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This study aimed to evaluate the impact of the policy to reduce the reimbursement fee for percutaneous endoscopic gastrostomy (PEG) on the number of PEG procedures performed among older adults with dementia. Interrupted time series (ITS). We used the monthly aggregated data of the number of PEG procedures in older adults with dementia (both broad and narrow definitions), between 2012 and 2018, from the claims data in Fukuoka Prefecture, Japan. A single ITS design was used to estimate changes in the outcome following each intervention (i.e., first, second, and third interventions performed in 2014, 2015, and 2016, respectively). A controlled ITS design was applied to estimate the effects after the sequence of interventions (pre-intervention: 2012–2014; post-intervention: 2016–2018). The control group comprised patients with malignant head and neck tumors who underwent PEG procedures outside the scope of this policy restriction. The number of PEG procedures decreased significantly only in the month wherein the third intervention was introduced (broad definition: IRR = 0.11, CI = 0.03–0.49; narrow definition: IRR = 0.15, CI = 0.03–0.75). No significant difference was observed between the treatment and control groups during the post-intervention phase. The impact of fee-revision policy for PEG on the decrease in PEG procedures among older adults with dementia is remarkably minimal. It is difficult to reduce unnecessary PEG procedures by relying on this financial incentive alone. Policy decision-makers should consider methods to prevent inappropriate use of artificial nutrition for older adults at their end-of-life stage by reforming the health delivery system. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) prevalence has increased globally with considerable morbidity and economic burden at both individual and national levels. Japan is the first and only country that has introduced a nationwide lifestyle guidance intervention program to manage and control MetS. We conducted a quasi-experiment approach—regression discontinuity design—to evaluate the impact of this intervention on health outcomes at the population level. We retrospectively collected data of adults aged ≥35 years who participated in health checkups in 2015. Age in 2015 was used as the assignment variable, and an age of 40 years old was the threshold because those with MetS aged ≥40 were required to receive lifestyle guidance intervention. Among 26,772 MetS adults, those who received the intervention had significant reductions in obesity measurements (bodyweight, waist circumference, and body mass index [BMI]) after 1 year of this intervention. Blood pressure was also significantly reduced in men after 1 year of undertaking the intervention. The results were similar when including demographic, socioeconomic, and behavioral covariates and using alternative functional forms to estimate the impact, or when bandwidths around intervention thresholds were changed. Our results showed that lifestyle guidance intervention for MetS has an important impact on weight loss and blood pressure reduction at the population level. This intervention could address the high burden of obesity and cardiovascular diseases in Japan and other countries with an unmet need for MetS prevention and management. • Japan has introduced a lifestyle guidance intervention program since 2008. • This program targets middle-aged people with metabolic syndrome. • This study evaluated the impact of this program at the population level. • We applied a quasi-experiment approach, which may be less affected by confounders. • Significant decreases in body weight and blood pressure were evident. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]