Updated on 2023/01/27

写真a

 
SUZUKI Etsuji
 
Organization
Faculty of Medicine, Dentistry and Pharmaceutical Sciences Assistant Professor
Position
Assistant Professor
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Degree

  • Ph.D. (Medicine) ( 2009.3   Okayama University )

Research Interests

  • environmental epidemiology

  • occupational health

  • causal inference

  • social epidemiology

  • epidemiologic methods

Research Areas

  • Life Science / Hygiene and public health (non-laboratory)

  • Life Science / Medical management and medical sociology

  • Informatics / Statistical science

Professional Memberships

  • Japan Epidemiological Association

    2015

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  • Japanese Society of Public Health

    2013

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  • Japan Society for Occupational Health

    2005

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  • Society for Epidemiologic Research

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Committee Memberships

  • SSM - Population Health   Editorial Board  

    2022.10   

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  • Journal of Epidemiology   Associate Editor  

    2021.1   

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  • Sangyo Eiseigaku Zasshi   Associate Editor  

    2020.3   

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  • Journal of Occupational Health   Associate Editor  

    2020.3   

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  • Environmental and Occupational Health Practice   Associate Editor  

    2020.3   

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  • Japanese Society of Public Health   Japanese Journal of Public Health, Review Committee  

    2015.4 - 2018.3   

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Papers

  • Erratum: Marginal Sufficient Component Cause Model: An Emerging Causal Model With Merits? International journal

    Etsuji Suzuki, Eiji Yamamoto

    Epidemiology   34 ( 1 )   e2 - e2   2023.1

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    Authorship:Lead author, Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Ovid Technologies (Wolters Kluwer Health)  

    DOI: 10.1097/ede.0000000000001558

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  • Diarrhea and related personal characteristics among Japanese university students studying abroad in intermediate- and low-risk countries Reviewed International journal

    Yamakawa M, Tsuda T, Wada K, Nagata C, Suzuki E

    PLoS One   2022.12

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  • Do complementary and alternative medicine users also use conventional medicine? A repeated cross-sectional study in Japan from 1995 to 2013 Reviewed International journal

    Nobuyoshi Matsuki, Etsuji Suzuki, Toshiharu Mitsuhashi, Soshi Takao, Takashi Yorifuji

    Journal of Integrative and Complementary Medicine   2022.11

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Mary Ann Liebert Inc  

    Introduction: It is recommended that users of complementary and alternative medicine (CAM) also seek conventional medical care to prevent the loss of access to appropriate medical care. However, the status of such use is unknown. The aim of this study was to examine the time trends in the proportion of CAM users who also receive conventional medical care for the same symptoms. Methods: This is a repeated cross-sectional study. Of data for 753,978 respondents to the Comprehensive Survey of Living Conditions, which was conducted seven times between 1995 and 2013, data from 17,707 individuals who used acupuncture, moxibustion, anma-massage-shiatsu, or judo therapy were analyzed. Cross-classified multilevel logistic regression models with individuals as level 1 and survey year and cohort as level 2 were used to calculate odds ratios (ORs) and 95% credible intervals (CIs) for combined use of CAM and conventional medical care. Age was entered as an individual-level variable. The period effect after 2003 was entered as a survey year-level variable because the number of eligible persons providing CAM treatments has increased since 2003. Results: Among the 17,707 CAM users, 11,567 (65.3%) were women. When age was entered as an explanatory variable, the results showed that both older men and women tended to receive conventional medical care (women, OR: 1.04, 95% CI: 1.03-1.04; men, OR: 1.03, 95% CI: 1.02-1.04). Additional examination of the possible period effect after 2003 showed a positive (although nonsignificant) association (women, OR: 1.36, 95% CI: 0.89-1.99; men, OR: 1.37, 95% CI: 0.94-1.91). Conclusions: As patient age increased, patients combined CAM use with conventional medicine. The findings also suggested that the combined use of CAM and conventional medicine has increased since 2003.

    DOI: 10.1089/jicm.2022.0631

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    Other Link: https://www.liebertpub.com/doi/pdf/10.1089/jicm.2022.0631

  • Breastfeeding at 6 months of age had a positive impact on overweight and obesity in Japanese adolescents at 15 years of age Reviewed International journal

    Tomoka Kadowaki, Naomi Matsumoto, Etsuji Suzuki, Toshiharu Mitsuhashi, Soshi Takao, Takashi Yorifuji

    Acta Paediatrica   112 ( 1 )   106 - 114   2022.9

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Wiley  

    AIM: A number of studies have indicated the potential benefits that breastfeeding has on reducing childhood obesity, but few studies have evaluated the effect on adolescent obesity. We examined the association between breastfeeding and overweight or obesity at 15 years of age using data from a large nationwide longitudinal study launched by the Japanese Government in 2001. METHODS: We analysed data for 26 164 participants with known infant feeding practices at 6 months of age, namely the duration of breastfeeding or formula feeding. Overweight or obesity at 15 years of age were calculated based on the subject's self-reported height and weight. Multinomial logistic regression analysis adjusted the data for child factors, namely sex, siblings, birth weight and physical activity clubs and the maternal factors of age, educational attainment and smoking status. RESULTS: Formula feeding was associated with an increased risk of overweight or obesity at 15 years of age. The adjusted odds ratios (95% confidence intervals) were 0.99 (0.89-1.09) for partial breastfeeding and 1.23 (1.02-1.48) for formula feeding, when exclusive breastfeeding was the reference category. CONCLUSION: Breastfeeding during infancy had potential benefits for overweight or obesity among 15-year-old adolescents. Our results provide further evidence of the importance of breastfeeding.

    DOI: 10.1111/apa.16551

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    Other Link: https://onlinelibrary.wiley.com/doi/full-xml/10.1111/apa.16551

  • A general explanation of the counterfactual definition of confounding Reviewed International journal

    Etsuji Suzuki, Michio Yamamoto, Eiji Yamamoto

    Journal of Clinical Epidemiology   148   189 - 192   2022.8

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    Authorship:Lead author, Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Elsevier BV  

    DOI: 10.1016/j.jclinepi.2022.02.002

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  • Tumor size before image-guided brachytherapy is an important factor of local control after radiotherapy for cervical squamous cell carcinoma: analysis in cases using central shielding Reviewed International journal

    Kotaro Yoshio, Hiroki Ihara, Kazuhiro Okamoto, Etsuji Suzuki, Takeshi Ogata, Soichi Sugiyama, Keiichiro Nakamura, Shoji Nagao, Hisashi Masuyama, Takao Hiraki

    Journal of Radiation Research   63 ( 5 )   772 - 779   2022.7

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Oxford University Press (OUP)  

    Abstract

    We analyzed the local control (LC) of cervical squamous cell carcinoma treated by computed tomography (CT)-based image-guided brachytherapy (IGBT) using central shielding (CS). We also examined the value of tumor diameter before brachytherapy (BT) as a factor of LC. In total, 97 patients were analyzed between April 2016 and March 2020. Whole-pelvic (WP) radiotherapy (RT) with CS was performed, and the total pelvic sidewall dose was 50 or 50.4 Gy; IGBT was delivered in 3–4 fractions. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions, and distribution was modified manually by graphical optimization. The median follow-up period was 31.8 months (6.3–63.2 months). The 1- and 2-year LC rates were 89% and 87%, respectively. The hazard ratio was 10.11 (95% confidence interval: 1.48–68.99) for local recurrence in those with a horizontal tumor diameter ≥ 4 cm compared to those with < 4 cm before BT. In CT-based IGBT for squamous cell carcinoma, favorable LC can be obtained in patients with a tumor diameter < 4 cm before BT. However, if the tumor diameter is ≥ 4 cm, different treatment strategies such as employing interstitial-BT for dose escalation may be necessary.

    DOI: 10.1093/jrr/rrac040

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  • Three doses of mRNA COVID‐19 vaccine protects from SARS‐CoV‐2 infections in Japan Reviewed International journal

    Katsuyuki Hotta, Etsuji Suzuki, Eiki Ichihara, Katsuyuki Kiura

    Journal of Internal Medicine   292 ( 4 )   687 - 689   2022.6

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Wiley  

    DOI: 10.1111/joim.13526

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    Other Link: https://onlinelibrary.wiley.com/doi/full-xml/10.1111/joim.13526

  • The primary importance of the research question: implications for understanding natural versus controlled direct effects Reviewed International coauthorship International journal

    Ian Shrier, Etsuji Suzuki

    International Journal of Epidemiology   51 ( 4 )   1041 - 1046   2022.5

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    Authorship:Last author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Oxford University Press (OUP)  

    DOI: 10.1093/ije/dyac090

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  • Incidence and clinical characteristics of spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan Reviewed International journal

    Masafumi Hiramatsu, Ryota Ishibashi, Etsuji Suzuki, Yuko Miyazaki, Satoshi Murai, Hiroki Takai, Yuji Takasugi, Yoko Yamaoka, Kazuhiko Nishi, Yu Takahashi, Jun Haruma, Tomohito Hishikawa, Takao Yasuhara, Masaki Chin, Shunji Matsubara, Masaaki Uno, Koji Tokunaga, Kenji Sugiu, Isao Date

    Journal of Neurosurgery: Spine   36 ( 4 )   670 - 677   2022.4

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Journal of Neurosurgery Publishing Group (JNSPG)  

    OBJECTIVE

    There have been no accurate surveillance data regarding the incidence rate of spinal arteriovenous shunts (SAVSs). Here, the authors investigate the epidemiology and clinical characteristics of SAVSs.

    METHODS

    The authors conducted multicenter hospital-based surveillance as an inventory survey at 8 core hospitals in Okayama Prefecture between April 1, 2009, and March 31, 2019. Consecutive patients who lived in Okayama and were diagnosed with SAVSs on angiographic studies were enrolled. The clinical characteristics and the incidence rates of each form of SAVS and the differences between SAVSs at different spinal levels were analyzed.

    RESULTS

    The authors identified a total of 45 patients with SAVSs, including 2 cases of spinal arteriovenous malformation, 5 cases of perimedullary arteriovenous fistula (AVF), 31 cases of spinal dural AVF (SDAVF), and 7 cases of spinal epidural AVF (SEAVF). The crude incidence rate was 0.234 per 100,000 person-years for all SAVSs including those at the craniocervical junction (CCJ) level. The incidence rate of SDAVF and SEAVF combined increased with advancing age in men only. In a comparative analysis between upper and lower spinal SDAVF/SEAVF, hemorrhage occurred in 7/14 cases (50%) at the CCJ/cervical level and in 0/24 cases (0%) at the thoracolumbar level (p = 0.0003). Venous congestion appeared in 1/14 cases (7%) at the CCJ/cervical level and in 23/24 cases (96%) at the thoracolumbar level (p < 0.0001).

    CONCLUSIONS

    The authors reported detailed incidence rates of SAVSs in Japan. There were some differences in clinical characteristics of SAVSs in the upper spinal levels and those in the lower spinal levels.

    DOI: 10.3171/2021.7.spine21233

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    Other Link: https://thejns.org/downloadpdf/journals/j-neurosurg-spine/36/4/article-p670.xml

  • Exchangeability of measures of association before and after exposure status is flipped: its relationship with confounding in the counterfactual model Reviewed International journal

    Etsuji Suzuki, Michio Yamamoto, Eiji Yamamoto

    Journal of Epidemiology   2022.1

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    Authorship:Lead author, Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Japan Epidemiological Association  

    BACKGROUND: The counterfactual definition of confounding is often explained in the context of exchangeability between the exposed and unexposed groups. One recent approach is to examine whether the measures of association (e.g., associational risk difference) are exchangeable when exposure status is flipped in the population of interest. We discuss the meaning and utility of this approach, showing their relationships with the concept of confounding in the counterfactual framework. METHODS: Three hypothetical cohort studies are used, in which the target population is the total population. After providing an overview of the notions of confounding in distribution and in measure, we discuss the approach from the perspective of exchangeability of measures of association (e.g., factual associational risk difference vs. counterfactual associational risk difference). RESULTS: In general, if the measures of association are non-exchangeable when exposure status is flipped, confounding in distribution is always present, although confounding in measure may or may not be present. Even if the measures of association are exchangeable when exposure status is flipped, there could be confounding both in distribution and in measure. When we use risk difference or risk ratio as a measure of interest and the exposure prevalence in the population is 0.5, testing the exchangeability of measures of association is equivalent to testing the absence of confounding in the corresponding measures. CONCLUSIONS: The approach based on exchangeability of measures of association essentially does not provide a definition of confounding in the counterfactual framework. Subtly differing notions of confounding should be distinguished carefully.

    DOI: 10.2188/jea.JE20210352

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  • Marginal sufficient component cause model: an emerging causal model with merits? Reviewed International journal

    Etsuji Suzuki, Eiji Yamamoto

    Epidemiology   32 ( 6 )   838 - 845   2021.11

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    Authorship:Lead author, Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:LIPPINCOTT WILLIAMS & WILKINS  

    For decades, the sufficient cause model and the counterfactual model have shaped our understanding of causation in biomedical science, and the link between these two models has enabled us to obtain a deeper understanding of causality. Recently, a new causal model-the marginal sufficient component cause model-was proposed and applied in the context of interaction or mediation. The proponents of this model have emphasized its utility in visualizing the presence of "agonism" (a subtype of mechanistic interaction) in the counterfactual framework, claiming that the concept of agonism has not been clearly defined in causal inference and that agonistic interaction cannot be visualized by the conventional sufficient cause model. In this article, we illustrate that careful scrutiny based on the conventional sufficient cause model yields further insights into the concept of agonism in a more biologic sense. We primarily focus on the following three points: (1) "agonism" defined in the counterfactual model can be visualized as sets of sufficient causes in the conventional sufficient cause model; (2) although the so-called independent competing assumption or no redundancy assumption may seem irrelevant in the marginal sufficient component cause model, researchers do need to assume that potential completion times of relevant marginal sufficient causes differ; and (3) possibly differing potential completion times of marginal sufficient causes cannot be discerned until their hidden mechanistic paths are considered in the conventional sufficient cause model. In this rapidly progressing field of research, decades after its introduction, the sufficient cause model retains its worth.

    DOI: 10.1097/EDE.0000000000001411

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  • Is a sense of community belonging associated with problem gambling in Canada? Reviewed International journal

    Masato Izutsu, Etsuji Suzuki

    Social Psychiatry and Psychiatric Epidemiology   56 ( 10 )   1871 - 1880   2021.10

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    Authorship:Last author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Springer Science and Business Media LLC  

    Purpose Despite the increasing demand for public health measures to prevent problem gambling, few studies have examined the association between community characteristics and problem gambling. The aim of this nationally representative cross-sectional study was to investigate the relationship between a sense of community belonging and problem gambling in Canada. We also examined whether this relationship was modified by sex and marital status. Methods Canadian Community Health Survey (2013-2014) data from 38,968 residents of Quebec, Saskatchewan, Manitoba, and British Columbia were analyzed. Problem gambling was assessed using the Canadian Problem Gambling Index. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for problem gambling. Results The prevalence of problem gambling was 1.4% (1.9% among males; 0.9% among females). We observed an inverse dose-response relationship between a sense of community belonging and problem gambling. Compared with those with a very strong sense of community belonging, the adjusted ORs for problem gambling were 1.07 (95% CI 0.65-1.76) for a somewhat strong sense, 1.27 (95% CI 0.77-2.11) for a somewhat weak sense, and 2.32 (95% CI 1.34-4.02) for a very weak sense of community belonging. The association was more prominent among females (except for those widowed/divorced/separated), whereas no clear association was found among males, irrespective of marital status. Conclusion When implementing public health measures to reduce problem gambling, it would be useful to account for possible differential impacts of a sense of community belonging by sex and marital status, which may reflect significant social contexts among residents.

    DOI: 10.1007/s00127-021-02040-w

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    Other Link: https://link.springer.com/article/10.1007/s00127-021-02040-w/fulltext.html

  • Strength in causality: discerning causal mechanisms in the sufficient cause model Reviewed International journal

    Etsuji Suzuki, Eiji Yamamoto

    European Journal of Epidemiology   36 ( 9 )   899 - 908   2021.9

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    Authorship:Lead author, Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Springer Science and Business Media LLC  

    DOI: 10.1007/s10654-021-00798-6

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    Other Link: https://link.springer.com/article/10.1007/s10654-021-00798-6/fulltext.html

  • Body Mass Index and Ventilator Dependence in Critically Ill Subjects in Japan: A Cohort Study Using a Nationwide Database Reviewed International journal

    Jun Fujinaga, Etsuji Suzuki, Hiromasa Irie, Mutsuo Onodera

    Respiratory Care   66 ( 9 )   1433 - 1439   2021.9

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Daedalus Enterprises  

    BACKGROUND: Body mass index (BMI) can be an important indicator for health outcomes among critically ill patients. However, the association between BMI and ventilator dependence at ICU discharge among these patients remains unknown. We aimed to evaluate the association between BMI at ICU admission and ventilator dependence at the time of ICU discharge. As secondary outcomes, we used ICU mortality, hospital mortality, and implementation of tracheostomy during ICU stay. METHODS: This is a retrospective cohort study. The data were derived from The Japanese Intensive Care Patient Database, a nationwide ICU database in Japan. We included all patients in the registry who were >= 16 y old, received mechanical ventilation, and were admitted to an ICU between April 2018 and March 2019. On the basis of their BMI at ICU admission, subjects were classified as underweight (< 18.5 kg/m(2)); normal weight (6 18.5 kg/m(2) to < 23 kg/m(2)); overweight (6 23 kg/m(2) to < 27.5 kg/m(2)); or obese (6 27.5 kg/m(2)). RESULTS: Among 11,801 analyzed subjects, 388 (3.3%) subjects were ventilator-dependent at ICU discharge. Compared with normal-weight subjects, the risk for ventilator dependence at ICU discharge increased among underweight subjects even after adjusting for potential confounders and inter-ICU variance in 2-level multivariable logistic regression analysis (odds ratio 1.46 [95% CI 1.18-1.79]). Although obesity was also associated with a higher risk of ventilator dependence, the association was less clear (odds ratio 1.10 [95% CI 0.99-1.22]). The risk of ICU mortality, hospital mortality, and implementation of tracheostomy also increased in underweight subjects. CONCLUSIONS: Critically ill underweight subjects had a higher risk of ventilator dependence at ICU discharge compared to normal-weight subjects, even after adjusting for potential confounders and inter-ICU variance. The association between BMI and ventilator dependence should be examined using information on subjects' nutritional status and frailty in further studies

    DOI: 10.4187/respcare.08660

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  • A Simple Prognostic Benefit Scoring System for Sarcoma Patients with Pulmonary Metastases: Sarcoma Lung Metastasis Score Reviewed International journal

    Haruchika Yamamoto, Hiromasa Yamamoto, Junichi Soh, Etsuji Suzuki, Kei Namba, Ken Suzawa, Kentaroh Miyoshi, Shinji Otani, Mikio Okazaki, Seiichiro Sugimoto, Masaomi Yamane, Takashi Yorifuji, Katsuhito Takahashi, Shinichi Toyooka

    Annals of Surgical Oncology   28 ( 7 )   3884 - 3890   2021.7

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    BACKGROUND: Pulmonary metastasectomy could be considered one of the treatment options for disease control in sarcoma patients with pulmonary metastases; however, there is little consensus regarding the suitable criteria for predicting the likely outcomes in these patients. The aim of this study was to establish a prognostic benefit scoring system based on preoperatively examined prognostic factors for sarcoma patients with pulmonary metastases. METHODS: This was a single-center, retrospective cohort study conducted in a cohort of 135 sarcoma patients who underwent a first pulmonary metastasectomy at Okayama University Hospital between January 2006 and December 2015. Based on the results of a multivariable logistic regression analysis performed to determine the factors influencing 3-year mortality, a Sarcoma Lung Metastasis Score was created and its correlation with 3-year survival was analyzed. RESULTS: The results of the multivariate analysis revealed significant differences in the disease-free interval (< 2 years vs. ≥ 2 years; odds ratio (OR) 4.22, 95% confidence interval (CI) 1.67-10.70), maximum tumor diameter (≥ 15 mm vs. < 15 mm; OR 3.86, 95% CI 1.75-8.52), and number of pulmonary metastases (≥ 6 vs. < 6; OR 2.65, 95% CI 1.06-6.620). The Sarcoma Lung Metastasis Score, which was defined as the total score of these three factors, reliably predicted 3-year survival (score: 0, 89.5%; 1, 63.2%; 2, 39.0%; 3, 10.5%). CONCLUSIONS: Our newly proposed simple Sarcoma Lung Metastasis Score appears to be a useful prognostic predictor for sarcoma patients with pulmonary metastases, in that it could be helpful for the selection of appropriate treatments for these patients.

    DOI: 10.1245/s10434-020-09272-1

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    Other Link: http://link.springer.com/article/10.1245/s10434-020-09272-1/fulltext.html

  • Erratum: A Graphical Description of Partial Exchangeability International journal

    Etsuji Suzuki, Eiji Yamamoto

    Epidemiology   32 ( 4 )   e15 - e15   2021.7

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    Authorship:Lead author, Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Ovid Technologies (Wolters Kluwer Health)  

    DOI: 10.1097/ede.0000000000001360

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  • Artificial intelligence and epidemiology in data science : Prediction and causal inference Invited

    Takashi Yorifuji, Etsuji Suzuki

    Okayama Igakkai Zasshi (Journal of Okayama Medical Association)   133 ( 1 )   55 - 57   2021.4

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    Authorship:Last author   Language:Japanese   Publishing type:Research paper (scientific journal)   Publisher:Okayama Medical Association  

    DOI: 10.4044/joma.133.55

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  • Trends in Incidence of Intracranial and Spinal Arteriovenous Shunts: Hospital-Based Surveillance in Okayama, Japan. Reviewed International journal

    Satoshi Murai, Masafumi Hiramatsu, Etsuji Suzuki, Ryota Ishibashi, Hiroki Takai, Yuko Miyazaki, Yuji Takasugi, Yoko Yamaoka, Kazuhiko Nishi, Yu Takahashi, Jun Haruma, Tomohito Hishikawa, Takao Yasuhara, Masaki Chin, Shunji Matsubara, Masaaki Uno, Koji Tokunaga, Kenji Sugiu, Isao Date

    Stroke   52 ( 4 )   1455 - 1459   2021.4

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:LIPPINCOTT WILLIAMS & WILKINS  

    BACKGROUND AND PURPOSE: To date, the incidence of intracranial and spinal arteriovenous shunts has not been thoroughly investigated. We aimed to clarify recent trends in the rates of intracranial and spinal arteriovenous shunts in Japan. METHODS: We conducted multicenter hospital-based surveillance at 8 core hospitals in Okayama Prefecture between April 1, 2009 and March 31, 2019. Patients who lived in Okayama and were diagnosed with cerebral arteriovenous malformations, dural arteriovenous fistulas (DAVFs), or spinal arteriovenous shunts (SAVSs) were enrolled. The incidence and temporal trends of each disease were calculated. RESULTS: Among a total of 393 cranial and spinal arteriovenous shunts, 201 (51.1%) cases of DAVF, 155 (39.4%) cases of cerebral arteriovenous malformation, and 34 (8.7%) cases of SAVS were identified. The crude incidence rates between 2009 and 2019 were 2.040 per 100 000 person-years for all arteriovenous shunts, 0.805 for cerebral arteriovenous malformation, 1.044 for DAVF, and 0.177 for SAVS. The incidence of all types tended to increase over the decade, with a notable increase in incidence starting in 2012. Even after adjusting for population aging, the incidence of nonaggressive DAVF increased 6.0-fold while that of SAVS increased 4.4-fold from 2010 to 2018. CONCLUSIONS: In contrast to previous studies, we found that the incidence of DAVF is higher than that of cerebral arteriovenous malformation. Even after adjusting for population aging, all of the disease types tended to increase in incidence over the last decade, with an especially prominent increase in SAVSs and nonaggressive DAVFs. Various factors including population aging may affect an increase in DAVF and SAVS.

    DOI: 10.1161/STROKEAHA.120.032052

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  • Re: A graphical description of partial exchangeability. Reviewed International journal

    Etsuji Suzuki, Eiji Yamamoto

    Epidemiology   32 ( 2 )   e7 - e9   2021.3

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    Authorship:Lead author, Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1097/EDE.0000000000001306

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  • Obesity and Remission Rates in Japanese Patients With Rheumatoid Arthritis Requiring Anti-Tumor Necrosis Factor Alpha Therapy Reviewed International journal

    Kenji Yamazaki, Etsuji Suzuki, Ryuhei Ishihara, Toshiaki Miyamoto

    Archives of Rheumatology   35 ( 4 )   600 - 608   2020.12

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Baycinar Medical Publishing  

    Objectives: This study aims to determine if obesity is a risk factor for a poor response to anti-tumor necrosis factor alpha (anti-TNF alpha) therapy in Japanese patients with rheumatoid arthritis (RA) using the appropriate body mass index (BMI) cut-off points for Asian populations.Patients and methods: This retrospective cohort study evaluated 382 outpatients with RA (98 males, 284 females; mean age 54.2 years; range, 18 to 84 years) who had received anti-TNFa therapy between May 2009 and July 2017. Patients were classified according to BMI at baseline as follows: <18.5 kg/m(2) (underweight), 18.5-23.0 kg/m(2) (normal weight), 23.0-27.5 kg/m(2) (overweight), and >= 27.5 kg/m(2) (obese). The response variable was defined as Simplified Disease Activity Index (SDAI) remission after 12 months. We estimated odds ratios (ORs) and their 95% confidence intervals (CIs) for poor response to the therapy.Results: After 87 patients were excluded, 183 (62.0%) of 295 had reached remission at the 12-month follow-up. Compared with normal-weight patients, the multivariate OR for poor response of obese patients was 2.2 (95% CI: 0.5-9.4). Adjusting for the baseline SDAI score, the corresponding OR was 1.8 (0.4-7.6).Conclusion: We found no statistically significant association between obesity and poor response to anti-TNFa therapy in Japanese patients with RA. Because this may partly be due to the limited statistical power of our study, further research is warranted to examine the possible effect modification across countries.

    DOI: 10.46497/archrheumatol.2020.7852

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  • Continuing surgical education of non-technical skills Reviewed International journal

    Masaomi Yamane, Seiichiro Sugimoto, Etsuji Suzuki, Keiju Aokage, Mikio Okazaki, Junichi Soh, Makio Hayama, Yuji Hirami, Takashi Yorifuji, Shinichi Toyooka

    Annals of Medicine and Surgery   58   177 - 186   2020.10

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Elsevier BV  

    Background: The non-technical skills for surgeons (NOTSS) system was developed as a tool to assess surgical skills for patient safety during surgery. This study aimed to develop a NOTSS-based training system for surgical trainees to acquire non-technical skills using a chest surgery scenario in a wet lab.Materials and methods: Trainees were categorized into three subgroups according to the years of experience as follows: Level A: 6 years or more; Level B: 3-5 years; and Level C: 1-2 years. Three stages of surgical procedure were designed: 1. chest wall resection and right upper lobe lobectomy, 2. right middle lobe sleeve lobectomy, and 3. right lower lobe lobectomy. One instructor was assigned to each operation table, who evaluated each participant's NOTSS scores consisting of 16 elements.Results: When comparing average NOTSS score of all the three procedures, significant differences were observed between Level A, B, and C trainees. As an example of varying elements by procedure, Level A trainees demonstrated differences in Situation Awareness, and a significant difference was observed in Level C trainees regarding the elements of Decision Making. On the contrary, no significant difference was observed among Level B trainees. In the comparison between first-time and experienced participants, a significant improvement was observed in some elements in Level B and C trainees.Conclusion: This study highlights the usefulness and feasibility of the NOTSS scoring system for surgeons with different experiences and the effectiveness of providing feedback to trainees during intraoperative handoffs in a wet lab.

