Biomedical subjects

Hideki Hashimoto

Publications and source records attributed to Hideki Hashimoto.

At least 19 recordsLinked to original sources

PubMed2006

Patients' preferences for decision making and the feeling of being understood in the medical encounter among patients with rheumatoid arthritis.

OBJECTIVE: To examine how patients' preferences for decision making in the medical encounter affect the association between their participation style and the feeling of being understood by the physician. METHODS: The study group comprised 115 patients with rheumatoid arthritis who were under continuous care by 8 rheumatologists at a university-affiliated rheumatology clinic in Tokyo, Japan. A questionnaire was distributed just after each encounter, in which patients' self-reported participation in communication during the visit, preference for decision making, and the feeling of being understood were measured. The feeling of being understood was regressed on the participation style and preference for decision making after controlling for demographic and functional variables. RESULTS: Patient participation in visit communication was positively associated with the feeling of being understood. This relationship was moderated by patients' preference for decision making. Patients with higher preference for decision making were more likely to feel understood when they more actively participated in visit communication, whereas this relationship was weaker among those with lower preference for decision making. CONCLUSION: Inviting patients to participate in visit communication may not always enhance the feeling of being understood by the physician when patients have less preference for autonomous decision making in the relationship with the physician. Exploring patients' preferences in the relationship would help physicians understand what the patient expects from visit communication and tailor their practice style to meet patients' needs.

Adult↗

PubMed2006

Pump-probe and pump-deplete-probe spectroscopies on carotenoids with N=9-15 conjugated bonds.

A series of all-trans-carotenoids with N=9, 13, and 15 conjugated bonds has been studied by pump-probe and pump-deplete-probe spectroscopies to obtain a systematic analysis of the energy flow between the different electronic states. The ultrafast dynamics in the carotenoids are initialized by excitation to the S2 state and subsequently manipulated by an additional depletion pulse in the near-IR spectral range. The changes in the dynamics after depletion of the excited state population allowed differentiation of the excited state absorption into two components, a major one corresponding to the well known S1 state and the small contribution on the red wing of the S0-S2 absorption band originating from the hot ground state. We found no evidence for an additional electronically excited state, usually called S*. Instead, a deactivation mechanism that includes the hot ground state supports the observed results nicely in the framework of a simple three state model (S2, S1, and S0).

Journal Article↗

PubMed2006

Association between serum albumin, carotid atherosclerosis, and metabolic syndrome in Japanese individuals.

Serum albumin is a maker of nutritional status and possesses antioxidative properties. Here, we have sought to investigate the mode of association between serum albumin levels, metabolic syndrome, and carotid atherosclerosis by analyzing the data of the cross-sectional data from 8143 individuals who underwent general health screening test. After adjusting for age, total cholesterol, and smoking status, the highest quartile of serum albumin (>or=4.7 g/dL) was associated with increased prevalence of metabolic syndrome with an odds ratio of 1.80 (95% CI 1.41-2.23, P<0.0001) in women, and 1.60 (95% CI 1.44-1.78, P<0.0001) in men, when compared to the lowest serum albumin quartile (<4.3g/dL). By contrast, when compared with the lowest quartile, the highest quartile of serum albumin was associated with reduced prevalence of carotid plaque with an odds ratio of 0.62 (95% CI 0.42-0.91, P<0.001) in women, and 0.76 (95% CI 0.62-0.93, P<0.01) in men, and for carotid intima-media thickening with an odds ratio of 0.57 (95% CI 0.35-0.94, P<0.05) in women, and 0.71 (95% CI 0.55-0.92, P<0.01) in men. Our data showed that higher serum albumin was inversely associated with the prevalence of early carotid atherosclerosis, although it was positively associated with the prevalence of metabolic syndrome. Whether these observations are in part explained by the antioxidative properties of albumin requires further investigation.

Aged↗

PubMed2006

Metabolic syndrome may not associate with carotid plaque in subjects with optimal, normal, or high-normal blood pressure.

