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Two types of analytical multi-level approach to analyse symptoms after exposure to poisons were performed using numerical data extracted from reports received by the JAPAN POISON INFORMATION CENTER on the number "Poisoning 110" during 1998-2017. In the first approach, data collected in 2017, 2012, 2007 and 2002 were used, while in the second approach, all data collected during 1999-2017 were used. In the first approach, according to the odds ratio, the order of causative agents was industrial drugs>home drugs>general drugs and in the second approach, it was industrial drugs>foods/natural poisoning>agricultural drugs. However, in the first approach, the order based on the 95% confidence interval (CI) and profile likelihood was general drugs>home drugs>industrial drugs and in the second approach, the order based on 95% CI, profile likelihood and Wald value was agricultural drugs>foods/natural poisoning>industrial drugs. These multi-prospects were developed using a multilevel approach and the most optimized model was selected from the number of numerical data and the adaptability of fit of the multi-level logistic regression models in this report. [ABSTRACT FROM AUTHOR]

Introduction: In Japan, a country at the forefront of population ageing, significant geographic variation has been observed in inpatient medical expenditures for older adults aged 75 and above (IMEP75), both at the small- and large-area levels. However, our understanding of how different levels of administrative (geographic) units contribute to the overall geographic disparities remains incomplete. Thus, this study aimed to assess the degree to which geographic variation in IMEP75 can be attributed to municipality-, secondary medical area (SMA)-, and prefecture-level characteristics, and identify key factors associated with IMEP75., Methods: Using nationwide aggregate health insurance claims data of municipalities for the period of April 2018 to March 2019, we conducted a multilevel linear regression analysis with three levels: municipalities, SMA, and prefectures. The contribution of municipality-, SMA-, and prefecture-level correlates to the overall geographic variation in IMEP75 was evaluated using the proportional change in variance across six constructed models. The effects of individual factors on IMEP75 in the multilevel models were assessed by estimating beta coefficients with their 95% confidence intervals., Results: We analysed data of 1,888 municipalities, 344 SMAs, and 47 prefectures. The availability of healthcare resources at the SMA-level and broader regions to which prefectures belonged together explained 57.3% of the overall geographic variance in IMEP75, whereas the effects of factors influencing healthcare demands at the municipality-level were relatively minor, contributing an additional explanatory power of 2.5%. Factors related to long-term and end-of-life care needs and provision such as the proportion of older adults certified as needing long-term care, long-term care benefit expenditure per recipient, and the availability of hospital beds for psychiatric and chronic care and end-of-life care support at home were associated with IMEP75., Conclusion: To ameliorate the geographic variation in IMEP75 in Japan, the reallocation of healthcare resources across SMAs should be considered, and drivers of broader regional disparities need to be further explored. Moreover, healthcare systems for older adults must integrate an infrastructure of efficient long-term care and end-of-life care delivery outside hospitals to alleviate the burden on inpatient care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shirakura, Shobugawa and Saito.)

Purpose: This study aimed to identify the association of suicidal ideation with job demands and job resources among Japanese workers. Methods: Valid data from questionnaires that were pre-collected from 42,499 workers (34,882 males and 7617 females) were used for multilevel logistic regression analyses. Job demands and job resources were selected as potential predictors of suicidal ideation. Lifestyle variables, support from family and friends, and suffering from depressive or eating disorders were used as covariates. Results: In the employee-level, most job demands and job resources had significant associations with the risk of suicidal ideation in both sexes. High coworker support had a significant negative association with the risk of suicidal ideation in the organization-level, irrespective of their gender. High physical demands and poor physical environment in the organization-level had significant positive associations with increased risk of suicidal ideation only among females. Conclusions: The risk of suicidal ideation among Japanese workers is associated with job demands and job resources in the employee-level, and coworker support in the organization-level may be important as well. [ABSTRACT FROM AUTHOR]