    DOI: 10.1016/j.amsu.2020.07.062

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  • Understanding marginal structural models for time-varying exposures: pitfalls and tips Invited Reviewed International journal

    Tomohiro Shinozaki, Etsuji Suzuki

    Journal of Epidemiology   30 ( 9 )   377 - 389   2020.9

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    Epidemiologists are increasingly encountering complex longitudinal data, in which exposures and their confounders vary during follow-up. When a prior exposure affects the confounders of the subsequent exposures, estimating the effects of the time-varying exposures requires special statistical techniques, possibly with structural (ie, counterfactual) models for targeted effects, even if all confounders are accurately measured. Among the methods used to estimate such effects, which can be cast as a marginal structural model in a straightforward way, one popular approach is inverse probability weighting. Despite the seemingly intuitive theory and easy-to-implement software, misunderstandings (or "pitfalls") remain. For example, one may mistakenly equate marginal structural models with inverse probability weighting, failing to distinguish a marginal structural model encoding the causal parameters of interest from a nuisance model for exposure probability, and thereby failing to separate the problems of variable selection and model specification for these distinct models. Assuming the causal parameters of interest are identified given the study design and measurements, we provide a step-by-step illustration of generalized computation of standardization (called the g-formula) and inverse probability weighting, as well as the specification of marginal structural models, particularly for time-varying exposures. We use a novel hypothetical example, which allows us access to typically hidden potential outcomes. This illustration provides steppingstones (or "tips") to understand more concretely the estimation of the effects of complex time-varying exposures.

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  • Inverted Internal Limiting Membrane Flap versus Internal Limiting Membrane Peeling for Macular Hole Retinal Detachment in High Myopia. Reviewed International journal

    Hiroshi Matsumae, Yuki Morizane, Shin Yamane, Shuichiro Yanagisawa, Toshiya Sakurai, Akira Kobori, Hisanori Imai, Yuki Kanzaki, Etsuji Suzuki, Kazuaki Kadonosono, Atsushi Hayashi, Fumio Shiraga, Shoji Kuriyama

    Ophthalmology. Retina   4 ( 9 )   919 - 926   2020.9

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    PURPOSE: To compare surgical outcomes between the inverted internal limiting membrane (ILM) flap technique and ILM peeling for macular hole retinal detachment (MHRD) in eyes with high myopia. DESIGN: Multicenter cohort study. PARTICIPANTS: We retrospectively reviewed medical records of consecutive patients treated between June 2008 and September 2018 at 7 hospitals and included 100 eyes with MHRD associated with high myopia in our study. All eyes underwent vitrectomy with the inverted ILM flap technique (57 eyes) or ILM peeling (43 eyes) and were followed up for more than 6 months. METHODS: We estimated odds ratios and their 95% confidence intervals (CIs) for macular hole (MH) closure using multivariate logistic regression analysis. We also examined factors associated with the postoperative best-corrected visual acuity (BCVA) at the final visit using multiple linear regression analysis. MAIN OUTCOME MEASURES: Macular hole closure and postoperative BCVA at the final visit. RESULTS: The MH closure rate was significantly higher in the inverted ILM flap group (80.7%) than in the ILM peeling group (37.2%; P < 0.001). Moreover, postoperative BCVA at the final visit was significantly better in the former group (0.88 ± 0.48 vs. 0.99 ± 0.48; P = 0.03). The retinal attachment rate (ILM flap, 91.2%; ILM peeling, 79.5%; P = 0.229) and recovery rates for the external limiting membrane and ellipsoid zone line (ILM flap, 10.9%; ILM peeling, 0%; P = 0.12) showed no significant intergroup differences. After adjustment for age, axis, tamponade substance, and dye for ILM staining, the inverted ILM flap technique was associated strongly and positively with MH closure (odds ratio, 7.14; 95% CI, 2.72-18.7; P = 0.001). Moreover, the inverted ILM flap technique and preoperative BCVA were associated significantly and positively with the postoperative BCVA at the final visit. CONCLUSIONS: Our findings suggest that the MH closure rate and postoperative visual outcome for eyes with high myopia-associated MHRD are better with the inverted ILM flap technique than with ILM peeling. Thus, vitrectomy with the inverted ILM flap technique should be considered as the initial surgery for MHRD associated with high myopia.

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  • Causal diagrams: pitfalls and tips Invited Reviewed International journal

    Etsuji Suzuki, Tomohiro Shinozaki, Eiji Yamamoto

    Journal of Epidemiology   30 ( 4 )   153 - 162   2020.4

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    Graphical models are useful tools in causal inference, and causal directed acyclic graphs (DAGs) are used extensively to determine the variables for which it is sufficient to control for confounding to estimate causal effects. We discuss the following ten pitfalls and tips that are easily overlooked when using DAGs: 1) Each node on DAGs corresponds to a random variable and not its realized values; 2) The presence or absence of arrows in DAGs corresponds to the presence or absence of individual causal effect in the population; 3) "Non-manipulable" variables and their arrows should be drawn with care; 4) It is preferable to draw DAGs for the total population, rather than for the exposed or unexposed groups; 5) DAGs are primarily useful to examine the presence of confounding in distribution in the notion of confounding in expectation; 6) Although DAGs provide qualitative differences of causal structures, they cannot describe details of how to adjust for confounding; 7) DAGs can be used to illustrate the consequences of matching and the appropriate handling of matched variables in cohort and case-control studies; 8) When explicitly accounting for temporal order in DAGs, it is necessary to use separate nodes for each timing; 9) In certain cases, DAGs with signed edges can be used in drawing conclusions about the direction of bias; and 10) DAGs can be (and should be) used to describe not only confounding bias but also other forms of bias. We also discuss recent developments of graphical models and their future directions.

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  • Across-Site Differences in the Mechanism of Alcohol-Induced Digestive Tract Carcinogenesis: An Evaluation by Mediation Analysis Reviewed International journal

    Yuriko N. Koyanagi, Etsuji Suzuki, Issei Imoto, Yumiko Kasugai, Isao Oze, Tomotaka Ugai, Madoka Iwase, Yoshiaki Usui, Yukino Kawakatsu, Michi Sawabe, Yutaka Hirayama, Tsutomu Tanaka, Tetsuya Abe, Seiji Ito, Koji Komori, Nobuhiro Hanai, Masahiro Tajika, Yasuhiro Shimizu, Yasumasa Niwa, Hidemi Ito, Keitaro Matsuo

    Cancer Research   80 ( 7 )   1601 - 1610   2020.4

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    A genetic variant on aldehyde dehydrogenase 2 (ALDH2 rs671, Glu504Lys) contributes to carcinogenesis after alcohol consumption. Somewhat conversely, the ALDH2 Lys allele also confers a protective effect against alcohol-induced carcinogenesis by decreasing alcohol consumption due to acetaldehyde-related adverse effects. Here, we applied a mediation analysis to five case-control studies for head and neck, esophageal, stomach, small intestine, and colorectal cancers, with 4,099 cases and 6,065 controls, and explored the potentially heterogeneous impact of alcohol drinking on digestive tract carcinogenesis by decomposing the total effect of the ALDH2 Lys allele on digestive tract cancer risk into the two opposing effects of the carcinogenic effect (direct effect) and the protective effect (indirect effect mediated by drinking behavior). Alcohol was associated with an increased risk of most digestive tract cancers, but significant direct effects were observed only for upper gastrointestinal tract cancer risk, and varied substantially by site, with ORs (95% confidence interval) of 1.83 (1.432.36) for head and neck cancer, 21.15 (9.11-49.12) for esophageal cancer, and 1.65 (1.38-1.96) for stomach cancer. In contrast, a significant protective indirect effect was observed on risk for all cancers, except small intestine cancer. These findings suggest that alcohol is a major risk factor for digestive tract cancers, but its impact as a surrogate for acetaldehyde exposure appears heterogeneous by site. Meanwhile, the behavior-related effect of the ALDH2 Lys allele results in a decreased risk of most digestive tract cancers.Significance: These findings support that genetic alcohol avoidance is a factor against alcohol-induced cancers.

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  • Urgent intubation without neuromuscular blocking agents and the risk of tracheostomy Reviewed International journal

    Jun Fujinaga, Etsuji Suzuki, Akira Kuriyama, Mutsuo Onodera, Hiroyuki Doi

    Internal and Emergency Medicine   15 ( 1 )   127 - 134   2020.1

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    Neuromuscular blocking agents play a significant role in improving the success rate for urgent intubation, although there is limited evidence about the effect on subsequent outcomes, such as the incidence of tracheostomy. In this retrospective cohort study, we aimed to examine the association between avoidance of neuromuscular blocking agents for urgent tracheal intubation and incidence of tracheostomy among patients in the intensive care unit (ICU). The setting of this study was an eight-bed ICU at a tertiary-care hospital in Okayama, Japan. We included patients who underwent urgent tracheal intubation at the emergency department or the ICU and were admitted to the ICU between April 2013 and November 2017. We extracted data on methods and medications of intubation, predictors for difficult intubation, Cormack-Lehane grade, patient demographics, primary diagnoses, reintubation. We estimated odds ratios and their 95% confidence intervals for elective tracheostomy during the ICU stay using logistic regression models. Of 411 patients, 46 patients underwent intubation without neuromuscular blocking agents and 61 patients underwent tracheostomy. After adjusting for potential confounders, patients who avoided neuromuscular blocking agents had more than double the odds of tracheostomy (odds ratio 2.59, 95% confidence interval 1.06-6.34, p value = 0.04). When stratifying the subjects by risk status for tracheostomy, the association was more pronounced in high-risk group, while we observed less significant association in the low-risk group. Avoidance of neuromuscular blocking agents for urgent intubation increases the risk of tracheostomy among emergency patients, especially those who have a higher risk for tracheostomy.

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  • On the collapsibility of measures of effect in the counterfactual causal framework Reviewed International coauthorship International journal

    Anders Huitfeldt, Mats J. Stensrud, Etsuji Suzuki

    Emerging Themes in Epidemiology   16 ( 1 )   1 - 1   2019.12

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    The relationship between collapsibility and confounding has been subject to an extensive and ongoing discussion in the methodological literature. We discuss two subtly different definitions of collapsibility, and show that by considering causal effect measures based on counterfactual variables (rather than measures of association based on observed variables) it is possible to separate out the component of non-collapsibility which is due to the mathematical properties of the effect measure, from the components that are due to structural bias such as confounding. We provide new weights such that the causal risk ratio is collapsible over arbitrary baseline covariates. In the absence of confounding, these weights may be used for standardization of the risk ratio.

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  • Effect heterogeneity and variable selection for standardizing causal effects to a target population Reviewed International coauthorship International journal

    Anders Huitfeldt, Sonja A. Swanson, Mats J. Stensrud, Etsuji Suzuki

    European Journal of Epidemiology   34 ( 12 )   1119 - 1129   2019.12

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    The participants in randomized trials and other studies used for causal inference are often not representative of the populations seen by clinical decision-makers. To account for differences between populations, researchers may consider standardizing results to a target population. We discuss several different types of homogeneity conditions that are relevant for standardization: Homogeneity of effect measures, homogeneity of counterfactual outcome state transition parameters, and homogeneity of counterfactual distributions. Each of these conditions can be used to show that a particular standardization procedure will result in an unbiased estimate of the effect in the target population, given assumptions about the relevant scientific context. We compare and contrast the homogeneity conditions, in particular their implications for selection of covariates for standardization and their implications for how to compute the standardized causal effect in the target population. While some of the recently developed counterfactual approaches to generalizability rely upon homogeneity conditions that avoid many of the problems associated with traditional approaches, they often require adjustment for a large (and possibly unfeasible) set of covariates.

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  • Inventory survey of spinal arteriovenous shunt in Okayama prefecture Reviewed

    Hiramatsu M, Ishibashi R, Takai H, Murai S, Suzuki E, Takahashi Y, Kidani N, Hishikawa T, Yasuhara T, Sugiu K, Date I

    4 ( Suppl. )   S161 - S161   2019.11

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  • Inventory survey of cerebral and spinal arteriovenous shunts in Okayama prefecture Reviewed

    Murai S, Hiramatsu M, Ishibashi R, Takai H, Suzuki E, Takahashi Y, Kidani N, Hishikawa T, Yasuhara T, Sugiu K, Date I

    4 ( Suppl. )   S153 - S153   2019.11

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  • Re: Associations Between Childhood Thyroid Cancer and External Radiation Dose After the Fukushima Daiichi Nuclear Power Plant Accident Reviewed International journal

    Toshihide Tsuda, Akiko Tokinobu, Eiji Yamamoto, Etsuji Suzuki

    Epidemiology   29 ( 6 )   e56 - e57   2018.11

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  • Mechanisms and uncertainty in randomized controlled trials: A commentary on Deaton and Cartwright Invited International coauthorship International journal

    Etsuji Suzuki, Tyler J. VanderWeele

    Social Science & Medicine   210   83 - 85   2018.8

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  • Diarrhea and related factors among passengers on world cruises departing from Japan Reviewed International journal

    Michiyo Yamakawa, Megumi Sasai, Yosuke Kasai, Toshihide Tsuda, Etsuji Suzuki

    Travel Medicine and Infectious Disease   23   56 - 63   2018.5

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    Background: Despite growth in the number of cruises worldwide, evidence about diarrhea experienced by cruise ship passengers remains sparse. We investigated rates of diarrhea and related factors among passengers on world cruises departing from Japan. Methods: Targeting passengers on five world cruises (n = 4180) from 2012 to 2013 (85–103 travel days), we calculated rates of health seeking behavior for diarrhea by sex, age group, and number of roommates for each cruise. We estimated rate ratios and 95% confidence intervals, using the group aged 20–39 years, women, and 2–4 roommates as referent categories. Results: We found 5.04–6.00 cases per 10,000 person-days in the five cruises, with an elevated number after calling at ports. Older passengers (&gt
    60 years) and passengers with fewer roommates had an elevated risk of health seeking behavior for diarrhea, although passengers aged &lt
    20 years had an elevated risk on one cruise. After controlling for covariates (including cruise), significant associations remained for passengers aged &gt
    60 years and without roommates. Conclusions: Older passengers and passengers with fewer roommates may be more likely to seek medical treatment for diarrhea during travel on a world cruise, and should take preventive measures.

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  • Covariate balance for no confounding in the sufficient-cause model Reviewed International journal

    Etsuji Suzuki, Toshihide Tsuda, Eiji Yamamoto

    Annals of Epidemiology   28 ( 1 )   48 - 53.e2   2018.1

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    Purpose: To show conditions of covariate balance for no confounding in the sufficient-cause model and discuss its relationship with exchangeability conditions.Methods: We consider the link between the sufficient-cause model and the counterfactual model, emphasizing that the target population plays a key role when discussing these conditions. Furthermore, we incorporate sufficient causes within the directed acyclic graph framework. We propose to use each of the background factors in sufficient causes as representing a set of covariates of interest and discuss the presence of covariate balance by comparing joint distributions of the relevant background factors between the exposed and the unexposed groups.Results: We show conditions for partial covariate balance, covariate balance, and full covariate balance, each of which is stronger than partial exchangeability, exchangeability, and full exchangeability, respectively. This is consistent with the fact that the sufficient-cause model is a "finer" model than the counterfactual model.Conclusions: Covariate balance is a sufficient, but not a necessary, condition for no confounding irrespective of the target population. Although our conceptualization of covariate imbalance is closely related to the recently proposed counterfactual-based definition of a confounder, the concepts of covariate balance and confounder should be clearly distinguished. (C) 2017 Elsevier Inc. All rights reserved.

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  • Are People With a History of Disease More Susceptible to a Short-term Exposure to Asian Dust? Reviewed International journal

    Saori Kashima, Takashi Yorifuji, Etsuji Suzuki

    Epidemiology   28 ( Suppl 1 )   S60 - S66   2017.10

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    Background: Factors influencing the susceptibility of the elderly to the adverse health effects of short-term exposure to desert dust have yet to be explored. We aimed to identify the disease histories that increase the susceptibility of the elderly to disease onset induced by dust events.Methods: We used a time-stratified case-crossover design using data on 17,874 elderly residents (>= 65 years) of Okayama, Japan, who were transported to hospital emergency rooms because of cardiovascular and respiratory diseases between 2006 and 2010. We used conditional logistic models to calculate the odds ratios (ORs) per inter-quartile increase of Asian dust. We then conducted stratified analyses based on patients with or without a history of chronic disease.Results: Dust concentration was associated with a higher risk of cardiovascular (3-day lag), cerebrovascular (same day), and respiratory (3-day lag) disease onset. Patients with a history of respiratory disease had a higher risk of cardiovascular (OR: 1.09 [95% confidence interval (CI) = 1.00, 1.19] vs. 0.99 [0.97, 1.01]; P for interaction = 0.03) or cerebrovascular (1.15 [1.01, 1.31] vs. 0.99 [0.97, 1.01]; P = 0.02) disease onset (2-day lag) than those without. Patients with diabetes also had a higher risk of cerebrovascular disease onset (1.09 [1.00, 1.19] vs. 0.99 [0.97, 1.01]; P = 0.05) (2-day lag). In contrast, patients with a history of cerebrovascular disease had a lower risk of respiratory disease.Conclusions: People with a history of respiratory disease or diabetes might have a greater susceptibility to cardiovascular disease from Asian dust and would therefore benefit from proactive interventions during desert dust events.

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  • Risk factors for wound complications in head and neck reconstruction: 773 free jejunal reconstruction procedures after total pharyngolaryngoesophagectomy Reviewed International journal

    Narushi Sugiyama, Soshi Takao, Etsuji Suzuki, Yoshihiro Kimata

    Head & Neck   39 ( 10 )   2057 - 2069   2017.10

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    Background: Most studies that examined risk factors for wound complications after head and neck reconstruction analyzed various complications collectively. Moreover, they included a wide variety of resection areas and reconstruction materials. To overcome these limitations, both the resection area and reconstruction method were constrained in the present study.Methods: Patients who underwent free jejunal graft reconstruction after pharyngolaryngoesophagectomy for hypopharyngeal cancer were enrolled. The outcomes of interest were abscesses, fistulas, and cervical skin flap necrosis.Results: Abscesses, fistulas, and cervical skin flap necrosis developed in 19.3%, 11.3%, and 8.2% of 773 patients, respectively. A significant relationship was found between use of an open drain and abscess formation and between a longer operation time and cervical skin flap necrosis.Conclusion: Our findings suggest that use of an open drain, cardiovascular disease, and a longer operation time are significant risk factors for abscess formation, fistula formation, and cervical skin flap necrosis, respectively.

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  • Is there an obesity paradox in the Japanese elderly population? A community-based cohort study of 13 280 men and women Reviewed International journal

    Kenji Yamazaki, Etsuji Suzuki, Takashi Yorifuji, Toshihide Tsuda, Toshiki Ohta, Kazuko Ishikawa-Takata, Hiroyuki Doi

    Geriatrics & Gerontology International   17 ( 9 )   1257 - 1264   2017.9

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    AimDespite increased interest in an obesity paradox (i.e. a survival advantage of being obese), evidence remains sparse in Japanese populations. We aimed to verify this phenomenon among community-dwelling older adults in Japan.MethodsOlder adults aged 65-84 years randomly chosen from all 74 municipalities in Shizuoka Prefecture completed questionnaires including body mass index information. Participants were followed from 1999 to 2009. Following World Health Organization guidelines, participants were classified using an appropriate body mass index for Asian populations as follows: <18.5 kg/m(2) (underweight), 18.5-23.0 kg/m(2) (normal weight), 23.0-27.5 kg/m(2) (overweight) and 27.5 kg/m(2) (obesity). We estimated hazard ratios and their 95% confidence intervals for all-cause mortality, controlling for sex, age, smoking status, alcohol consumption, physical activity, hypertension and diabetes mellitus.ResultsCompared with normal-weight participants, overweight/obese participants tended to have lower hazard ratios; the multivariate hazard ratios (95% confidence interval) were 0.86 (0.62-1.19) for obesity, 0.83 (0.73-0.94) for overweight and 1.60 (1.40-1.82) for underweight. In subgroup analyses by sex and age, the hazard ratios tended to be lower among obese men, albeit not significantly; hazard ratios (95% confidence interval) were 0.56 (0.25-1.27) in men aged 65-74 years, and 0.78 (0.41-1.45) in men aged 75-84 years.ConclusionsThe present study provides evidence of a conservative obesity paradox among older Japanese people, using the appropriate body mass index cut-off points for Asian populations. In particular, obese older men tend to have a lower risk of all-cause mortality. Geriatr Gerontol Int 2017; 17: 1257-1264.

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  • A typology of four notions of confounding in epidemiology Reviewed International journal

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    Journal of Epidemiology   27 ( 2 )   49 - 55   2017.2

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    Confounding is a major concern in epidemiology. Despite its significance, the different notions of confounding have not been fully appreciated in the literature, leading to confusion of causal concepts in epidemiology. In this article, we aim to highlight the importance of differentiating between the subtly different notions of confounding from the perspective of counterfactual reasoning. By using a simple example, we illustrate the significance of considering the distribution of response types to distinguish causation from association, highlighting that confounding depends not only on the population chosen as the target of inference, but also on the notions of confounding in distribution and confounding in measure. This point has been relatively underappreciated, partly because some literature on the concept of confounding has only used the exposed and unexposed groups as the target populations, while it would be helpful to use the total population as the target population. Moreover, to clarify a further distinction between confounding "in expectation" and "realized" confounding, we illustrate the usefulness of examining the distribution of exposure status in the target population. To grasp the explicit distinction between confounding in expectation and realized confounding, we need to understand the mechanism that generates exposure events, not the product of that mechanism. Finally, we graphically illustrate this point, highlighting the usefulness of directed acyclic graphs in examining the presence of confounding in distribution, in the notion of confounding in expectation. (C) 2016 The Authors. Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association.

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  • Social Capital and Suicidal Ideation in Community-Dwelling Older Residents: A Multilevel Analysis of 10,094 Subjects in Japan Reviewed International coauthorship International journal

    Masayuki Noguchi, Tomoko Kobayashi, Toshihide Iwase, Etsuji Suzuki, Ichiro Kawachi, Soshi Takao

    The American Journal of Geriatric Psychiatry   25 ( 1 )   37 - 47   2017.1

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    Objective: Social capital, the collective resources of groups including perceptions of trust and reciprocity, is recognized as an important contributor to suicide. We examined the association of individual-and community-level social capital with suicidal ideation after adjusting for social support among older adults living in the community. Methods: In August 2010 we sent questionnaires to all residents aged 65 years and older living in 3 rural municipalities (N = 21,232) in Okayama Prefecture, Japan; 13,919 questionnaires were returned (response rate: 65.6%). The final analysis included 10,094 participants. The outcome variable was suicidal ideation. Exposure variables were individual-level mistrust and lack of reciprocity (level 1), and the aggregated responses of these variables from 35 communities in the municipalities (level 2). Covariates included age, sex, educational attainment, marital status, the number of cohabitants, years of residence, self-rated socioeconomic status, disability, social support, and psychological distress. Multilevel logistic regression analysis was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: After adjusting for social support and psychological distress, we found that mistrust and lack of reciprocity were only associated with suicidal ideation at the individual level. Stratified analysis showed that among subjects with psychological distress, mistrust was associated with suicidal ideation at individual (OR: 1.88; 95% CI: 1.42-2.51) and community levels (OR: 1.98; 95% CI: 1.02-3.81). Conclusions: Our findings show that individual-and community-level social capital is a possible protective factor for suicidal ideation, particularly for people with psychological distress.

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  • Errors in causal inference: an organizational schema for systematic error and random error Reviewed International coauthorship International journal

    Etsuji Suzuki, Toshihide Tsuda, Toshiharu Mitsuhashi, Mohammad Ali Mansournia, Eiji Yamamoto

    Annals of Epidemiology   26 ( 11 )   788 - 793.e1   2016.11

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    Purpose: To provide an organizational schema for systematic error and random error in estimating causal measures, aimed at clarifying the concept of errors from the perspective of causal inference.Methods: We propose to divide systematic error into structural error and analytic error. With regard to random error, our schema shows its four major sources: nondeterministic counterfactuals, sampling variability, a mechanism that generates exposure events and measurement variability.Results: Structural error is defined from the perspective of counterfactual reasoning and divided into nonexchangeability bias (which comprises confounding bias and selection bias) and measurement bias. Directed acyclic graphs are useful to illustrate this kind of error. Nonexchangeability bias implies a lack of "exchangeability" between the selected exposed and unexposed groups. A lack of exchangeability is not a primary concern of measurement bias, justifying its separation from confounding bias and selection bias. Many forms of analytic errors result from the small-sample properties of the estimator used and vanish asymptotically. Analytic error also results from wrong (misspecified) statistical models and inappropriate statistical methods.Conclusions: Our organizational schema is helpful for understanding the relationship between systematic error and random error from a previously less investigated aspect, enabling us to better understand the relationship between accuracy, validity, and precision. (C) 2016 Elsevier Inc. All rights reserved.

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  • Risk factors of thrombosis in a single method of microsurgical head and neck reconstruction: A multi-institutional study of 773 reconstructions with a free jejunal graft after total pharyngolaryngoesophagectomy for hypopharyngeal cancer Reviewed International journal

    Narushi Sugiyama, Soshi Takao, Etsuji Suzuki, Yoshihiro Kimata

    Head & Neck   38 ( 11 )   1688 - 1694   2016.11

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    Background. The risk factors for thrombus formation in anastomotic vessels in free-flap head and neck reconstruction have been previously reported. However, the evidence is inconsistent.Methods. In total, 773 patients who underwent free jejunal graft reconstruction after pharyngolaryngoesophagectomy for hypopharyngeal cancer were enrolled at 12 institutions in Japan from 1995 to 2006. Both the resection area and the applied reconstruction method were constrained to overcome the limitations of previous studies. After the exclusion of recurrent cases, odds ratios (ORs) and 95% confidence intervals (CIs) for thrombosis were calculated in a multivariate logistic regression analysis.Results. Postoperative anastomotic thrombosis developed in 23 patients (3.0%). In the multivariate analysis, the OR for thrombosis per 100-mL increase in blood loss was 1.24 (95% CI = 1.02-1.51), even after controlling for other risk factors.Conclusion. Our results show that the blood loss volume is an independent risk factor for thrombosis in free tissue grafts. (C) 2016 Wiley Periodicals, Inc.

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  • Toward a further understanding of causality in medicine: a contribution to “seizon and life sciences” Invited

    Etsuji Suzuki

    Journal of Seizon and Life Sciences   27 ( 1 )   97 - 106   2016.9

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  • The authors respond: erratum International journal

    Toshihide Tsuda, Akiko Tokinobu, Eiji Yamamoto, Etsuji Suzuki

    Epidemiology   27 ( 5 )   e36 - e36   2016.9

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    DOI: 10.1097/ede.0000000000000516

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  • Thyroid Cancer Detection by Ultrasound Among Residents Ages 18 Years and Younger in Fukushima, Japan Reviewed International journal

    Toshihide Tsuda, Akiko Tokinobu, Eiji Yamamoto, Etsuji Suzuki

    Epidemiology   27 ( 3 )   316 - 322   2016.5

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    Background: After the Great East Japan Earthquake and Tsunami in March 2011, radioactive elements were released from the Fukushima Daiichi Nuclear Power Plant. Based on prior knowledge, concern emerged about whether an increased incidence of thyroid cancer among exposed residents would occur as a result.Methods: After the release, Fukushima Prefecture performed ultrasound thyroid screening on all residents ages 18 years. The first round of screening included 298,577 examinees, and a second round began in April 2014. We analyzed the prefecture results from the first and second round up to December 31, 2014, in comparison with the Japanese annual incidence and the incidence within a reference area in Fukushima Prefecture.Results: The highest incidence rate ratio, using a latency period of 4 years, was observed in the central middle district of the prefecture compared with the Japanese annual incidence (incidence rate ratio = 50; 95% confidence interval [CI] = 25, 90). The prevalence of thyroid cancer was 605 per million examinees (95% CI = 302, 1,082) and the prevalence odds ratio compared with the reference district in Fukushima Prefecture was 2.6 (95% CI = 0.99, 7.0). In the second screening round, even under the assumption that the rest of examinees were disease free, an incidence rate ratio of 12 has already been observed (95% CI = 5.1, 23).Conclusions: An excess of thyroid cancer has been detected by ultrasound among children and adolescents in Fukushima Prefecture within 4 years of the release, and is unlikely to be explained by a screening surge.

