Biomedical subjects

Shunichi Fukuhara

Publications and source records attributed to Shunichi Fukuhara.

At least 19 recordsLinked to original sources

PubMed2006

Health-related quality of life of predialysis patients with chronic renal failure.

BACKGROUND: Health-related quality of life (HQOL) of predialysis patients with chronic renal failure (CRF) has received less attention than that of dialysis patients. We investigated changes in SF-36 over 1 year and examined associations between clinical parameters and SF-36 in predialysis CRF patients. METHODS: Subjects were 471 predialysis CRF patients. SF-36 and clinical parameters were measured every 8 weeks for 48 weeks. Of the 471 subjects, 294 underwent one or more follow-ups. We analyzed the pooled dataset of the 294 CRF patients and 2002 subjects from Japanese general population using analysis of covariance. RESULTS: After adjustment for age and sex, the 1-year declines in SF-36 domains were significantly greater in the predialysis patients than in the general population. For a 10% decline in hematocrit from the baseline survey value, the decline in vitality of SF-36 was 4.5 points (p = 0.003), while for a 10% increase in serum creatinine from the baseline survey value, respective declines in physical functioning, role-physical and mental health were 1.2 (p = 0.004), 1.9 (p = 0.035), and 1.0 points (p = 0.008). CONCLUSION: Among these predialysis CRF patients, the decline in HQOL was faster than that in the general population, and was associated with an increase in serum creatinine and decline in hematocrit.

Cost of Illness↗

PubMed2006

Validation of the Japanese version of the Quality of Life-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA).

OBJECTIVE: To evaluate validity and reliability of the Japanese version of the Quality of Life-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA). DESIGN: Observational study; cross-sectional, longitudinal. METHODS: Seventy-five adults with growth hormone deficiency completed the SF-36 (a generic health-related QOL scale) and the QoL-AGHDA before growth hormone replacement therapy and approximately 3 weeks later (when the therapy began). A sample (n=1000) of controls from the general population was also studied. We computed rates of missing data, measured reproducibility and internal consistency reliability, and tested for known-groups validity, concurrent validity, unidimensionality (by principle component analysis), and content validity. RESULTS: Rates of missing data were low (0-1.4%). The mean of QoL-AGHDA scores in the patients was 8.2 (SD, 6.4). The scores were reproducible (k=0.41-0.78), and internally consistent (alpha=0.91) and the scale was unidimensional. QoL-AGHDA scores were associated with SF-36 scores as hypothesized. Scores were significantly higher in the patients than in controls (8.1+/-0.7, and 5.6+/-0.2, P<0.001). Discrimination between patients and controls was slightly better using scores on the "General Health" and "Role Physical" subscale of the SF-36 as explanatory variables than using QoL-AGHDA scores. CONCLUSIONS: The QoL-AGHDA's reliability, validity, and rates of missing data were satisfactory, and the scale was confirmed to be unidimensional. However, because some subscales of the SF-36 were better for discriminating patients from controls, the content validity of the QoL-AGHDA may need to be re-evaluated.

Adolescent↗

PubMed2006

Validation of the Burden Index of Caregivers (BIC), a multidimensional short care burden scale from Japan.

BACKGROUND: We constructed a concise multidimensional care burden scale that reflects circumstances unique to Japan, with a focus on intractable neurological diseases. We surveyed 646 family caregivers of patients with intractable neurological diseases or stroke using 28 preliminary care burden scale items obtained from qualitative research. The results were used to finalize the feeling of care burden scale (BIC: burden index of caregivers), and verify its reliability and validity. METHODS: The survey was conducted among caregivers providing home health care to patients with intractable neurological diseases (PD [Parkinson's disease], SCD [spinocerebellar degeneration], MSA [multiple system atrophy], and ALS [amyotrophic lateral sclerosis]) or CVA (cerebrovascular accident) using a mailed, self-administered questionnaire between November, 2003 and May, 2004. RESULTS: Response rates for neurological and CVA caregivers were 50% and 67%, respectively, or 646 in total (PD, 279; SCD, 78; MSA, 39; ALS, 30; and CVA, 220). Item and exploratory factor analyses led to a reduction to 11 items, comprising 10 items from the 5 domains of time-dependent burden, emotional burden, existential burden, physical burden, and service-related burden; and 1 item on total burden. Examination of validity showed a moderate correlation between each domain of the BIC and the SF-8 (Health related quality of life scale, Short Form-8), while the correlation coefficient of the overall BIC and CES-D was 0.62. Correlation between the BIC and ZBI, a preexisting care burden scale, was high (r = 0.84), while that with the time spent on providing care was 0.47. The ICC (Intraclass correlation coefficient) by test-retest reliability was 0.83, and 0.68 to 0.80 by individual domain. CONCLUSION: These results show that the BIC, a new care burden scale comprising 11 items, is highly reliable and valid.

