-60, 2001.03.
140. Toshihide Tsuda, Yoshio Mino, Akira Babazono, Jun Shigemi, Tadahiro Otsu, Eiji Yamamoto, A case-control study of the relationships among silica exposure, gastric cancer, and esophageal cancer, American Journal of Industrial Medicine, 10.1002/1097-0274(200101)39:1<52::AID-AJIM5>3.0.CO;2-C, 39, 1, 52-57, 2001.01, [URL], Background: We examined the effect of silica exposure on gastric and esophageal cancer mortality using a cancer control series in a population setting. Methods: Cases and controls were restricted to male subjects and were drawn from death certificates in the Tobi area of Japan. A control group was selected from a series of deaths due to colon cancer, and cancers of other organs. The Japanese death certificate system is comprehensive because all deaths must be reported to the local office and death certificates are written by medical doctors. Age and smoking habits adjusted the Mantel-Haenszel odds ratios were estimated. Results: For gastric cancer, the age-, smoking-adjusted odds ratios were 1.22 (95% CI 0.74-2.01)for colon cancer and the other cancer control for silica exposure work, and 1.36 (95% CI 0.76-2.43) for silicosis. For esophageal cancer, the age- and smoking-adjusted odds ratios were 1.53 (95% CI 0.59-3.96) for the cancer control for silica exposure, and 2.33 (95% CI 0.87-6.23) for silicosis, respectively. Conclusions: The results suggest that gastric and esophageal cancer were related to silica exposure and silicosis in the study area, although they did not reach a statistically significant level because of the small sample size. The estimated odds ratios were higher for esophageal cancer and silicotic patients..
141. Yoshio Mino, Jun Shigemi, Tadahiro Otsu, Atsuhiko Ohta, Toshihide Tsuda, Nobufumi Yasuda, Akira Babazono, Eiji Yamamoto, Smoking and mental health
Cross-sectional and cohort studies in an occupational setting in Japan, Preventive Medicine, 10.1006/pmed.2000.0803, 32, 4, 371-375, 2001.01, [URL], Background. The relationship between smoking and mental health remains unclear. Methods. We carried out a cross-sectional study and a cohort study on the possible association of smoking and mental health in 782 workers. Using a questionnaire including the 30-item General Health Questionnaire (GHQ-30) and items related to the smoking state, the association between smoking and mental health was evaluated separately in males and females. The subjects were classified into smokers and nonsmokers, and changes in the GHQ score during a 2-year follow-up period were evaluated. To control potential confounding factors, multiple regression analyses were performed. Results. The cross-sectional study showed no difference in the GHQ score between smokers and nonsmokers among males but a significantly higher GHQ score for smokers than nonsmokers among females. This difference among females was confirmed to be significant by multiple regression analysis. The 2-year cohort study showed a decrease in the GHQ score in each group and no reduction in the difference in the GHQ score between smokers and nonsmokers among females. Conclusions. No difference was observed in mental health between smokers and nonsmokers in males. However, in females, smokers showed poorer mental health than nonsmokers, and this difference remained unchanged even after 2 years..
142. Masayuki Kubota, Akira Babazono, Hideyasu Aoyama, Women's anxiety in old age and long-term care provision for the elderly, Acta medica Okayama, 54, 2, 75-83, 2000.12, The purpose of this study was to verify the differences in women's anxiety in old age, the expected long-term care provision, and the expected final location for terminal care for the women themselves and for their parents. In addition, we examined factors that related to their anxiety and needs. The subjects were 1,000 women of the Seikatsu Club customer cooperative association in Chiba; 539 responded to our survey. The subjects were more anxious for their parents than for themselves. They more strongly expected long-term care for their parents to be provided by their family than they expected the same for themselves. Although no differences were observed in the expected location for terminal care, most subjects expected their home to be the terminal location. Analysis by the multiple logistic regression model indicated that the following factors were significantly related to the anxiety in old age: age odds ratio [OR= 1.81], employment [OR = 2.25] for women, and planning to live with parents [OR = 2.42], housing conditions [OR = 0.56] for parents. The following factors were significantly related to the expected long-term care provision: age [OR = 2.22] for women, and age [OR = 2.1 5], living with parents [OR = 3.58], and employment [OR = 2.33] for parents. Age [OR = 2.14] for women, and planning to live with parents [OR = 2.09] for parents were significantly related to the expected final location of terminal care. This survey showed that women expected long-term care for their parents to be provided by their family, while many expected public long-term care services for themselves. This is the biggest difference in women's outlook on long-term care for their parents and for themselves. Multivariate analysis suggested that women aged 40 years or over, who will need long-term care in the future, tended to expect public home care services for themselves. It is virtually certain that the demand for public home care services will increase in the future..
143. 津田敏秀、馬場園明, 医学における因果関係の認識と合意, 健康支援, 2, 38-53, 2000.09.
