Introduction: Patients often refer to information on the Internet when selecting a medical institution, and some patients provide feedback on their experiences. In this study, we analyzed the content of patients' evaluations of medical institutions on Google.Methods: This study evaluated Google reviews and ratings of medical institutions in Shizuoka Prefecture. We coded the reviews with 12 items according to their content, and further categorized them into "positive," "negative," "unclassifiable," and "no description." We used modified Poisson regression analysis to investigate the relationship between ratings and assessment items.Results: Our sample consisted of 2,044 medical institutions. The number of reviews included in the analysis was 13,769. Reviews frequently commented on "doctor's behaviors," and positive comments about doctor's behaviors were significantly associated with high ratings (B: 0.76, 95%CI: 0.70 to 0.82), whereas negative comments were associated with low ratings (−4.65, −5.24 to −4.06).Conclusion: Within the reviews on Google, doctors' behavior had an impact on the ratings of medical institutions.

Previous studies showed associations of sedentary behavior with cardiovascular risks, independent of moderate-to-vigorous physical activity. However, few studies have focused on Japanese workers. This study examined the joint association of television viewing time (TV) and walking time (WT) with overweight/obesity among Japanese municipal office workers. A cross-sectional survey collected height, weight, and time spent in TV and WT from 2,175 Japanese workers, aged 22-62 years-old, by self-administered questionnaire. Participants were classified into four categories according to TV (dichotomized into long (>2 hours/day) and short (≤2 hours/day) by the median) and WT (dichotomized into long (≥30 minutes/day) and short (<30 minutes/day) by 30 minutes/day). Odds ratios (OR) for overweight/obesity (body mass index ≥25kg/m²) were calculated according to the four TV/WT categories, adjusted for potential confounders. Overweight/obesity accounted for 30.5% of men and 15.3% of women. Among men, the adjusted ORs (95% CI) of overweight/obesity were 1.14 (0.76, 1.70) for long TV/long WT, 1.13 (0.77, 1.65) for short TV/short WT, and 0.97 (0.67, 1.42) for short TV/long WT, compared with the reference category (long TV/short WT). Among women, the adjusted ORs (95% CI) were 0.70 (0.39, 1.13) for long TV/long WT, 0.55 (0.33, 0.94) for short TV/short WT, and 0.54 (0.33, 0.89) for short TV/long WT. Spending a long time watching television was associated with a higher risk of being obese in Japanese female municipal office workers, independent of WT. Further studies using prospective designs are warranted to develop an effective weight control program for Japanese workers.

Background: Epidemiological findings suggest that weight fluctuations are associated with unfavorable health outcomes compared with stable weight. However, the interrelationship between the weight cycling history and dieting status in a non-clinical male trial on the risk for bio-behavioral health is unclear. Objective: The purpose of this study was to examine the relation between weight cycling history as a result of intentional weight loss and bio-behavioral health in Japanese adult males. Method: A cross-sectional study was performed on a group of 146 Japanese working males (47.5±9.3 yr.). Each subject completed a series of self-reported questionnaires in which information about weight cycling history, current dieting practices, life-styles, and social background were assessed. Results of the physical check up were used to assess biological parameters. Self-reported weight cycling was defined as intentionally losing 10% of one's weight and regaining the lost weight. Results: Cyclers reported a significantly greater incidence of current dieting and recent weight gain compared with non-cyclers. Taking regular meals, eating breakfast everyday, and not eating snacks between meals every day were significantly less frequent among cyclers compared with non-cyclers after controlling for BMI. The adjusted odds ratio for AST abnormality was 5.46 (95%CI: 1.08 −27.67), ALT abnormality was 3.31 (95%CI: 1.24−8.78), and γ-GTP was 3.38 (95%CI: 1.07−10.67) among cyclers, compared with non-cyclers. Conclusion: These findings suggest that a history of weight cycling in men, regardless of current weight status, is associated with adverse bio-behavioral health. The risk for several liver enzyme abnormalities associated with weight cycling history was substantial, independent of relative body weight and lifestyle factors.
Weight ; Health ; brief historical notes, excludes case histories ; Japanese language ; Cephalic index

Purpose: To create flow charts of eating and swallowing that make it easy to identify the cases requiring professional treatment including dysphagia rehabilitation during oral intake.Subjects: 28 patients (mean age: 78.7±11.3 years) with dysphagia who underwent videofluorography (hereinafter “VF”).Methods: We conducted various tests such as Repetitive Salvia Swallowing Test (RSST), Modified Water Swallowing Test (MWST) and Food Test (FT), and studied relationships between VF findings and Fujishima's grade of eating and swallowing capability.Results: After the examination of th results of RSST (sensitivity: 0.83, specificity: 0.22), MWST (sensitivity: 0.56, specificity: 0.72), FT (sensitivity: 0.33, specificity: 0.75), VF and grade of eating and swallowing capability of Fujishima, the use of MWST and FT was appropriate. However, four cases in which the results of MWST and FT were over the cut-off value had misswallowed water and food. We created the flowcharts considering that all of those 4 cases are also the cases that suffered from the consequences of cerebral strokes.