Recent trends towards harmonising and internationalising business and economics studies in higher education are affecting the structure and content of programmes and courses, and necessitate more transparent and comparable information on students’ economic knowledge and skills. In this study, we examine by linear multilevel regression modelling the current state of macroeconomic knowledge of higher education students in Germany and Japan, while controlling for the effects of key study-related aspects such as study progress and completion of economics courses. We assess macroeconomic knowledge using the internationally established Test of Understanding in College Economics, which has been adapted and validated for use in Germany and Japan. We found a significant positive correlation between students’ level of knowledge and study progress in both countries, as well as varied gender-related and country-specific differences. Implications for assessment practices and future research are discussed. [ABSTRACT FROM PUBLISHER]

This paper examines the interdependent foreign market entry decisions of multinational corporations (MNCs). Based on the argument that legitimacy and competition are two important forces in foreign market entry decisions, we hypothesize that an MNCs market entry decisions are influenced by its own prior entry and prior exit decisions and those of other MNCs. We examine this general proposition at four levels of analysis: the host country, global industry (an industry that spans host countries), local industry (an industry that is separately defined within each host country), and parent firm level. Our analysis of a panel data of over 4000 market entry decisions that were made by Japanese MNCs shows that an MNCs market entry decision has a stronger inverted U-shaped relationship with the prior entry and exit decisions of other MNCs at the local industry level than the prior entry and exit decisions of other MNCs at the host country and global industry levels. We also find that both the prior entry and prior exit decisions of an MNC have a marginal influence on its own subsequent market entry decisions at the parent firm level. [ABSTRACT FROM AUTHOR]

Background: Precarious job status is negatively related with workers' health. Research has yet to address whether and to what extent the area-level risk of precarious employment is associated with workers' health, independently from their job status. We addressed this issue in the present study., Methods: We estimated multi-level logistic regression models using repeated cross-sectional data comprising 253,048 men and 210,761 women aged 20-59 years who were living in 47 prefectures. This data were obtained from population-based surveys conducted in 2010, 2013, and 2016 in Japan., Results: For male workers, the estimated odds of reporting poor self-rated health, subjective symptoms, and problems in activities of daily living for those residing in the prefectures in the highest tertile of the proportion of precarious employees were 1.10 (95% confidence interval [CI], 1.01-1.18), 1.12 (95% CI, 1.05-1.19), and 1.15 (95% CI, 1.04-1.28) times, respectively, higher than those living in the prefectures in the lowest tertile, even after controlling for individuals' job status and key covariates. The results remained largely similar, despite focusing on the sample with information about household income, which was available from the survey, and controlling for it. In contrast, the results indicated that women's health outcomes were not associated with the prefecture-level proportion of precarious employees., Conclusions: The area-level risk of precarious employment matters for male workers' health independently from their job status, underscoring the importance of policy measures aimed to reduce the adverse impacts of precarious employment on workers' health.

Objective: To determine the effect of preoperative patient and hospital factors on resource use, cost and length of stay (LOS) among patients undergoing off-pump coronary artery bypass grafting (OPCAB)., Design: Observational retrospective study., Settings: Data from the Japanese Administrative Database., Participants: Patients who underwent isolated, elective OPCAB between April 2011 and March 2012., Primary Outcome Measures: The primary outcomes of this study were inpatient cost and LOS associated with OPCAB. A two-level hierarchical linear model was used to examine the effects of patient and hospital characteristics on inpatient costs and LOS. The independent variables were patient and hospital factors., Results: We identified 2491 patients who underwent OPCAB at 268 hospitals. The mean cost of OPCAB was $40 665 ±7774, and the mean LOS was 23.4±8.2 days. The study found that select patient factors and certain comorbidities were associated with a high cost and long LOS. A high hospital OPCAB volume was associated with a low cost (-6.6%; p=0.024) as well as a short LOS (-17.6%, p<0.001)., Conclusions: The hospital OPCAB volume is associated with efficient resource use. The findings of the present study indicate the need to focus on hospital elective OPCAB volume in Japan in order to improve cost and LOS., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)