144. Yoshio Mino, Jun Shigemi, Tadahiro Otsu, Toshihide Tsuda, Akira Babazono, Does smoking cessation improve mental health?, Psychiatry and clinical neurosciences, 10.1046/j.1440-1819.2000.00654.x, 54, 2, 169-172, 2000.04, [URL], There is a possibility that cessation of smoking improves mental health, but there are no studies that have demonstrated this. A cohort study was performed for 1 year in 18 males who spontaneously stopped smoking (cessation group) and 173 who continued to smoke (smoking group). The mental health state was evaluated using the Japanese version of the 30-item General Health Questionnaire (GHQ-30) before the cessation of smoking and 6 months and 1 year after smoking cessation. Changes in the GHQ score were compared between the cessation and smoking groups. In order to control the effects of confounding factors, multiple regression analyses were performed using the GHQ score after 6 months and 1 year as dependent variables. The GHQ score in the cessation group significantly decreased 6 months and 1 year after smoking cessation (P < 0.04 and 0.01, respectively, by paired t-test). In the smoking group, the GHQ score slightly decreased. Repeated measure analysis of variance revealed that the decrease in the GHQ score in the cessation group was significantly larger than in the smoking group. Multiple regression analysis revealed significant effects of smoking cessation on mental health after controlling for other confounding factors. It can be concluded that smoking cessation may improve mental health..
145. Yoshio Mino, Jun Shigemi, Toshihide Tsuda, Nobufumi Yasuda, Akira Babazono, Paul Bebbington, Recovery from mental ill health in an occupational setting
A cohort study in Japan, Journal of Occupational Health, 10.1539/joh.42.66, 42, 2, 66-71, 2000.03, [URL], Objectives: The purpose of this study is to clarify the degree of recovery from mental ill health in occupational settings and the nature of perceived job stress associated with recovery. Methods: A 1-year cohort study was carried out in 287 of 763 workers who scored 8 or more on the General Health Questionnaire (GHQ-30), and the proportion recovering during the year was compared according to the presence of individual perceived job stress items. To control confounding factors, multiple logistic analysis was used. Results: Recovery from mental ill health was observed in 48.7% after the first 6 months and in 66.1% after 1 year. During the first 6-month period, no identified job stress item was associated with recovery. During the second 6- month period, however, the odds ratio (95% confidence interval) between recovery and the absence of perceived job stress was 4.2 (1.3-13.1) for 'Too much responsibility', even after controlling for sex, age, the degree of family life satisfaction, physical health state, and the initial GHQ score. Conclusion: Relief from excessive responsibility might promote recovery in mentally ill workers..
146. Hagihara A, Babazono A, Tarumi K, Sly DF, Health locus of control, health value and knowledge of HIV/AIDS among white and black mothers of schoolchildren, Japanese Journal of Health Promotion, 1, 21-34, 1999.02.
147. Akihito Hagihara, Kimio Tarumi, Akira Babazono, Koichi Nobutomo, Kanehisa Morimoto, Work versus non-work predictors of job satisfaction among Japanese white-collar workers, Journal of Occupational Health, 10.1539/joh.40.285, 40, 4, 285-292, 1998.10, [URL], In the present study, we conducted a cross-sectional study of male white-collar workers in Japan, and evaluated the relative importance of work and non-work factors in deciding the level of subject's job satisfaction. Survey data collected from white-collar workers at a large steel company in Osaka, Japan were analyzed. The results show that work factors play a more important role in predicting the subject's work satisfaction than do non- work factors. The majority of significant predictors of job satisfaction were related to company controlled working conditions rather than variables under the direct control of the individual. The results imply that the level of job satisfaction among the workers can be more effectively improved through the implementation of some basic policies by the company than through efforts of the workers..
148. 山田裕章、馬場園明、橋本公雄、吉永亮二, GHQ得点を利用した集団のメンタルヘルス, 健康科学, 20、9-14, 1998.03.
149. Akira Babazono, J. Weiner, H. Hamada, T. Tsuda, Y. Mino, A. L. Hillman, Health policy in transition terminal care and site of death in Japan, Journal of Health Services Research and Policy, 10.1177/135581969800300204, 3, 2, 77-81, 1998.01, [URL], Objectives: In Japan, hospitals have replaced homes as the predominant site of death, especially for the elderly. Site of death is a reliable indicator of where older people receive care before they die. We conducted a population-based study to identify the factors that determine site of death in a typical rural area in Japan. Methods: Study subjects were residents of Kawakami town, aged 70 years or older, who died during 1981 and 1990. Death certificates provided information on age, gender, cause of death, duration of illness before death, family members, family occupation, and site of death. Results: Among 455 subjects, 52.7% died at home, while 47.3% died in hospital. Multiple logistic regression analyses indicated that subjects with cancer were 6.1 times more likely to die in hospitals than those with other diseases. Subjects who died in their seventies were 2.3 times more likely to die in hospital than older subjects. Members of non-farming families were 1.7 times more likely to die in hospital than members of farming families. Gender, duration of illness, and the presence of spouse or children in the household were not significantly related to site of death according to multivariate analyses, although trends did exist. Conclusion: This case study illustrates the importance of developing geriatric care systems in Japan, utilizing alternatives to hospitals, such as nursing homes and formal home care. This is particularly true for patients with cancer. As the older population rapidly increases in Japan, the need for alternatives in geriatric care grows more critical..
150. Akira Babazono, Janet Weiner, Toshihide Tsuda, Yoshio Mino, Alan L. Hillman, The effect of a redistribution system for health care for the elderly on the financial performance of health insurance societies in Japan, International Journal of Technology Assessment in Health Care, 10.1017/S0266462300011430, 14, 3, 458-466, 1998.01, [URL], Health care for the elderly in Japan is financed through a pool to which all insurers contribute. We analyzed insurers' financial data to evaluate this redistribution system. Cost sharing affected financial performance substantially. The current formula for cost-sharing redistributes elderly health care costs unequally and should be changed..
