Social capital and self-rated oral health among young people

Furuta M, Ekuni D, Takao S, Suzuki E, Morita M, Kawachi I. Social capital and self‐rated oral health among young people. Community Dent Oral Epidemiol 2012; 40: 97–104. © 2011 John Wiley & Sons A/S Abstract – Objectives: A few studies have revealed the impact of neighborhood social capital on oral health among young people. We sought to examine the associations of social capital in three settings (families, neighborhoods, and schools) with self‐rated oral health among a sample of college students in Japan. Methods: Cross‐sectional survey of 967 students in Okayama University, aged 18 and 19 years, was carried out. Logistic regression was used to examine the associations of poor self‐rated oral health with perceptions of social capital, adjusting for self‐perceived household income category and oral health behaviors. Results: The prevalence of subjects with poor self‐rated oral health was 22%. Adjusted for gender, self‐perceived household income category, dental fear, toothbrush frequency, and dental floss use, poor self‐rated oral health was significantly associated with lower level of neighborhood trust [odds ratio (OR) 2.22; 95% confidence interval (CI): 1.40–3.54] and lower level of vertical trust in school (OR 1.71; 95% CI: 1.05–2.80). Low informal social control was unexpectedly associated with better oral health (OR 0.54; 95% CI: 0.34–0.85). Conclusions: The association of social capital with self‐rated oral health is not uniform. Higher trust is associated with better oral health, whereas higher informal control in the community is associated with worse oral health.     

Melatonin and hormonal changes in disturbed sleep during late pregnancy

Abstract: Although sleep disturbance is commonly reported in pregnancy, there have been surprisingly few studies on the etiology of this condition. Since most hormones show circadian rhythmicity and maintain specific phase relationships with that of the sleep-wake cycle, it was of interest to establish whether sleep disturbances covaried with endocrine changes. This overnight study of pregnant women compared melatonin, cortisol, and prolactin secretion rhythms in six good sleepers and six poor sleepers. The groups were compared by ratios of the areas under the various hormonal curves. Significant differences in the cortisol/melatonin ratio were found between the poor sleeper group (lower values) and the good sleeper group (higher values). Nonsignificant trends, which might be expected to become significant with larger sample sizes, were found for decreased amplitude in the cortisol rhythm and increased amplitude in the melatonin rhythm in poor sleepers. The decreased amplitude of the cortisol rhythm in poor sleepers appeared to be due to a suppression of the early morning (0500–0800) rise. Prolactin levels were high and showed no rhythmicity in both groups. These differences may reflect changes in the circadian pacemaker system of poor sleepers, with increases in melatonin release being a response to counteract poor sleep.     

Hybrid Assistive Limb (HAL) Rehabilitation in Patients with Acute Hemorrhagic Stroke

The efficacy of hybrid assistive limb (HAL) rehabilitation in the acute phase of stroke remains unclear. The purpose of this study was to evaluate the outcomes of patients with acute intracranial hemorrhage (ICH) who were treated with or without HAL rehabilitation. Among 270 patients with acute ICH from 2009 to 2014, 91 patients with supratentorial ICH were included in this retrospective study. Of these, 14 patients (HAL group) received HAL rehabilitation at approximately 1 week after ICH occurrence, while the remaining 77 patients received usual rehabilitation without HAL (N-HAL group). We obtained various patient data from the hospitals where the patients were moved to for further rehabilitation. Statistical comparisons were performed for the characteristics of the ICH patients, and outcomes between the HAL and N-HAL groups. There were no differences in outcomes between the HAL and N-HAL groups. However, patients with right ICH in the HAL group exhibited a significant association with a functional independence measure (FIM) score of ≥ 110 compared with patients in the N-HAL group (HAL group: 81.8%, N-HAL group: 43.9%, P = 0.04). In patients with right ICH, HAL rehabilitation was associated with improved outcomes as evaluated by the FIM score. Thus, HAL rehabilitation may improve outcomes of acute ICH in appropriately selected patients.     

Evaluation of an internet-based self-help program for better quality of sleep among Japanese workers: a randomized controlled trial

The effectiveness of Internet-based self-help programs for insomnia is still unclear. A randomized controlled trial was conducted to evaluate the effect of an Internet-based self-help program for better quality of sleep among adult workers. Forty-three volunteers were recruited and randomly assigned to either an intervention group (n=21) or a waiting-list group (n=22). The intervention group participated in a two-week Internet-based program, including selecting and daily practicing sleep-related target behaviors and monitoring those behaviors along with sleep quality. At the same time, each participant received automatically generated, personalized messages and reports both daily and weekly. A total of 12 intervention group participants and 18 waiting-list group participants completed questionnaires at baseline, post-intervention, and at a 3-wk follow-up. Subjective sleep quality was measured by a self-reported questionnaire developed for this study. The sleep quality score increased in the intervention group at post-intervention, with a significant interaction effect [F(1,28)=5.19, p=0.031]. Sleep-related behaviors also greatly increased in the intervention group at post-intervention, with a significant interaction effect [F(1,28)=7.14, p=0.012]. Sleep-onset latency reduced in the intervention group at follow-up, with a marginally significant effect [F(1,28)=3.52, p=0.071]. The Internet-based self-help program improves subjective sleep quality and sleep-onset latency among adult workers.     