Much evidence indicates that metabolic syndrome is a risk factor for the development of cardiovascular disease, but whether metabolic syndrome is an independent risk factor for early atherosclerosis in the individuals with only minor hemodynamic abnormalities, if any, is not well investigated. Here we have investigated the association between metabolic syndrome and carotid atherosclerosis in individuals with blood pressure of <140/90 mm Hg. Between 1994 and 2003, 8143 subjects underwent general health screening including carotid ultrasonography. Of 8143 individuals, 5661 individuals without antihypertensive medications who had blood pressure of <140/90 mm Hg were considered to have optimal, normal, or high-normal blood pressure. After adjustment for age, systolic blood pressure, body mass index, total and high-density lipoprotein cholesterol, triglycerides, fasting glucose, and smoking status, metabolic syndrome was not found to be an independent risk factor for carotid plaque (odds ratio: 1.65; 95% CI; 0.72 to 3.76 in women and odds ratio: 0.95; 95% CI: 0.70 to 1.28 in men) or for carotid intima-media thickening (odds ratio: 0.56; 95% CI: 0.18 to 1.72 in women and odds ratio: 0.93 95% CI: 0.62 to 1.38 in men) in these subjects. Thus, presence of metabolic syndrome may not increase the prevalence of carotid atherosclerosis independent of other cardiovascular risk factors in Japanese individuals with optimal, normal, or high-normal blood pressure.

Adult↗

PubMed2006

Higher serum uric acid is associated with increased arterial stiffness in Japanese individuals.

Hyperuricemia is postulated to be a risk factor for atherosclerotic diseases, although whether it is independent of classical atherogenic risk factors is controversial. The automatic computer-assisted measurement of brachial-ankle pulse wave velocity (baPWV) is a valid and reproducible method by which to assess arterial stiffness, a potential surrogate marker of early atherosclerosis. By analyzing cross-sectional data from 982 individuals who underwent health screening, we have investigated whether serum uric acid is associated with high baPWV, which was determined as the highest quartile of baPWV values, in a sex-specific manner. Multivariate analysis showed that the odds ratios (95% CI) of the highest baPWV quartile across the sex-specific quartiles of serum uric acid were 1.0, 2.80 (0.93-8.40), 2.13 (0.74-6.19), and 2.76 (1.01-7.55) in women, and 1.0, 1.10 (0.55-2.20), 1.97 (1.04-3.75), and 2.24 (1.10-4.56) in men after adjusting for age, total and HDL-cholesterol, BMI, systolic blood pressure, triglycerides, fasting glucose and smoking status. The association between uric acid and high baPWV was observed in both subjects with metabolic syndrome and those without. These data suggest that in both genders, serum uric acid level is associated with increased baPWV, a marker of arterial stiffness, and is in part independent of other conventional risk factors for atherosclerosis and metabolic syndrome.

Aged↗

PubMed2006

Discriminative validity and responsiveness of the Oswestry Disability Index among Japanese outpatients with lumbar conditions.

The Oswestry Disability Index (ODI) is one of the most used assessment scales for patients with spine conditions, and translations into several languages have already been available. However, the scale's discriminative validity and responsiveness to the clinical change was somewhat understudied in these translated versions of the ODI. In this study, we independently developed a Japanese version of the ODI, and tested its discriminative and responsive performances among outpatients with various spinal conditions. We recruited 167 outpatients from seven participating clinics, and concurrently measured the translated ODI and MOS Short Form 36 (SF36) as a reference scale. We also obtained from medical records clinical information such as diagnoses, the past history of surgery, and existence of subjective symptoms and clinical signs. For testing discriminative validity, scores were compared by the number of symptoms and signs, with the trend test. Receiver operating characteristics (ROC) analysis was also conducted to compare ODI and SF36 in their performance to discriminate the existence of signs/symptoms, by chi-square test on the area under ROC curve (AUC). For 35 patients (17 clinically stable, 18 undergoing surgery and clinically significantly changed), the two scales were repeatedly administered after 3-6 months to compare responsiveness by using ROC analysis. The translated ODI and the SF36 Physical Function (PF) subscale showed a significant trend increase as the numbers of symptoms/signs increased. They also showed comparable performance in discriminating the existence of signs/symptoms (AUC=0.70-0.76 for ODI, 0.69-0.70 for SF36 PF, P=0.15-0.81), and clinical status change over time (AUC=0.82 for ODI, 0.72 for SF36 PF, P=0.31). Our results showed that the translated Japanese ODI showed fair discriminative validity and responsiveness as the original English scale showed.