151. 山田裕章、馬場園明、橋本公雄, 職場の自覚的ストレスと精神的健康, 九州神経精神医学, 43, 79-85, 1997.08.
152. Toshihide Tsuda, Yoshio Mino, Eiji Yamamoto, Hiroaki Matsuoka, Akira Babazono, Jun Shigemi, Masaya Miyai, Causal inference in medicine
A reaction to the report, 'Incidence of Minamata Disease in Communities along the Agano River, Niigata, Japan - Patterns of the exposure and official diagnosis of patients', Japanese Journal of Hygiene, 10.1265/jjh.52.511, 52, 2, 511-526, 1997.07, [URL], Kondo's 'Incidence of Minamata Disease in Communities along the Agano River, Niigata, Japan (Jap. J. Hyg. 51:599-611;1996)' is critically reviewed. The data of the article were obtained from most of the residents living in the Agano river villages where Minamata disease was discovered in June, 1965. However, sampling proportions were much different between in the population base and in the cases. The method of identification of cases from the data and the reason for the difference were not clearly demonstrated. The citations of reference articles are insufficient despite the fact that other epidemiologic studies on methyl-mercury poisoning have been reported not only in Japan, but also around the world. His 'analysis of the recognized patients' is erroneous. Both the sampling scheme of information of hair mercury and the modeling of the analysis are based on Kondo' s arbitrary interpretation, not on epidemiologic theory. His 'analysis of the rejected applicants' is also erroneous. His calculations of the attributable proportion are incorrect and self-induced in both the assignments of data and analysis of data. Kondo has failed to study the epidemiologic theories in light of changes in the field. Therefore, his article is lacking in epidemiologic theory, a logical base and scientific inference. In Japan, epidemiologic methodology has rarely been used in studies on Minamata Disease in either Kumamoto and Niigata. The government has used neurologically specific diagnosis based on combinations of symptoms to judge the causality between each of symptoms and methyl-mercury poisoning. Epidemiologic data obtained in Minamata, Kumamoto in 1971 indicate that the criteria set by the government in 1977 have produced much more false-negative patients than false-positive patients. As a result, a huge number of symptomatic patients, including those with peripheral neuropathy or with constriction of the visual field, did not receive any help or compensation until 1995. The authors emphasize that the causal relationship between each symptom and methyl- mercury exposure should be reevaluated epidemiologically in Japan..
153. Kubota M, Babazono A, Utilizing CCRC concept for long-term care policy of Japan: , 19, 31-40, 1997., J Health Science, 19, 31-40, 1997.03.
154. Toshihide Tsuda, Akira Babazono, Eiji Yamamoto, Yoshio Mino, Hiroaki Matsuoka, A meta-analysis on the relationship between pneumoconiosis and lung cancer, Journal of Occupational Health, 10.1539/joh.39.285, 39, 4, 285-294, 1997.01, [URL], An excess of lung cancer deaths among pneumoconiosis patients has been noted for many years but there has not been agreement on the excess of lung cancer deaths among pneumoconiosis patients in Japan. A meta-analysis on the relationship between silicosis/pneumoconiosis and lung cancer mortality was conducted, by using 36 mortality studies published from 1950 to 1994. MEDICINE and other information sources were used for the information retrieval. After the critical appraisal, 32 eligible studies were identified. Study estimates were then pooled by using both the fixed effect model and the random effect model. An excess of lung cancer mortality among people with silicosis/pneumoconiosis was shown in all 32 studies. Although homogeneity among the studies was rejected (p<0.05) because the shape of the funnel plots assumed a symmetrical pyramidal shape, the summary rate ratio was estimated. The estimated rate ratio was 2.74 (95 percent confidence interval 2.60-2.90) in all 32 studies, and 2.77 (2.61-2.94) in 25 cohort studies. The random effect model results were almost the same as the fixed model results. The estimates in the Japanese studies were a little higher than the overall estimates, which indicated that lung cancer mortality was about three times higher among silicotic patients than among people in the control. This indicated a causal-relationship between silicosis and lung cancer. This means that lung cancer should be regarded as one of the important complications of silicosis/pneumoconiosis. We recommend further research on the relationship between silica exposure and lung cancer..
155. Jun Shigemi, Yoshio Mino, Toshihide Tsuda, Akira Babazono, Hideyasu Aoyama, The relationship between job stress and mental health at work, Industrial health, 10.2486/indhealth.35.29, 35, 1, 29-35, 1997.01, [URL], In order to evaluate the relationship between job stress and mental health, a cross-sectional study was conducted using a questionnaire relating to demographics, subjective job stress and mental health state. The questionnaire consisted of a 30-item Japanese version of the General Health Questionnaire (GHQ) developed by Goldberg in addition to questions about subjective job stress, to measure mental health and job stress conditions, respectively. All subjects were employees of an electronic company in Japan. Among 782 workers, 763 workers responded to the questionnaire satisfactorily (response rate was 97.6%). People whose GHQ score was more than 7 were classified as having psychiatric problems, while the remaining respondents were considered as having no mental health problems. We employed a multiple logistic regression analysis to estimate the relationship between subjective job stress and mental health, adjusting for gender, age, marital state, familial stress, and physical health state. Subjective job stress was significantly associated with the state of mental health. In particular, the items of 'too much trouble at work,' 'too much responsibility,' 'are not allowed to make mistakes,' 'poor relationship with superiors,' and 'cannot keep up with technology' were significantly related to mental health..