Aged↗

PubMed2006

Japanese version of the Dermatology Life Quality Index: validity and reliability in patients with acne.

BACKGROUND: Patient-reported quality of life is strongly affected by some dermatologic conditions. We developed a Japanese version of the Dermatology Life Quality Index (DLQI-J) and used psychometric methods to examine its validity and reliability. METHODS: The Japanese version of the DLQI was created from the original (English) version, using a standard method. The DLQI-J was then completed by 197 people, to examine its validity and reliability. Some participants completed the DLQI-J a second time, 3 days later, to examine the reproducibility of their responses. In addition to the DLQI-J, the participants completed parts of the SF-36 and gave data on their demographic and clinical characteristics. Their physicians provided information on the location and clinical severity of the skin disease. RESULTS: The participants reported no difficulties in answering the DLQI-J items. Their mean age was 24.8 years, 77.2% were female, and 78.7% had acne vulgaris. The mean score of DLQI was 3.99(SD: 3.99). The responses were found to be reproducible and stable. Results of principal-component and factor analysis suggested that this scale measured one construct. The correlations of DLQI-J scores with sex or age were very poor, but those with SF-36 scores and with clinical severity were high. CONCLUSION: The DLQI-J provides valid and reliable data despite having only a small number of items.

Acne Vulgaris↗

PubMed2006

Health-related quality of life among Japanese women with iron-deficiency anemia.

Iron-deficiency anemia (IDA) is a common disease in females of childbearing age. Although iron supplementation quickly improves laboratory-measured parameters, its effect on health-related quality of life is unknown. Here, we conducted a prospective follow-up study to evaluate health-related quality of life in pre-menopausal women diagnosed with IDA. A convenience sample of 92 patients who visited Tokai University Hospital and three other affiliated hospitals were asked to fill out the Medical Outcome Study 36-item short-form health survey (SF-36) during the course of treatment (baseline, and 1 and 3 months after the start of treatment). At baseline, vitality and general health scores were significantly lower than the Japanese national norms. After the start of therapy, however, a significant improvement was seen in all domain scores except role emotional (RE), and at 3 months all eight scores were comparable to or greater than the national norms. In particular, physical functioning and vitality scores of patients with a lower hemoglobin level ( < 9.0 g/dl) at baseline showed a dramatic improvement. Iron supplementation in IDA patients improves not only hemoglobin levels, but also physical function, vitality, and general health perception.

Adolescent↗

PubMed2006

Discrepancy between disability and the severity of low back pain: demographic, psychologic, and employment-related factors.

STUDY DESIGN: Survey of a random sample of all registered residents of Japan between the ages of 20 and 79 years (n = 2966), focusing on those who had had low back pain (LBP) within the past month (n = 906). OBJECTIVE: To learn more about the characteristics of people in whom the severity of LBP and the disability attributed to that pain are discrepant. SUMMARY OF BACKGROUND DATA: LBP can cause disability, but levels of pain and of disability can be discrepant. Some people with severe pain are only slightly disabled, some with mild pain are very disabled, and others have no such discrepancy. METHODS.: Severity of LBP was measured with a visual analog scale. Disability was measured with the Roland-Morris Disability Questionnaire, which quantifies disability in many daily activities, not necessarily disability related to employment. The respondents also provided demographic information, and completed the SF-36 and questionnaires about perceived stress, employment, and satisfaction with employment. RESULTS: In about 45% of those patients with LBP, the severity of the pain and level of disability attributed to that pain were discrepant. People with a high level of disability despite only mild pain were older, felt more stress, were more depressed, worked more overtime, and were less satisfied with their job content, income, working conditions, and relationships with coworkers. People with little disability despite severe pain were the opposite in all those respects. CONCLUSIONS: A group of patients with LBP can be identified for whom the most appropriate interventions should consider psychosocial factors.