Adult↗

PubMed2006

The diffusion of medical technology, local conditions, and technology re-invention: a comparative case study on coronary stenting.

Innovation of medical technology is a major driving force behind the increase in medical expenditures in developed countries. Previous studies identified that the diffusion of medical technology varied across countries according to the characteristics of regulatory policy and payment systems. Based on Roger's diffusion of innovation theory, this study purported to see how local practice norms, the evolving nature of diffusing technology, and local clinical needs in addition to differences in politico-economic systems would affect the process of innovation diffusion. Taking a case of coronary stenting, an innovative therapeutic technology in early 1990s, we provided a case study of hospital-based data between two teaching high-tech hospitals in Japan and the US for discussion. Stenting began to be widely used in both countries when complementary new technology modified its clinical efficacy, but the diffusion process still differed between the two hospitals due to (1) distinctive payment systems for hospitals and physicians, (2) practice norms in favor of percutaneous intervention rather than bypass surgery that was shaped by payment incentives and cultural attitudes, and (3) local patient's clinical characteristics that the technology had to be tailored for. The case study described the diffusion of stent technology as a dynamic process between patients, physicians, hospitals, health care systems, and technology under global and local conditions.

Aged↗

PubMed2006

Carotenoid-bacteriochlorophyll energy transfer in LH2 complexes studied with 10-fs time resolution.

In this report, we present a study of carotenoid-bacteriochlorophyll energy transfer processes in two peripheral light-harvesting complexes (known as LH2) from purple bacteria. We use transient absorption spectroscopy with approximately 10 fs temporal resolution, which is necessary to observe the very fast energy relaxation processes. By comparing excited-state dynamics of the carotenoids in organic solvents and inside the LH2 complexes, it has been possible to directly evaluate their energy transfer efficiency to the bacteriochlorophylls. In the case of okenone in the LH2 complex from Chromatium purpuratum, we obtained an energy transfer efficiency of etaET2=63+/-2.5% from the optically active excited state (S2) and etaET1=61+/-2% from the optically dark state (S1); for rhodopin glucoside contained in the LH2 complex from Rhodopseudomonas acidophila these values become etaET2=49.5+/-3.5% and etaET1=5.1+/-1%. The measurements also enabled us to observe vibrational energy relaxation in the carotenoids' S1 state and real-time collective vibrational coherence initiated by the ultrashort pump pulses. Our results are important for understanding the dynamics of early events of photosynthesis and relating it to the structural arrangement of the chromophores.

Bacterial Chromatophores↗

PubMed2006

Menopause is an independent factor augmenting the age-related increase in arterial stiffness in the early postmenopausal phase.

The present study examined whether the menopause augments the age-related increase in brachial-ankle pulse-wave velocity (PWV). In total, 3149 women (ranging in age from 21 to 94 years) undergoing an annual health screening examination were enrolled in a cross-sectional study. Conventional atherosclerotic risk factors were examined, and the brachial-ankle PWV of each subject was determined. The relationship between age and the brachial-ankle PWV assumed the form of a quadratic curve, and the slope of the curve was relatively steeper after the menopause (brachial-ankle PWV = 0.17 x age2 - 0.58 x age + 812) than before (brachial-ankle PWV = 0.23 x age2 - 8.92 x age + 1058). A logistic regression analysis conducted for subjects between the ages of 45 and 56 years (mean age of menopause +/- 2 standard deviations) demonstrated that women who had experienced the menopause at least 6 years previously demonstrated a significant risk of belonging to the highest PWV tertile {adjusted odds ratio: 2.08 (95% confidential interval: 1.04-4.17)}, independent of age and other atherosclerotic risk factors (hypertension, hypercholesterolemia, diabetes mellitus, obesity, and smoking). Thus, this study suggested that the menopause augments the age-related increase in arterial stiffness during the early postmenopausal phase and that this augmentation is probably related, at least in part, to estrogen deficiency. The contribution of this menopause-related increase in arterial stiffness to the risk of cardiovascular disease in postmenopausal women should be further evaluated.

Adult↗

PubMed2006

Evaluating medical students' non-verbal communication during the objective structured clinical examination.