156. Takami Sato, Akira Babazono, Jerry A. Shields, Carol L. Shields, Patrick De Potter, Michael J. Mastrangelo, Time to systemic metastases in patients with posterior uveal melanoma, Cancer Investigation, 10.3109/07357909709115761, 15, 2, 98-105, 1997.01, [URL], A total of 116 patients, all of whom had systemic metastases from posterior uveal melanoma, were evaluated to identify potential indicators for time to systemic metastasis. In the multivariate Cox proportional hazards model with clinically available variables, the age at initial treatment for uveal melanoma, gender and diameter of the primary tumor were revealed to be independent predictive factors for time to systemic metastasis. Age older than 60 years, male gender, and diameter of the primary uveal melanoma more than 10 mm were proved to be independent unfavorable factors. The estimated median time to systemic metastasis for the most unfavorable group (age >60, male, diameter >10 mm) was 20.2 months in contrast with 76.1 months for the most favorable group (age ≤60, female, diameter ≤10 mm). Although the results of this study cannot be applied to all patients with posterior uveal melanoma, predictive factors for time to systemic metastasis in those patients who have recurred supplement the information obtained from prognostic factors for the likelihood of metastasis or survival. They contribute not only to our understanding of the biology of metastasizing posterior uveal melanoma, but also in developing appropriate strategies for follow-up and treatment..
157. Hayato Uchida, Yoshio Mino, Toshihide Tsuda, Akira Babazono, Yuichi Kawada, Hidetoshi Araki, Takanori Ogawa, Hideyasu Aoyama, Relation between the Instrumental Activities of Daily Living and Physical Fitness Tests in Elderly Women, Acta medica Okayama, 50, 6, 325-333, 1996.12, A cross-sectional study was conducted to quantitatively evaluate the relationship between the instrumental activities of daily living (IADL) and various physical fitness tests in elderly women living at home. The study focused on the total population of those women aged 65 years and over living in Y Town, Hyogo Prefecture, Japan, who visited a nursing home for day services. A total of 128 subjects were divided into two groups: dependent in IADL group (n = 49) and independent in IADL group (n = 79). The magnitude of the relation was evaluated by the odds ratio (OR). The following tests showed a significant decrease in IADL: knee-raising test [age-adjusted OR=4.23, 95% confidence interval (CI) 1.81-9.87], height (age-adjusted OR=4.09, 95% CI 1.75-9.56), grip strength (age-adjusted OR=3.68, 95% CI 1.57-8.60), sit-and-reach test (age-adjusted OR=2.76, 95% Cl 1.20-6.34), and standing on one leg with closed eyes (age-adjusted OR=2.56, 95% Cl 1.09-5.97). Multivariate analysis' using Hayashi's quantification method I indicated that knee-raising was the test most highly correlated with decreased IADL. These results suggest that measurement of knee-raising ability, muscle strength of the lower extremities and flexibility of hip joint could be the most useful factors to assess the level of instrumental self-support ability..
158. 津田敏秀、馬場園明、三野善央:, じん肺患者における肺癌の多発;メタアナリシスの試み, 産業衛生学雑誌, 38、70-71, 1996.03.
159. Toshihide Tsuda, Akira Babazono, Yoshio Mino, Hiroaki Matsuoka, Eiji Yamamoto, Causal inference in medicine - A historical view in epidemiology, Japanese Journal of Hygiene, 10.1265/jjh.51.558, 51, 2, 558-568, 1996.01, [URL], Changes of causal inference concepts in medicine, especially those having to do with chronic diseases, were reviewed. The review is divided into five sections. First, several articles on the increased academic acceptance of observational research are cited. Second, the definitions of confounder and effect modifier concepts are explained. Third, the debate over the so-called "criteria for causal inference" was discussed. Many articles have pointed out various problems related to the lack of logical bases for standard criteria, however, such criteria continue to be misapplied in Japan. Fourth, the Popperian and verificationist concepts of causal inference are summarized. Lastly, a recent controversy on meta-analysis is explained. Causal inference plays an important role in epidemiologic theory and medicine. However, because this concept has not been well-introduced in Japan, there has been much misuse of the concept, especially when used for conventional criteria..
160. Akira Babazono, Toshihide Tsuda, Yoshio Mino, The US health care and the reform, Japanese Journal of Hygiene, 10.1265/jjh.51.666, 51, 3, 666-676, 1996.01, [URL], Securing access to medical services, controlling costs and improving quality are goals of health care system. Although they are all the same all over the country, each country has its own culture, health care system and health care problems. In the United States, employer-based and individual purchases of private health insurance coverage play a major role, although governmental programs such as Medicaid and Medicare exist for the poor and the elderly. Private health insurance had traditionally secured patients' freedom of choice of health care providers and physicians' professional freedom and had paid providers on a fee-for-service basis. Now, the U.S. has 40 million uninsured persons who do not have access to medical services, although it spends as much as its 14% of GNP on health care. In the early 1990s, this became a major political problem. President Clinton proposed the 'Health Security Act' which would enable any American to have access to comprehensive health care with managed competition to activate the health care market, but it was not enacted. Nevertheless, it is clear that managed care and managed competition will dominate and that traditional free-for- service plan will be eroded in the health care market. Japan has a universal health care system. We do not have any uninsured or high medical costs. However, it is difficult to improve the quality of health care services within the present system. Japan can learn the system about disclosure of health care information from the managed care in the U.S..