Adult↗

PubMed2006

Association between high voltage overhead transmission lines and mental health: a cross-sectional study.

We examined the association between residential proximity to 60 Hz high voltage (22-500 kV) overhead transmission lines (HVOTLs) and mental health (MH). The subjects were 223 mothers with a mean age of 37 years. The distance from the subject's residence to the closest HVOTL was measured on a map. MH status was assessed by the SF-36 Health Survey, which was scored on a 0-100 point scale, and an individual with a score of 52 points or less was defined as having poor MH. Logistic regression models were used to examine the association between the distance from the subjects' residence to the closest HVOTL and MH status. The prevalence of poor MH was 15%. Among the 223 subjects, 10 lived within 100 m of a HVOTL. The adjusted odds ratios (OR) for poor MH among those who lived 101-300 m or within 100 m from HVOTL were 1.29 (95% confidence interval (CI): 0.35-10.13) and 1.87 (95% CI: 0.35-10.13), respectively, against the reference category (300+ m). MH status was not significantly associated with the distance between the subject's residence and the closest HVOTL.

Adult↗

PubMed2006

Psychological adjustment has a greater effect on health-related quality of life than on severity of disease in Parkinson's disease.

The objective of this study was to investigate the effect of psychological adjustment to Parkinson's disease (PD) on the health-related quality of life (HRQL) in patients with this condition. One hundred eighty-three patients (77 male, 106 female; mean age, 65.8 years) were evaluated using the Parkinson's Disease Questionnaire (PDQ-39) and the Japanese version of the Nottingham Adjustment Scale (NAS-J). Multiple regression analysis was performed using age and sex as the explanatory variables. Comparisons were made of changes in R2 when severity and psychological adjustment subscales were added. In addition, comparisons were made of HRQL scores between groups with different levels of psychological adjustment. R2 was higher when psychological adjustment was included in comparison with severity in the some subscales (emotional well-being, stigma, social support, cognition, communication, and bodily discomfort). HRQL was significantly lower in the low-adjustment group compared with other groups. Psychological adjustment had a greater effect than severity of disease on several subscales in the HRQL of patients with PD. This finding suggests that, in addition to any suppression of the progression of symptoms, psychological intervention may also be effective in enhancing the HRQL of patients with PD.

Aged↗

PubMed2006

Gender differences in effects of physical activity on quality of life and resource utilization.

BACKGROUND: Physical activity is associated with health-related quality of life (HRQOL) in the general population, but the effects may be different between sexes. In addition, the effects on resource utilization are not well elucidated. METHODS: A population-based cross-sectional survey was conducted in a rural town, and follow-up data were obtained after 1 year. Physical activity was measured in two ways: amount and maximum intensity. The association between physical activity and the MOS Short Form-36 (SF-36) at baseline, and hospitalization, sick days, and medications in the following year were assessed by multiple regression models. RESULTS: Among 4018 adult residents eligible, 3529 (62.4%) had completed the follow-up questionnaire. A greater amount of exercise was positively correlated with all domains of the SF-36: 2.4-9.5 increase in 100-scale at baseline, but association between maximum intensity and SF-36 was observed in only women. It was also associated with a 20-50% higher utilization of over-the-counter drugs in the following year in both sexes, but the effects of maximum intensity on sick days had different directions for men (relative risk, 2.0-2.4) and women (relative risk, 0.3-0.5). CONCLUSION: The amount of physical activity had positive effects on HRQOL for both men and women, but women had more preferable effects of maximum intensity on HRQOL and resource utilization than men.

Adult↗

PubMed2006

Families' and physicians' predictions of dialysis patients' preferences regarding life-sustaining treatments in Japan.