OBJECTIVES: Non-verbal communication (NVC) in medical encounters is an important method of exchanging information on emotional status and contextualising the meaning of verbal communication. This study aimed to assess the impact of medical students' NVC on interview evaluations by standardised patients (SPs). METHODS: A total of 89 medical interviews in an objective structured clinical examination (OSCE) for post-clerkship medical students were analysed. All interviews were videotaped and evaluated on 10 non-verbal behaviour items. In addition, the quality of the interview content was rated by medical faculty on 5 items and the interview was rated by SPs on 5 items. The relationships between student NVC and SP evaluation were examined by multivariate regression analyses controlling for the quality of the interview content. RESULTS: Standardised patients were likely to give higher ratings when students faced them directly, used facilitative nodding when listening to their talk, looked at them equally when talking and listening, and spoke at a similar speed and voice volume to them. These effects of NVC remained significant after controlling for the quality of the interview content. CONCLUSIONS: This study provided evidence of specific non-verbal behaviours of doctors that may have additional impacts on the patient's perception of his or her visit, independently of the interview content. Education in basic NVC should be incorporated into medical education alongside verbal communication.

Education, Medical, Undergraduate↗

PubMed2006

Controlled trial of worksite health education through face-to-face counseling vs. e-mail on drinking behavior modification.

This study examined the effectiveness of a traditional face-to-face health education and e-mail health education on alcohol usage among male workers in comparison with a control group. Male workers at a manufacturing plant (N=36) who had abnormal serum gamma-GTP were stratified by age and job types, then randomized into three groups: face-to-face education, e-mail education, and the control. The subjects were assessed on their knowledge about and attitude towards drinking, reported alcohol consumption, and serum gamma-GTP before the start of education and 2 months later after comparison of the education. Paired t-test and repeated ANOVA were conducted to test the significance of changes pre and post the intervention and across groups. In the face-to-face group, knowledge (p=0.001), attitude (p=0.026), alcohol consumption (p=0.003) and serum gamma-GTP showed significant improvement. In the e-mail group, only alcohol consumption showed marginal improvement (p=0.077). In the control group, no variables remarkably changed. These results indicate that the face-to-face health education was more effective than the e-mail program. We discuss why the face-to-face approach was superior to the e-mail approach in this study by referring to self-monitoring, goal setting processes and timely feedback. We concluded that further studies are warranted to identify the effect of health education using e-mails and other network tools in consideration of the above three factors.

Adult↗

PubMed2005

Synergistic acceleration of arterial stiffening in the presence of raised blood pressure and raised plasma glucose.

Arterial stiffness is recognized as a marker of arterial damage and an indicator of cardiovascular risk. This observational study was conducted to examine the synergistic effect of raised blood pressure (RBP; > or =130/85 mm Hg) and raised plasma glucose (RPG; > or =110 mg/dL) even at levels below those conventionally used to define hypertension and diabetes on the rate of increase of the pulse wave velocity (PWV) over a 3-year period in 2080 Japanese men (age 42+/-9 years). First, the subjects were classified into 4 groups based on the presence at the first examination of RBP, RPG, both abnormalities, or neither abnormality. The estimated annual rate of increase of the PWV was higher in subjects with both the abnormalities than in those with either abnormality alone or neither of the 2 abnormalities. Second, the subjects were also classified based on the evolutional status of these abnormalities during the study period; persistence of both of the abnormalities synergistically accelerated the rate of increase of the PWV (68.3+/-7.1 cm/s per year), as compared with the persistence of either abnormality alone (persistence of RBP alone: 18.2+/-1.6 cm/s per year; persistence of RPG alone: 21.2+/-7.4 cm/s per year) or persistence of neither abnormality (11.1+/-0.8 cm/s per year; P<0.01). Thus, blood pressure and fasting plasma glucose levels even below those defining hypertension and diabetes may synergistically lead to progression of arteriosclerotic arterial damage. This synergistic progression may contribute to the additive increases in the risk of cardiovascular events, at least in part.

Adult↗

PubMed2005

Profiling of resource use variation among six diseases treated at 82 Japanese special functioning hospitals, based on administrative data.