161. 佐々木千恵、馬場園明、津田敏秀、三野善央, 身体活動の労働者の体力に及ぼす影響, 日本衛生学雑誌, 50、876-885, 1995.10.
162. Y. Mino, S. Tanaka, T. Tsuda, A. Babazono, S. Inoue, H. Aoyama, Training in evaluation of expressed emotion using the Japanese version of the Camberwell Family Interview, Acta Psychiatrica Scandinavica, 10.1111/j.1600-0447.1995.tb09565.x, 92, 3, 183-186, 1995.09, [URL], To evaluate the effect of training in rating expressed emotion (EE) using the Japanese version of the Camberwell Family Interview (CFI), interrater reliability between a certified rater and a trainee was examined. The material was 65 CFI interviews with the families of 46 schizophrenic patients. The two raters independently rated EE status, critical comments (CC), hostility (H), emotional overinvolvement (EOI), warmth (W) and positive remarks (PR). The interrater reliability was satisfactory with regard to EE status, CC, H, EOI and PR. In the category of W, however, the results were unsatisfactory, as there was no positive development of agreement over time. In fathers, the interrater reliability of W was lower than in other relationships. Use of interview transcripts could contribute to a more satisfactory interrater agreement in EOI, and this is recommended as a useful training tool in EE evaluation..
163. Toshihide Tsuda, Akira Babazono, Eiji Yamamoto, Norio Kurumatani, Yoshio Mino, Takanori Ogawa, Yoshiki Kishi, Hideyasu Aoyama, Ingested arsenic and internal cancer
A historical cohort study followed for 33 years, American Journal of Epidemiology, 10.1093/oxfordjournals.aje.a117421, 141, 3, 198-209, 1995.02, [URL], A historical cohort study was conducted to investigate the long-term effect of exposure to ingested arsenic. The 454 residents who had been identified in a list made in 1959 were followed until 1992. They lived in an arsenic-polluted area, called Namiki-cho, Nakajo-machi, in Niigata Prefecture, Japan, and used well water containing inorganic arsenic. The exposure period was estimated to be about 5 years (1955-1959). Death certificates for the people who died between 1959 and 1992 were examined, and a total of 113 of the 454 residents were estimated to have drunk well water containing a high dose of arsenic (≥1 ppm). The standardized mortality rate ratios of these 113 residents were 15.69 for lung cancer (observed/expected = 8/0.51; 95% confidence interval (CI) 7.38-31.02) and 31.18 for urinary tract cancer (observed/expected = 3/0.10; 95% CI 8.62-91.75). Cox's proportional hazard analyses demonstrated that the hazard ratios of the highest exposure level group (≥1 ppm) versus the background exposure level group (0.001 ppm) were 1.74 (95% CI 1.10-2.74) for all deaths and 4.82 (95% CI 2.09-11.14) for all cancers. The analysis according to the skin signs of chronic arsenicism in 1959 showed that they were useful risk indicators for subsequent cancer development. In the development of lung cancer, there was evidence of synergism between arsenic intake and smoking habit..
164. Akira Babazono, Alan L. Hillman, Declining cost-effectiveness of screening for disease
The Case of Gastric Cancer in Japan, International Journal of Technology Assessment in Health Care, 10.1017/S0266462300006954, 11, 2, 354-364, 1995.01, [URL], We examined the cost-effectiveness of screening for gastric cancer in hypothetical cohorts of asymptomatic Japanese ages 40, 50, 60, and 70, followed for 10 years. Current screening recommendations in Japan are not optimal. Although indirect x-ray is the correct method, screening for gastric cancer may not be cost-effective for Japanese under the age of 50. Policymakers worldwide should monitor the changing incidence of disease as they consider and recommend screening policies..
165. C. Sasaki, Akira Babazono, T. Tsuda, Y. Mino, Effect of physical activity on physical fitness among workers, Japanese Journal of Hygiene, 10.1265/jjh.50.876, 50, 4, 876-885, 1995.01, [URL], We conducted a cross-sectional study to clarify the effects of physical activity on physical fitness. Physical fitness tests were offered to workers of companies manufacturing automobile parts from December, 1992 to December, 1993. The subjects were 1,217 male and 600 female workers who participated in the physical fitness test. From this group, we analyzed 1,048 male and 522 female workers who answered a physical activity questionnaire. The questionnaire included age, sex, working posture, physical activity during working time and physical activity during leisure time. The physical fitness tests were composed of grip strength, standing trunk flexion, foot balance with closed eyes, jumping reaction time and step tests. We classified the subjects into low performance group and high performance group for each test. In addition, we classified the subjects into different groups by age (16-29 years old, 30-49 years old and 50-69 years old), by working posture (standing and sitting), as well as by activity levels during working time and leisure time physical activities (inactive and active). Thus, we examined potential risk factors for the physical fitness by a multiple logistic regression model. The results were as follows: 1. Standing work was a significant risk factor for grip strength, foot balance with closed eyes and jumping reaction time in male workers, and standing trunk flexion, foot balance with closed eyes, jumping reaction time and the step test in female workers. 2. Physical activity during working time was not related to physical fitness in male and female workers. 3. Inactivity during leisure time was a significant risk factor for standing trunk flexion, foot balance with closed eyes, jumping reaction time and the step test in male workers, and grip strength and foot balance with closed eyes in female workers. 4. Young age (16-29 years old) was a significant risk factor for grip strength, standing trunk flexion, foot balance with closed eyes, jumping reaction time and the step test in male and female workers. Middle age (30-49 years old) was a significant risk factor for foot balance with closed eyes and jumping reaction time in male workers, and standing trunk flexion, foot balance with closed eyes, jumping reaction time and the step test in female workers..