BACKGROUND: Substituted judgment traditionally has been used often for patient care in Japan regardless of the patient's competency. It has been believed that patient preferences are understood intuitively by family and caregivers. However, there are no data to support this assumption. METHODS: A questionnaire survey was administered to 450 dialysis patients in 15 hospitals to determine their preferences for cardiopulmonary resuscitation (CPR) and dialysis therapy under various circumstances. Simultaneously, we asked family members and physicians of these patients about patient preferences to evaluate their ability to predict what their patients would want. The accuracy of families' and physicians' judgments was assessed by means of kappa coefficient. RESULTS: Three hundred ninety-eight pairs, consisting of a patient, 1 of his or her family members, and the physician in charge, participated from 15 hospitals in Japan, with a response rate of 88%. Sixty-eight percent of family members correctly predicted patients' current preferences for CPR, 67% predicted patients' preferences for dialysis when they were severely demented, and 69% predicted patients' preferences for dialysis when they had terminal cancer. Corresponding figures for physicians were 60%, 68%, and 66%. When using kappa coefficient analysis, those results indicated that neither family members nor physicians more accurately predicted their patients' wishes about life-sustaining treatments than expected by chance alone. (All kappa coefficients <0.4.) CONCLUSION: Our study suggests that patients who want to spend their end-of-life period as they want should leave better advance directives.

Adult↗

PubMed2006

Falls in blood pressure in patients with obstructive sleep apnoea after long-term nasal continuous positive airway pressure treatment.

OBJECTIVES: Effective treatment of obstructive sleep apnoea (OSA) with nasal continuous positive airway pressure (nCPAP) lowers blood pressure (BP). The long-term effects of nCPAP treatment on BP in OSA patients are not well known. The time period of such treatment sufficient to lower BP in OSA patients is also not known. We investigated compliance with long-term nCPAP therapy and its effects on BP. METHODS: This observational study involved 66 OSA patients [59 men, seven women; mean age, 51 (48-54) years; body mass index (BMI), 28.7 (27.7-29.7) kg/m; apnoea and hypopnoea, 50.3 (45.6-55.0)/h; 95% confidence intervals]. BP and BMI were measured before the study and at two checkpoints after usage of nCPAP [620 (552-688) and 1071 (1000-1143) days]. RESULTS: The different times between the first and second checkpoints for detecting objective compliance were 17 (4-30) min (P = 0.003). Diastolic BP decreased by 5.9 (3.1-8.7) mmHg after 600 days nCPAP treatment and by 4.6 (2.0-7.2) mmHg after 1000 days (P = 0.0006). Systolic BP and BMI did not change significantly. Usage of nCPAP treatment for a daily average of 3 h was needed to achieve a significant decrease in diastolic BP [7.4 (4.3-10.6) mmHg, P < 0.0001]. Diastolic BP of normotensive OSA patients did not change significantly by nCPAP treatment, but that of hypertensive OSA patients decreased significantly within 1 month-3 years of nCPAP treatment whether or not medication was used. CONCLUSIONS: In patients with severe OSA, the use of nCPAP for a daily average of 3 h would be sufficient to decrease the diastolic BP of hypertensive OSA patients.

Blood Pressure↗

PubMed2006

Prognostic factors for a composite end-point of renal outcomes in patients with chronic kidney disease.

We aimed to investigate prognostic factors for a composite end-point of end-stage renal disease (ESRD) and the progression of renal disease in Japanese patients with chronic renal disease. Using a composite end-point comprising a doubling of serum creatinine (sCr), an increase in sCr level to 6.0 mg/dL, or initiation of dialysis and renal transplantation caused by ESRD, we examined data obtained in a prospective cohort study. The present study consisted of 641 patients who were 20 years of age or older with chronic renal disease caused by diabetic nephropathy, glomerulonephritis, or nephrosclerosis, and who had baseline sCr levels of 5.0 mg/dL or less. The following criteria were examined as prognostic factors: sex; age; elapsed time from initial diagnosis; disease underlying the nephropathy (diabetic or non-diabetic); complications with hypertension, hyperlipidemia, or anemia; baseline sCr level; therapeutic regimen, including use of ACE inhibitors or Ca2+ -channel blockers; and diet. A log-rank test was used for univariate analysis, and Cox regression analysis was used for multivariate analysis. Underlying disease (diabetic or non-diabetic), baseline sCr level, and Ca2+ -channel blocker therapy were significantly related to event incidence. In the present study, we identified underlying disease and baseline sCr level as important prognostic factors for a composite end-point in a predialysis patient population in both the early and middle stages of renal disease. These factors should be considered as balancing variables for randomization in future clinical studies.