BACKGROUND: Profiling treatment in Japanese hospitals has rarely been conducted systematically with an administrative database. The study aims to present descriptive statistics of medical profiling and to examine the sources of variation in resource used for six common diseases. METHODS: Administrative records for 266,677 patients were analyzed to examine variation in length of stay (LOS) and total charge (TC) by hierarchical multiple linear regression for cases of ischemic stroke, ischemic heart disease (IHD), great vessel disease (GVD), respiratory neoplasm, gastric neoplasm and colonic neoplasm. RESULTS: Average LOS and TC increased with disease severity and invasiveness of surgical procedure. The coefficient of determination of the full model was highest for LOS in IHD (0.432), and for TC that was highest in GVD (0.702). Among various variable sets examined, surgical procedures explained largest variance in resource use. CONCLUSION: With a standardized database derived from claims data, wide audience of stakeholders in Japanese healthcare will be able to access the profiling of practice or disease variation concerned.

Aged↗

PubMed2005

Sub-micro-second time-resolved absorption spectroscopy of a polar carotenoid analogue, 2-(all-trans-retinylidene)indan-1,3-dione; formation of the dication by direct triplet-excited sensitization.

Sub-micro-second time-resolved difference absorption spectra of a polar carotenoid analogue, 2-(all-trans-retinylidene)indan-1,3-dione (hereafter, we will call RetInd), were recorded in tetrahydrofuran at room temperature upon anthracene-sensitized triplet excitation. In addition to the typical Tn <-- T1 absorption spectrum of anthracene followed by that of RetInd, a novel transient species, which peaked at 670 nm, was detected. The lifetime and the population of the 670 nm species was not affected by the presence of oxygen but was quenched by the cation scavenger, triethylamine. Therefore, we have identified this species as a "cation". The transient 670 nm species was not generated by direct photoexcitation of RetInd in the absence of a triplet sensitizer. Therefore, this species was not generated via the T1 species of RetInd but rather via an "invisible state" of RetInd, which is generated by direct energy or electron transfer from T1 anthracene. This proposed pathway was confirmed by a singular-value decomposition followed by a global fitting analysis. The "cation" of RetInd shows vibrational structure in its absorption spectrum, and its lifetime was determined to be 15 micros. Chemical oxidation of RetInd in 2,2,2-trifluoroethanol (dichloromethane) produced a broad absorption band around 880 (1013) nm, which could be transformed into a shoulder around 640 (675) nm upon addition of increasing amounts of the oxidant, FeCl3. The former absorption band can be assigned to a radical cation, while the latter to a dication. Because of the spectral similarity, the 670 nm species can be assigned to the dication, and the "invisible state" is ascribed to the radical cation of RetInd. This is the first direct evidence for the production of a dication of a biological polyene moiety generated in non-halogenated solution following anthracene-sensitized excitation.

Journal Article↗

PubMed2005

Patients' perceptions of visit companions' helpfulness during Japanese geriatric medical visits.

OBJECTIVE: Elderly patients are often accompanied during medical visits by a companion, usually a family member. This study explores the association between patients' expectations regarding the communication role of their companions, and the role intended and taken by companions during the medical visits, on patient perceptions of companion helpfulness. METHODS: Participants included 63 patients aged 65 or over who were under continuous care of nine attending physicians at a university-affiliated geriatric clinic in Tokyo, and their companions during the medical visit. These medical visits were audiotape recorded and coded using a Japanese translation of the Roter Interaction Analysis System (RIAS). RESULTS: The discrepancy between what patients expected of their companions, and what companions intended and actually did during the visit, predicted patient ratings of companion helpfulness. It was especially noteworthy that the highest ratings of companion helpfulness occurred when patients expected their companion to be actively involved in communication and they were. However, if the patient anticipated only a limited companion role, the companion was not viewed as very helpful regardless of the role they played. DISCUSSION: There would be a largely unexploited potential for improving communication effectiveness through the optimal engagement of companions in visit communication.

Aged↗

PubMed2005

The effect of a subsidy policy on the utilization of community care services under a public long-term care insurance program in rural Japan.