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  • The Authors Respond Invited International journal

    Toshihide Tsuda, Akiko Tokinobu, Eiji Yamamoto, Etsuji Suzuki

    Epidemiology   27 ( 3 )   e21 - e23   2016.5

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    DOI: 10.1097/ede.0000000000000468

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  • Correction: Community-Level Social Capital and Psychological Distress among the Elderly in Japan: A Population-Based Study International coauthorship International journal

    Tomoko Kobayashi, Etsuji Suzuki, Masayuki Noguchi, Ichiro Kawachi, Soshi Takao

    PLOS ONE   10 ( 12 )   e0144683 - e0144683   2015.12

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  • Home visits by commissioned welfare volunteers and psychological distress: a population-based study of 11,312 community-dwelling older people in Japan Reviewed International journal

    Masayuki Noguchi, Toshihide Iwase, Etsuji Suzuki, Soshi Takao

    International Journal of Geriatric Psychiatry   30 ( 12 )   1156 - 1163   2015.12

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    ObjectiveNovel countermeasures to increase healthcare expenditures should be explored in rapidly aging societies, including Japan. Social support is a resource for the older people that effectively reduces psychological distress, with or without specialized health service provision. This cross-sectional study was conducted to determine whether home visits by commissioned welfare volunteers (organizations of community residents assigned by national or local governments) are associated with a lower risk of psychological distress among the older people.MethodsQuestionnaires were sent in August 2010 to all residents aged 65years in three municipalities (n=21,232) in Okayama Prefecture in Japan; 13,929 were returned (response rate=65.6%). The final sample size for the analysis was 11,312 participants. Home visits, psychological distress (Kessler Psychological Distress Scale: K6>5), and severe psychological distress (K6>13) were measured by the questionnaire. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for psychological distress, adjusting for age, gender, education, marital status, and qualification for long-term care insurance.ResultsThe prevalence was 41.4% for psychological distress and 6.5% for severe psychological distress among all participants. Home visits were significantly associated with a lower risk of psychological distress after adjusting for the covariates (OR: 0.71, 95% CI: 0.65-0.77). These associations were comparable for men and women. The association was clearer for severe psychological distress (OR: 0.51, 95% CI: 0.43-0.61).ConclusionsHome visits by commissioned welfare volunteers are significantly associated with a lower risk of psychological distress among older people. Copyright (c) 2015 John Wiley & Sons, Ltd.

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  • Community-Level Social Capital and Psychological Distress among the Elderly in Japan: A Population-Based Study Reviewed International coauthorship International journal

    Tomoko Kobayashi, Etsuji Suzuki, Masayuki Noguchi, Ichiro Kawachi, Soshi Takao

    PLoS One   10 ( 11 )   e0142629   2015.11

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    Despite accumulating evidence, previous studies have not clearly separated the contribution of community-level social capital on mental health from that of individual-level social support. We examined the association between community-level social capital and psychological distress in a sample of older Japanese individuals, taking into account the effects of individual-level social capital and social support. We collected data via a cross-sectional survey among all residents aged &gt;= 65 in three rural municipalities in Okayama Prefecture. We measured two components of social capital in the questionnaire: perceptions of trust and reciprocity in the community. Community-level social capital was obtained by aggregating individual responses and calculating the proportion of subjects reporting mistrust and lack of reciprocity. Psychological distress was assessed by the Kessler Psychological Distress scale. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for psychological distress using two-level Poisson regression models (9,761 individuals nested within 35 communities). The prevalence of psychological distress was 39.8%. Low community-level social capital was associated with psychological distress, even after controlling for individual-level social support, age, sex, educational attainment, frequency of alcohol consumption, smoking status, body mass index, marital status, socioeconomic status, and number of cohabiters. The adjusted RRs per 10% increase of the proportion of mistrust and lack of reciprocity in the communities were 1.23 (95% CI: 1.01-1.51) and 1.12 (95% CI: 1.02-1.24), respectively. Lower levels of community-level social capital are associated with psychological distress among the Japanese elderly population, even after adjusting for individual- level perceptions of social capital and social support.

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  • Generalized causal measure: the beauty lies in its generality Invited International journal

    Etsuji Suzuki

    Epidemiology   26 ( 4 )   490 - 495   2015.7

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    DOI: 10.1097/ede.0000000000000304

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  • Are family, neighbourhood and school social capital associated with higher self-rated health among Croatian high school students? A population-based study Reviewed International coauthorship International journal

    Dario Novak, Etsuji Suzuki, Ichiro Kawachi

    BMJ Open   5 ( 6 )   e007184 - e007184   2015.6

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    Objectives: We investigated the associations between self-rated health and social capital among Croatian high school students.Design: A cross-sectional survey among high school students was carried out in the 2013-2014 school year.Setting: High schools in Croatia.Participants: Subjects were 3427 high school students (1688 males and 1739 females), aged 17-18 years.Main outcome measure: Self-rated health was assessed by the single item: "How do you perceive your health?". Possible responses were arranged along a five-item Likert-type scale: 1 very poor, 2 poor, 3 fair, 4 good, 5 excellent. The outcome was binarised as 'good health' (excellent, good or fair) versus 'poor health' (poor or very poor).Methods: We calculated ORs and 95% CIs for good self-rated health associated with family, neighbourhood and school social capital, while adjusting for gender, self-perceived socioeconomic status, psychological distress, physical activity and body mass index. We used generalised estimating equations using an exchangeable correlation matrix with robust SEs.Results: Good self-rated health was significantly associated with higher family social capital (OR 2.43; 95% CI 1.55 to 3.80), higher neighbourhood trust (OR 2.02; 95% CI 1.48 to 2.76) and higher norms of reciprocity at school (OR 1.79; 95% CI 1.13 to 2.84). When all of the social capital variables were entered simultaneously, good self-rated health remained significantly associated with higher family social capital (OR 1.98; 95% CI 1.19 to 3.30), neighbourhood trust (OR 1.77; 95% CI 1.25 to 2.51) and reciprocity at school (OR 1.71; 95% CI 1.08 to 2.73).Conclusions: Higher levels of social capital were independently associated with higher self-rated health among youth. Intervention and policies that leverage community social capital might serve as an avenue for health promotion in youth.

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  • Erratum to: Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community? (Soc Psychiatry Psychiatr Epidemiol, (2014), 49, (619-627), 10.1007/s00127-013-0752-5) International journal

    Masayuki Noguchi, Toshihide Iwase, Etsuji Suzuki, Yoko Kishimoto, Soshi Takao

    Social Psychiatry and Psychiatric Epidemiology   50 ( 3 )   505 - 506   2015.3

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    DOI: 10.1007/s00127-014-0967-0

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  • Does the introduction of newborn hearing screening improve vocabulary development in hearing-impaired children? A population-based study in Japan Reviewed International journal

    Shuhei Ohmori, Akiko Sugaya, Naomi Toida, Etsuji Suzuki, Masato Izutsu, Tomoko Tsutsui, Yuko Kataoka, Yukihide Maeda, Kunihiro Fukushima, Kazunori Nishizaki

    International Journal of Pediatric Otorhinolaryngology   79 ( 2 )   196 - 201   2015.2

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    Objective: Permanent hearing impairment has a life-long impact on children and its early identification is important for language development. A newborn hearing screening (NHS) program has started in Okayama Prefecture, Japan, in 1999 to detect hearing impairment immediately after birth. We aim to examine the effect of this screening program on vocabulary development in pre-school children in a before and after comparative study design.
    Methods: A total of 107 5-year-old children who graduated from Okayama Kanariya Gakuen (an auditory center for hearing-impaired children) between 1998 and 2011 were enrolled in this study. The pre-NHS group (n = 40) was defined as those who graduated between 1998 and 2003, while the post-NHS group (n = 67) was defined as those who graduated between 2004 and 2011. The primary outcome was receptive vocabulary, which was assessed by the Picture Vocabulary Test [score &lt;18 (low) vs. score &gt;18 (high)]. The secondary outcome was productive vocabulary, or the number of productive words, which was assessed by an original checklist [&lt;1773 words (low) vs. &gt;1773 (high)]. We calculated odds ratios and 95% confidence intervals for vocabulary development and compared both groups.
    Results: The adjusted Picture Vocabulary Test score and number of productive words were significantly higher (p &lt; 0.01) in the post-NHS group than the pre-NHS group. Odds ratios were 2.63 (95% confidence interval: 1.17-5.89) for receptive vocabulary and 4.17 (95% confidence interval: 1.69-10.29) for productive vocabulary.
    Conclusions: The introduction of NHS in Okayama Prefecture significantly improved both receptive and productive vocabulary development in hearing-impaired children. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

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  • Prefecture-level economic conditions and risk of suicide in Japan: a repeated cross-sectional analysis 1975–2010 Reviewed International coauthorship International journal

    Etsuji Suzuki, Saori Kashima, Ichiro Kawachi, S. V. Subramanian

    European Journal of Public Health   24 ( 6 )   949 - 954   2014.12

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    <title>Abstract</title>
    Background: Geographical inequalities in suicide have risen dramatically across 47 prefectures in Japan since 1995. We sought to examine temporal changes in the associations between prefecture-level economic conditions and completed suicide during the recent 35 years, controlling for individual composition in each prefecture. Methods: Based on quinquennial vital statistics and census data from 1975 to 2010, we analysed the entire population aged 25–64 years. The total number of suicides was 87 553 men and 34 559 women. As indicators of prefecture-level economic conditions, we used average yearly income, average savings and income inequality (measured by Gini coefficients for yearly income). For each sex, we estimated odds ratios and 95% credible intervals for suicide using multilevel logistic regression models, with cells at level 1, years at level 2 and prefectures at level 3. Results: Even after adjusting for individual age, occupation and time trends, low average savings at prefecture level were associated with a higher risk of suicide among men (odds ratio in low vs. high savings: 1.13, 95% credible interval: 1.05–1.21), whereas no clear patterns were observed with other economic indicators. When we further examined the associations in year-specific models by conducting a two-level analysis, both average yearly income and average savings were inversely associated with suicide risk in recent years. No clear association was found between income inequality and suicide risk for either sex. Conclusion: The present findings suggest that low area socioeconomic status may be driving the growing geographical inequalities in suicide in Japan, primarily among men.

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  • Living will interest and preferred end-of-life care and death locations among Japanese adults 50 and over: a population-based survey Reviewed International journal

    Hiroyuki Nishie, Satoshi Mizobuchi, Etsuji Suzuki, Kenji Sato, Yuichiro Toda, Junji Matsuoka, Hiroshi Morimatsu

    Acta Medica Okayama   68 ( 6 )   339 - 348   2014.12

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    The main purpose of this study was to determine the relationships between Japanese individuals' interest in living wills and their preferred end-of-life care and death locations. Questionnaires were mailed to 1,000 individuals aged &gt;= 50 to measure these 2 factors. We examined the associations between the respondents' characteristics and their preferred care and death locations by using multinomial logistic regression models. The response rate was 74%. Home was the most frequently preferred place for end-of-life care (64%), and a palliative care unit (PCU) was the most commonly preferred place to die (51%). Living will interest was associated with a preference for care (odds ratio [OR] 4.74, 95% confidence interval [CI] 1.95-12.1) and death (OR 2.75, 95% CI 1.70-4.47) in a PCU rather than a hospital, but it was not associated with the choice between receiving care or dying at home instead of a hospital. We must consider why Japanese people think home death is impracticable. The Japanese palliative care system should be expanded to meet patients' end-of-life needs, and this includes not only facilitating home care but also increasing access to PCU care.

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  • Hourly differences in air pollution and risk of respiratory disease in the elderly: a time-stratified case-crossover study Reviewed International journal

    Takashi Yorifuji, Etsuji Suzuki, Saori Kashima

    Environmental Health   13 ( 1 )   67   2014.12

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    Background: Epidemiological studies have shown adverse effects of short-term exposure to air pollution on respiratory disease outcomes; however, few studies examined this association on an hourly time scale. We evaluated the associations between hourly changes in air pollution and the risk of respiratory disease in the elderly, using the time of the emergency call as the disease onset for each case.Methods: We used a time-stratified case-crossover design. Study participants were 6,925 residents of the city of Okayama, Japan, aged 65 or above who were taken to hospital emergency rooms between January 2006 and December 2010 for onset of respiratory disease. We calculated city-representative hourly average concentrations of air pollutants from several monitoring stations. By using conditional logistic regression models, we estimated odds ratios per interquartile-range increase in each pollutant by exposure period prior to emergency call, adjusting for hourly ambient temperature, hourly relative humidity, and weekly numbers of reported influenza cases aged >= 60.Results: Suspended particulate matter (SPM) exposure 24 to <72 hours prior to the onset and ozone exposure 48 to <96 hours prior to the onset were associated with the increased risk of respiratory disease. For example, following one interquartile-range increase, odds ratios were 1.05 (95% confidence interval: 1.01, 1.09) for SPM exposure 24 to <48 hours prior to the onset and 1.13 (95% confidence interval: 1.04, 1.23) for ozone exposure 72 to <96 hours prior to the onset. Sulfur dioxide (SO2) exposure 0 to <24 hours prior to onset was associated with the increased risk of pneumonia and influenza: odds ratio was 1.07 per one interquartile-range increase (95% confidence interval: 1.00, 1.14). Elevated risk for pneumonia and influenza of SO2 was observed at shorter lags (i.e., 8-18 hours) than the elevated risks for respiratory disease of SPM or ozone. Overall, the effect estimates for chronic obstructive pulmonary disease and allied conditions were equivocal.Conclusions: This study provides further evidence that hourly changes in air pollution exposure increase the risks of respiratory disease, and that SO2 may be related with more immediate onset of the disease than other pollutants.

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  • Asian dust and daily emergency ambulance calls among elderly people in Japan: an analysis of its double role as a direct cause and as an effect modifier Reviewed International journal

    Saori Kashima, Takashi Yorifuji, Etsuji Suzuki

    Journal of Occupational & Environmental Medicine   56 ( 12 )   1277 - 1283   2014.12

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    Objective: To evaluate the direct health effects of Asian dust on ambulance calls and its role as an effect modifier on the effects of anthropogenic air pollution in Japan. Methods: The subjects were 51,945 elderly residents who visited hospital emergency departments from 2006 to 2010. We evaluated the impact of Asian dust by time-series analyses and the excess risk from suspended particulate matter (SPM) stratified by Asian-dust exposure. Results: Asian dust was associated with daily ambulance calls due to all-cause, cardiovascular, and respiratory disease independently of SPM, for example, the relative risk per interquartile increase in Asian dust (3-day lag) was 1.021 (1.002 to 1.039) for cardiovascular disease. Furthermore, Asian dust modified the effects of SPM on cardiovascular and respiratory diseases. Conclusions: Asian dust had adverse effects and modified the effect of SPM.

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  • Outdoor air pollution and out-of-hospital cardiac arrest in Okayama, Japan Reviewed International journal

    Takashi Yorifuji, Etsuji Suzuki, Saori Kashima

    Journal of Occupational & Environmental Medicine   56 ( 10 )   1019 - 1023   2014.10

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    Objectives: We evaluated the association between short-term exposure to outdoor air pollution and out-of-hospital cardiac arrest in Japan. Methods: We studied 558 residents of Okayama, Japan, who visited hospital emergency departments between January 2006 and December 2010 for out-of-hospital cardiac arrest using a time-stratified case-crossover design. We calculated city-representative average concentrations of different air pollutants and examined the association between air pollution and cardiac arrest. Results: Exposure to air pollution was associated with an elevated risk of cardiac arrest; for example, odds ratios was 1.17 (95% confidence interval, 1.02 to 1.33) per interquartile-range increase in suspended particulate matter concentrations in the previous 48 to 72 hours. We also observed different susceptibilities to suspended particulate matter and ozone exposures by age category. Conclusions: Short-term exposure to outdoor air pollution was associated with increased risk of cardiac arrest.

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  • A simple example as a pedagogical device? International journal

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    Annals of Epidemiology   24 ( 7 )   560 - 561   2014.7

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    DOI: 10.1016/j.annepidem.2014.04.003

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  • Further refinements to the organizational schema for causal effects International journal

    Etsuji Suzuki, Eiji Yamamoto

    Epidemiology   25 ( 4 )   618 - 619   2014.7

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    DOI: 10.1097/ede.0000000000000114

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  • Cardiovascular emergency hospital visits and hourly changes in air pollution Reviewed International journal

    Takashi Yorifuji, Etsuji Suzuki, Saori Kashima

    Stroke   45 ( 5 )   1264 - 1268   2014.5

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    Background and Purpose Few studies have examined the effect of hourly changes in air pollution on cardiovascular disease morbidity. We evaluated the associations between hourly changes in air pollution and the risks of several types of cardiovascular disease.Methods We used a time-stratified case-crossover design. Study participants were 10 949 residents of the city of Okayama, Japan, aged 65 years who were taken to hospital emergency rooms between January 2006 and December 2010 for onset of cardiovascular disease. We calculated city representative hourly average concentrations of air pollutants from several monitoring stations and examined the associations between air pollution exposure before the case event, focusing mainly on suspended particulate matter, and disease onset.Results Suspended particulate matter exposure 0 to <6 hours before the case events was associated with risks of onset of cardiovascular and cerebrovascular disease; odds ratios after 1 interquartile range increase in suspended particulate matter exposure were 1.04 (95% confidence interval, 1.01-1.06) for cardiovascular disease and 1.04 (95% confidence interval, 1.00-1.08) for cerebrovascular disease. We observed an elevated risk of hemorrhagic as well as ischemic stroke, but the risk was slightly higher for hemorrhagic stroke, and this elevation was persistent. Women tended to have higher effect estimates.Conclusions This study provides further evidence that particulate matter exposure increases the risks of onset of cardiovascular and cerebrovascular disease (including hemorrhagic stroke) shortly after exposure.

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  • Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community? Reviewed International journal

    Masayuki Noguchi, Toshihide Iwase, Etsuji Suzuki, Yoko Kishimoto, Soshi Takao

    Social Psychiatry and Psychiatric Epidemiology   49 ( 4 )   619 - 627   2014.4

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    Aims Social support has consistently been reported to be effective in reducing suicidal ideation. This cross-sectional study was performed to determine whether home visits by commissioned welfare volunteers (i.e., organizations of community residents appointed by national or prefectural governments) are associated with a lower risk of suicidal ideation among the elderly.Methods In August 2010, questionnaires were sent to all residents aged >= 65 years in three municipalities (n = 21,232) in Okayama prefecture, Japan, and 13,929 returned the questionnaire (response rate: 65.6 %). We finally analyzed 11,218 subjects. Both home visits by commissioned welfare volunteers and suicidal ideation within the last 30 days were assessed in the questionnaire. Odds ratios (ORs) and 95 % confidence intervals (CIs) for suicidal ideation were calculated adjusting for age, sex, educational attainment, and marital status. We then additionally adjusted for instrumental and emotional support, separately.Results The prevalence of suicidal ideation was 10.0 % and higher in women than in men (11.4 % vs. 8.0 %). Home visits were significantly associated with a lower risk of suicidal ideation after adjusting for instrumental and emotional support, respectively (OR: 0.60, 95 % CI: 0.53-0.69; OR: 0.67, 95 % CI: 0.59-0.78). In sex-stratified analysis, the association was clearer for women than for men: the corresponding ORs among women were 0.55 (95 % CI: 0.46-0.65) and 0.61 (95 % CI: 0.52-0.73), whereas they were 0.71 (95 % CI: 0.56-0.90) and 0.78 (95 % CI: 0.61-0.99) among men.Conclusion Our findings suggest that home visits by commissioned welfare volunteers are significantly associated with lower suicidal ideation among the elderly, particularly in women.

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  • Trends in geographic distribution of nursing staff in Japan from 2000 to 2010: a multilevel analysis Reviewed International journal

    Masato Izutsu, Etsuji Suzuki, Yukako Izutsu, Hiroyuki Doi

    Acta Medica Okayama   68 ( 2 )   101 - 110   2014.4

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    The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types: public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PUN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased; the RRs per 1-year increment were 1.022 (95% CI: 1.020-1.023), 1.021 (95% CI: 1.019-1.022), and 1.037 (95% CI: 1.037-1.038), respectively. In contrast, AN significantly decreased; the RR per 1-year increment was 0.993 (95% CI: 0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.

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  • Socioeconomic status, health behavior, and mortality: old question plus modern methods equals new insights? Invited International coauthorship International journal

    Basile Chaix, David Evans, Etsuji Suzuki

    Epidemiology   25 ( 2 )   178 - 181   2014.3

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  • Alternative Definitions of “Proportion Eliminated” Reviewed International journal

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    Epidemiology   25 ( 2 )   308 - 309   2014.3

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  • On the “Proportion Eliminated” for Risk Differences Versus Excess Relative Risks Reviewed International coauthorship International journal

    Etsuji Suzuki, David Evans, Basile Chaix, Tyler J. VanderWeele

    Epidemiology   25 ( 2 )   309 - 310   2014.3

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  • The bright side and dark side of workplace social capital: opposing effects of gender on overweight among Japanese employees Reviewed International coauthorship International journal

    Tomoko Kobayashi, Etsuji Suzuki, Tuula Oksanen, Ichiro Kawachi, Soshi Takao

    PLoS ONE   9 ( 1 )   e88084   2014.1

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    Background: A growing number of studies have sought to examine the health associations of workplace social capital; however, evidence of associations with overweight is sparse. We examined the association between individual perceptions of workplace social capital and overweight among Japanese male and female employees.Methodology/Principal Findings: We conducted a cross-sectional survey among full-time employees at a company in Osaka prefecture in February 2012. We used an 8-item measure to assess overall and sub-dimensions of workplace social capital, divided into tertiles. Of 1050 employees, 849 responded, and 750 (624 men and 126 women) could be linked to annual health check-up data in the analysis. Binomial logistic regression models were used to calculate odds ratios and 95% confidence intervals for overweight (body mass index: >= 25 kg/m(2), calculated from measured weight and height) separately for men and women. The prevalence of overweight was 24.5% among men and 14.3% among women. Among men, low levels of bonding and linking social capital in the workplace were associated with a nearly 2-fold risk of overweight compared to high corresponding dimensions of social capital when adjusted for age, sleep hours, physiological distress, and lifestyle. In contrast, among women we found lower overall and linking social capital to be associated with lower odds for overweight even after covariate adjustment. Subsequently, we used multinomial logistic regression analyses to assess the relationships between a 1 standard deviation (SD) decrease in mean social capital and odds of underweight/overweight relative to normal weight. Among men, a 1-SD decrease in overall, bonding, and linking social capital was significantly associated with higher odds of overweight, but not with underweight. Among women, no significant associations were found for either overweight or underweight.Conclusions/Significance: We found opposite gender relationships between perceived low linking workplace social capital and overweight among Japanese employees.

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  • ASV treatment for sleep-disordered breathing with heart failure: an application in a home care setting Reviewed

    Yamazaki K, Fujii M, Fujii M, Tsuda T, Suzuki E

    Nihon Puraimari Kea Rengō Gakkai shi   37 ( 4 )   342 - 345   2014

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    Introduction : We report the effect of adaptive servo ventilation (ASV) treatment on heart failure in a home care setting.<br>Methods : For eight home care patients aged ≥75 with heart failure, we diagnosed sleep-disordered breathing (SDB) by using a simplified monitor and implemented ASV treatment. We assessed its effect on heart failure by using NT-proBNP. We also assessed its effects on SDB by using apnea hypopnea index (AHI).<br>Results : Three patients dropped out because they felt fear of putting on the mask. Among the other five patients, we observed a significant decrease rate of NT-proBNP (mean : -0.43, 95% confidence interval (CI) : -0.64, -0.22) after the ASV treatment. With regard to AHI, we observed a decreasing tendency (mean : -20.4 /hour, 95% CI : -41.2/hour, 0.4/hour).<br>Conclusion : This study suggests that ASV treatment is effective for a treatment of heart failure in a home care setting.

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  • Group involvement and self-rated health among the Japanese elderly: an examination of bonding and bridging social capital Reviewed International journal

    Yoko Kishimoto, Etsuji Suzuki, Toshihide Iwase, Hiroyuki Doi, Soshi Takao

    BMC Public Health   13 ( 1 )   1189   2013.12

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    Background: To date, only a small amount of research on bonding/bridging social capital has separately examined their effects on health though they have been thought to have differential effects on health outcomes. By using a large population-based sample of elderly Japanese people, we sought to investigate the association between bonding and bridging social capital and self-rated health for men and women separately.Methods: In August 2010, questionnaires were sent to all residents aged >= 65 years in three municipalities in Okayama prefecture (n = 21232), and 13929 questionnaires were returned (response rate: 65.6%). Social capital was measured from survey responses to questions on participation in six different types of groups: a) the elderly club or sports/hobby/culture circle; b) alumni association; c) political campaign club; d) citizen's group or environmental preservation activity; e) community association; and f) religious organization. Participant perception of group homogeneity (gender, age, and previous occupation) was used to divide social capital into bonding or bridging. Odds ratios (ORs) and 95% confidence intervals (CIs) for poor self-rated health were calculated.Results: A total of 11146 subjects (4441 men and 6705 women) were available for the analysis. Among men, bonding and bridging social capital were inversely associated with poor self-rated health (high bonding social capital; OR: 0.55, 95% CI: 0.31-0.99; high bridging social capital; OR: 0.62, 95% CI: 0.48-0.81) after adjusting for age, educational attainment, smoking status, frequency of alcohol consumption, overweight, living arrangements, and type-D personality. The beneficial effect among women was more likely limited to bonding social capital (high bonding social capital; OR: 0.34, 95% CI: 0.12-1.00), and the association between bridging social capital and self-rated health was less clear (high bridging social capital; OR: 0.69, 95% CI: 0.44-1.07).Conclusions: Bonding/bridging social capital could have differential associations with self-rated health among the Japanese elderly depending on the individual's sex. Considering the lack of consensus on how to measure bonding and bridging social capital, however, we need to carefully assess the generalizability of our findings. Further research is warranted to identify health-relevant dimensions of social capital in different cultural or economic settings.