Aged↗

PubMed2006

Linguistic adaptation and validation of the General Oral Health Assessment Index (GOHAI) in an elderly Japanese population.

OBJECTIVES: This study sought to develop a Japanese version of the General Oral Health Assessment Index (GOHAI) and validate its use in an elderly Japanese population. METHODS: The GOHAI scale was translated in a standardized way consisting of forward translation, pilot study, and backward translation. Psychometric properties of the final version were assessed on 175 participants (mean age: 70.0 years, SD 6.4). RESULTS: The response rate was more than 98% for each item. The reliability in terms of a Cronbach's alpha value was 0.89. The mean GOHAI scores were significantly lower for participants with poor perceived oral health (P<0. 001) or poor perceived general health (P<0.01). Significant correlations were observed between the GOHAI scores and the general health or physical functioning scores of the Medical Outcome Study Short Form 36 (P<0.01). CONCLUSIONS: The present study showed that the Japanese version of the GOHAI was psychometrically valid in an elderly sample population.

Aged↗

PubMed2006

Associations between exposure to ambient photochemical oxidants and the vitality or mental health domain of the health related quality of life.

BACKGROUND: Ambient air pollution may affect the health related quality of life (HRQOL) of people, as assessed by the vitality (VT) and mental health (MH) domains of the SF-36 health survey (SF-36). METHODS: In a nationwide survey, 4500 people aged 20 years and older were selected from the entire population of Japan by stratified random sampling in October 2002. A total of 2896 subjects filled out the self administered questionnaire that included the SF-36 and demographic characteristics. Data were linked from the questionnaires with the data on air pollutants in the cities where the subjects resided. The paper examined the relations between the mean concentration of each air pollutant and the VT or MH score on the SF-36 using analysis of covariance. RESULTS: On crude analysis, the respondents who were exposed to a higher mean two month concentration of photochemical oxidants (Ox) showed a significant linear trend toward lower VT score (p = 0.028). This association remained even after adjustment for subjective demographic characteristics and meteorological variables (p = 0.033). There was a common tendency that subjects who were exposed to higher concentrations of Ox had a lower mean VT or MH score; however, there was a significant association only between Ox concentration and VT score. CONCLUSION: The score on the VT domain of the SF-36 was associated with the mean concentration of Ox during the previous two month period. Assessing the health effects of air pollution by measuring the HRQOL, such as by using the SF-36, may provide a new method of formulating air pollution policies.

Adult↗

PubMed2006

[Clinical effects of photodynamic therapy with Verteporfin for age-related macular degeneration 1: three-month results].

PURPOSE: To evaluate the 3-month effects after one-time photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). SUBJECTS AND METHODS: The subjects were 122 patients with subfoveal CNV due to AMD detected by fluorescein angiography (FA). FA, indocyanine-green angiography (IA), and the examination of visual acuity were done before and 3 months after PDT. The diameter of CNV in FA was compared, and ophthalmological examination before the treatment determined whether there were any factors associated with a reduction or suppression of CNV. RESULTS: 3 months after PDT, 89 eyes had a significant (p < 0.001) reduction of CNV (41 eyes had blockage of CNV). In case of polypoidal choroidal vasculopathy (PCV) detected by IA, CNV was significantly reduced compared with the effects of other types of therapy (p = 0.032). Moreover, CNV was blocked significantly when fibrin tissue was present on a part of CNV before treatment (p = 0.026). Visual acuity was maintained or improved in 96 eyes. CONCLUSION: One-time PDT was effective in reducing or suppressing CNV as confirmed by FA.

Aged↗

PubMed2006

[Assessment of the quality of life of patients with age-related macular degeneration after photodynamic therapy].