Declining Accuracy in Disease Classification on Health Insurance Claims: Should We Reconsider Classification by Principal Diagnosis?

Background

An ideal classification should have maximum intercategory variance and minimal intracategory variance. Health insurance claims typically include multiple diagnoses and are classified into different disease categories by choosing principal diagnoses. The accuracy of classification based on principal diagnoses was evaluated by comparing intercategory and intracategory variance of per-claim costs and the trend in accuracy was reviewed.

Methods

Means and standard deviations of log-transformed per-claim costs were estimated from outpatient claims data from the National Health Insurance Medical Benefit Surveys of 1995 to 2007, a period during which only the ICD10 classification was applied. Intercategory and intracategory variances were calculated for each of 38 mutually exclusive disease categories and the percentage of intercategory variance to overall variance was calculated to assess the trend in accuracy of classification.

Results

A declining trend in the percentage of intercategory variance was observed: from 19.5% in 1995 to 10% in 2007. This suggests that there was a decline in the accuracy of disease classification in discriminating per-claim costs for different disease categories. The declining trend temporarily reversed in 2002, when hospitals and clinics were directed to assign the principal diagnosis. However, this reversal was only temporary and the declining trend appears to be consistent.

Conclusions

Classification of health insurance claims based on principal diagnoses is becoming progressively less accurate in discriminating per-claim costs. Researchers who estimate disease-specific health care costs using health insurance claims must therefore proceed with caution.Key words: health insurance claims, ICD10, intracategory variance, intercategory variance, log-normal distribution     

Brain serotonin transporter density and aggression in abstinent methamphetamine abusers

CONTEXT: In animals, methamphetamine is known to have a neurotoxic effect on serotonin neurons, which have been implicated in the regulation of mood, anxiety, and aggression. It remains unknown whether methamphetamine damages serotonin neurons in humans. OBJECTIVE: To investigate the status of brain serotonin neurons and their possible relationship with clinical characteristics in currently abstinent methamphetamine abusers. DESIGN: Case-control analysis. SETTING: A hospital research center. PARTICIPANTS: Twelve currently abstinent former methamphetamine abusers (5 women and 7 men) and 12 age-, sex-, and education-matched control subjects recruited from the community. INTERVENTIONS: The brain regional density of the serotonin transporter, a structural component of serotonin neurons, was estimated using positron emission tomography and trans-1,2,3,5,6,10-beta-hexahydro-6-[4-(methylthio)phenyl]pyrrolo-[2,1-a]isoquinoline ([(11)C](+)McN-5652). Estimates were derived from region-of-interest and statistical parametric mapping methods, followed by within-case analysis using the measures of clinical variables. MAIN OUTCOME MEASURES: The duration of methamphetamine use, the magnitude of aggression and depressive symptoms, and changes in serotonin transporter density represented by the [(11)C](+)McN-5652 distribution volume. RESULTS: Methamphetamine abusers showed increased levels of aggression compared with controls. Region-of-interest and statistical parametric mapping analyses revealed that the serotonin transporter density in global brain regions (eg, the midbrain, thalamus, caudate, putamen, cerebral cortex, and cerebellum) was significantly lower in methamphetamine abusers than in control subjects, and this reduction was significantly inversely correlated with the duration of methamphetamine use. Furthermore, statistical parametric mapping analyses indicated that the density in the orbitofrontal, temporal, and anterior cingulate areas was closely associated with the magnitude of aggression in methamphetamine abusers. CONCLUSIONS: Protracted abuse of methamphetamine may reduce the density of the serotonin transporter in the brain, leading to elevated aggression, even in currently abstinent abusers.     

Analysis of synovial fluid components of hydrarthrosis in long-term hemodialysis patients

The synovial fluid components in long-term hemodialysis patients (HD; 43 knees in 43 patients) were investigated and compared with those in patients with osteoarthritis (OA; 21 knees in 21 patients) and rheumatoid arthritis (RA; 26 knees in 26 patients). The average ages in the three groups were, respectively, 60.7 years (range, 34–79 years), 63.2 years (range, 48–88 years), and 59.7 years (range, 37–76 years). The duration of hemodialysis in the HD group averaged 14.0 years (range, 4–24 years). The concentrations of hyaluronic acid, protein, and isomers of chondroitin sulfate (chondroitin 6-sulfate [C6S] and chondroitin 4-sulfate [C4S]) in the synovial fluid, and its viscosity were measured. Differences in each of the parameters were investigated according to disease clinical stage, roentgenological grade, and periods of dialysis in the HD group. The viscosity of the synovial fluid and the concentration of hyaluronic acid in HD patients were similar to those in OA patients; however, the C6S/C4S ratio in the synovial fluid of HD patients was similar to that in RA patients. The latter finding suggests that synovitis may be present in the hydrarthrosis of HD patients. The cause of this synovitis in HD patients remains to be elucidated. Received for publication Feb. 19, 1998; accepted on July 29, 1998