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  • A counterfactual approach to bias and effect modification in terms of response types Reviewed International journal

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    BMC Medical Research Methodology   13 ( 1 )   101   2013.12

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    Background: The counterfactual approach provides a clear and coherent framework to think about a variety of important concepts related to causation. Meanwhile, directed acyclic graphs have been used as causal diagrams in epidemiologic research to visually summarize hypothetical relations among variables of interest, providing a clear understanding of underlying causal structures of bias and effect modification. In this study, the authors aim to further clarify the concepts of bias (confounding bias and selection bias) and effect modification in the counterfactual framework.Methods: The authors show how theoretical data frequencies can be described by using unobservable response types both in observational studies and in randomized controlled trials. By using the descriptions of data frequencies, the authors show epidemiologic measures in terms of response types, demonstrating significant distinctions between association measures and effect measures. These descriptions also demonstrate sufficient conditions to estimate effect measures in observational studies. To illustrate the ideas, the authors show how directed acyclic graphs can be extended by integrating response types and observed variables.Results: This study shows a hitherto unrecognized sufficient condition to estimate effect measures in observational studies by adjusting for confounding bias. The present findings would provide a further understanding of the assumption of conditional exchangeability, clarifying the link between the assumptions for making causal inferences in observational studies and the counterfactual approach. The extension of directed acyclic graphs using response types maintains the integrity of the original directed acyclic graphs, which allows one to understand the underlying causal structure discussed in this study.Conclusions: The present findings highlight that analytic adjustment for confounders in observational studies has consequences quite different from those of physical control in randomized controlled trials. In particular, the present findings would be of great use when demonstrating the inherent distinctions between observational studies and randomized controlled trials.

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  • Type D personality is associated with psychological distress and poor self-rated health among the elderly: a population-based study in Japan Reviewed International journal

    Yosuke Kasai, Etsuji Suzuki, Toshihide Iwase, Hiroyuki Doi, Soshi Takao

    PLoS ONE   8 ( 10 )   e77918 - e77918   2013.10

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    We investigated the association between Type D personality, psychological distress, and self-ratings of poor health in elderly Japanese people. In August 2010, questionnaires were sent to all residents aged >= 65 in three municipalities (n = 21232) in Okayama Prefecture, Japan, and. 13929 questionnaires were returned (response rate: 65.6%). To assess mental and physical health outcomes, we used the Kessler Psychological Distress Scale and a single item question regarding perceived general health. We analyzed 9759 questionnaires to determine odds ratios (ORs) and 95% confidence intervals (CIs) for several health outcomes, adjusting for sex, age, smoking status, frequency of alcohol consumption, overweight status, educational attainment, socioeconomic status, and number of cohabiters. The multiple imputation method was employed for missing data regarding Type D personality. The prevalence of Type D personality in our sample was 46.2%. After adjusting for covariates, we found that participants with Type D personality were at 4-5 times the risk of psychological distress, and twice the risk of poor self-rated health. This association was stronger in participants aged 65-74 years (psychological distress; OR: 5.80, 95% CI: 4.96-6.78, poor self-rated health; OR: 2.84, 95% CI: 2.38-3.38) than in those aged over 75 years (psychological distress; OR: 4.54, 95% CI: 3.96-5.19, poor self-rated health; OR: 2.05, 95% CI: 1.79-2.34). Type D personality is associated with adverse health status among Japanese elderly people in terms of mental and physical risk; therefore, further research into the implications of this personality type is warranted.

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  • Workplace determinants of social capital: cross-sectional and longitudinal evidence from a Finnish cohort study Reviewed International coauthorship International journal

    Tuula Oksanen, Ichiro Kawachi, Anne Kouvonen, Soshi Takao, Etsuji Suzuki, Marianna Virtanen, Jaana Pentti, Mika Kivimäki, Jussi Vahtera

    PLoS ONE   8 ( 6 )   e65846   2013.6

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    Objective:To examine which contextual features of the workplace are associated with social capital.Methods:This is a cohort study of 43,167 employees in 3090 Finnish public sector workplaces who responded to a survey of individual workplace social capital in 2000-02 (response rate 68%). We used ecometrics approach to estimate social capital of work units. Features of the workplace were work unit's demographic and employment patterns and size, obtained from employers' administrative records. We used multilevel-multinomial logistic regression models to examine cross-sectionally whether these features were associated with social capital between individuals and work units. Fixed effects models were used for longitudinal analyses in a subsample of 12,108 individuals to examine the effects of changes in workplace characteristics on changes in social capital between 2000 and 2004.Results:After adjustment for individual characteristics, an increase in work unit size reduced the odds of high levels of individual workplace social capital (odds ratio 0.94, 95% confidence interval 0.91-0.98 per 30-person-year increase). A 20% increase in the proportion of manual and male employees reduced the odds of high levels of social capital by 8% and 23%, respectively. A 30% increase in temporary employees and a 20% increase in employee turnover were associated with 11% (95% confidence interval 1.04-1.17) and 24% (95% confidence interval 1.18-1.30) higher odds of having high levels of social capital respectively). Results from fixed effects models within individuals, adjusted for time-varying covariates, and from social capital of the work units yielded consistent results.Conclusions:These findings suggest that workplace social capital is contextually patterned. Workplace demographic and employment patterns as well as the size of the work unit are important in understanding variations in workplace social capital between individuals and workplaces. © 2013 Oksanen et al.

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  • Social and geographical inequalities in suicide in Japan from 1975 through 2005: a census-based longitudinal analysis Reviewed International coauthorship International journal

    Etsuji Suzuki, Saori Kashima, Ichiro Kawachi, S. V. Subramanian

    American Journal of Epidemiology   177 ( Suppl 11 )   S30 - S30   2013.6

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  • Social and geographical inequalities in suicide in Japan from 1975 through 2005: a census-based longitudinal analysis Reviewed International coauthorship International journal

    Etsuji Suzuki, Saori Kashima, Ichiro Kawachi, S. V. Subramanian

    PLoS ONE   8 ( 5 )   e63443 - e63443   2013.5

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    Background: Despite advances in our understanding of the countercyclical association between economic contraction and suicide, less is known about the levels of and changes in inequalities in suicide. The authors examined social and geographical inequalities in suicide in Japan from 1975 through 2005.Methods: Based on quinquennial vital statistics and census data, the authors analyzed the entire population aged 25-64 years. The total number of suicides was 75,840 men and 30,487 women. For each sex, the authors estimated odds ratios (ORs) and 95% credible intervals (CIs) for suicide using multilevel logistic regression models with "cells'' (cross-tabulated by age and occupation) at level 1, seven different years at level 2, and 47 prefectures at level 3. Prefecture-level variance was used as an estimate of geographical inequalities in suicide.Results: Adjusting for age and time-trends, the lowest odds for suicide was observed among production process and related workers (the reference group) in both sexes. The highest OR for men was 2.52 (95% CI: 2.43, 2.61) among service workers, whereas the highest OR for women was 9.24 (95% CI: 7.03, 12.13) among security workers. The degree of occupational inequalities increased among men with a striking change in the pattern. Among women, we observed a steady decline in suicide risk across all occupations, except for administrative and managerial workers and transport and communication workers. After adjusting for individual age, occupation, and time-trends, prefecture-specific ORs ranged from 0.76 (Nara Prefecture) to 1.36 (Akita Prefecture) for men and from 0.79 (Kanagawa Prefecture) to 1.22 (Akita Prefecture) for women. Geographical inequalities have increased primarily among men since 1995.Conclusions: The present findings demonstrate a striking temporal change in the pattern of social inequalities in suicide among men. Further, geographical inequalities in suicide have considerably increased across 47 prefectures, primarily among men, since 1995.

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  • Individual-level social capital and self-rated health in Japan: An application of the Resource Generator Reviewed International coauthorship International journal

    Tomoko Kobayashi, Ichiro Kawachi, Toshihide Iwase, Etsuji Suzuki, Soshi Takao

    Social Science & Medicine   85   32 - 37   2013.5

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    Despite accumulating evidence of associations between social capital and health in public health research, a criticism of the field has been that researchers have exclusively focused on concepts of social cohesion to the exclusion of individual-level approaches. In the present study, we evaluated the association between social capital measured by the Resource Generator (an individual-level assessment of access to social capital) and self-rated health among Japanese population in a cross-sectional study. A postal survey of 4000 randomly selected residents in Okayama City (western Japan) was conducted in February 2009. We divided the overall scores from the Resource Generator Japan scale into quartiles. Odds ratios (ORs) and 95% confidence intervals (CIs) for self-rated health were calculated separately by sex. Individuals with the highest quartile of scores had significantly lower odds of poor health compared to the lowest group after covariate adjustment among both men and women (men; OR: 0.45, 95% CI: 0.24-0.86, women; OR: 0.44, 95% CI: 0.25-0.79, respectively) and there were also significant dose-response relationships. In the sub-domains of Resource Generator Japan scale, a differential pattern was observed by sex. Women showed a clear dose response relationship with health across all four sub-scales (domestic resources, expert advice, personal skills, and problem solving resources). In contrast, only the domain of expert advice exhibited a strong association with men's health. Among both men and women individual-level social capital measured by the Resource Generator was related to reduced odds of poor health even after taking into account individual confounders. Although we cannot exclude reverse causation due to the cross-sectional design, our study adds to the accumulating evidence of the potential utility of the Resource Generator for evaluating the relationship between individual-level access to social capital and health. (C) 2013 Elsevier Ltd. All rights reserved.

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  • Shift work and diabetes mellitus among male workers in Japan: does the intensity of shift work matter? Reviewed International journal

    Katsuhiko Ika, Etsuji Suzuki, Toshiharu Mitsuhashi, Soshi Takao, Hiroyuki Doi

    Acta Medica Okayama   67 ( 1 )   25 - 33   2013.2

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    The purpose of this study was to examine the association between shift work and diabetes mellitus by separating shift workers according to the intensity of their shift work (seasonal shift work and continuous shift work). Between May and October 2009, we collected data from annual health checkups and questionnaires at a manufacturing company in Shizuoka, Japan. Questionnaires were returned by 1,601 workers (response rate: 96.2%, men/women = 1,314/287). Diabetes mellitus was defined as hemoglobin Alc &gt;= 6.5% and fasting blood sugar &gt;= 126 mg/dl. After exclusions, which included all the women and clerical workers because they did not work in shifts, we analyzed 475 skilled male workers. After adjusting for age, smoking status, frequency of alcohol consumption, and cohabitation status, odds ratios for diabetes mellitus were 0.98 (95% confidence interval [CI]: 0.28-4.81) and 2.10 (95% CI: 0.77-5.71) among seasonal shift workers and continuous shift workers, respectively, compared with non-shift workers. In an age-stratified analysis (&lt; 45 years vs. &gt;= 45 years), the association between continuous shift work and diabetes mellitus was more pronounced among older participants. Compared with non-shift workers, the risk of diabetes mellitus was increased among continuous shift workers, whereas its effect is limited among seasonal shift workers.

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  • Progression-free survival and overall survival in phase III trials of molecular-targeted agents in advanced non-small-cell lung cancer Reviewed International coauthorship International journal

    Katsuyuki Hotta, Etsuji Suzuki, Massimo Di Maio, Paolo Chiodini, Yoshiro Fujiwara, Nagio Takigawa, Eiki Ichihara, Martin Reck, Christian Manegold, Lothar Pilz, Akiko Hisamoto-Sato, Masahiro Tabata, Mitsune Tanimoto, Frances A. Shepherd, Katsuyuki Kiura

    Lung Cancer   79 ( 1 )   20 - 26   2013.1

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    Background: We examined how crossover therapy might affect the association between progression-free survival (PFS) and overall survival (OS) in non-small cell lung cancer (NSCLC).Methods: We extracted PFS- and OS-hazard ratios (HRs) in phase III trials of molecular-targeted agents for advanced NSCLC. Their relationship was modeled in a linear function with the coefficient of determination (R-squared) to assess the correlation between PFS and OS.Results: Thirty-four trials with 35 pairs for the investigational and reference arms were identified (24,158 patients). Overall, there was little correlation between PFS- and OS-HRs (R-squared = 0.14), suggesting PFS-HR could account only for 14% of variation in OS-HR The median proportion of crossover therapy per trial was 20%. If patients seldom crossed over (none or <1%), the association between PFS- and OS-HRs was strong (R-squared = 0.69). When the proportion of crossover was >= 1%, however, R-squared declined considerably (>= 1% to <20% crossover, R-squared = 0.27; >= 20% to <40%, R-squared = 0.06; and >= 40%, R-squared = 0.27).Conclusions: A PFS advantage seldom is associated with an OS advantage any longer. Our analysis suggests this is due to a high level of crossover now that an increasing number of active agents are available for NSCLC. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

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  • Clarifying the use of aggregated exposures in multilevel models: self-included vs. self-excluded measures Reviewed International coauthorship International journal

    Etsuji Suzuki, Eiji Yamamoto, Soshi Takao, Ichiro Kawachi, S. V. Subramanian

    PLoS ONE   7 ( 12 )   e51717 - e51717   2012.12

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    Background: Multilevel analyses are ideally suited to assess the effects of ecological (higher level) and individual (lower level) exposure variables simultaneously. In applying such analyses to measures of ecologies in epidemiological studies, individual variables are usually aggregated into the higher level unit. Typically, the aggregated measure includes responses of every individual belonging to that group (i.e. it constitutes a self-included measure). More recently, researchers have developed an aggregate measure which excludes the response of the individual to whom the aggregate measure is linked (i.e. a self-excluded measure). In this study, we clarify the substantive and technical properties of these two measures when they are used as exposures in multilevel models.Methods: Although the differences between the two aggregated measures are mathematically subtle, distinguishing between them is important in terms of the specific scientific questions to be addressed. We then show how these measures can be used in two distinct types of multilevel models-self-included model and self-excluded model-and interpret the parameters in each model by imposing hypothetical interventions. The concept is tested on empirical data of workplace social capital and employees' systolic blood pressure.Results: Researchers assume group-level interventions when using a self-included model, and individual-level interventions when using a self-excluded model. Analytical re-parameterizations of these two models highlight their differences in parameter interpretation. Cluster-mean centered self-included models enable researchers to decompose the collective effect into its within-and between-group components. The benefit of cluster-mean centering procedure is further discussed in terms of hypothetical interventions.Conclusions: When investigating the potential roles of aggregated variables, researchers should carefully explore which type of model-self-included or self-excluded-is suitable for a given situation, particularly when group sizes are relatively small.

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  • Long working hours and metabolic syndrome among Japanese men: a cross-sectional study Reviewed International journal

    Tomoko Kobayashi, Etsuji Suzuki, Soshi Takao, Hiroyuki Doi

    BMC Public Health   12 ( 1 )   395   2012.12

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    Background: The link between long working hours and health has been extensively studied for decades. Despite global concern regarding metabolic syndrome, however, no studies to date have solely evaluated the relationship between long working hours and that syndrome. We therefore examined the association between long working hours and metabolic syndrome in a cross-sectional study.Methods: Between May and October 2009, we collected data from annual health checkups and questionnaires from employees at a manufacturing company in Shizuoka, Japan. Questionnaires were returned by 1,601 workers (response rate: 96.2%; 1,314 men, 287 women). After exclusions, including women because of a lack of overtime work, the analysis was performed for 933 men. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for metabolic syndrome. Further, we conducted a stratified analysis by age-group (<40 years vs. >= 40 years).Results: Metabolic syndrome was identified in 110 workers (11.8%). We observed a positive association between working hours and metabolic syndrome after adjusting for age, occupation, shift work, smoking status, frequency of alcohol consumption, and cohabiting status. Compared with subjects who worked 7-8 h/day, multivariate ORs for metabolic syndrome were 1.66 (95% CI, 0.91-3.01), 1.48 (95% CI, 0.75-2.90), and 2.32 (95% CI, 1.04-5.16) for those working 8-9 h/day, 9-10 h/day, and >10 h/day, respectively. Similar patterns were obtained when we excluded shift workers from the analysis. In age-stratified analysis, the corresponding ORs among workers aged >= 40 years were 2.02 (95% CI, 1.04-3.90), 1.21 (95% CI, 0.53-2.77), and 3.14 (95% CI, 1.24-7.95). In contrast, no clear association was found among workers aged <40 years.Conclusions: The present study suggests that 10 h/day may be a trigger level of working hours for increased risk of metabolic syndrome among Japanese male workers.

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  • Time changes, so do people Invited International journal

    Etsuji Suzuki

    Social Science & Medicine   75 ( 3 )   452 - 456   2012.8

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    When one discusses the dynamic changes in human health over time, one innately conceptualizes time from the three different, but related perspectives - age, period, and cohort. To determine their separate contributions to health outcomes, age-period-cohort analyses have been used for the past 80 years. This commentary aims to provide some insight into this analytical method by distinguishing the concept of time in terms of composition and context. To demonstrate, the author uses hypothetical nested data structures of age-period-cohort analyses in the two types of individual-level data, i.e., repeated cross-sectional survey and longitudinal data on the same individuals. The conceptual distinctions between composition and context have profound implications of hypothetical interventions in age-period-cohort analyses. Age is a compositional variable, and a hypothetical intervention to change age is at the individual level. By contrast, both period and cohort are contexts, and thus two distinct types of hypothetical interventions can be envisaged to examine their contextual effects. On a related issue, the author also discusses manipulability of time. Although time is a significant context in biomedical science, it is not the only context. In this commentary, context is proposed to be classified into three fundamental dimensions - relational, spatial, and temporal. Inattention to the contextual triad leads to a biased and precarious knowledge base for public health action, and the continuing flow of performance over time is an intrinsic component of improving our understanding of multilevel causal inference in the new era of eco-epidemiology. (C) 2012 Elsevier Ltd. All rights reserved.

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  • Geographic inequalities in all-cause mortality in Japan: compositional or contextual? Reviewed International coauthorship International journal

    Etsuji Suzuki, Saori Kashima, Ichiro Kawachi, S. V. Subramanian

    PLoS ONE   7 ( 6 )   e39876 - e39876   2012.6

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    Background: A recent study from Japan suggested that geographic inequalities in all-cause premature adult mortality have increased since 1995 in both sexes even after adjusting for individual age and occupation in 47 prefectures. Such variations can arise from compositional effects as well as contextual effects. In this study, we sought to further examine the emerging geographic inequalities in all-cause mortality, by exploring the relative contribution of composition and context in each prefecture.Methods: We used the 2005 vital statistics and census data among those aged 25 or older. The total number of decedents was 524,785 men and 455,863 women. We estimated gender-specific two-level logistic regression to model mortality risk as a function of age, occupation, and residence in 47 prefectures. Prefecture-level variance was used as an estimate of geographic inequalities in mortality, and prefectures were ranked by odds ratios (ORs), with the reference being the grand mean of all prefectures (value = 1).Results: Overall, the degree of geographic inequalities was more pronounced when we did not account for the composition (i.e., age and occupation) in each prefecture. Even after adjusting for the composition, however, substantial differences remained in mortality risk across prefectures with ORs ranging from 0.870 (Okinawa) to 1.190 (Aomori) for men and from 0.864 (Shimane) to 1.132 (Aichi) for women. In some prefectures (e. g., Aomori), adjustment for composition showed little change in ORs, while we observed substantial attenuation in ORs in other prefectures (e. g., Akita). We also observed qualitative changes in some prefectures (e. g., Tokyo). No clear associations were observed between prefecture-level socioeconomic status variables and the risk of mortality in either sex.Conclusions: Geographic disparities in mortality across prefectures are quite substantial and cannot be fully explained by differences in population composition. The relative contribution of composition and context to health inequalities considerably vary across prefectures.

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  • Association between proximity to a health center and early childhood mortality in Madagascar Reviewed International coauthorship International journal

    Saori Kashima, Etsuji Suzuki, Toshiharu Okayasu, Razafimahatratra Jean Louis, Akira Eboshida, S. V. Subramanian

    PLoS ONE   7 ( 6 )   e38370 - e38370   2012.6

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    Objective: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance.Methods: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia.Results: Compared with those who lived >1.5-3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0-10.0 km away from a health center were 1.36 (95% CI: 0.92-2.01) and 1.42 (95% CI: 1.06-1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status.Conclusions: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better infant health.

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  • Clarifying the use of aggregated exposures in multilevel models: self-included vs. self-excluded measures Reviewed International coauthorship International journal

    Etsuji Suzuki, Eiji Yamamoto, Soshi Takao, Ichiro Kawachi, S. V. Subramanian

    American Journal of Epidemiology   175 ( Suppl 11 )   S17 - S17   2012.6

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  • Do bonding and bridging social capital have differential effects on self-rated health? A community based study in Japan Reviewed International coauthorship International journal

    Toshihide Iwase, Etsuji Suzuki, Takeo Fujiwara, Soshi Takao, Hiroyuki Doi, Ichiro Kawachi

    Journal of Epidemiology and Community Health   66 ( 6 )   557 - 562   2012.6

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    Background Few studies have examined the potential difference in the relationship between bonding versus bridging social capital and health outcomes. We sought to examine the association between these different types of social capital and self-rated health in a population-based study.Methods In February 2009, 4000 residents of Okayama City (aged 20-80 y) were randomly selected for a survey on social capital and health. The survey asked about participation in six different types of associations: Parents and Teachers Association, sports clubs, alumni associations, political campaign clubs, citizen's groups and community associations. We distinguished between bonding and bridging social capital by asking participants about their perceived homogeneity (with respect to gender, age and occupation) of the groups they belonged to. ORs and 95% CIs for poor health were calculated.Results Bridging social capital (ie, participation in groups involving people from a diversity of backgrounds) was inversely associated with poor health in both sexes and women appeared to benefit more than men. Compared to those who reported zero participation, high bridging social capital was associated with a reduced odds of poor health (OR 0.25, 95% CI 0.11 to 0.55) in women after controlling for demographic variables, socioeconomic status, smoking habit and overweight. By contrast, bonding social capital was not consistently associated with better health in either gender.Conclusions The present study suggests that bonding and bridging social capital have differential associations with health and that the two forms of social capital need to be distinguished in considering interventions to promote health.

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  • Workplace social capital and risk of chronic and severe hypertension Reviewed International coauthorship International journal

    Tuula Oksanen, Ichiro Kawachi, Markus Jokela, Anne Kouvonen, Etsuji Suzuki, Soshi Takao, Marianna Virtanen, Jaana Pentti, Jussi Vahtera, Mika Kivimäki

    Journal of Hypertension   30 ( 6 )   1129 - 1136   2012.6

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    Objective: The association between workplace factors and the development of hypertension remains uncertain. We examined the risk of hypertension as a function of workplace social capital, that is, social cohesion, trust and reciprocity in the workplace.Methods: A total of 11 777 male and 49 145 female employees free of chronic hypertension at baseline in 2000-2004 were followed up for incident hypertension until the end of 2005 (the Finnish Public Sector Study). We used survey responses from the participants and their coworkers in the same work unit to assess workplace social capital at baseline. Follow-up for incident hypertension was based on record linkage to national health registers (mean follow-up 3.5 years, 1424 incident hypertension cases).Results: Male employees in work units characterized by low workplace social capital were 40-60% more likely to develop chronic hypertension compared to men in work units with high social capital [age-adjusted hazard ratio 1.57, 95% confidence interval (CI) 1.15-2.14 for self-assessed social capital and 1.41, 95% CI 1.01-1.97 for coworkers' assessment]. According to path analysis adjusted for covariates, the association between low self-reported social capital and hypertension was partially mediated by obesity (P for pathway = 0.02) and alcohol consumption (P = 0.03). For coworker-assessed social capital, the corresponding mediation pathways did not reach statistical significance (P = 0.055 and 0.22, respectively). No association between workplace social capital and hypertension was found for women.Conclusion: These data suggest that low self-reported workplace social capital is associated with increased near-term risk of hypertension in men in part due to unhealthy lifestyle.

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  • Social capital and self-rated oral health among young people Reviewed International coauthorship International journal

    Michiko Furuta, Daisuke Ekuni, Soshi Takao, Etsuji Suzuki, Manabu Morita, Ichiro Kawachi

    Community Dentistry and Oral Epidemiology   40 ( 2 )   97 - 104   2012.4

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    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). Conclusion: 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.

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  • On the relations between excess fraction, attributable fraction, and etiologic fraction Reviewed International journal

    Etsuji Suzuki, Eiji Yamamoto, Toshihide Tsuda

    American Journal of Epidemiology   175 ( 6 )   567 - 575   2012.3

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    It has been noted that there is ambiguity in the expression "attributable fraction," and epidemiologic literature has drawn a distinction between "excess fraction" and "etiologic fraction." These quantities do not necessarily approximate one another, and the etiologic fraction is not generally estimable without strong biologic assumptions. In previous studies, researchers have explained the relations between excess and etiologic fractions in the potential-outcome framework, and few authors have explained the relations between these concepts by showing the correspondence between the potential-outcome model and the sufficient-cause model. In this article, the authors thoroughly clarify the conceptual relations between excess, attributable, and etiologic fractions by explicating the correspondence between these 2 models. In so doing, the authors take into account the potential completion time of each sufficient cause, which contributes to further insight to clarify the 2 types of etiologic fraction, i.e., accelerating etiologic proportion and total etiologic proportion. These 2 measures cannot be distinguished in epidemiologic data, and the differences might be subtle. However, they are closely related to a very fundamental issue of causal inference, that is, how researchers define etiology. Further, the authors clarify the relation between 3 distinct assumptions-positive monotonicity, no preventive action (or sufficient-cause positive monotonicity), and no preventive sequence.

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  • Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005 Reviewed International coauthorship International journal

    Etsuji Suzuki, Saori Kashima, Ichiro Kawachi, S V Subramanian

    BMJ Open   2 ( 2 )   e000425 - e000425   2012.3

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    Objectives: To examine trends in social and geographic inequalities in all-cause premature adult mortality in Japan.Design: Observational study of the vital statistics and the census data.Setting: Japan.Participants: Entire population aged 25 years or older and less than 65 years in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005. The total number of decedents was 984 022 and 532 223 in men and women, respectively.Main outcome measures: For each sex, ORs and 95% Cls for mortality were estimated by using multilevel logistic regression models with 'cells' (cross-tabulated by age and occupation) at level 1, 8 years at level 2 and 47 prefectures at level 3. The prefecture-level variance was used as an estimate of geographic inequalities of mortality.Results: Adjusting for age and time-trends, compared with production process and related workers, ORs ranged from 0.97 (95% Cl 0.96 to 0.98) among administrative and managerial workers to 2.22 (95% Cl 2.19 to 2.24) among service workers in men. By contrast, in women, the lowest odds for mortality was observed among production process and related workers (reference), while the highest OR was 12.22 (95% Cl 11.40 to 13.10) among security workers. The degree of occupational inequality increased in both sexes. Higher occupational groups did not experience reductions in mortality throughout the period and was overtaken by lower occupational groups in the early 1990s, among men. Conditional on individual age and occupation, overall geographic inequalities of mortality were relatively small in both sexes; the ORs ranged from 0.87 (Okinawa) to 1.13 (Aomori) for men and from 0.84 (Kanagawa) to 1.11 (Kagoshima) for women, even though there is a suggestion of increasing inequalities across prefectures since 1995 in both sexes.Conclusions: The present findings suggest that both social and geographic inequalities in all-cause mortality have increased in Japan during the last 3 decades.