166. Y. Mino, T. Tsuda, J. Shigemi, S. Tanihara, H. Aoyama, Akira Babazono, Family intervention for schizophrenia based on expressed emotion (EE) research
a review of the technique and evaluation, [Nippon kōshū eisei zasshi] Japanese journal of public health, 42, 5, 301-312, 1995.01, The present study reviews eight series of trials on psycho-social family intervention for schizophrenia based on Expressed Emotion (EE). All studies used randomized controlled trials (RCT) except one which was non-randomized controlled trial. The relapse risk ratios (intervention/control) for 9-12 months after discharge were 0 to .73 and for 24 months were .20 to .57. Taking into account the shortcomings of the studies, the authors conclude that psycho-social family intervention based on EE is effective in preventing schizophrenic relapse, and discuss four important issues: 1) For effective family intervention, methods for Japanese patients should be established from a trans-cultural view point; 2) The interaction of two or more therapeutic measures should be evaluated quantitatively; 3) The mechanisms of schizophrenic relapse prevention through family psycho-social intervention should be explored. A psycho-physiological study including skin conductance measurement is promising; 4) The authors point out the ethical aspect of family intervention, and discuss the importance of informed consent and the need to place emphasis on family's needs..
167. Akira Babazono, Toshihide Tsuda, Yoshio Mino, Takanori Ogawa, Hideyasu Aoyama, Optimal Screening Interval for Gastric Cancer in Japan, Journal of epidemiology, 10.2188/jea.5.67, 5, 2, 67-74, 1995.01, [URL], Annual gastric cancer screening has been recommended for residents over the age of 40 in Japan. We conducted a cost-effectiveness study in order to determine an optimal screening interval in both genders using a cohort model. Hypothetical cohorts of 100,000 asymptomatic individuals aged 40 were assumed to have taken part in each strategy with a follow-up period of 20 years. In order to evaluate both the cost and effectiveness of the gastric cancer screening, a Markov modeling process was used. The incremental cost per year-of-life saved in gastric cancer screening, compared to no screening, illustrates a tendency toward a higher cost per year-of-life saved in both, shorter than and longer than 3-year screening intervals. Our results indicate that the recommended method of annual screening represents the least cost-effective option regarding both genders. The incremental cost per year-of-life saved of annual screening strategy was 2,764,000 yen ($25,127) for males and 3,753,000yen ($34,118) for females, compared to no screening. The figures of the incremental cost per year-of-life saved in the three year screening interval at 1,670,000 yen ($15,182) for males and 2,431,000yen ($22,100) for females clearly show this strategy as the most efficient solution in both genders, compared to no screening. However, the screening program on annual basis is not considered to be less efficient than other screening programs so far. The cost-effectiveness of gastric cancer is decreasing as its incidence decreases. It is very important for policy makers to pay attention to the incidence of diseases targeted by screening programs and to evaluate screening interval. J Epidemiol, 1995; 5: 67-74..
168. Akira Babazono, Alan L. Hillman, A comparison of international health outcomes and health care spending, International Journal of Technology Assessment in Health Care, 10.1017/S0266462300006619, 10, 3, 376-381, 1994.01, [URL], Does increased spending improve health outcomes? We analyzed 1988 data from OECD countries to determine how key health care indexes correlate with health care outcomes. Total health care spending per capita and outpatient and inpatient utilization are not related to health outcomes. How our resources are allocated seems to be more important than how much money is actually spent..
169. T. Tsuda, E. Yamamoto, Akira Babazono, Y. Mino, T. Ogawa, J. Shigemi, H. Aoyama, An epidemiologic research design using the annual of the pathological autopsy cases in Japan, Japanese Journal of Hygiene, 10.1265/jjh.49.753, 49, 4, 753-761, 1994.01, [URL], Epidemiologic research designs using the Annual of the Pathological Autopsy Cases in Japan (APAC hereinafter) are discussed in this paper. The APAC data base has been recommended for use in epidemiologic research. However, it has not often been utilized for such research, even though it covers all pathological autopsy cases in Japan, perhaps because of different sampling proportions of each disease and because of the dead control series in APAC. First, we present epidemiologic measures in using the APAC. We show that the data base can be treated as a case-control design and that the magnitude of the exposure effect should be estimated by an odds ratio. Next, selection bias and information bias in using the APAC are discussed. The independence of the control series from the exposure is important in the determination of the control disease. Because this design is based on internal comparison, non-differential misclassification should be stressed more than differential misclassification..