OBJECTIVE: To quantify quality of life (QOL) changes in patients who have received a single session of photodynamic therapy (PDT) for subfoveal choroidal neovascularization, secondary to age-related macular degeneration (AMD), and to identify factors that correlate with the QOL changes. METHODS: The QOL changes in 88 patients with AMD were scored with the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) before and 3 months after a single PDT with routine ophthalmologic examinations. We used multiple regression analysis to evaluate VFQ-25 sub-scale scores and ophthalmologic findings in these patients before PDT, to identify impact on the effectiveness of PDT. We also evaluated changes in ophthalmologic findings influencing the QOL score. RESULTS: The sub-scale scores for both 'mental health' (p = 0.02) and 'role limitation' (p = 0.03) improved significantly in all 88 cases, but only 'mental health' improved significantly in 34 cases in which PDT was effective. Multiple regression analysis in all 88 cases revealed that the factors contributing significantly to improvement in 'mental health' were a lower pre-PDT 'mental health' score (p < 0.01) and the presence of fibrous tissue (p = 0.01) before the PDT session. The lower the role limitation before PDT (p < 0.01), the more significant was the improvement in this score. CONCLUSION: Although no baseline sub-scale score was identified as predicting the effectiveness of a single PDT session, the scores for both 'mental health' and 'role limitation' improved.

Aged↗

PubMed2005

Psychometric properties of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), Japanese version.

BACKGROUND: The importance of evaluating the outcomes of health care from the standpoint of the patient is now widely recognized. The purpose of this study is to develop and test a Japanese version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). METHODS: A Japanese version was developed with a previously standardized method. The questionnaire and optional items were completed by 245 patients with cataracts, glaucoma, or age-related macular degeneration, by 110 others before and after cataract surgery, and by a reference group (n = 31). We computed rates of missing data, measured reproducibility and internal consistency reliability, and tested for convergent and discriminant validity, concurrent validity, known-groups validity, factor structure, and responsiveness to change. RESULTS: Based on information from the participants, some items were changed to 2-step items (asking if an activity was done, and if it was done, then asking how difficult it was). The near-vision and distance-vision subscales each had 1 item that was endorsed by very few participants, so these items were replaced with items that were optional in the English version. For example, more than 60% of participants did not drive, so the driving question was excluded. Reliability and validity were adequate for all subscales except driving, ocular pain, color vision, and peripheral vision. With cataract surgery, most scores improved by at least 20 points. CONCLUSION: With minor modifications from the English version, the Japanese NEI VFQ-25 can give reliable, valid, responsive data on vision-related quality of life, for group-level comparisons or for tracking therapeutic outcomes.

Adult↗

PubMed2005

Usefulness of five-item and three-item Mental Health Inventories to screen for depressive symptoms in the general population of Japan.

BACKGROUND: The five-question Mental Health Inventory (MHI-5) is a brief questionnaire that can be used to screen for depressive symptoms. Removing the 2 anxiety-related items from the MHI-5 yields the MHI-3. We assessed the performance of the Japanese versions of the MHI-5 and MHI-3 in detecting depressive symptoms in the general population of Japan. METHODS: From the population of Japan, 4500 people 16 years old or older were selected by stratified-random sampling. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36, which includes the MHI-5) and the Zung Self-rating Depression Scale (ZSDS) were included in a self-administered questionnaire. ZSDS scores of 48 and above were taken to indicate the presence of moderate or severe depressive symptoms, and scores of 56 and above were taken to indicate the presence of severe depressive symptoms. We computed the correlation coefficient between the ZSDS score and the scores on the MHI-5 and MHI-3. We also computed the sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. RESULTS: Of the 3107 subjects (69% of the 4500 initially selected), 14.0% had moderate or severe depressive symptoms, and 2.0% had severe depressive symptoms as measured with the ZSDS. The correlations of ZSDS scores with MHI-5 scores and with MHI-3 scores were similar: -0.63 and -0.61, respectively. These correlation coefficients were almost the same whether or not the data were stratified by age and sex. For detecting severe depressive symptoms with the MHI-5, the area under the ROC curve was 0.942 (95%CI: 0.919 - 0.965); for the MHI-3, it was 0.933 (95%CI: 0.904 - 0.962). CONCLUSION: The MHI-5 and MHI-3 scores were correlated with the ZSDS score, and can be used to identify people with depressive symptoms in the general population of Japan.

Adult↗