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  • Does open-air exposure to volatile organic compounds near a plastic recycling factory cause health effects? Reviewed International journal

    Takashi Yorifuji, Miyuki Noguchi, Toshihide Tsuda, Etsuji Suzuki, Soshi Takao, Saori Kashima, Yukio Yanagisawa

    Journal of Occupational Health   54 ( 2 )   79 - 87   2012.3

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    Does Open-air Exposure to Volatile Organic Compounds near a Plastic Recycling Factory Cause Health Effects?: Takashi YORIFUJI, et al. Department of Human Ecology, Okayama University Graduate School of Environmental Sciences-Objectives: After a plastic reprocessing factory began to operate in August 2004, the residents around the factory in Neyagawa, Osaka, Japan, began to complain of symptoms. Therefore, we conducted an exposure assessment and a population-based epidemiological study in 2006. Methods: To assess exposure, volatile organic compounds (VOCs) and total VOCs were measured at two locations in the vicinity of the factory. In the population-based study, a total of 3,950 residents were targeted. A self-administered questionnaire was used to collect information about subjects' mucocutaneous or respiratory symptoms. Using logistic regression models, we compared the prevalence of symptoms in July 2006 by employing the farthest area from the factory as a reference, and prevalence odds ratios (PORs) and their 95% confidence intervals (Cis) were estimated. Results: The concentration of total VOCs was higher in the vicinity of the factory. The prevalence of mucocutaneous and respiratory symptoms was the highest among the residents in the closest area to the factory. Some symptoms were significantly increased among the residents within 500 m of the factory compared with residents of an area 2800 m from the factory: e.g., sore throat (POR=3.2, 95% CI: 1.3-8.0), eye itch (POR=3.0, 95% CI: 1.5-6.0), eye discharge (POR=6.0, 95% CI: 2.3-15.9), eczema (POR=3.0, 95% CI: 1.1-7.9) and sputum (POR=2.4, 95% CI: 1.1-5.1). Conclusions: Despite of the limitations of this study, these results imply a possible association of open-air VOCs with mucocutaneous and respiratory symptoms. Because this kind of plasticre cycling factory only recently came into operation, more attention should be paid to the operation of plastic recycling factories in the environment. (J Occup Health 2012; 54: 79-87)

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  • Maternal working hours and early childhood overweight in Japan: a population-based study Reviewed International journal

    Toshiharu Mitsuhashi, Etsuji Suzuki, Soshi Takao, Hiroyuki Doi

    Journal of Occupational Health   54 ( 1 )   25 - 33   2012.1

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    Maternal Working Hours and Early Childhood Overweight in Japan: A Population-based Study: Toshiharu MITSUHASHI, et al. Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Objectives: There has been a growing concern that maternal employment could have adverse or beneficial effects on children's health. Although recent studies demonstrated that maternal employment was associated with a higher risk of childhood overweight, the evidence remains sparse in Asian countries. We sought to examine the relationship between maternal working hours and early childhood overweight in a rural town in Okayama Prefecture. Methods: In February 2008, questionnaires were sent to parents of all preschool children aged >= 3 yr in the town to assess maternal working status (working hours and form of employment), children's body mass index, and potential confounders. Childhood overweight was defined following the age and sex-specific criteria of the International Obesity Task Force. Odds ratios (ORs) and 95% confidence intervals (CIs) for childhood overweight were estimated in a logistic regression. We used generalized estimating equations with an exchangeable correlation matrix, considering the correlation between siblings. Results: We analyzed 364 preschool children. Adjusting for each child's characteristics (age, sex), mother's characteristics (age, obesity, educational attainment, smoking status, and social participation), and family's characteristics (number of siblings), children whose mothers work <8 h/day had a substantially lower risk for being overweight (OR: 0.28, 95% CI: 0.09, 0.93) compared with children of non-working mothers, whereas the relationship was less pronounced among children whose mothers work >= 8 h/day (OR: 0.71, 95% CI: 0.19, 2.68). We observed similar patterns in a stratified analysis by the form of maternal employment. Conclusion: Short maternal working hours are associated with a lower odds of early childhood overweight. (J Occup Health 2012; 54: 25-33)

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  • Weighing up the dead and missing: reflections on inverse-probability weighting and principal stratification to address truncation by death Invited International coauthorship International journal

    Basile Chaix, David Evans, Juan Merlo, Etsuji Suzuki

    Epidemiology   23 ( 1 )   129 - 131   2012.1

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  • The usefulness of pre-radiofrequency ablation SUVmax in 18F-FDG PET/CT to predict the risk of a local recurrence of malignant lung tumors after lung radiofrequency ablation Reviewed International journal

    Sosuke Harada, Shuhei Sato, Etsuji Suzuki, Yoshihiro Okumura, Takao Hiraki, Hideo Gobara, Hidefumi Mimura, Susumu Kanazawa, Mitsumasa Kaji, Toshiyoshi Fujiwara

    Acta Medica Okayama   65 ( 6 )   395 - 402   2011.12

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    The aim of the present study was to assess the diagnostic usefulness of Fluorine-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography/computed tomography (PET/CT) in the prediction of local recurrence of malignant lung tumors by analyzing the pre-radiofrequency ablation (RFA) maximal standardized uptake value (SUVmax). We performed a historical cohort study of consecutive malignant lung tumors treated by RFA from January 2007 to May 2008 at Okayama University Hospital. We selected only lung tumors examined by PET/CT within 90 days before RFA and divided them (10 primary and 29 metastatic) into 3 groups according to their tertiles of SUVmax. We calculated recurrence odds ratios in the medium group and the high group compared to the low group using multivariate logistic analysis. After we examined the relationship between SUVmax and recurrence in a crude model, we adjusted for some factors. Tumors with higher SUVmax showed higher recurrence odds ratios (medium group; 1.84, high group; 4.14, respectively). The tumor size also increased the recurrence odds ratio (2.67); we thought this was mainly due to selection bias because we excluded tumors less than 10 mm in diameter. This study demonstrated the pre-RFA SUVmax in PET/CT may be a prognostic factor for local recurrence of malignant lung tumors.

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  • Workplace Social Capital and Adherence to Antihypertensive Medication: A Cohort Study Reviewed International coauthorship International journal

    Tuula Oksanen, Ichiro Kawachi, Anne Kouvonen, Etsuji Suzuki, Soshi Takao, Noora Sjösten, Marianna Virtanen, Jaana Pentti, Jussi Vahtera, Mika Kivimäki

    PLoS ONE   6 ( 9 )   e24732 - e24732   2011.9

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    Background: While hypertension is a common and treatable health problem, adherence to antihypertensive medication remains a challenge. This study examines the hypothesis that workplace social capital may influence adherence to antihypertensive medication among hypertensive employees.Methodology/Principal Findings: We linked survey responses to nationwide pharmacy records for a cohort of 3515 hypertensive employees (mean age 53.9 years, 76% women) who required continuous antihypertensive drug therapy (the Finnish Public Sector study). A standard scale was used to measure workplace social capital from co-workers' assessments and self-reports in 2000-2004. Non-adherence to antihypertensive medication was determined based on the number of days-not-treated at the year following the survey using comprehensive prescription records. Negative binomial regression models were conducted adjusting for socio-demographic characteristics, duration of hypertension, behaviour-related risk factors, and co-morbid conditions. The overall rate of days-not-treated was 20.7 per person-year (78% had no days-not-treated). Higher age, obesity, and presence of somatic co-morbidities were all associated with better adherence, but this was not the case for co-worker-assessed or self-reported workplace social capital. The rate of days-not-treated was 19.7 per person-year in the bottom fourth of co-worker-assessed workplace social capital, compared to 20.4 in the top fourth. The corresponding rate ratio from the fully-adjusted model was 0.95 (95% confidence interval (CI) 0.58-1.56). In a subgroup of 907 new users of antihypertensive medication this rate ratio was 0.98 (95% CI 0.42-2.29).Conclusions/Significance: We found no consistent evidence to support the hypothesized effect of workplace social capital on adherence to drug therapy among employees with chronic hypertension.

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  • Workplace Social Capital and All-Cause Mortality: A Prospective Cohort Study of 28 043 Public-Sector Employees in Finland Reviewed International coauthorship International journal

    Tuula Oksanen, Mika Kivimäki, Ichiro Kawachi, S. V. Subramanian, Soshi Takao, Etsuji Suzuki, Anne Kouvonen, Jaana Pentti, Paula Salo, Marianna Virtanen, Jussi Vahtera

    American Journal of Public Health   101 ( 9 )   1742 - 1748   2011.9

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    Objectives. We examined the association between workplace social capital and all-cause mortality in a large occupational cohort from Finland.Methods. We linked responses of 28043 participants to surveys in 2000 to 2002 and in 2004 to national mortality registers through 2009. We used repeated measurements of self- and coworker-assessed social capital. We carried out Cox proportional hazard and fixed-effects logistic regressions.Results. During the 5-year follow-up, 196 employees died. A 1-unit increase in the mean of repeat measurements of self-assessed workplace social capital (range 1-5) was associated with a 19% decrease in the risk of all-cause mortality (age- and gender-adjusted hazard ratio [HR]=0.81; 95% confidence interval [CI) =0.66, 0.99). The corresponding point estimate for the mean of coworker-assessed social capital was similar, although the association was less precisely estimated (age- and gender-adjusted HR=0.77; 95% CI=0.50, 1.20). In fixed-effects analysis, a 1-unit increase in self-assessed social capital across the 2 time points was associated with a lower mortality risk (odds ratio=0.81; 95% CI=0.55, 1.19).Conclusions. Workplace social capital appears to be associated with lowered mortality in the working-aged population. (Am J Public Health. 2011;101: 1742-1748. doi:10.2105/AJPH.2011.300166)

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  • On the link between sufficient-cause model and potential-outcome model Reviewed International journal

    Etsuji Suzuki, Eiji Yamamoto, Toshihide Tsuda

    American Journal of Epidemiology   173 ( Suppl 11 )   S271 - S271   2011.6

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  • Identification of operating mediation and mechanism in the sufficient-component cause framework Reviewed International journal

    Etsuji Suzuki, Eiji Yamamoto, Toshihide Tsuda

    American Journal of Epidemiology   173 ( Suppl 11 )   S184 - S184   2011.6

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  • Identification of operating mediation and mechanism in the sufficient-component cause framework Reviewed International journal

    Etsuji Suzuki, Eiji Yamamoto, Toshihide Tsuda

    European Journal of Epidemiology   26 ( 5 )   347 - 357   2011.5

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    The assessment of mediation and mechanism is one way to more deeply explore cause-effect relationships, providing a stronger test and explanation of the observed associations. Most previous studies have described direct and indirect effects in terms of potential outcomes and response types, exploring mediation analysis in the counterfactual (= potential-outcome) framework. A recent paper by Hafeman (Eur J Epidemiol 23(11):711-721, 2008) provided a conceptual description of mediation in the sufficient-component cause framework, and VanderWeele (Eur J Epidemiol 24(5):217-224, 2009) explored the distinctions and relationships between the concepts of mediation and mechanism. This study builds on this prior work and demonstrates that further insight can be given by elucidating the concepts of mediation and mechanism in the sufficient-component cause framework, distinguishing their operation from presence. The careful consideration of the concepts of mediation and mechanism can clarify the relationship between them. Then, the present article describes how investigators can identify mediation as well as mechanism by showing their correspondence with direct and indirect effects in the counterfactual framework. This study also demonstrates how a researcher can decompose the total effect into the effect due to mediated paths and the effect due to non-mediated paths in terms of the probabilities of background factors of sufficient causes.

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  • Environmental factors and seasonal influenza onset in Okayama city, Japan: case-crossover study Reviewed International journal

    Yuuki Tsuchihashi, Takashi Yorifuji, Soshi Takao, Etsuji Suzuki, Shigeru Mori, Hiroyuki Doi, Toshihide Tsuda

    Acta Medica Okayama   65 ( 2 )   97 - 103   2011.4

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    Seasonal influenza infection is a major challenge in public health. The term "seasonal influenza" refers to the typical increase in the number of influenza patients in the winter season in temperature zones. However, it is not clear how environmental factors within a single flu season affect influenza infection in a human population. Therefore, we evaluated the effects of temperature and humidity in the 2006-7 flu season on the onset of seasonal influenza using a case-crossover study. We targeted patients who attended one pediatric clinic in Okayama city, Japan and who were diagnosed as being infected with the seasonal influenza virus. Using 2 references (time-stratified and symmetric bidirectional design), we estimated the effects of average temperature and relative humidity from the onset day (lag0) to 10 days before (lag10). The total number of subjects was 419, and their onset days ranged from 26 December 2006 to 30 April 2007. While the onset was significantly associated with lower temperature, relative humidity was not related. In particular, temperatures before the 3-day incubation period had higher-magnitude odds ratios. For example, the odds ratio and 95% confidence interval for average temperature at time lag 8 was 1.12 (1.08-1.17) per 1.0 degrees C decrease. Low environmental temperature significantly increased the risk of seasonal influenza onset within the 2006-7 winter season.

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  • Outbreak of Salmonella Braenderup infection originating in boxed lunches in Japan in 2008 Reviewed International journal

    Yoshinori Mizoguchi, Etsuji Suzuki, Hiroaki Tsuchida, Toshihide Tsuda, Eiji Yamamoto, Katsumi Nakase, Hiroyuki Doi

    Acta Medica Okayama   65 ( 2 )   63 - 69   2011.4

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    There have been only 2 reports of a large-scale foodborne outbreak arising from Salmonella enterica serotype Braenderup infection worldwide. On August 9, 2008, an outbreak originating in boxed lunches occurred in Okayama, Japan. We conducted a cohort study of 786 people who received boxed lunches from a particular catering company and collected 644 questionnaires (response rate: 82%). Cases were defined as those presenting with diarrhea (&gt;= 4 times in 24h) or fever (&gt;= 38 degrees C) between 12 am on August 8 and 12 am on August 14. We identified 176 cases (women/men: 39/137); younger children (aged &lt; 10 years) appeared to more frequently suffer severe symptoms. Three food items were significantly associated with higher risk of illness; tamagotoji (soft egg with mixed vegetables and meat) (relative risk (RR): 11.74, 95% confidence interval (CI): 2.98-46.24), pork cooked in soy sauce (RR: 3.17, 95% CI: 1.24-8.10), and vinegared food (RR: 4.13, 95% CI: 1.60-10.63). Among them, only the RR of tamagotoji was higher when we employed a stricter case definition. Salmonella Braenderup was isolated from 5 of 9 sampled cases and 6 food handlers. It is likely that unpasteurized liquid eggs contaminated by Salmonella Braenderup and used in tamagotoji caused this outbreak.

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  • The local efficacy of I-131 for F-18 FDG PET positive lesions in patients with recurrent or metastatic thyroid carcinomas Reviewed International journal

    Kotaro Yoshio, Shuhei Sato, Yoshihiro Okumura, Kuniaki Katsui, Mitsuhiro Takemoto, Etsuji Suzuki, Norihisa Katayama, Mitsumasa Kaji, Susumu Kanazawa

    Clinical Nuclear Medicine   36 ( 2 )   113 - 117   2011.2

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    Purpose: The aim of this study was to evaluate the local efficacy of I-131 for F-18 fluorodeoxyglucose positron emission tomography (FDG PET)-positive lesions.
    Methods: Whole-body FDG PET/CT was performed on 37 patients (55 cases: 16 men, 21 women; age range: 24-82 years; mean age +/- standard deviation: 60.5 +/- 16.0 years) with differentiated thyroid cancer after total thyroidectomy. The metastatic or recurrent lesions were divided into 5 categories: primary tumor bed, lymph node, lung, bone, and other. The well-defined lesions were measured on CT, and the sizes were compared before and after radioactive iodine therapy.
    Results: The analysis was performed on 37 patients with 44 lesions (lymph node: 24, lung: 16, bone: 4). Sixteen lesions (70%) were increased and 7 (30%) showed no change or reduction when there was positive accumulation on FDG PET/CT and negative accumulation on I-131 (F(+)I(-)) group. In the positive accumulation for both FDG PET/CT and I-131 (F(+)I(+)) group, 5 lesions (63%) were increased and 3 (37%) showed no change or reduction. There was no significant difference for the tendency to increase in size between the F(+)I(-) and the F(+)I(+) groups.
    Conclusions: Lesions which show positive accumulations on FDG PET/CT have a greater tendency to increase in size. FDG-avid lesions are resistant to radioactive iodine therapy with or without I-131 uptake.

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  • On the link between sufficient-cause model and potential-outcome model Reviewed International journal

    Etsuji Suzuki, Eiji Yamamoto, Toshihide Tsuda

    Epidemiology   22 ( 1 )   131 - 132   2011.1

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  • Association between poor performance status and risk for toxicity during erlotinib monotherapy in Japanese patients with non-small cell lung cancer: Okayama Lung Cancer Study Group experience Reviewed International journal

    Katsuyuki Hotta, Katsuyuki Kiura, Nagio Takigawa, Etsuji Suzuki, Hiroshige Yoshioka, Toshiaki Okada, Daizo Kishino, Hiroshi Ueoka, Koji Inoue, Masahiro Tabata, Mitsune Tanimoto

    Lung Cancer   70 ( 3 )   308 - 312   2010.12

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    Background: The relationship between poor performance status (PS) and toxicity during chemotherapy is controversial. We examined this for erlotinib monotherapy in non-small cell lung cancer (NSCLC) patients.
    Patients and methods: Toxicity during the first month of therapy was recorded in 209 patients receiving erlotinib for NSCLC, and its association with PS was assessed.
    Results: Of 209 patients, 52, 115, 30 and 12 had a PS of 0, 1, 2 and 3-4, respectively. Treatment was discontinued in 26% of patients within 1 month, with a higher rate in poorer PS patients (17%, 25%, 37% and 42%). Discontinuation was predominantly due to disease progression, rather than adverse events, in both the whole cohort (82% vs. 18%) and the poorest PS subgroup (100% vs. 0%). Three, two, and four patients with a PS of 1,2 and 3-4, respectively, died within 1 month; all six deaths of PS 2-4 patients were attributed to disease progression. Treatment interruption and dose reduction rates were similar among the subgroups. The principal adverse event was skin rash, with identical incidence in all PS subgroups.
    Conclusions: Poor PS is unlikely to increase the risk for toxicity during erlotinib monotherapy, but was related to low compliance, probably because of disease progression rather than treatment-related toxicity. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

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  • Oseltamivir and abnormal behaviors Invited International journal

    Takashi Yorifuji, Etsuji Suzuki, Toshihide Tsuda

    Epidemiology   21 ( 6 )   916 - 916   2010.11

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  • Multi-level, cross-sectional study of workplace social capital and smoking among Japanese employees Reviewed International coauthorship International journal

    Etsuji Suzuki, Takeo Fujiwara, Soshi Takao, S. V. Subramanian, Eiji Yamamoto, Ichiro Kawachi

    BMC Public Health   10   489 - 489   2010.8

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    Background: Social capital is hypothesized to be relevant to health promotion, and the association between community social capital and cigarette smoking has been examined. Individual-level social capital has been found to be associated with smoking cessation, but evidence remains sparse on the contextual effect of social capital and smoking. Further, evidence remains sparse on the association between smoking and social capital in the workplace, where people are spending an increasing portion of their daily lives. We examined the association between workplace social capital and smoking status among Japanese private sector employees.
    Methods: We employed a two-stage stratified random sampling procedure. Of the total of 1,800 subjects in 60 companies, 1,171 (men/women; 834/337) employees (65.1%) were identified from 46 companies in Okayama in 2007. Workplace social capital was assessed in two dimensions; trust and reciprocity. Company-level social capital was based on inquiring about employee perceptions of trust and reciprocity among co-workers, and then aggregating their responses in order to calculate the proportion of workers reporting mistrust and lack of reciprocity. Multilevel logistic regression analysis was conducted using Markov Chain Monte Carlo methods to explore whether individual-and company-level social capital was associated with smoking. Odds ratios (ORs) and 95% credible intervals (CIs) for current smoking were obtained.
    Results: Overall, 33.3% of the subjects smoked currently. There was no relationship between individual-level mistrust of others and smoking status. By contrast, one-standard deviation change in company-level mistrust was associated with higher odds of smoking (OR: 1.25, 95% CI: 1.06-1.46) even after controlling for individual-level mistrust, sex, age, occupation, educational attainment, alcohol use, physical activity, body mass index, and chronic diseases. No clear associations were found between lack of reciprocity and smoking both at the individual-and company-level.
    Conclusions: Company-level mistrust is associated with higher likelihood of smoking among Japanese employees, while individual perceptions of mistrust were not associated. The link between lack of reciprocity and smoking was not supported either at the individual-or company-level. Further studies are warranted to examine the possible link between company-level trust and smoking cessation in the Japanese workplace.

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  • Does social capital promote physical activity? A population-based study in Japan Reviewed International coauthorship International journal

    Kazumune Ueshima, Takeo Fujiwara, Soshi Takao, Etsuji Suzuki, Toshihide Iwase, Hiroyuki Doi, S. V. Subramanian, Ichiro Kawachi

    PLoS ONE   5 ( 8 )   e12135 - e12135   2010.8

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    Background: To examine the association between individual-level social capital and physical activity.
    Methodology/Principal Findings: In February 2009, data were collected in a population-based cross-sectional survey in Okayama city, Japan. A cluster-sampling approach was used to randomly select 4,000 residents from 20 school districts. A total of 2260 questionnaires were returned (response rate: 57.4%). Individual-level social capital was assessed by an item inquiring about perceived trust of others in the community (cognitive dimension of social capital) categorized as low trust (43.0%), mid trust (38.6%), and high trust (17.3%), as well as participation in voluntary groups (structural dimension of social capital), which further distinguished between bonding (8.9%) and bridging (27.1%) social capital. Using logistic regression, we calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for physical inactivity associated with each domain of social capital. Multiple imputation method was employed for missing data. Among total participants, 68.8% were physically active and 28.9% were inactive. Higher trust was associated with a significantly lower odds of physical inactivity (OR = 0.58, 95% CI = 0.42-0.79) compared with low trust. Both bridging and bonding social capital were marginally significantly associated with lower odds of physical inactivity (bridging, OR = 0.79, 95% CI = 0.62-1.00; bonding, OR = 0.71, 95% CI = 0.48-1.03) compared with lack of structural social capital.
    Conclusions/Significance: Low individual-level social capital, especially lower trust of others in the community, was associated with physical inactivity among Japanese adults.

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  • Lung function and blood markers of nutritional status in non-COPD aging men with smoking history: A cross-sectional study Reviewed International journal

    Nobuyoshi Shiozawa, Kanae Hayashimoto, Etsuji Suzuki, Hiroshi Kikuchi, Shingo Takata, Kozo Ashida, Masutaka Watanabe, Yasuhiro Hosaki, Fumihiro Mitsunobu

    International Journal of Chronic Obstructive Pulmonary Disease   5   233 - 233   2010.7

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  • Increased Risk of Lung Cancer Mortality among Residents near an Asbestos Product Manufacturing Plant Reviewed International journal

    Shinji Kumagai, Norio Kurumatani, Toshihide Tsuda, Takashi Yorifuji, Etsuji Suzuki

    International Journal of Occupational and Environmental Health   16 ( 3 )   268 - 278   2010.7

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    We investigated whether individuals exposed to asbestos by living near an asbestos-manufacturing facility experienced increased lung cancer mortality. We studied a neighborhood around such a plant in the central Japanese city of Hashima. From 1943 to 1991 this plant produced insulation and packing material using amosite- and chrysotile-type asbestos fibers. The study group was comprised of 577 households. We obtained demographic information by a questionnaire and determined the underlying cause of death for deceased household members from death certificates. Using hourly meteorological data from local observatories, we estimated relative asbestos concentrations in the plant's vicinity, determined the quartile boundaries, and designated each study subject's quartile of ambient exposure. Finally, we calculated standardized mortality ratios to evaluate the association of residential asbestos with lung cancer risk. Our findings strongly suggest that neighborhood asbestos exposure can increase the risk of lung cancer mortality in men and probably in women.

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  • Does low workplace social capital have detrimental effect on workers' health? Reviewed International coauthorship International journal

    Etsuji Suzuki, Soshi Takao, S. V. Subramanian, Hirokazu Komatsu, Hiroyuki Doi, Ichiro Kawachi

    Social Science & Medicine   70 ( 9 )   1367 - 1372   2010.5

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    While the majority of studies of social capital and health have focused on conceptualizing social capital at the geographic level, evidence remains sparse on workplace social capital. We examined the association between workplace social capital and health status among Japanese private sector employees in a cross-sectional study. By employing a two-stage stratified random sampling procedure, 1147 employees were identified from 46 companies in Okayama in 2007. Workplace social capital was measured based on two components; trust and reciprocity. Company-level social capital was based on aggregating employee responses and calculating the proportion of workers reporting mistrust and lack of reciprocity. Multilevel logistic regression analysis was conducted using Markov Chain Monte Carlo methods to explore whether individual- and company-level mistrust and lack of reciprocity were associated with poor self-rated health. Odds ratios (ORs) and 95% credible intervals (as) for poor health were obtained for each variable. Workers reporting individual-level mistrust and lack of reciprocity had approximately double the odds of poor health even after controlling for sex, age, occupation, educational attainment, smoking, alcohol use, physical activity, body mass index, and chronic diseases. While we found some suggestion of a contextual association between company-level mistrust and poor health, no association was found between company-level lack of reciprocity and health. Despite the thorough examination of cross-level interaction terms between company-level social capital and individual characteristics, no clear patterns were observed. Individual perceptions of mistrust and lack of reciprocity at work have adverse effects on self-rated health among Japanese workers. Although the present study possibly suggests the contextual effect of workplace mistrust on workers' health, the contextual effect of workplace lack of reciprocity was not supported. (C) 2010 Elsevier Ltd. All rights reserved.

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  • Physical activity and mortality risk in the Japanese elderly: A cohort study Reviewed International journal

    Kazumune Ueshima, Kazuko Ishikawa-Takata, Takashi Yorifuji, Etsuji Suzuki, Saori Kashima, Soshi Takao, Masumi Sugiyama, Toshiki Ohta, Hiroyuki Doi

    American Journal of Preventive Medicine   38 ( 4 )   410 - 418   2010.4

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    Background: Physical activity recommendations for older adults with poor health needs to be understood.
    Purpose: This study aims to examine the association between the frequency of physical activity and mortality among a sample of elderly subjects, most of whom were under treatment for pre-existing disease.
    Methods: Data on the frequency of leisure-time physical activity, walking for transportation, and non-exercise physical activity were obtained from a population-based cohort study in Shizuoka, Japan. Of the randomly selected 22,200 residents aged 65-84 years, 10,385 subjects were followed from 1999 to 2006 and analyzed. Hazard ratios (HRs) and 95% CIs were obtained for all-cause; cardiovascular disease (CVD); and cancer mortality, after adjusting for covariates such as preexisting disease(s) A subgroup analysis that was restricted to subjects under treatment for preexisting disease(s) at baseline was further conducted. Data were collected between 1999 and 2006, and all analyses were conducted in 2008 and 2009.
    Results: Every physical activity was associated with a reduced risk of all-cause and CVD mortality, among not only the total sample but even those under treatment. The HRs for CVD mortality among participants with 5 or more days of non-exercise physical activity per week for the total sample and those with pre-existing disease(s) were 038 (95% CI=0.22, 0 55) and 0.35 (95% CI=0.24, 052), respectively, compared with no non-exercise physical activity. The association between physical activity and cancer mortality was not clear
    Conclusions: This study suggests a protective effect of physical activity on all-cause and CVD mortality among Japanese elderly people with pre-existing disease (Am J Prev Med 2010;38(4) 410-418) (C) 2010 American Journal of Preventive Medicine

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  • Long-term exposure to traffic-related air pollution and mortality in Shizuoka, Japan Reviewed International journal

    Takashi Yorifuji, Saori Kashima, Toshihide Tsuda, Soshi Takao, Etsuji Suzuki, Hiroyuki Doi, Masumi Sugiyama, Kazuko Ishikawa-Takata, Toshiki Ohta

    Occupational and Environmental Medicine   67 ( 2 )   111 - 117   2010.2

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    Objectives The number of studies investigating the health effects of long-term exposure to air pollution is increasing, however, most studies have been conducted in Western countries. The health status of Asian populations may be different to that of Western populations and may, therefore, respond differently to air pollution exposure. Therefore, we evaluated the health effects of long-term exposure to traffic-related air pollution in Shizuoka, Japan.
    Methods Individual data were extracted from participants of an ongoing cohort study. A total of 14 001 older residents, who were randomly chosen from all 74 municipalities of Shizuoka, completed questionnaires and were followed from December 1999 to March 2006. Individual nitrogen dioxide exposure data, as an index for traffic-related exposure, were modelled using a land use regression model. We assigned participants an estimated concentration of nitrogen dioxide exposure during 2000-2006. We then estimated the adjusted HR and their Cl for a 10 mu g/m(3) increase in exposure to nitrogen dioxide for all-cause or cause-specific mortality.
    Results The adjusted HR for all-cause mortality was 1.02 (95% Cl 0.96 to 1.08). Regarding cause-specific mortality, the adjusted HR for cardiopulmonary mortality was 1.16 (95% Cl 1.06 to 1.26); in particular the adjusted HR for ischaemic heart disease mortality was 1.27 (95% Cl 1.02 to 1.58) and for pulmonary disease mortality it was 1.19 (95% Cl 1.02 to 1.38). Furthermore, among non-smokers, a 10 mu g/m(3) increase in nitrogen dioxide was associated with a higher risk for lung cancer mortality (HR 1.30, 95% Cl 0.85 to 1.93).
    Conclusion Long-term exposure to traffic-related air pollution, indexed by nitrogen dioxide concentration, increases the risk of cardiopulmonary mortality, even in a population with a relatively low body mass index and increases the risk of lung cancer mortality in nonsmokers.