This cross-sectional study investigated the effect of an interim subsidy policy for low-income beneficiaries to buy home help services under Japanese long-term care insurance (LTCI) for the service utilization of home help and other community care services. Claims records during the period from October to December 2001 were reviewed to compare the monthly amounts for each service and out-of-pocket copayment for subsidized (n = 137) and non-subsidized (n = 124) beneficiaries. A multivariable linear regression analysis was conducted to control for age, gender, household size, length of care, and care eligibility level. Compared with the non-subsidized beneficiaries, the subsidized beneficiaries used 1.53 times as much home help service (p < 0.001), and spent 0.70 times as much on out-of-pocket copayments (p < 0.001), while they used fewer adult daycare services (0.71 times as much as the non-subsidized did, p = 0.063). The results strongly indicated that the interim subsidy for low-income beneficiaries alleviated the economic burden, but also resulted in service overuse and the substitution of home help services for other community care services. The policy implications of these findings were discussed.

Aged↗

PubMed2005

Effects of shift work on QTc interval and blood pressure in relation to heart rate variability.

OBJECTIVES: There is evidence that shift work contributes to excess cardiovascular mortality. The purpose of this study was to determine the effects of shift work on heart rate-corrected QT (QTc) and blood pressure in relation to heart rate variability (CV(RR)). METHODS: The study population consisted of 153 male shiftworkers and 87 male day workers who were employed at a copper-smelting plant. The QTc interval, total power spectral density (t-PSD) of 100 RR intervals, PSDs with frequencies of 0.01 Hz-0.15 Hz and 0.15 Hz-0.40 Hz (PSD(LF) and PSD(HF)), CV(RR), low frequency (LF) component variability and high frequency (HF) component variability (CCV(LF) and CCV(HF)) and %LF (PSD(LF)/(PSD(LF)+PSD(HF)) .100) were measured (LF and HF components are thought to reflect the sympathetic and parasympathetic activities, respectively). RESULTS: The QTc interval was significantly longer in the shiftworkers than in the day workers, although there was no significant difference in systolic or diastolic blood pressure between the two groups. Also, the CCV(LF) and log(PSD(LF)) were significantly depressed in the shiftworkers. In the day workers, the QTc interval was significantly related to the CV(RR), log(t-PSD), CCV(HF), log(PSD(HF)),%LF, and log(LF/HF ratio) (partial correlation coefficient r=-0.305, -0.377, -0.312, -0.355, 0.297, and 0.277, respectively). In the shiftworkers only two relations of the QTc interval to non-specific CV(RR) and log(t-PSD) were significant. CONCLUSION: The clear association between long QTc interval and reduced parasympathetic activity observed in the day workers did not exist in the shiftworkers. Rather, the shiftworkers had a selective reduction in sympathetic drive, which may have compensated for prolonged QTc interval due to shift work. On the other hand, the impact of shift work on hypertension remains unclear, although reduced sympathetic drive in the shiftworkers may explain the absence of differences in blood pressure between shiftworkers and day workers to some extent.

Adult↗

PubMed2005

Association between cigarette smoking, metabolic syndrome, and carotid arteriosclerosis in Japanese individuals.

Cigarette smoking is associated with increased insulin resistance and other metabolic abnormalities. Here, we investigate the prevalence of metabolic syndrome (MetS) in cigarette smokers and people who never smoked by analyzing cross-sectional data of 5033 subjects aged between 35 and 65 years who underwent general health screening. Both former and current smoking was associated with an increased incidence of metabolic syndrome defined by modified-National Cholesterol Education Program (NCEP) criteria with odds ratios of 1.77 (95% CI 1.42-2.22, P < 0.0001) and 2.38 (95% CI 1.95-2.91, P < 0.0001), respectively. In both former and current smokers, prevalence of metabolic syndrome increased when the duration of cigarette smoking was > or = 10 years. The positive association between metabolic syndrome and smoking was only partially reversed even 5 years after quitting. Multivariate logistic regression analysis showed that metabolic syndrome was an independent risk factor for carotid plaque with an odds ratio of 1.72 (95% CI 1.43-2.08, P < 0.0001). On the other hand, when limited to individuals without metabolic syndrome, former and current smoking was still found to be associated with carotid plaque with odds ratios of 1.49 (95% CI 1.15-1.92, P = 0.0023) and 1.57 (95% CI 1.22-2.03, P = 0.0005), respectively, in men. Collectively, these data suggest that the atherogenic consequences of smoking may, at least in part, be explained by its association with metabolic syndrome.

Adult↗