170. H. Uchida, Y. Mino, Akira Babazono, T. Ogawa, H. Aoyama, Comparative analysis on the physique and batting records of the players in the National Summer High School Baseball Tournaments before and after the adoption of metal bats., Acta medica Okayama, 48, 4, 217-223, 1994.01, To clarify the influence of the introduction of metal bats on the physique and batting records of the players in the National Summer High School Baseball Tournaments, a comparative analysis was conducted between height, body weight, body-weight ratio (body weight/height), batting average and home run average of the best four teams' players (n = 493) and those of the other teams' players (n = 4,590) in three periods: the period of the use of wooden bats, that of the use of both wooden and metal bats and that of the use of metal bats. In the period of metal bat use, the mean values of physique of the best four teams' players were significantly larger (P < 0.05) and their average number of home runs was significantly higher than those of the other teams' players (P < 0.01). The only significant differences between the two groups in those indices for each time period were for height in the wood and metal/wood periods. This study demonstrated that the differences between the home run average and physique, including height, body weight and body-weight ratio of the best four teams and the rest of the teams were the greatest after the use of metal bats. These findings suggest that the importance of the home run average increased and was associated with large-size of physique after the use of metal bats in the National Summer High School Baseball Tournaments..
171. Toshihide Tsuda, Eiji Yamamoto, Akira Babazono, Yoshio Mino, Yoshiki Kishi, Norio Kurumatani, Takanori Ogawa, Hideyasu Aoyama, Comparisons of survival time estimates for niigata prefecture (japan) residents exposed to ingested arsenic, Applied Organometallic Chemistry, 10.1002/aoc.590080313, 8, 3, 237-244, 1994.01, [URL], Survival analysis was used to analyze follow‐up data on an arsenic‐poisoned area, identified in 1959, in order to assess the effect of arsenic on survival time. The subjects were 443 residents of Namiki‐cho, Nakajo‐machi, Niigata Prefecture, Japan, who ingested well water contaminated with arsenic between 1955 and 1959. Their exposure to arsenic was only by ingestion of well water. We observed this historical cohort from October 1959 to February 1992. Survival time was calculated in two ways: from 1959 (the end of exposure) until death or until 1992 (the termination of follow‐up); or from birth until death or until 1992. The entire cohort was divided into two groups according to the arsenic concentration measured in the wells in 1959. Different survival curves of the two were drawn using the Kaplan–Meier method. The lifetime survival curves indicate that the lifetimes of arsenic‐exposed residents were significantly shorter than that of the low‐dose exposure group or of unexposed residents. From the differences in the estimated lifetime survival curves, the effect of arsenic on the mortality of the residents can be inferred..
172. Akira Babazono, Toshihide Tsuda, Eiji Yamamoto, Yoshio Mino, Tsuneko Babazono, Yoshiki Kishi, Jun Sigemi, Takanori Ogawa, Hideyasu Aoyama, Risk Factors for Low Birth Weight Infants in Japan, Journal of epidemiology, 10.2188/jea.4.91, 4, 2, 91-98, 1994.01, [URL], Prevalence of low birth weight infants in Japan has been increasing, although infant mortality is the lowest in the world. We conducted a population based case-control study to clarify risk factors for low birth weight infants in Japan. Information was obtained by questionnaire. The response rate was 78.9% from 402 cases and 804 controls. The majority of low birth weight infants belongs to full-term case group. This is considered to be an important factor for low infant mortality in Japan. We examined potential risk factors by a multiple logistic regression model. Lower maternal academic career and toxemia were identified as significant risk factors for pre-term low birth weight infants, while maternal shorter height, lower prepregnancy weight, maternal smoking and employment during pregnancy and hypertension were identified as significant risk factors for full-term low birth weight infants. The Japanese small physique and prevalent hypertension are considered to be causes for the high prevalence of low birth weight infants. J Epidemiol, 1994 ; 4: 91-98..
173. Yoshio Mino, Toshihide Tsuda, Akira Babazono, Hideyasu Aoyama, Simpei Inoue, Hirotoshi Sato, Hirosh Ohara, Depressive states in workers using computers, Environmental Research, 10.1006/enrs.1993.1126, 63, 1, 54-59, 1993.10, [URL], There have been few reports investigating the depressive states in workers using computers. We describe the depressive states observed in workers using computers and discuss the sources of their occupational stresses. The first subject is a 34-year-old male manager of a manufacturing company who had customarily worked until 9 PM. In 1985, it became necessary for him to work until midnight; symptoms of depression began to appear during this period, exacerbated after trouble with a computer. In 1986, he visited a psychiatrist and his condition was diagnosed as Major Depression according to DSM-III. The second subject is a 26-year-old male VDT (visual display terminal) operator in a general hospital. Before the onset, he had had to work until 8 PM and, at the end of each month, until midnight. Two months later, he became depressed and his condition was diagnosed as Major Depression according to DSM-III. The third subject is a 32-year-old male chief in the computer programming section of a bank. He had had to work until 8 PM, became depressed, and visited a psychiatrist who diagnosed his condition as Major Depression according to DSM-III. The authors discuss these cases from the standpoint of occupational stresses, as they are associated with work overload, and the important role these stresses played in the onset of the workers’ depressive states..