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  • Implications for future adverse effect studies of neuraminidase inhibitors

    Yorifuji T, Tsuda T, Kashima S, Suzuki E, Doi H

    BMJ   2009.12

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  • Short Seminars on Epidemiology for Clinician: Clinical Research Based on Community Hospitals: Lesson 5: The Basic Role of Statistics in Clinical Studies Invited

    Komatsu T, Suzuki E, Doi H

    Journal of Japanese Association for Acute Medicine   20 ( 10 )   851 - 859   2009.10

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    The fundamental statistical knowledge that is required in clinical studies is, first, being able to decide "Which test would be the best to use in which situation" when comparing basic attributes, and understanding logistic regression analysis as a form of multivariate analysis that is used to "adjust for confounding factors". In addition, because many clinical studies use survival time as their outcome, it is also important to learn about survival analysis. When comparing basic attributes, after determining whether the variables are "continuous variables" or "categorical variables", the decision as to which test to use depends on whether "2 groups" are going to be compared or "more than 3 groups" are going to be compared. Logistic regression analysis is often used when there are two outcome values, and it is possible to estimate the effect of exposure as an odds ratio. By contrast, with the Cox proportional hazard model, which is used in survival analyses, the effect of exposure can be estimated in the form of a hazard ratio. "Increasing the statistical knowledge required after studying epidemiology thoroughly" might be an efficient way to acquire knowledge about clinical studies in the midst of a busy clinical practice.

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  • Green tea consumption and mortality among Japanese elderly people: The Prospective Shizuoka Elderly Cohort Reviewed International journal

    Etsuji Suzuki, Takashi Yorifuji, Soshi Takao, Hirokazu Komatsu, Masumi Sugiyama, Toshiki Ohta, Kazuko Ishikawa-Takata, Hiroyuki Doi

    Annals of Epidemiology   19 ( 10 )   732 - 739   2009.10

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    PURPOSE: To investigate the association between green tea consumption and mortality from all causes, cancer, and cardiovascular disease (CVD) among elderly people.METHODS: In a population-based, prospective cohort study, a total of 14,001 elderly residents (aged 65-84 years), randomly chosen from all 74 municipalities in Shizuoka, Japan, completed questionnaires that included items about frequency of green tea consumption. They were followed for up to 6 years, from December 1999 to March 2006. Consequently, 12,251 subjects were analyzed to estimate the hazard ratios (HRs) for all-cause mortality, cancer, and CVD.RESULTS: Among 64,002 person-years, 1,224 deaths were identified (follow-up rate, 71.6%). The multivariate HRs and 95% confidence intervals (CIs) for CVD mortality compared those who consumed seven or more cups per day with those who consumed less than one cup per day, were 0.24 (0.14-0-40), 0.30 (0.15-0.61), and 0.18 (0.08-0.40) for total participants, men, and women, respectively. Although green tea consumption was not inversely associated with cancer mortality, green tea consumption and colorectal cancer mortality were inversely associated with a moderate dose-response relationship.CONCLUSIONS: Green tea consumption is associated with reduced mortality from all causes and CVD. This study also suggests that green tea Could have protective effects against colorectal cancer. Ann Epidemiol 2009; 19:732-739. (C) 2009 Elsevier Inc. All rights reserved.

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  • Work-based social networks and health status among Japanese employees Reviewed International coauthorship International journal

    Etsuji Suzuki, Soshi Takao, S V Subramanian, Hiroyuki Doi, Ichiro Kawachi

    Journal of Epidemiology and Community Health   63 ( 9 )   692 - 696   2009.9

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  • Causal inference in medicine part II. Directed Acyclic Graphs: A useful method for confounder selection, categorization of potential biases, and hypothesis specification Reviewed

    Suzuki E, Komatsu H, Yorifuji T, Yamamoto E, Doi H, Tsuda T

    Japanese Journal of Hygiene   64 ( 4 )   796 - 805   2009.9

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    Confounding is frequently a primary concern in epidemiological studies. With the increasing complexity of hypothesized relationships among exposures, outcomes, and covariates, it becomes very difficult to present these hypotheses lucidly and comprehensively. Graphical models are of great benefit in this regard. In this article, we focuse on directed acyclic graphs (DAGs), and review their value for confounder selection, categorization of potential biases, and hypothesis specification. We also discuss the importance of considering causal structures before selecting the covariates to be included in a statistical model and the potential biases introduced by inappropriately adjusting statistical models for covariates. DAGs are nonparametric and qualitative tools for visualizing research hypotheses regarding an exposure, an outcome, and covariates. Causal structures represented in DAGs will rarely be perfectly "correct" owing to the uncertainty about the underlying causal relationships. Nevertheless, to the extent that using DAGs forces greater clarity about causal assumptions, we are able to consider key sources of bias and uncertainty when interpreting study results. In summary, in this article, we review the following three points. (1) Although researchers have not adopted a consistent definition of confounders, using DAGs and the rules of d-separation we are able to identify clearly which variables we must condition on or adjust for in order to test a causal hypothesis under a set of causal assumptions. (2) We also show that DAGs should accurately correspond to research hypotheses of interest. To obtain a valid causal interpretation, research hypotheses should be defined explicitly from the perspective of a counterfactual model before drawing DAGs. A proper interpretation of the coefficients of a statistical model for addressing a specific research hypothesis relies on an accurate specification of a causal DAG reflecting the underlying causal structure. Unless DAGs correspond to research hypotheses, we cannot reliably reach proper conclusions testing the research hypotheses. Finally, (3) we have briefly reviewed other approaches to causal inference, and illustrate how these models are connected.<br>

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  • Short Seminars on Epidemiology for Clinician: Clinical Research Based on Community Hospitals: Lesson 4: Views on Biases and Approaches to Interpreting Results Invited

    Komatsu T, Suzuki E, Doi H

    Journal of Japanese Association for Acute Medicine   20 ( 9 )   794 - 800   2009.9

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  • Causal inference in medicine part I. Counterfactual models: An approach to clarifying discussions in research and applied public health Reviewed

    Suzuki E, Komatsu H, Yorifuji T, Yamamoto E, Doi H, Tsuda T

    Japanese Journal of Hygiene   64 ( 4 )   786 - 795   2009.9

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  • Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: A population-based cohort study Reviewed International journal

    Etsuji Suzuki, Takashi Yorifuji, Kazumune Ueshima, Soshi Takao, Masumi Sugiyama, Toshiki Ohta, Kazuko Ishikawa-Takata, Hiroyuki Doi

    Preventive Medicine   49 ( 2-3 )   135 - 141   2009.8

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    Objective. To investigate the associations between sleep duration and mortality in the elderly by controlling for sleep quality.Method. Data were collected from participants in a cohort study in Shizuoka, Japan. A total of 14,001 elderly residents (aged 65-85 years), randomly chosen from all 74 municipalities in the prefecture. completed questionnaires that evaluated sleep duration, sleep complaints, and the use of hypnotics. Participants were followed from 1999 to 2006. We analyzed 11,395 subjects to estimate the hazard ratios (HR) for mortality from all causes and cardiovascular disease (CVD).Results. With 60,252 person-years, 1004 deaths were identified. While short sleep duration and mortality were not associated, longer sleep duration was associated with higher risk of mortality in both sexes. Compared with those who slept 7 h, the multivariate HR and 95% confidence interval of CVD mortality for those who slept >= 10 h was 1.95 (1.18-3.21) and, for those who slept <= 5 h, it was 1.10 (0.62-1.93). Although no clear association was found between sleep quality and mortality, long sleep duration was associated with higher risk of CVD mortality among those with poor sleep quality.Conclusion. Long sleep duration is associated with higher risk of CVD mortality among the elderly with poor sleep quality. (C) 2009 Elsevier Inc. All rights reserved.

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  • Short Seminars on Epidemiology for Clinician: Clinical Research Based on Community Hospitals: Lesson 3: How to Construct Research Hypotheses, and Directed Acyclic Graphs Invited

    Komatsu T, Suzuki E, Doi H

    Journal of Japanese Association for Acute Medicine   20 ( 7 )   397 - 403   2009.7

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  • Oseltamivir and abnormal behaviors: true or not? Reviewed International journal

    Takashi Yorifuji, Etsuji Suzuki, Toshihide Tsuda

    Epidemiology   20 ( 4 )   619 - 621   2009.7

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    Oseltamivir is a neuraminidase inhibitor that inhibits influenza virus proliferation, and is used as an antiviral drug against influenza A and B viruses. Recently, concerns have been raised about hallucinations, delirium, and abnormal activity after administration of oseltamivir for treatment of infection with influenza virus. A large epidemiologic study was conducted in Japan in the winter of 2006-2007 to assess the relationship between oseltamivir intake and adverse behaviors, and an interim report was released on 10 July 2008. In the report, the research group concluded that no positive associations were detected between oseltamivir intake and abnormal behaviors. However, the analytic method used in the study was flawed. A correct analysis (based on person-time) shows a rate ratio of 1.57 (95% confidence interval = 1.34-1.83). This example clearly illustrates the importance of person-time in the analysis of cohort studies.

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  • Short Seminars on Epidemiology for Clinician: Clinical Research Based on Community Hospitals: Lesson 2: Basic Knowledge of Epidemiology and How to Read Paper Invited

    Komatsu T, Suzuki E, Doi H

    Journal of Japanese Association for Acute Medicine   20 ( 6 )   338 - 344   2009.6

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    Comprehending academic theses (i.e., critical appraisal) is a fundamental technique that is necessary when conducting research: in recent days with the practice of EBM, it has become a prerequisite needed even by clinicians. A great many clinicians find understanding academic theses almost painful. However, the authors believe that acquiring a basic knowledge of epidemiology and studying the methods of writing academic theses are the best approach if one wishes to master a technique that will lead to an understanding of academic theses. For the fundamental knowledge of epidemiology, understanding epidemiological indices and outcome measures, which are necessary for quantitative estimation of the effects of exposure (treatment) on the outcome, as well as the research design that are a prerequisite in considering biases are extremely important. For an interpretation of academic theses, on the other hand, one's efficacy to read and understand academic theses improves dramatically if he understands the paragraph structure and learns to do "paragraph reading" (reading each paragraph consecutively). The best training is to read these academic theses while referring to various guidelines for writing papers.

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  • Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: a population-based cohort study Reviewed International journal

    Etsuji Suzuki, Takashi Yorifuji, Kazumune Ueshima, Soshi Takao, Masumi Sugiyama, Hiroyuki Doi

    American Journal of Epidemiology   169 ( Suppl 11 )   S92 - S92   2009.6

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  • Short Seminars on Epidemiology for Clinician: Clinical Research Based on Community Hospitals: Lesson 1: The Role of Epidemiology and Statistics in Clinical Research Invited

    Komatsu T, Suzuki E, Doi H

    Journal of Japanese Association for Acute Medicine   20 ( 5 )   288 - 293   2009.5

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  • Total mercury content in hair and neurologic signs: historic data from Minamata Reviewed International journal

    Takashi Yorifuji, Toshihide Tsuda, Soshi Takao, Etsuji Suzuki, Masazumi Harada

    Epidemiology   20 ( 2 )   188 - 193   2009.3

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    Background: Large-scale methylmercury poisonings have occurred in Japan (Minamata and Niigata) and in Iraq. The current WHO threshold for adult exposure (hair level: 50 mu g/g) was based on evidence from Niigata, which included only acute and severe cases. That study leaves open the possibility of more subtle effects at lower exposure levels.Methods: The Shiranui sea had been contaminated in the 1950s by the discharge of methylmercury from a factory near Minamata.In 1960, the hair mercury content of 1694 residents living on the coastline of the Shiranui sea was measured by researchers from the Kumamoto Prefecture Institute for Health Research. Independently, in 1971, a population-based study to examine neurologic signs was conducted in the Minamata and Goshonoura areas, on the coastline of the Shiranui Sea, and the Ariake area (reference), by researchers at Kumamoto University. We identified 120 residents from exposed areas who were included in both datasets, plus 730 residents of Ariake (an unexposed area) who were also examined for neurologic signs.Results: Hair mercury levels were associated with perioral sensory loss in a dose-response relationship. The adjusted prevalence odds ratios and 95% confidence intervals for perioral sensory loss, compared with the lowest exposure category (0-10 mu g/g), were 4.5 (0.5-44), 9.1 (1.0-83), and 10 (0.9-110), for the dose categories >10 to 20, >20 to 50, and >50 mu g/g, respectively. The prevalence of all neurologic signs was higher in the exposure area than in Ariake.Conclusions: An increased prevalence of neurologic signs, especially perioral sensory loss, was found among residents with hair mercury content below 50 mu g/g.

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  • Long-term exposure to particulate matter and all-cause and cause-specific morality in Japan: Shizuoka Study Reviewed International journal

    Takashi Yorifuji, Saori Kashima, Etsuji Suzuki, Soshi Takao, Toshihide Tsuda, Masumi Sugiyama, Hiroyuki Doi

    Epidemiology   19 ( 6 )   S195   2008.11

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  • Evaluation of an Internet‐Based Self‐Help Program for Better Quality of Sleep among Japanese Workers: A Randomized Controlled Trial Reviewed International journal

    Etsuji Suzuki, Masao Tsuchiya, Kumi Hirokawa, Toshiyo Taniguchi, Toshiharu Mitsuhashi, Norito Kawakami

    Journal of Occupational Health   50 ( 5 )   387 - 399   2008.9

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    Sciences-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.

    DOI: 10.1539/joh.l7154

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  • Causal interpretation based on DAGs Reviewed International journal

    Etsuji Suzuki, Hirokazu Komatsu, Takashi Yorifuji, Toshihide Tsuda

    Epidemiology   19 ( 2 )   361 - 361   2008.3

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    DOI: 10.1097/ede.0b013e31816379b1

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Books

  • Social Epidemiology second edition

    Suzuki E, Michibata T, Mitsuhashi T, Tanihara S( Role: Joint translator ,  A historical framework for social epidemiology: social determinants of population health)

    Taishukan Shoten  2017.9  ( ISBN:9784469268294

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    Responsible for pages:3–24   Language:Japanese Book type:Scholarly book

    CiNii Books

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  • Epistasis: Methods and Protocols International journal

    Etsuji Suzuki, Tyler J. VanderWeele( Role: Joint author ,  Compositional epistasis: an epidemiologic perspective)

    Springer  2015 

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    Responsible for pages:197–216   Language:English Book type:Scholarly book

    DOI: 10.1007/978-1-4939-2155-3_11

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  • Global Perspectives on Social Capital and Health

    Suzuki E( Role: Sole translator ,  Workplace social capital and health)

    Nippon Hyoron sha  2013.8  ( ISBN:453558642X

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  • Global Perspectives on Social Capital and Health International journal

    Tuula Oksanen, Etsuji Suzuki, Soshi Takao, Jussi Vahtera, Mika Kivimäki( Role: Joint author ,  Workplace social capital and health)

    Springer  2013.7  ( ISBN:1461474639

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    Responsible for pages:23-63   Language:English Book type:Scholarly book

    DOI: 10.1007/978-1-4614-7464-7_2

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  • Current Topics in Public Health

    Yasutaka Chiba, Etsuji Suzuki( Role: Joint author ,  Causal inference with intermediates: simple methods for principal strata effects and natural direct effects)

    InTech  2013.5 

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    DOI: 10.5772/53193

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  • Public Health Education Through Case Method: Vol. 4

    Mizoguchi Y, Suzuki E, Yorifuji T, Takao S( Role: Joint author ,  Foodborne diseases control based on epidemiologic theories: current problems and future challenges)

    Shinoharashinsha  2008.11  ( ISBN:4884123190

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    Responsible for pages:89–111   Language:Japanese Book type:Scholarly book

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  • Social Capital and Health

    Suzuki E( Role: Sole translator ,  Measurement of individual social capital: questions, instruments, and measures)

    Nippon Hyoron sha  2008.4  ( ISBN:4535982937

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    Responsible for pages:49–79   Language:Japanese Book type:Scholarly book

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  • Social Capital and Health

    Suzuki E( Role: Sole translator ,  Network-based approaches for measuring social capital)

    Nippon Hyoron sha  2008.4  ( ISBN:4535982937

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    Total pages:217p   Responsible for pages:101–131   Language:Japanese Book type:Scholarly book

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  • A Book for Mental Health Specialists in the Workplace

    Suzuki E( Role: Contributor ,  Risk assessment and handling of suicide among the employees)

    Baifukan  2007.5  ( ISBN:4563057118

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    Responsible for pages:170–198   Language:Japanese Book type:Scholarly book

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  • A Book for Mental Health Specialists in the Workplace

    Suzuki E( Role: Contributor ,  Consultation to supervisors)

    Baifukan  2007.5  ( ISBN:4563057118

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    Responsible for pages:62–71   Language:Japanese Book type:Scholarly book

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  • Public Health Education Through Case Method: Vol. 3

    Suzuki E, Mitsuhashi T, Takao S, Kawakami N( Role: Joint author ,  Widening the stage for woman physicians)

    Shinoharashinsha Publishers  2006.10  ( ISBN:488412295X

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    Responsible for pages:143–168   Language:Japanese Book type:Scholarly book

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MISC

  • Mechanisms in causality: epidemiologic methods to open the “black box” Invited

    Suzuki E

    Japan Epidemiological Association News Letter   ( 57 )   10 - 10   2021.4

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  • Combination of Neutrophil to Lymphocyte Ratio and Glasgow Prognostic Score Improves Prognostic Accuracy in Lung Transplantation: Validation of 9 Preoperative Prognostic Scoring Methods

    H. Yamamoto, S. Sugimoto, E. Suzuki, Y. Tomioka, T. Shiotani, D. Shimizu, K. Matsubara, K. Miyoshi, S. Otani, M. Okazaki, M. Yamane, S. Toyooka

    The Journal of Heart and Lung Transplantation   40 ( 4 )   2021.4

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    DOI: 10.1016/j.healun.2021.01.1007

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  • AI, data science, and causal inference: a perspective on occupational health Reviewed

    Suzuki E, Mituhashi T, Yamamoto M, Takao S, Yorifuji T, Yamamoto E

    Sangyou Eiseigaku Zasshi   62 ( Suppl )   407 - 407   2020.5

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  • 地域高齢者におけるソーシャル・キャピタルと希死念慮との関連 International coauthorship

    野口正行, 小林朋子, 岩瀬敏秀, 鈴木越治, カワチ イチロー, 高尾総司

    日本社会精神医学会プログラム・抄録集   37th   2018.3

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    J-GLOBAL

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  • Health issues and related factors during study abroad programs among Japanese university students Reviewed

    Yamakawa M, Suzuki E, Sasai M, Ono M, Tsuda T, Nakase K

    Global Health Congress 2017, Abstract Book   58th(Web)   2017.11

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    J-GLOBAL

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  • On significance testing when reporting results of descriptive statistics: a discussion based on the CONSORT 2010 statement and the STROBE statement Reviewed

    Suzuki E, Mituhashi T, Takao S, Tsuda T

    Sangyou Eiseigaku Zasshi   57 ( Suppl )   466 - 466   2015.5

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  • Extended causal diagrams integrating response types and observed variables Reviewed International journal

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    American Journal of Epidemiology   177 ( Suppl 11 )   S100 - S100   2013.6

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  • A potential-outcomes causal framework for age-period-cohort analysis Reviewed International journal

    Etsuji Suzuki

    American Journal of Epidemiology   177 ( Suppl 11 )   S173 - S173   2013.6

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    Symposium: New methods for an old epidemiologic problem: age, period, and cohorts effects. (Symposium chairs: Whitney Robinson, Katherine M. Keyes)

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  • A review of workplace social capital and health Reviewed International coauthorship

    Suzuki E, Oksanen T, Vahtera J, Kivimäki M, Takao S

    Sangyou Eiseigaku Zasshi   55 ( Suppl )   502 - 502   2013.5

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  • Interobserver variability of 3T and 1.5T MRI/CT fusion-based postimplant dosimetry of prostate brachytherapy Reviewed

    Katayama N, Yamashita M, Bekku K, Tanimoto R, Suzuki E, Takemoto M, Waki T, Katsui K, Nasu Y, Kanazawa S

    The 72nd Annual Meeting of the Japan Radiological Society, Abstract Book   S230 - S230   2013.2

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  • Carcinogenic effect of radiation of less than 100 mSv: Statistical significance and clinical significance

    Tsuda T, Yamamoto E, Suzuki E

    Science   83 ( 7 )   735 - 742   2013

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  • GEOGRAPHIC VARIATIONS IN ALL-CAUSE MORTALITY IN JAPAN: COMPOSITIONAL OR CONTEXTUAL? Reviewed International coauthorship International journal

    E. Suzuki, S. Kashima, I. Kawachi, S. V. Subramanian

    AMERICAN JOURNAL OF EPIDEMIOLOGY   175   S82 - S82   2012.6

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  • Does Open-air Exposure to Volatile Organic Compounds near a Plastic Recycling Factory Cause Health Effects? (vol 54, pg 79, 2012)

    Takashi Yorifuji, Miyuki Noguchi, Toshihide Tsuda, Etsuji Suzuki, Soshi Takao, Saori Kashima, Yukio Yanagisawa

    JOURNAL OF OCCUPATIONAL HEALTH   54 ( 3 )   254 - 254   2012.5

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  • Individual-level social capital and self-rated health in Japan: an application of the Resource Generator Reviewed

    Kobayashi T, Iwase T, Mitsuhashi T, Takao S, Suzuki E

    Sangyou Eiseigaku Zasshi   54 ( Suppl )   503 - 503   2012.5

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  • Shift work and diabetes mellitus among Japanese male workers: a comparison between irregular and regular shift workers Reviewed

    Ika K, Suzuki E, Mitsuhashi T, Kobayashi T, Takao S

    Sangyou Eiseigaku Zasshi   54 ( Suppl )   444 - 444   2012.5

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  • Maternal working hours and early childhood overweight in Japan: an update Reviewed

    Mitsuhashi T, Suzuki E, Takao S, Tsuda T, Doi H

    Sangyou Eiseigaku Zasshi   54 ( Suppl )   362 - 362   2012.5

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  • Work and health (20) – Problem resolution of health checkup and subsequent measures No. 4

    Takao S, Suzuki E

    Kenko Kanri   ( 11 )   40 - 41   2011.11

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  • WORKPLACE SOCIAL CAPITAL AND ALL-CAUSE MORTALITY: A PROSPECTIVE COHORT STUDY OF 28,043 PUBLIC SECTOR EMPLOYEES, 2000-2009 Reviewed International coauthorship International journal

    T. Oksanen, M. Kivimaki, I. Kawachi, S. V. Subramanian, S. Takao, E. Suzuki, A. Kouvonen, J. Pentti, P. Salo, M. Virtanen, J. Vahtera

    AMERICAN JOURNAL OF EPIDEMIOLOGY   173   S50 - S50   2011.6

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  • Work and health (14) – Paradigm shift of health checkup and subsequent measures No. 1

    Takao S, Suzuki E

    Kenko Kanri   ( 5 )   34 - 35   2011.5

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  • Does shift work increase the risk of diabetes mellitus among shift workers? Reviewed

    Ika K, Suzuki E, Mitsuhashi T, Kobayashi T, Takao S

    Sangyou Eiseigaku Zasshi   53 ( Suppl )   470 - 470   2011.5

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  • Relationship between maternal working hours and children's overweight Reviewed

    Mitsuhashi T, Suzuki E, Takao S, Tsuda T

    Sangyou Eiseigaku Zasshi   53 ( Suppl )   552 - 552   2011.5

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  • Influence of crossover therapy on the association between progression-free survival (PFS) and overall survival (OS) in randomized trials of molecular-targeted agents for advanced non-small cell lung cancer (NSCLC). Reviewed International journal

    K. Hotta, K. Kiura, E. Suzuki, N. Takigawa, Y. Fujiwara, E. Ichihara, M. Tabata, M. Tanimoto

    JOURNAL OF CLINICAL ONCOLOGY   29 ( 15 )   2011.5

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  • Report on visit to institutions of cancer research in Europe

    Suzuki E

    Quarterly Report, Mid-West Japan Cancer Professional Education Consortium   29   5 - 10   2011.2

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  • Environmental Exposure to Asbestos and Pleural Plaques Among Retirees in a Factory Without Asbestos Use in H City, Japan Reviewed International journal

    Takashi Yorifuji, Etsuji Suzuki, Toshihide Tsuda, Yuji Natori, Eisuke Matsui

    EPIDEMIOLOGY   22 ( 1 )   S76 - S76   2011.1

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    Language:English   Publishing type:Research paper, summary (international conference)   Publisher:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1097/01.ede.0000391895.33567.d5

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  • Increased Risk of Lung Cancer Mortality Among Residents Who Had Lived Near an Asbestos Product Manufacturing Plant Reviewed International journal

    Shinji Kumagai, Norio Kurumatani, Toshihide Tsuda, Takashi Yorifuji, Etsuji Suzuki

    EPIDEMIOLOGY   22 ( 1 )   S75 - S76   2011.1

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    DOI: 10.1097/01.ede.0000391894.33567.9c

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  • Work and health (9) – Three requirements for returning to work

    Takao S, Suzuki E

    Kenko Kanri   ( 12 )   34 - 35   2010.12

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  • Training program on food-borne disease epidemiology (21) – Closing remarks of the serial

    Nakase K, Tsuchida H, Mizoguchi Y, Yamamoto E, Tsuda T, Kashima S, Tsuchihashi Y, Yorifuji T, Suzuki E, Doi H

    Food Sanitation Research   60 ( 6 )   33 - 44   2010.6

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  • WORKPLACE SOCIAL CAPITAL AND SMOKING AMONG JAPANESE PRIVATE SECTOR EMPLOYEES Reviewed International coauthorship International journal

    E. Suzuki, T. Fujiwara, S. Takao, S. V. Subramanian, E. Yamamoto, I. Kawachi

    AMERICAN JOURNAL OF EPIDEMIOLOGY   171   S13 - S13   2010.6

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  • MULTILEVEL MODELS FROM TWO DISTINCTIVE DEFINITIONS OF AGGREGATED VARIABLES: SELF-INCLUSION AND SELF-EXCLUSION PROCEDURES Reviewed International coauthorship International journal

    E. Suzuki, E. Yamamoto, S. Takao, I. Kawachi, S. V. Subramanian

    AMERICAN JOURNAL OF EPIDEMIOLOGY   171   S139 - S139   2010.6

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  • DOES LOW WORKPLACE SOCIAL CAPITAL HAVE DETRIMENTAL EFFECT ON WORKERS&apos; HEALTH? Reviewed International coauthorship International journal