Objective : To translate the Abbreviated Neighborhood Environment Walkability Scale into Japanese (ANEWS-J) and to examine its reliability.Methods : One hundred sixty three community residents (male: 38.7%, age: 21-69 years old) of 600 who were randomly selected from the registry of residential addresses of Taitoh Ward in Tokyo and Fujinomiya City in Shizuoka Prefecture, responded to mail survey including ANEWS-J. Seventy-seven of 163 answered same questionnaire twice with ten days interval to examine the test-retest reliability.The questionnaire was translated into Japanese and fixed through the processes of preliminary test, backtranslation into English and discussion with authors of original version.Intraclass correlation coefficients (ICCs) were calculated for the evaluation of reliability of ANEWS-J.Results : ICCs of the eight subscales of ANEWS-J were residential density; r=0.95 (95% confidence interval; 0.93-0.97), land use mix - diversity; r=0.96 (0.94-0.98), land use mix - access; r=0.90 (0.84-0.94), street connectivity; r=0.83 (0.74-0.90), sidewalk / bike lane; r=0.82 (0.71-0.89), aesthetics; r=0.85 (0.76-0.91), traffic safety; r=0.81 (0.70-0.89), crime safety; r=0.76 (0.62-0.86).Stratified analyses by gender and residential district showed satisfactory reproducibility of the subscales (r=0.63-0.97). Conclusion : Acceptable reliabilities of all eight subscales of ANEWS-J were confirmed in this study.

Background: Perceived benefits and barriers to exercise are important correlates of exercise participation. Purpose: To develop a short version of the perceived benefits and barriers to exercise scale and to examine its validity and reliability. Methods: A population-based cross-sectional study of 865 participants (age: 20-69 years old, men: 46.5%) was conducted in four cities in Japan (Koganei, Tshukuba, Shizuoka, Kagoshima). Perceived benefits and barriers scale including five benefit subscales (physical benefit, psychological benefit, social benefit, weight management, self-improvement) with 10 items, five barrier subscales (discomfort, lack of motivation, lack of time, lack of social support, poor physical environment) with 10 items and stage of change for exercise behavior were assessed by self-administered questionnaire. Results: Confirmatory factor analyses to examine the construct validity revealed acceptable fit indices (benefit scale: GFI=.980, AGFI=.951, RMSEA=.058, AIC=151.669, barrier scale: GFI=.973, AGFI=.949, RMSEA=.060, AIC=166.084). Seven of ten subscales indicated significant linear associations with stage of change for exercise behavior, criterion-related validity was revealed. The reliability of the scale was found to be good as internal consistency and inter-rater reliability. Conclusion: The short version of the perceived benefits and barriers scale developed in this study demonstrated acceptable construct validity, criterion-related validity, internal consistency and inter-rater reliability.

The purpose of this cross-sectional study is to investigate the difference in physical activity among elderly living in different areas in Japan (“Bunkyo Ward in Tokyo” (Bunkyo) and “Fuchu City in Tokyo” (Fuchu) as urban areas, and “Oyama Town in Shizuoka” (Oyama) as a non-urban area). Participants were 1859 community-dwelling residents aged 65-74 years, randomly selected from the residential registry (response rate: 68.9%). A mail survey using self-administered questionnaires was conducted. Multivariate logistic regression analyses were used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) of various types of physical activity (eg, walking (Walking), going out (Going-out), bicycling (Bicycling), exercise habits (Exercise)), according to residential areas (reference category: Fuchu), stratified by gender, adjusting for socio-demographic variables. There was a significant difference in Going-out (ORs = 0.61 (95% CI: 0.44-0.86) for men, 0.48 (0.33-0.69) for women)), and Bicycling (0.04 (0.03-0.07) for men, 0.04 (0.02-0.07) for women) in Oyama compared to Fuchu. Furthermore, for women, there was a significant difference in Walking (0.56 (0.38-0.81)) and Exercise (0.59 (0.41-0.85)) in Oyama compared to Fuchu. There was a significant difference in Bicycling and Going-out for men in Bunkyo compared to Fuchu, but there was not a significant difference in other items. Low physical activity levels were observed in the elderly in the non-urban area compared to urban areas. The association was stronger in women. Regional difference might need to be taken into account for an effective physical activity intervention.

The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

BACKGROUND: Although non-thyroidal illness syndrome (NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine (fT3) levels in trauma patients requiring massive transfusion have not been reported. METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions (>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of fT3, free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation. RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial fT3 levels in group M (1.95±0.37 pg/mL) were significantly lower than those in group C (2.49±0.72 pg/mL;P<0.01) and remained low until 1 week after admission. Initial inter-group fT4 and TSH levels were not significantly different. TSH levels at 1 week (1.99±1.64 μIU/mL) were higher than at admission (1.48±0.5 μIU/mL) in group C (P<0.05). CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.

PURPOSE: Few reports have been made on the therapeutic effects as well as pathological features of an antithrombin preparation in patients diagnosed with septic disseminated intravascular coagulation (DIC) by the diagnostic criteria for acute DIC. MATERIALS AND METHODS: A total of 88 sepsis patients who had received inpatient hospital care during the period from January 2000 through December 2008 were divided into two groups, an antithrombin group and a non-antithrombin group, to study the outcomes. Furthermore, the relationship between sepsis-related factors and DIC in 44 patients was studied. RESULTS: The antithrombin group contained 34 patients, and the non-antithrombin group contained 54 patients. The outcomes were significantly better in the antithrombin group. The levels of protein C were low in DIC patients. CONCLUSION: Our results suggest that early administration of antithrombin might improve outcomes of septic DIC patients in the diagnostic criteria for Japanese Association for Acute Medicine acute DIC.
Aged ; Disseminated Intravascular Coagulation/complications/diagnosis/*drug therapy ; Female ; Fibrinolytic Agents/*therapeutic use ; Humans ; Male ; Middle Aged ; Sepsis/complications/diagnosis/*drug therapy ; Time Factors ; Treatment Outcome