Thirdly, using alternative models, the predictions are improved so that the local Japanese value set achieves MAE in the order of 0.01.

No abstract

The effects of three frequently rotating shifts in an irregular sequence on the daily activities of 239 Japanese female hospital nurses were studied by the time-budget method. The nurses recorded their daily activities for several consecutive days. The questionnaire was returned by 80.8% of the participants, and recordings of 1016 days were analysed. A two-way analysis of variance clarified that the shift combination influenced the daily activities. The most distinct result was that nurses spent significantly more time on free-time activities on the day when they worked the night shift followed by the evening shift than they did on the day when they worked any other shift combination. Nurses offset sleep deprivation either by sleeping during the day before and after working the night shift (82-100%) or by sleeping 2 to 4 h later in the morning after working the evening shift and on days off. There was a strong positive correlation between total sleep time (including day sleep) and the length of the interval between two consecutive shifts (r = 0.95, p < 0.001). This result suggests that more than 16 h between work shifts is required to allow more than 7 h of total sleep time. In an analysis by household status, nurses who had young children (average age, 2.8 years) slept less and spent less time on free-time activities than did other nurses.

No abstract

Not only is the number of computed tomography (CT) units relative to population in Japan the highest in the world, that of magnetic resonance imaging (MRI) units is second only to the United States. This study examines the diffusion pattern of MRI in Japan, as well as the factors that influence it. The number of MRI units has increased sharply, closely following CT, as has been the case in the United States. This pattern of diffusion in Japan was determined mainly by the following factors: the technological attributes of MRI; the market situation of the medical engineering industry; the reimbursement system of health insurance; and Japan's sociocultural background. However, the introduction of MRI in Japan was not linked to any formal assessment of its efficacy or effectiveness.

Objective:Disease management (DM) approach is increasingly advocated as a means of improving effectiveness and efficiency of healthcare for chronic diseases. To evaluate the evidence on effectiveness and efficiency of DM, evidence synthesis was carried out.Methods:To locate eligible meta-analyses and systematic reviews, we searched Medline, EMBASE, the Cochrane Library, SCI-EXPANDED, SSCI, A&HCI, DARE, HTA and NHS EED from 1995 to 2010. Two reviewers independently extracted data and assessed a study quality.Results:Twenty-eight meta-analyses and systematic reviews were included for synthesizing evidence. The proportion of articles which observed improvement with a reasonable amount of evidence was the highest at process (69%), followed by health services (63%), QOL (57%), health outcomes (51%), satisfaction (50%), costs (38%) and so on. As to mortality, statistically significant results were observed only in coronary heart disease. Important components in DM, such as a multidisciplinary approach, were identified.Conclusion:The evidence synthesized shows considerable evidence in the effectiveness and efficiency of DM programs in process, health services, QOL and so on. The question is no longer whether DM programs work, but rather which type or component of DM programs works best and efficiently in the context of each healthcare system or country.

The discriminating ability of HbA1c is almost the same as that of FPG, therefore HbA1c is a good alternative to FPG. Fructosamine is not suitable for diabetes screening.

In order to estimate occupational risk factors for health problems among truck drivers, a questionnaire survey of working conditions, job content in truck transportation, subjective symptoms and present illnesses was carried out among 541 truck transportation workers in 1997. The valid response rate was 85.7%, and 134 local truck drivers, 199 long-distance truck drivers and 71 clerical workers were analyzed. First, to examine occupational risk factors and health problems among the three groups, the authors analyzed working conditions, job content in truck transportation, subjective symptoms and present illnesses. Second, to estimate the work-relatedness of health problems among local truck drivers and long-distance truck drivers, logistic regression analyses were conducted, and odds ratios and 95% confidence intervals were computed. The prevalence rates of working factors affecting health problems of truck drivers were significantly higher than those of clerical workers in the items on irregular shift work, working environment, working posture, handling heavy materials, job stress due to overloading and long working time and limited time off. The prevalence rates for subjective symptoms (ringing in the ears, neck pain and low back pain) and present illnesses (hypertension, ulcers in the digestive tract, back injuries, whiplash injuries and hemorrhoids) among truck drivers were significantly higher than those of clerical workers. In logistic regression analyses, many work-related items except age, BMI and smoking habit showed significantly higher odds ratios for subjective symptoms and present illnesses of truck drivers. Odds ratios for hypertension, heart diseases and related subjective symptoms among local truck drivers were significantly increased by job career, twisting posture, vibration and driving stress. Odds ratios for gastro-duodenal diseases and related subjective symptoms were significantly increased by narrow working space, sleeping in the truck, driving distance, squatting posture and driving stress. Odds ratios for ringing in the ears among local truck drivers were significantly increased by job career, long working time, narrow working space, sleeping in the truck and driving stress. Odds ratios for musculo-skeletal diseases and related subjective symptoms were significantly increased by overwork, vibration, narrow working space, sitting posture and shortage of recess. Odds ratios for fatigue symptoms were significantly increased by the shortage of recess, vibration and driving stress. In order to cope with the health problems of truck drivers, it is recommended that working conditions and work loads for among truck drivers as described above be improved.