    E. Suzuki, S. Takao, S. V. Subramanian, H. Komatsu, H. Doi, I. Kawachi

    AMERICAN JOURNAL OF EPIDEMIOLOGY   171   S12 - S12   2010.6

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  • Training program on food-borne disease epidemiology (20) – Descriptive epidemiology and geographic information system (GIS)

    Kashima S, Tsuchihashi Y, Yorifuji T, Suzuki E, Doi H, Tsuchida H, Nakase K, Mizoguchi Y, Yamamoto E, Tsuda T

    Food Sanitation Research   60 ( 5 )   47 - 56   2010.5

  • Health management system in the workplace and its implementation: discrepancy due to sampling methods Reviewed

    Ika K, Mitsuhashi T, Ueshima K, Iwase T, Kobayashi T, Suzuki E, Takao S

    Sangyou Eiseigaku Zasshi   52 ( Suppl )   611 - 611   2010.5

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  • Presence or absence of appointed occupational physicians and obesity and smoking: a comparison between random sample and convenient sample Reviewed

    Ueshima K, Iwase T, Mitsuhashi T, Ika K, Kobayashi T, Suzuki E, Takao S

    Sangyou Eiseigaku Zasshi   52 ( Suppl )   614 - 614   2010.5

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  • Health and safety efforts in the workplace and employees’ poor self-rated health in Japan: a survey for health promotion in Okayama prefecture Reviewed

    Iwase T, Mituhashi T, Ueshima K, Ika K, Kobayashi T, Suzuki E, Takao S

    Sangyou Eiseigaku Zasshi   52 ( Suppl )   613 - 613   2010.5

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  • Health and safety efforts in the workplace and employees’ BMI and smoking prevalence: a survey for health promotion in Okayama prefecture Reviewed

    Mitsuhashi T, Ueshima K, Iwase T, Ika K, Kobayashi T, Suzuki E, Takao S

    Sangyou Eiseigaku Zasshi   52 ( Suppl )   613 - 613   2010.5

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  • Health and safety efforts in the workplace and employees’ self-rated health: a survey for health promotion in Okayama prefecture Reviewed

    Takao S, Suzuki E, Mitsuhashi T, Iwase T, Ueshima K, Ika K, Kobayashi T, Doi H

    Sangyou Eiseigaku Zasshi   52 ( Suppl )   612 - 612   2010.5

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  • Health management system in the workplace and its objective assessment by employees in Okayama prefecture Reviewed

    Kobayashi T, Iwase T, Mitsuhashi T, UeshimaK, Ika K, Suzuki E, Takao S

    Sangyou Eiseigaku Zasshi   52 ( Suppl )   612 - 612   2010.5

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  • Work and health (1) – Two health managements

    Takao S, Suzuki E

    Kenko Kanri   ( 4 )   42 - 43   2010.4

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  • Training program on food-borne disease epidemiology (19) – Case control study (3): Multi-prefectural diffuse outbreaks which are difficult to be investigated by classical method

    Nakase K, Tsuchida H, Mizoguchi Y, Tsuda T, Yamamoto E, Doi H, Tsuchihashi Y, Yorifuji T, Suzuki E

    Food Sanitation Research   60 ( 4 )   29 - 38   2010.4

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    Other Link: http://search.jamas.or.jp/link/ui/2010164789

  • Training program on food-borne disease epidemiology (18) – “Cause” of food-borne disease and recall

    Tsuda T, Tsuchida H, Nakase K, Mizoguchi Y, Yamamoto E, Doi H, Tsuchihashi Y, Yorifuji T, Suzuki E

    Food Sanitation Research   60 ( 3 )   37 - 46   2010.3

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    Other Link: http://search.jamas.or.jp/link/ui/2010142590

  • Who assesses the evidence? Encouragement for critical appraisal

    Suzuki E

    Monthly Report, Mid-West Japan Cancer Professional Education Consortium   25   5 - 6   2010.3

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  • Training program on food-borne disease epidemiology (17) – Bias in epidemiology:type, magnitude, direction, and its countermeasures: The second part

    Tsuda T, Tsuchida H, Nakase K, Mizoguchi Y, Yamamoto E, Doi H, Tsuchihashi Y, Yorifuji T, Suzuki E

    Food Sanitation Research   60 ( 2 )   39 - 46   2010.2

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    Other Link: http://search.jamas.or.jp/link/ui/2010109350

  • Training program on food-borne disease epidemiology (16) – Bias in epidemiology:type, magnitude, direction, and its countermeasures: The first part

    Tsuda T, Tsuchida H, Nakase K, Mizoguchi Y, Yamamoto E, Doi H, Tsuchihashi Y, Yorifuji T, Suzuki E

    Food Sanitation Research   60 ( 1 )   47 - 55   2010.1

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  • Induction period and latent period of cancer: long or short?

    Suzuki E

    Monthly Report, Mid-West Japan Cancer Professional Education Consortium   23   3 - 5   2010.1

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  • Epidemiology: a methodology to disentangle the web of causation

    Suzuki E

    Monthly Report, Mid-West Japan Cancer Professional Education Consortium   17   5 - 6   2009.7

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  • Green tea consumption and mortality among Japanese elderly: a population-based cohort study Reviewed International journal

    E. Suzuki, T. Yorifuji, S. Takao, H. Komatsu, M. Sugiyama, H. Doi

    American Journal of Epidemiology   169 ( Suppl 11 )   S83 - S83   2009.6

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  • Development of measures against overwork based on risk management in the workplace Reviewed

    Takao S, Suzuki E, Kamizato E, Mitsuhashi T, Ueshima K, Iwase T, Doi H

    Sangyou Eiseigaku Zasshi   51 ( Suppl )   639 - 639   2009.3

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  • Association between social network at work and self-rated health among Japanese workers Reviewed

    Suzuki E, Takao S, Doi H

    Sangyou Eiseigaku Zasshi   50 ( Suppl )   461 - 461   2008.6

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  • Development and assessment of subsequent measures of health checkup based on risk management in the workplace: report of a trial of two cases Reviewed

    Takao S, Suzuki E, Kamizato E, Komatsu H, Ueshima K, Iwase T, Doi H

    Sangyou Eiseigaku Zasshi   50 ( Suppl )   570 - 570   2008.6

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    J-GLOBAL

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Presentations

  • Ambient heat exposure after the rainy season is associated with an increased risk of stroke International conference

    Fujimoto R, Suzuki E, Kashima S, Nakamura K, Oka T, Ito H, Yorifuji T

    ESC Asia 2022 with APSC & AFC  2022.12.2  European Society of Cardiology

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    Language:English   Presentation type:Poster presentation  

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  • Hypothermic Out-of-hospital Cardiac Arrest: Favorable Outcomes, But With Limited Defibrillation Or Adrenaline Administration Effectiveness In The Prehospital Setting International conference

    Takashi Hongo, Hiromichi Naito, Tetsuya Yumoto, Ryouhei Yumoto, Etsuji Suzuki, Takashi Yorifuji, Atsunori Nakao

    Resuscitation Science Symposium 2022  2022.11 

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    Event date: 2022.11.5 - 2022.11.6

    Language:English   Presentation type:Poster presentation  

    Venue:Chicago, IL  

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  • Attributable fraction and related measures: conceptual relations in the counterfactual framework International conference

    Suzuki E, Yamamoto E

    55th Annual Meeting of the Society for Epidemiologic Research  2022.6.16  Society for Epidemiologic Research

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    Event date: 2022.6.14 - 2022.6.17

    Language:English   Presentation type:Poster presentation  

    Venue:Chicago, IL  

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  • Hourly association between ambient temperature and cardiovascular emergency calls: risk awareness and measures against high temperature in exercise therapy

    Fujimoto R, Suzuki E, Nakamura K, Oka T, Ito H, Yorifuji T

    The 28th Annual Meeting of the Japanese Association of Cardiac Rehabilitation  2022.6 

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    Event date: 2022.6.11 - 2022.6.12

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Okinawa  

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  • Hourly association between ambient temperature and cardiovascular emergency calls: risk awareness and measures against high temperature

    Fujimoto R, Suzuki E, Nakamura K, Oka T, Ito H, Yorifuji T

    The 25th Congress of Japanese Society for Emergency Medicine  2022.5.26 

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    Event date: 2022.5.25 - 2022.5.27

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Osaka  

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  • Measurement method of axial length in eyes with retinal detachment

    Kimura S, Goto Y, Kanenaga K, Hosokawa M, Shiode Y, Doi S, Matoba R, Kanzaki Y, Suzuki E, Morizane Y

    The 126th Annual Meeting of the Japanese Ophthalmological Society  2022.4 

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    Event date: 2022.4.14 - 2022.4.17

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Osaka  

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  • Heat exposure after the rainy season is associated with an increased risk of cardiovascular emergency International conference

    Fujimoto R, Suzuki E, Nakamura K, Yorifuji T, Ito H

    ESC Preventive Cardiology Congress 2022  2022.4  European Society of Cardiology

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    Event date: 2022.4.7 - 2022.4.9

    Language:English   Presentation type:Poster presentation  

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  • Hourly association between ambient temperature and acute myocardial infarction

    Fujimoto R, Suzuki E, Nakamura K, ItoH, Yorifuji T

    The 86th Annual Scientific Meeting of the Japanese Circulation Society  2022.3 

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    Event date: 2022.3.11 - 2022.3.13

    Language:English   Presentation type:Poster presentation  

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  • Regional characteristics and incidence of cerebral and spinal arteriovenous shunts in Okayama prefecture

    Murai S, Takasugi Y, Hiramatsu M, Suzuki E, Ishibashi R, Miyazaki Y, Haruma J, Hishikawa T, Yasuhara T, Sugiu K, Date I

    The 37th Annual Meeting of The Japanese Society for Neuroendovascular Therapy  2021.11 

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    Event date: 2021.11.25 - 2021.11.27

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukuoka  

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  • The onset of cardiac failure and heat exposure after the end of the rainy season among the elderly

    Fujimoto R, Suzuki E, Nakamura K, Yorifuji T, Ito H

    The 25th Annual Scientific Meeting of the Japanese Heart Failure Society  2021.10.1 

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    Event date: 2021.10.1 - 2021.10.3

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Okayama  

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  • Risk perception, worry, and hand hygiene behavior among Japanese university students studying abroad: a prospective study

    Yamakawa M, Tanaka Y, Suzuki E

    25th Annual Meeting of the Japanese Society of Travel and Health  2021.8 

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    Event date: 2021.8.21 - 2021.8.22

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • Marginal sufficient component cause model: an emerging causal model with authenticity? International conference

    Suzuki E, Yamamoto E

    54th Annual Meeting of the Society for Epidemiologic Research  2021.6.23  Society for Epidemiologic Research

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    Event date: 2021.6.22 - 2021.6.25

    Language:English   Presentation type:Oral presentation (general)  

    Venue:San Diego, CA (online conference)  

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  • Hourly temperature in summer and emergency ambulance calls due to ischemic heart diseases in the elderly

    Fujimoto R, Suzuki E, Nakamura K, Yorifuji T, Ito H

    The 116th and 118th Meeting of Chugoku and Shikoku Regional Association, The Japanese Circulation Society  2021.6.5 

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    Event date: 2021.6.5 - 2021.6.6

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Kagawa  

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  • Should confounding be distinguished from bias? A perspective on epidemiology in the era of AI

    Suzuki E, Shinozaki T, Mituhashi T, Tsuda T, Yamamoto E

    The 94th Annual Meeting of Japan Society for Occupational Health  2021.5.20 

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    Event date: 2021.5.18 - 2021.5.21

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Matsumoto, Nagano  

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  • Combination of neutrophil to lymphocyte ratio and Glasgow prognostic score improves prognostic accuracy in lung transplantation: validation of 9 preoperative prognostic scoring methods International conference

    Yamamoto H, Sugimoto S, Suzuki E, Tomioka Y, Shiotani T, Shimizu D, Matsubara K, Miyoshi K, Otani S, Okazaki M, Yamane M, Toyooka S

    The ISHLT (International Society for Heart and Lung Transplantation), 41st Annual Meeting & Scientific Sessions  2021.4 

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    Event date: 2021.4.24 - 2021.4.28

    Language:English   Presentation type:Poster presentation  

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  • Cardiovascular emergency hospital visits and heat exposure after the end of the rainy season among the elderly

    Fujimoto R, Suzuki E, Nakamura K, Ito H, Yorifuji T

    The 85th Annual Scientific Meeting of the Japanese Circulation Society  2021.3 

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    Event date: 2021.3.26 - 2021.3.28

    Language:English   Presentation type:Oral presentation (general)  

    Venue:Yokohama  

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  • Body mass index and ventilator dependence in critically ill patients: a cohort study using a nationwide database

    Fujinaga J, Suzuki E, Irie H, Onodera M

    The 48th Annual Meeting of the Japanese Society of Intensive Care Medicine  2021.2 

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    Event date: 2021.2.12 - 2021.2.14

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • Exchangeability of measures of association before and after exposure to the risk factor is flipped: its relationship with confounding in the counterfactual model

    Suzuki E, Yamamoto M, Yamamoto E

    The 31st Annual Scientific Meeting of the Japan Epidemiological Association  2021.1 

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    Event date: 2021.1.27 - 2021.1.29

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Saga  

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  • The meaning of arrows: reflections on the assumption of faithfulness in causal directed acyclic graphs International conference

    Suzuki E, Shinozaki T, Yamamoto E

    53rd Annual Meeting of the Society for Epidemiologic Research  2020.12  Society for Epidemiologic Research

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    Event date: 2020.12.16 - 2020.12.18

    Language:English   Presentation type:Poster presentation  

    Venue:Boston, MA (online conference)  

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  • A different perspective of “cross-world independence assumption” and the utility of natural effects compared to controlled effects International coauthorship International conference

    Shrier I, Suzuki E

    53rd Annual Meeting of the Society for Epidemiologic Research  2020.12  Society for Epidemiologic Research

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    Event date: 2020.12.16 - 2020.12.18

    Language:English   Presentation type:Poster presentation  

    Venue:Boston, MA (online conference)  

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  • Incidence and characteristics of treatment outcome of cerebral arteriovenous malformation in Okayama prefecture

    Miyazaki Y, Hiramatsu M, Ishibashi R, Takai H, Matsubara S, Murai S, Suzuki E, Minami Y, Kinoshita K, Uno M

    The 36th Annual Meeting of The Japanese Society for Neuroendovascular Therapy  2020.11 

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    Event date: 2020.11.19 - 2020.11.21

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Kyoto  

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  • Associations between personal characteristics and diarrhea among Japanese university students studying abroad according to the destination’s risk categories

    Yamakawa M, Tsuda T, Wada K, Nagata C, Suzuki E

    Global Health Congress 2020  2020.11 

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    Event date: 2020.11.1 - 2020.11.3

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Osaka  

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  • Incidence and characteristics of complications of cerebral dural arteriovenous fistulas in Okayama prefecture

    Ishibashi R, Hiramatsu M, Takai H, Murai S, Suzuki E, Miyazaki Y, Iwasaki K, Chin M

    The 79th Annual Meeting of the Japan Neurosurgical Society  2020.10 

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    Event date: 2020.10.15 - 2020.10.17

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Okayama  

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  • Inventory survey of spinal arteriovenous shunt in Okayama prefecture

    Hiramatsu M, Ishibashi R, Takai H, Murai S, Suzuki E, Miyazaki Y, Takahashi Y, Kidani N, Hishikawa T, Yasuhara T, Sugiu K, Date I

    The 49th Annual Meeting of Japanese Society on Surgery for Cerebral Stroke  2020.8 

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    Event date: 2020.8.23 - 2020.9.24

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Yokohama  

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  • Inventory survey of cerebral dural arteriovenous fistulas in Okayama prefecture

    Ishibashi R, Hiramatsu M, Takai H, Murai S, Suzuki E, Miyazaki Y, Fujiwara T, Kaneko R, Hayashi T, Takata K, Morita T, Uesato M, Kinosada M, Kurosaki Y, Handa A, Chin M, Yamagata S

    The 49th Annual Meeting of Japanese Society on Surgery for Cerebral Stroke  2020.8 

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    Event date: 2020.8.23 - 2020.9.24

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Yokohama  

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  • Inventory survey of cerebral and spinal arteriovenous shunts in Okayama prefecture

    Murai S, Hiramatsu M, Ishibashi R, Miyazaki Y, Takai H, Suzuki E, Haruma J, Hishikawa T, Yasuhara T, Sugiu K, Date I

    The 49th Annual Meeting of Japanese Society on Surgery for Cerebral Stroke  2020.8 

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    Event date: 2020.8.23 - 2020.9.24

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Yokohama  

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  • Inventory survey of cerebral arteriovenous malformation in Okayama prefecture

    Miyazaki Y, Hiramatsu M, Ishibashi R, Takai H, Matsubara S, Murai S, Suzuki E, Minami Y, Kinoshita K, Uno M

    The 7th congress of the Cardiovascular Stroke Society of Japan  2020.8 

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    Event date: 2020.8.23 - 2020.9.24

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Yokohama  

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  • AI, data science, and causal inference: a perspective on occupational health

    Suzuki E, Mituhashi T, Yamamoto M, Takao S, Yorifuji T, Yamamoto E

    The 93rd Annual Meeting of Japan Society for Occupational Health  2020.5 

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    Event date: 2020.5.13 - 2020.5.16

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Asahikawa, Hokkaido  

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  • A different perspective of “cross-world independence assumption” and the utility of natural effects compared to controlled effects International coauthorship International conference

    Shrier I, Suzuki E

    The third European Causal Inference Meeting (EuroCIM 2020) 

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    Event date: 2020.4.22 - 2020.4.24

    Language:English   Presentation type:Poster presentation  

    Venue:Oslo  

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  • Inventory survey of cerebral and spinal arteriovenous shunts in Okayama prefecture

    Murai S, Hiramatsu M, Ishibashi R, Takai Y, Suzuki E, Takahashi Y, Kitani N, Hishikawa T, Yasuhara T, Sugiu K, Date I

    The 35th Annual Meeting of The Japanese Society for Neuroendovascular Therapy  2019.11 

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    Event date: 2019.11.21 - 2019.11.23

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • Inventory survey of dural arteriovenous fistula in Okayama prefecture

    Ishibashi R, Hiramatsu M, Takai Y, Murai S, Suzuki E, Morita T, Uezato M, Kinosada M, Kurosaki Y, Handa A, Chin M, Yamagata S

    The 35th Annual Meeting of The Japanese Society for Neuroendovascular Therapy  2019.11 

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    Event date: 2019.11.21 - 2019.11.23

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • Inventory survey of spinal arteriovenous shunt in Okayama prefecture

    Hiramatsu M, Ishibashi R, Takai Y, Murai S, Suzuki E, Takahashi Y, Kitani N, Hishikawa T, Yasuhara T, Sugiu K, Date I

    The 35th Annual Meeting of The Japanese Society for Neuroendovascular Therapy  2019.11 

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    Event date: 2019.11.21 - 2019.11.23

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • Mechanisms and sufficient causes: an insight into how researchers define etiology. (Invited Session: Recent Advances on Causal Inference in Observational Studies) Invited International conference

    Suzuki E

    2019 WNAR/IMS/JR Annual Meeting  2019.6.25  Co-sponsored by Western North America Region (WNAR) of The International Biometric Society (IBS), Institute of Mathematical Statistics (IMS), and Japanese Region (JR) of The IBS

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    Event date: 2019.6.23 - 2019.6.26

    Language:English   Presentation type:Oral presentation (invited, special)  

    Venue:Portland, OR  

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  • Graphical representation of theorems for propensity score methods: an application of single world intervention graphs International coauthorship International conference

    Suzuki E, Stensrud MJ, Yamamoto E

    52nd Annual Meeting of the Society for Epidemiologic Research  2019.6.19  Society for Epidemiologic Research

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    Event date: 2019.6.18 - 2019.6.21

    Language:English   Presentation type:Poster presentation  

    Venue:Minneapolis, MN  

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  • Causal diagrams for propensity score methods International conference

    Suzuki E, Shinozaki T, Yamamoto E

    2019 Atlantic Causal Inference Conference  2019.5.23 

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    Event date: 2019.5.22 - 2019.5.24

    Language:English   Presentation type:Poster presentation  

    Venue:Montreal  

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  • Thyroid cancer under 19 at the accident in Fukushima: The sixth report – the 2nd and 3rd round screening results International conference

    Tsuda T, Miyano Y, Tokinobu A, Yamamoto E, Suzuki E

    2018 Conference of the International Society of Environmental Epidemiology  2018.8 

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    Event date: 2018.8.26 - 2018.8.30

    Language:English   Presentation type:Poster presentation  

    Venue:Ottawa  

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  • Further remarks on covariate balance for no confounding International conference

    Suzuki E, Tsuda T, Yamamoto E

    51st Annual Meeting of the Society for Epidemiologic Research  2018.6.20  Society for Epidemiologic Research

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    Event date: 2018.6.19 - 2018.6.22

    Language:English   Presentation type:Poster presentation  

    Venue:Baltimore, MD  

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  • Covariate balance for no confounding in the sufficient-cause model International conference

    Suzuki E

    2018 Atlantic Causal Inference Conference  2018.5.22 

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    Event date: 2018.5.22 - 2018.5.23

    Language:English   Presentation type:Poster presentation  

    Venue:Pittsburgh, PA  

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  • Health issues and related factors during study abroad programs among Japanese university students

    Yamakawa M, Suzuki E, Sasai M, Ono M, Tsuda T, Nakase K

    Global Health Congress 2017  2017.11 

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    Event date: 2017.11.24 - 2017.11.26

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Tokyo  

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  • A causal approach to the healthy worker effect International conference

    Suzuki E, Tsuda T, Yamamoto E

    50th Annual Meeting of the Society for Epidemiologic Research  2017.6  Society for Epidemiologic Research

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    Event date: 2017.6.20 - 2017.6.23

    Language:English   Presentation type:Poster presentation  

    Venue:Seattle, WA  

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  • A new approach to effect heterogeneity for binary outcomes International coauthorship International conference

    Huitfeldt A, Stensrud M, Goldstein A, Suzuki E, Swanson S

    The 2017 Atlantic Causal Inference Conference  2017.5 

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    Event date: 2017.5.23 - 2017.5.25

    Language:English   Presentation type:Poster presentation  

    Venue:Chapel Hill, NC  

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  • Ambient temperature and daily emergency ambulance calls in Japanese elderly: a time-series analysis International conference

    Suzuki E, Yorifuji T, Kashima S, Yamamoto E, Tsuda T

    9th European Public Health Conference  2016.11 

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    Event date: 2016.11.9 - 2016.11.12

    Language:English   Presentation type:Poster presentation  

    Venue:Vienna  

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  • How to translate prevalence to incidence in the setting of screening: an application of steady-state dynamic population model International conference

    Suzuki E, Tsuda T, Yamamoto E

    28th Annual Conference of the International Society for Environmental Epidemiology  2016.9.1 

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    Event date: 2016.9.1 - 2016.9.4

    Language:English   Presentation type:Poster presentation  

    Venue:Rome  

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  • Thyroid cancer under 19 in Fukushima: The fourth report from the second round screening International conference

    Tsuda T, Suzuki E, Tokinobu A, Yamamoto E

    28th Annual Conference of the International Society for Environmental Epidemiology  2016.9.1 

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    Event date: 2016.9.1 - 2016.9.4

    Language:English   Presentation type:Poster presentation  

    Venue:Rome  

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  • Short-term effects of Asian dust in patients with a history of disease: a case-crossover study among the elderly men and women in Japan International conference

    Kashima S, Yorifuji T, Suzuki E, Tsuchihashi Y, Eboshida A

    28th Annual Conference of the International Society for Environmental Epidemiology  2016.9.1 

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    Event date: 2016.9.1 - 2016.9.4

    Language:English   Presentation type:Poster presentation  

    Venue:Rome  

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  • Symptoms that university students experience when studying abroad in summer and their factors

    Yamakawa M, Suzuki E, Ono M, Sasai M, Tsuda T

    20th Annual Meeting of the Japanese Society of Travel and Health  2016.7 

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    Event date: 2016.7.23 - 2016.7.24

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Kurashiki, Okayama  

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  • Thyroid cancer among 18 years old or younger after the 2011 nuclear accident in Fukushima International conference

    Tsuda T, Tokinobu A, Suzuki E, Yamamoto E

    Conference of International Society for Environmental Epidemiology and International Society of Exposure Science – Asia Chapter 2016  2016.6 

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    Event date: 2016.6.26 - 2016.6.29

    Language:English   Presentation type:Poster presentation  

    Venue:Sapporo, Hokkaido  

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  • Clarifying the concept of covariate balance using the sufficient-cause model International conference

    Suzuki E, Tsuda T, Yamamoto E

    4th Epidemiology Congress of the Americas  2016.6 

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    Event date: 2016.6.21 - 2016.6.24

    Language:English   Presentation type:Poster presentation  

    Venue:Miami, FL  

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  • Errors in causal inference International conference

    Suzuki E, Tsuda T, Mitsuhashi, T, Yamamoto E

    4th Epidemiology Congress of the Americas  2016.6 

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    Event date: 2016.6.21 - 2016.6.24

    Language:English   Presentation type:Poster presentation  

    Venue:Miami, FL  

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  • Age, period, and cohort effects on international travel rates among Japanese men and women: a descriptive analysis from 1985 to 2013 International conference

    Yamakawa M, Suzuki E, Tsuda T

    11th Asia Pacific Travel Health Conference  2016.3 

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    Event date: 2016.3.2 - 2016.3.5

    Language:English   Presentation type:Poster presentation  

    Venue:Kathmandu  

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  • Sufficient-cause model and potential-outcome model Invited International conference

    Suzuki E

    International Workshop on Causal Inference  2016.1  The Institute of Statistical Mathematics

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    Event date: 2016.1.6 - 2016.1.7

    Language:English   Presentation type:Symposium, workshop panel (nominated)  

    Venue:Tokyo  

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  • Association between Asian dust and ambulance transport: an analysis of direct effect and effect modification

    Kashima S, Yorifuji T, Suzuki E, Eboshida A

    The 74th Annual Meeting of Japanese Society of Public Health  2015.11 

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    Event date: 2015.11.4 - 2015.11.6

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Nagasaki  

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  • Workplace social capital and overweight among Japanese employees

    Kobayashi T, Suzuki E, Takao S, Iso H

    The 74th Annual Meeting of Japanese Society of Public Health  2015.11 

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    Event date: 2015.11.4 - 2015.11.6

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Nagasaki  

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  • How can we define "proportion eliminated" to make it a policy-relevant measure of direct effects? International conference

    Suzuki E, Mitsuhashi T, Tsuda T, Yamamoto E

    8th European Public Health Conference  2015.10 

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    Event date: 2015.10.14 - 2015.10.17

    Language:English   Presentation type:Poster presentation  

    Venue:Milan  

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  • The significance of generalized causal measures in public health International conference

    Suzuki E

    8th European Public Health Conference  2015.10 

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    Event date: 2015.10.14 - 2015.10.17

    Language:English   Presentation type:Poster presentation  

    Venue:Milan  

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  • Thyroid cancer under 19 in Fukushima: The third report International conference

    Tsuda T, Tokinobu A, Suzuki E, Yamamoto E

    27th Annual Conference of the International Society for Environmental Epidemiology  2015.8 

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    Event date: 2015.8.30 - 2015.9.3

    Language:English   Presentation type:Poster presentation  

    Venue:Sao Paulo  

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  • A graphical illustration of the principal stratification approach: an application of extended directed acyclic graphs International conference

    Suzuki E, Mitsuhashi T, Tsuda T, Yamamoto E

    48th Annual Meeting of the Society for Epidemiologic Research  2015.6  Society for Epidemiologic Research