174. Toshihide Tsuda, Takanori Ogawa, Akira Babazono, Hirohisa Hamada, Susumu Kanazawa, Yoshio Mino, Hideyasu Aoyaam, Eiji Yamamoto, Norio Kurumatani, Historical cohort studies in three arsenic poisoning areas in japan, Applied Organometallic Chemistry, 10.1002/aoc.590060405, 6, 4, 333-341, 1992.01, [URL], The results of historical cohort studies of three arsenic poisoning incidents in Japan are presented. The first episode was in a small mountainous community near an arsenic mine and refinery, at Toroku, where patients with chronic arsenism were certified by application of the Pollution Health Damage Compensation Law. The second area was in a small town, Namiki‐cho, near Nakajo‐machi, where wells were poisoned by arsenic produced in an arsenic(III) sulfide factory. As to the third cohort, eight residents of Nishikawa‐machi who ingested well‐water suffered arsenic poisoning about 35 years ago. The standardized mortality ratios were used in analyzing these data. Excesses of cancer mortality, especially lung cancer, were observed among the subjects in these areas. In Japan, there are many arsenic poisoning episodes, involving for example soy‐sauce poisoning, powdered‐milk poisoning and other incidents associated with arsenic mines. Thus it is necessary to clarify the chronic effects of arsenic in these areas..
175. Toshihide Tsuda, Akira Babazono, Takanori Ogawa, Hirohisa Hamada, Yoshio Mino, Hideyasu Aoyama, Norio Kurumatani, Tsuyoshi Nagira, Nobuyuki Hotta, Masazumi Harada, Shigemi Inomata, Inorganic arsenic
A dangerous enigma for mankind, Applied Organometallic Chemistry, 10.1002/aoc.590060403, 6, 4, 309-322, 1992.01, [URL], Human being have been using inorganic arsenic for a long time. Many reports on arsenic poisoning have been published: eg case reports, examination reports, post mortem reports, and epidemiological studies. Several aspects and features of arsenic poisoning are discussed in this report. Methods of inferring arsenic‐related disease, disease classification according to acute or chronic criteria, exposure route, interaction, confounding factors, and the oxidation state of arsenic are all discussed. The effects of arsenic are classified into skin, respiratory system, gastrointestinal tract, liver, cardiovascular system, nervous system, and bone marrow effects. Carcinogenicity is an important chronic effect of arsenic poisoning, so special attention is paid to it in this review. In Japan, there have been many incidents of arsenic poisoning. In this review, we often use data from these cases, such as the Morinaga powdered‐milk poisoning case, the Ube soy‐sauce poisoning case, the Toroku mine incident, and the Nakajo well‐water poisoning case. We emphasize here the necessity of planning follow‐up studies and total health care for patients exposed to arsenic..
176. Akira Babazono, Takanori Ogawa, Tsuneko Babazono, Hirohisa Hamada, Toshihide Tsuda, Hideyasu Aoyama, The effect of a cost sharing provision in japan, Family Practice, 10.1093/fampra/8.3.247, 8, 3, 247-252, 1991.11, [URL], Babazono A, Ogawa T, Babazono T, Hamada H, Tsuda T and Aoyama H. The effect of a cost sharing provision in Japan. Family Practice 1991; 8: 247-252. This study evaluated the effect of a 10% cost sharing provision, introduced in October 1984, on demand for medical services. We analysed the data of 1701 health insurance societies, all of which joined the National Federation of Health Insurance Societies between 1983 and 1985. The case rate (per 1000 persons) and the number of serviced days (per case) were analysed as indicators of demand for inpatient, outpatient and dental medical services. The case rate was considered to bean indicator of the patient's behaviour, while the number of serviced days was influenced by the doctor's behaviour. Multiple linear regression analysis was used with each indicator to isolate the effect of the cost sharing provision, adjusted for other variables which influenced demand for medical services. The case rate was reduced significantly in all medical services. This means that a patient was discouraged from using a medical facility by the cost sharing provision. There was little difference among medical services. The number of serviced days was also reduced significantly in all medical services. There was a large difference among medical services. The effect on outpatient service was much greater than that on any other service..
177. 馬場園明, 一割負担導入の高血圧症患者に対する影響, 日本衛生学雑誌, 45、849-859, 1991.10.
178. 馬場園明、小河孝則、馬場園常子、濱田裕久、青山英康, 老人医療費拠出金の健康保険組合の財政に与える影響, 日本衛生学雑誌, 46、890-897, 1991.10.
179. 馬場園明, 定率負担導入による受診行動への影響と健康保険組合の特性, 岡山医学雑誌, The impact of partial cost sharing on the attitude of insured persons in Health Insurance Societies, 1991.06.
180. 馬場園明、馬場園常子、山本光昭、山本尚子、井谷徹、青山英康、横田文吉、山口正民、浜名正太郎、平野寛、瀧谷泰博, プライマリ・ケアの概念認識と日常診療, プライマリ・ケア, 13、 45-56, 1991.04.
181. 中瀬克己、和気健三、馬場園明, AIDSに関する知識と意識との関連と教育による効果, 厚生の指標, 38、7、23-29, 1991.04.
182. A. Babazono, T. Ogawa, T. Babazono, H. Hamada, H. Aoyama, The effect of sharing medical costs for the aged 70 or more on the financial balance of the health insurance society, Japanese Journal of Hygiene, 10.1265/jjh.46.890, 46, 4, 890-897, 1991.01, [URL].
183. A. Babazono, The impact of partial cost sharing on the attitude of insured persons with hypertension, Japanese Journal of Hygiene, 10.1265/jjh.45.849, 45, 4, 849-859, 1990.01, [URL].

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