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    Event date: 2015.6.16 - 2015.6.19

    Language:English   Presentation type:Poster presentation  

    Venue:Denver, CO  

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  • Is there an obesity paradox in the Japanese elderly? A community-based cohort study of 13,280 men and women International conference

    Yamazaki K, Suzuki E, Yorifuji T, Tsuda T, Doi H

    48th Annual Meeting of the Society for Epidemiologic Research  2015.6  Society for Epidemiologic Research

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    Event date: 2015.6.16 - 2015.6.19

    Language:English   Presentation type:Poster presentation  

    Venue:Denver, CO  

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  • A unifying approach to the concepts of confounding and confounders International conference

    Suzuki E, Tsuda T, Mitsuhashi T, Yamamoto E

    48th Annual Meeting of the Society for Epidemiologic Research  2015.6  Society for Epidemiologic Research

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    Event date: 2015.6.16 - 2015.6.19

    Language:English   Presentation type:Poster presentation  

    Venue:Denver, CO  

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  • Identifying the two axes of confounding International conference

    Suzuki E, Mitsuhashi T, Tsuda T, Yamamoto E

    48th Annual Meeting of the Society for Epidemiologic Research  2015.6  Society for Epidemiologic Research

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    Event date: 2015.6.16 - 2015.6.19

    Language:English   Presentation type:Poster presentation  

    Venue:Denver, CO  

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  • On significance testing when reporting results of descriptive statistics: a discussion based on the CONSORT 2010 statement and the STROBE statement

    Suzuki E, Mituhashi T, Takao S, Tsuda T

    The 88th Annual Meeting of Japan Society for Occupational Health  2015.5 

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    Event date: 2015.5.13 - 2015.5.16

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Osaka  

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  • Association between home visits by commissioned welfare volunteers and psychological distress: a survey among the elderly in Okayama prefecture

    Noguchi M, Iwase T, Suzuki E, Takao S

    The 34th Meeting of Japanese Society for Social Psychiatry  2015.3 

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    Event date: 2015.3.5 - 2015.3.6

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Toyama  

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  • Asian dust and daily emergency hospital visits among elderly people in Japan International conference

    Kashima S, Yorifuji T, Suzuki E

    4th Regional Conference of the International Society of Environmental Epidemiology Asia Chapter (ISEE Asia)  2014.11 

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    Event date: 2014.11.29 - 2014.12.2

    Language:English   Presentation type:Poster presentation  

    Venue:Shanghai  

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  • Sufficient-cause model and potential-outcome model Invited International conference

    Suzuki E, Tsuda T, Yamamoto E

    Kyoto International Conference on Modern Statistics in the 21st Century  2014.11 

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    Event date: 2014.11.17 - 2014.11.18

    Language:English   Presentation type:Oral presentation (invited, special)  

    Venue:Kyoto  

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  • Thyroid cancer under 19 in Fukushima: The second report International conference

    Tsuda T, Tokinobu A, Suzuki E, Yamamoto E

    26th Annual Conference of the International Society for Environmental Epidemiology  2014.8 

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    Event date: 2014.8.24 - 2014.8.26

    Language:English   Presentation type:Poster presentation  

    Venue:Seattle, WA  

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  • Asian dust and risk of emergency transport among elderly people in Japan: a case-crossover study International conference

    Kashima S, Yorifuji T, Suzuki E, Eboshida A

    26th Annual Conference of the International Society for Environmental Epidemiology  2014.8 

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    Event date: 2014.8.24 - 2014.8.26

    Language:English   Presentation type:Poster presentation  

    Venue:Seattle, WA  

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  • Applications of multilevel analysis in occupational health research: an example of workplace social capital International coauthorship

    Suzuki E, Kawachi I, Subramanian SV, Yamamoto E, Takao S

    The 87th Annual Meeting of Japan Society for Occupational Health  2014.5 

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    Event date: 2014.5.21 - 2014.5.24

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Okayama  

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  • Cardiovascular emergency hospital visits and hourly changes in air pollution

    Yorifuji T, Suzuki E, Kashima S, Tsuda T

    The 72nd Annual Meeting of Japanese Society of Public Health  2013.10 

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    Event date: 2013.10.23 - 2013.10.25

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Mie  

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  • Thyroid cancer under 18 in Fukushima, Japan International conference

    Tsuda T, Yamamoto E, Suzuki E

    25th Annual Conference of the International Society for Environmental Epidemiology  2013.8.23 

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    Event date: 2013.8.19 - 2013.8.23

    Language:English   Presentation type:Oral presentation (general)  

    Venue:Basel  

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  • The effects of varying social contexts on growing geographical inequalities in suicide in Japan: a multilevel analysis from 1975 to 2005 International coauthorship International conference

    Suzuki E, Kashima S, Kawachi I, Subramanian SV

    25th Annual Conference of the International Society for Environmental Epidemiology  2013.8.20 

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    Event date: 2013.8.19 - 2013.8.23

    Language:English   Presentation type:Poster presentation  

    Venue:Basel  

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  • The effects of varying social contexts on growing geographical inequalities in suicide in Japan: a multilevel analysis from 1975 to 2005 International conference

    25th Annual Conference of the International Society for Environmental Epidemiology 

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    Event date: 2013.8.19 - 2013.8.23

    Language:English   Presentation type:Poster presentation  

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  • Thyroid cancer under 18 in Fukushima, Japan International conference

    25th Annual Conference of the International Society for Environmental Epidemiology 

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    Event date: 2013.8.19 - 2013.8.23

    Language:English   Presentation type:Oral presentation (general)  

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  • Social and geographical inequalities in suicide in Japan from 1975 through 2005: a census-based longitudinal analysis International coauthorship International conference

    Suzuki E, Kashima S, Kawachi I, Subramanian SV

    46th Annual Meeting of the Society for Epidemiologic Research  2013.6  Society for Epidemiologic Research

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    Event date: 2013.6.18 - 2013.6.21

    Language:English   Presentation type:Poster presentation  

    Venue:Boston, MA  

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  • Extended causal diagrams integrating response types and observed variables International conference

    Suzuki E, Mitsuhashi T, Tsuda T, Yamamoto E

    46th Annual Meeting of the Society for Epidemiologic Research  2013.6  Society for Epidemiologic Research

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    Event date: 2013.6.18 - 2013.6.21

    Language:English   Presentation type:Poster presentation  

    Venue:Boston, MA  

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  • A potential-outcomes causal framework for age-period-cohort analysis. [Symposium: New methods for an old epidemiologic problems: age, period, and cohorts effects. (Symposium chairs: Whitney Robinson, Katherine M. Keyes)] International conference

    Suzuki E

    46th Annual Meeting of the Society for Epidemiologic Research  2013.6  Society for Epidemiologic Research

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    Event date: 2013.6.18 - 2013.6.21

    Language:English   Presentation type:Symposium, workshop panel (public)  

    Venue:Boston, MA  

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  • The effect of community resource on suicidal ideation among the elderly people in Okayama prefecture

    Noguchi M, Iwase T, Suzuki E, Kishimoto Y, Okamoto M, Takao S

    The 109th Annual Meeting of the Japanese Society of Psychiatry and Neurology  2013.5 

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    Event date: 2013.5.23 - 2013.5.25

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Fukuoka  

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  • A review of workplace social capital and health International coauthorship

    Suzuki E, Oksanen T, Vahtera J, Kivimäki M, Takao S

    The 86th Annual Meeting of Japan Society for Occupational Health  2013.5.16 

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    Event date: 2013.5.15 - 2013.5.17

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Ehime  

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  • A characteristic description of workplace social capital

    Takao S, Suzuki E, Doi H

    The 86th Annual Meeting of Japan Society for Occupational Health  2013.5.16 

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    Event date: 2013.5.15 - 2013.5.17

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Ehime  

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  • Interobserver variability of 3T and 1.5T MRI/CT fusion-based postimplant dosimetry of prostate brachytherapy International conference

    Katayama N, Yamashita M, Bekku K, Tanimoto R, Suzuki E, Takemoto M, Katsui K, Nasu Y, Kumon H, Kanazawa S

    2nd European Society for Radiotherapy & Oncology (ESTRO) Forum  2013.4 

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    Event date: 2013.4.19 - 2013.4.23

    Language:English   Presentation type:Poster presentation  

    Venue:Geneva  

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  • Interobserver variability of 3T and 1.5T MRI/CT fusion-based postimplant dosimetry of prostate brachytherapy

    Katayama N, Yamashita M, Bekku K, Tanimoto R, Suzuki E, Takemoto M, Waki T, Katsui K, Nasu Y, Kanazawa S

    The 72nd Annual Meeting of the Japan Radiological Society  2013.4 

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    Event date: 2013.4.11 - 2013.4.14

    Language:Japanese  

    Venue:Yokohama, Kanagawa  

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  • The effect of informal support on suicidal ideation among the elderly people

    Noguchi M, Iwase T, Suzuki E, Kishimoto Y, Okamoto M, Takao S

    The 36th Society of Mental Health  2012.11 

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    Event date: 2012.11.15 - 2012.11.16

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Okayama  

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  • Temporal changes in the rates of death and permanent disability from occupational injuries in Thailand: an analysis by area and company scale

    Yamakawa M, Sithisarankul P, Suzuki E, Hengpraprom S, Tsuda T

    The 27th Annual Meeting of Japan Association for International Health  2012.11 

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    Event date: 2012.11.3 - 2012.11.4

    Language:Japanese   Presentation type:Poster presentation  

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  • A counterfactual approach to bias and modification International conference

    Suzuki E, Mitsuhashi T, Tsuda T, Yamamoto E

    45th Annual Meeting of the Society for Epidemiologic Research  2012.6  Society for Epidemiologic Research

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    Event date: 2012.6.27 - 2012.6.30

    Language:English   Presentation type:Poster presentation  

    Venue:Minneapolis, MN  

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  • Geographic variations in all-cause mortality in Japan: compositional or contextual? International coauthorship International conference

    Suzuki E, Kashima S, Kawachi I, Subramanian SV

    45th Annual Meeting of the Society for Epidemiologic Research  2012.6  Society for Epidemiologic Research

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    Event date: 2012.6.27 - 2012.6.30

    Language:English   Presentation type:Poster presentation  

    Venue:Minneapolis, MN  

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  • Time changes, so do people: reflections on age-period-cohort analyses by distinguishing the concept of time in terms of composition and context International conference

    Suzuki E

    45th Annual Meeting of the Society for Epidemiologic Research  2012.6  Society for Epidemiologic Research

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    Event date: 2012.6.27 - 2012.6.30

    Language:English   Presentation type:Poster presentation  

    Venue:Minneapolis, MN  

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  • Clarifying the use of aggregated exposures in multilevel models: self-included vs. self-excluded measures International coauthorship International conference

    Suzuki E, Yamamoto E, Takao S, Kawachi I, Subramanian SV

    45th Annual Meeting of the Society for Epidemiologic Research  2012.6  Society for Epidemiologic Research

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    Event date: 2012.6.27 - 2012.6.30

    Language:English   Presentation type:Poster presentation  

    Venue:Minneapolis, MN  

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  • Critical flaw of the measure against "cause investigation" to mental disorders at workplaces: a discussion using the causal pie model

    Takao S, Suzuki E

    The 85th Annual Meeting of Japan Society for Occupational Health  2012.6.2 

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    Event date: 2012.5.30 - 2012.6.2

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Nagoya  

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  • Individual-level social capital and self-rated health in Japan: an application of the Resource Generator

    Kobayashi T, Iwase T, Mitsuhashi T, Takao S, Suzuki E

    The 85th Annual Meeting of Japan Society for Occupational Health  2012.6.2 

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    Event date: 2012.5.30 - 2012.6.2

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  • Workplace social capital and hypertension among Japanese workers

    Suzuki E, Takao S

    The 85th Annual Meeting of Japan Society for Occupational Health  2012.6.1 

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    Event date: 2012.5.30 - 2012.6.2

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  • Type D personality is associated with psychological distress and poor self-rated health among the elderly: a population-based study in Okayama prefecture

    Kasai Y, Iwase T, Takao S, Suzuki E

    The 85th Annual Meeting of Japan Society for Occupational Health  2012.6.1 

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    Event date: 2012.5.30 - 2012.6.2

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  • Group involvement and health status among Japanese elderly: an examination of bonding and bridging social capital

    Kishimoto Y, Iwase T, Takao S, Suzuki E

    The 85th Annual Meeting of Japan Society for Occupational Health  2012.6.1 

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    Event date: 2012.5.30 - 2012.6.2

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  • Shift work and diabetes mellitus among Japanese male workers: a comparison between irregular and regular shift workers

    Ika K, Suzuki E, Mitsuhashi T, Kobayashi T, Takao S

    The 85th Annual Meeting of Japan Society for Occupational Health  2012.6.1 

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    Event date: 2012.5.30 - 2012.6.2

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  • Maternal working hours and early childhood overweight in Japan: an update

    Mitsuhashi T, Suzuki E, Takao S, Tsuda T, Doi H

    The 85th Annual Meeting of Japan Society for Occupational Health  2012.5.31 

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    Event date: 2012.5.30 - 2012.6.2

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  • The optimal thickness of CT screening for asbestos-related pleural plaques on the diaphragm

    Sakamoto H, Kato K, Suzuki E, Takao S, Yoshio K, Uga M, Masaoka, Y, Yamamoto H, Kanazawa S

    The 71st Annual Meeting of the Japan Radiological Society  2012.4 

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    Event date: 2012.4.12 - 2012.4.15

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • Growing social and geographic inequalities in all-cause mortality, Japan, 1970 to 2005 International coauthorship International conference

    Suzuki E, Kashima S, Kawachi I, Subramanian SV

    23rd Annual Conference of the International Society for Environmental Epidemiology  2011.9 

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    Event date: 2011.9.13 - 2011.9.16

    Language:English   Presentation type:Poster presentation  

    Venue:Barcelona  

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  • Influence of crossover therapy on the association between progression-free survival (PFS) and overall survival (OS) in randomized trials of molecular-targeted agents for advanced non-small-cell lung cancer (NSCLC)

    Hotta K, Kiura K, Takigawa N, Suzuki E, Fujiwara Y, Ichihara E, Tabata M, Tanimoto M

    The 9th Annual Meeting of Japanese Society of Medical Oncology  2011.7 

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    Event date: 2011.7.21 - 2011.7.23

    Language:Japanese   Presentation type:Poster presentation  

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  • Workplace social capital and all-cause mortality: A prospective cohort study of 28,043 public sector employees, 2000-2009 International coauthorship International conference

    Oksanen T, Kivimäki M, Kawachi I, Subramanian SV, Takao S, Suzuki E, Kouvonen A, Pentti J, Salo P, Virtanen M, Vahtera J

    Third North American Congress of Epidemiology  2011.6 

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    Event date: 2011.6.21 - 2011.6.24

    Language:English   Presentation type:Poster presentation  

    Venue:Montreal, QC  

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  • On the link between sufficient-cause model and potential-outcome model International conference

    Suzuki E, Yamamoto E, Tsuda T

    Third North American Congress of Epidemiology  2011.6 

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    Event date: 2011.6.21 - 2011.6.24

    Language:English   Presentation type:Poster presentation  

    Venue:Montreal, QC  

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  • Identification of operating mediation and mechanism in the sufficient-component cause framework International conference

    Suzuki E, Yamamoto E, Tsuda T

    Third North American Congress of Epidemiology  2011.6 

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    Event date: 2011.6.21 - 2011.6.24

    Language:English   Presentation type:Poster presentation  

    Venue:Montreal, QC  

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  • On the relations between excess fraction, attributable fraction, and etiologic fraction International conference

    Suzuki E, Yamamoto E, Tsuda T

    Third North American Congress of Epidemiology  2011.6 

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    Event date: 2011.6.21

    Language:English   Presentation type:Poster presentation  

    Venue:Montreal, QC  

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  • Directed acyclic graphs in neighborhood and health research (social epidemiology) Invited International coauthorship International conference

    Chaix B, Suzuki E

    Seminar on recent advances in statistics for causal analysis  2011.6  Institut National de la Santé et de la Recherche Médicale

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    Event date: 2011.6.6 - 2011.6.8

    Language:English   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Bordeaux  

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  • Influence of crossover therapy on the association between progression-free survival (PFS) and overall survival (OS) in randomized trials of molecular-targeted agents for advanced non-small-cell lung cancer (NSCLC) International conference

    Hotta K, Kiura K, Suzuki E, Takigawa N, Fujiwara Y, Ichihara E, Tabata M, Tanimoto M

    2011 ASCO (American Society of Clinical Oncology) 47th Annual Meeting  2011.6 

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    Event date: 2011.6.3 - 2011.6.7

    Language:English   Presentation type:Poster presentation  

    Venue:Chicago, IL  

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  • Workplace social capital and metabolic syndrome among Japanese workers

    Suzuki E, Takao S

    The 84th Annual Meeting of Japan Society for Occupational Health  2011.5 

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    Event date: 2011.5.18 - 2011.5.20

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  • The association between metabolic syndrome and work hours among men in Japan

    Kobayashi T, Iwase T, Suzuki E, Takao S

    The 84th Annual Meeting of Japan Society for Occupational Health  2011.5 

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    Event date: 2011.5.18 - 2011.5.20

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  • Relationship between maternal working hours and children's overweight

    Mitsuhashi T, Suzuki E, Takao S, Tsuda T

    The 84th Annual Meeting of Japan Society for Occupational Health  2011.5 

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    Event date: 2011.5.18 - 2011.5.20

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  • Does shift work increase the risk of Diabetes Mellitus among shift workers?

    Ika K, Suzuki E, Mitsuhashi T, Kobayashi T, Takao S

    The 84th Annual Meeting of Japan Society for Occupational Health  2011.5 

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    Event date: 2011.5.18 - 2011.5.20

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  • Group involvement and health status among Japanese workers

    Kishimoto Y, Suzuki E, Takao S, Doi H

    The 84th Annual Meeting of Japan Society for Occupational Health  2011.5 

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    Event date: 2011.5.18 - 2011.5.20

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  • Social capital and oral health among young people

    Morita M, Furuta M, Ekuni D, Suzuki E, Takao S

    The 21st Annual Scientific Meeting of the Japan Epidemiological Association  2011.1.21 

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    Event date: 2011.1.21 - 2011.1.22

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Sapporo, Hokkaido  

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  • Increased risk of lung cancer mortality among residents who had lived near an asbestos product manufacturing plant International conference

    Kumagai S, Kurumatani N, Tsuda T, Yorifuji T, Suzuki E

    22nd Annual Conference of the International Society for Environmental Epidemiology  2010.8 

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    Event date: 2010.8.28 - 2010.9.1

    Language:English   Presentation type:Poster presentation  

    Venue:Seoul  

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  • Environmental exposure to asbestos and pleural plaques among retirees in a factory without asbestos use in H city, Japan International conference

    Yorifuji T, Suzuki E, Tsuda T, Natori Y, Matsui E

    22nd Annual Conference of the International Society for Environmental Epidemiology  2010.8 

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    Event date: 2010.8.28 - 2010.9.1

    Language:English   Presentation type:Poster presentation  

    Venue:Seoul  

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  • Research experience in Okayama University International conference

    Yorifuji T, Suzuki E, Kashima S, Tsuda T, Doi H

    22nd Annual Conference of the International Society for Environmental Epidemiology  2010.8 

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    Event date: 2010.8.28 - 2010.9.1

    Language:English   Presentation type:Symposium, workshop panel (nominated)  

    Venue:Seoul  

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  • Workplace social capital and smoking among Japanese private sector employees International coauthorship International conference

    Suzuki E, Fujiwara T, Takao S, Subramanian SV, Yamamoto E, Kawachi I

    43rd Annual Meeting of the Society for Epidemiologic Research  2010.6  Society for Epidemiologic Research

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    Event date: 2010.6.23 - 2010.6.26

    Language:English   Presentation type:Poster presentation  

    Venue:Seattle, WA  

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  • Multilevel models from two distinctive definitions of ecological variables: self-inclusion and self-exclusion procedures International coauthorship International conference

    Suzuki E, Yamamoto E, Takao S, Kawachi I, Subramanian SV

    43rd Annual Meeting of the Society for Epidemiologic Research  2010.6  Society for Epidemiologic Research

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    Event date: 2010.6.23 - 2010.6.26

    Language:English   Presentation type:Poster presentation  

    Venue:Seattle, WA  

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  • Does low workplace social capital have detrimental effect on workers' health? International coauthorship International conference

    Suzuki E, Takao S, Subramanian SV, Komatsu H, Doi H, Kawachi I

    43rd Annual Meeting of the Society for Epidemiologic Research  2010.6  Society for Epidemiologic Research

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    Event date: 2010.6.23 - 2010.6.26

    Language:English   Presentation type:Poster presentation  

    Venue:Seattle, WA  

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  • Workplace social capital and health: findings from Japan International conference

    Suzuki E

    The 2nd International Symposium on Social Capital and Health  2010.6 

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    Event date: 2010.6.5 - 2010.6.6

    Language:English   Presentation type:Oral presentation (general)  

    Venue:Okayama  

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  • Health management system in the workplace and its objective assessment by employees in Okayama prefecture

    Kobayashi T, Iwase T, Mitsuhashi T, UeshimaK, Ika K, Suzuki E, Takao S

    The 83rd Annual Meeting of Japan Society for Occupational Health  2010.5.28 

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    Event date: 2010.5.26 - 2010.5.28

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukui  

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  • Health management system in the workplace and its implementation: discrepancy due to sampling methods

    Ika K, Mitsuhashi T, Ueshima K, Iwase T, Kobayashi T, Suzuki E, Takao S

    The 83rd Annual Meeting of Japan Society for Occupational Health  2010.5.28 

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    Event date: 2010.5.26 - 2010.5.28

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukui  

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  • Health and safety efforts in the workplace and employees’ poor self-rated health in Japan: a survey for health promotion in Okayama prefecture

    Iwase T, Mituhashi T, Ueshima K, Ika K, Kobayashi T, Suzuki E, Takao S

    The 83rd Annual Meeting of Japan Society for Occupational Health  2010.5.28 

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    Event date: 2010.5.26 - 2010.5.28

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukui  

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  • Presence or absence of appointed occupational physicians and obesity and smoking: a comparison between random sample and convenient sample

    Ueshima K, Iwase T, Mitsuhashi T, Ika K, Kobayashi T, Suzuki E, Takao S

    The 83rd Annual Meeting of Japan Society for Occupational Health  2010.5.28 

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    Event date: 2010.5.26 - 2010.5.28

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukui  

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  • Health and safety efforts in the workplace and employees’ self-rated health: a survey for health promotion in Okayama prefecture

    Takao S, Suzuki E, Mitsuhashi T, Iwase T, Ueshima K, Ika K, Kobayashi T, Doi H

    The 83rd Annual Meeting of Japan Society for Occupational Health  2010.5.28 

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    Event date: 2010.5.26 - 2010.5.28

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukui  

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  • Health and safety efforts in the workplace and employees’ BMI and smoking prevalence: a survey for health promotion in Okayama prefecture

    Mitsuhashi T, Ueshima K, Iwase T, Ika K, Kobayashi T, Suzuki E, Takao S

    The 83rd Annual Meeting of Japan Society for Occupational Health  2010.5.28 

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    Event date: 2010.5.26 - 2010.5.28

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukui  

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  • Workplace social capital and employees’ health

    Suzuki E, Takao S

    The 83rd Annual Meeting of Japan Society for Occupational Health  2010.5.27 

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    Event date: 2010.5.26 - 2010.5.28

    Language:Japanese   Presentation type:Oral presentation (general)  

    Venue:Fukui  

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  • Green tea consumption and mortality among Japanese elderly people

    Suzuki E, Yorifuji T, Takao S, Sugiyama M, Doi H

    The 46th Meeting of Shizuoka Prefecture Public Health  2010.1.27 

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    Event date: 2010.1.27

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • An epidemiologic study of lung cancer among the residents near NICHIAS factory in Hashima city

    Kumagai S, Tsuda T, Yorifuji T, Suzuki E

    The 16th Meeting of Asbestos and Mesothelioma  2009.10.3 

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    Event date: 2009.10.3

    Language:Japanese   Presentation type:Symposium, workshop panel (nominated)  

    Venue:Gifu  

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  • An epidemiologic study of pleural plaque among workers in a neighboring factory to NICHIAS factory in Hashima city

    Yorifuji T, Suzuki E, Tsuda T, Kumagai S

    The 16th Meeting of Asbestos and Mesothelioma  2009.10.3 

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    Event date: 2009.10.3

    Language:Japanese   Presentation type:Symposium, workshop panel (nominated)  

    Venue:Gifu  

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  • Green tea consumption and mortality among Japanese elderly: a population-based cohort study International conference

    Suzuki E, Yorifuji T, Takao S, Komatsu H, Sugiyama M, Doi H

    42nd Annual Meeting of the Society for Epidemiologic Research  2009.6  Society for Epidemiologic Research

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    Event date: 2009.6.23 - 2009.6.26

    Language:English   Presentation type:Oral presentation (general)  

    Venue:Anaheim, CA  

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  • Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: a population-based cohort study International conference

    Suzuki E, Yorifuji T, Ueshima K, Takao S, Sugiyama M, Doi H

    42nd Annual Meeting of the Society for Epidemiologic Research  2009.6  Society for Epidemiologic Research

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    Event date: 2009.6.23 - 2009.6.26

    Language:English   Presentation type:Poster presentation  

    Venue:Anaheim, CA  

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  • Development of measures against overwork based on risk management in the workplace

    Takao S, Suzuki E, Kamizato E, Mitsuhashi T, Ueshima K, Iwase T, Doi H

    The 82nd Annual Meeting of Japan Society for Occupational Health  2009.5.22 

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    Event date: 2009.5.20 - 2009.5.22

    Language:Japanese  

    Venue:Fukuoka  

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  • Excess mortality from lung cancer among the residents near NICHIAS factory in Hashima city

    Kumagai S, Tsuda T, Yorifuji T, Suzuki E

    The 82nd Annual Meeting of Japan Society for Occupational Health  2009.5.22 

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    Event date: 2009.5.20 - 2009.5.22

    Language:Japanese  

    Venue:Fukuoka  

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  • Work-based social networks and health status among Japanese employees

    Suzuki E, Takao S, Doi H

    The 82nd Annual Meeting of Japan Society for Occupational Health  2009.5.21 

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    Event date: 2009.5.20 - 2009.5.22

    Language:Japanese  

    Venue:Fukuoka  

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  • Current status of health care action within companies in Okayama: A comparison between awareness among companies and employees

    Ueshima K, Suzuki E, Takao S, Doi H

    The 82nd Annual Meeting of Japan Society for Occupational Health  2009.5.21 

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    Event date: 2009.5.20 - 2009.5.22

    Language:Japanese  

    Venue:Fukuoka  

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  • Perception of health management within workplaces in Okayama: A comparison between employer and employees

    Kamizato E, Suzuki E, Takao S, Doi H

    The 82nd Annual Meeting of Japan Society for Occupational Health  2009.5.21 

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    Event date: 2009.5.20 - 2009.5.22

    Venue:Fukuoka  

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  • Management for metabolic syndrome at workplace and body mass index among Japanese employees

    Iwase T, Suzuki E, Takao S, Doi H

    The 82nd Annual Meeting of Japan Society for Occupational Health  2009.5.21 

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    Event date: 2009.5.20 - 2009.5.22

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukuoka  

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  • Association between green tea consumption and all-cause mortality

    Suzuki E, Yorifuji T, Takao S, Sugiyama M, Doi H

    The 67th Annual Meeting of Japanese Society of Public Health  2008.11.7 

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    Event date: 2008.11.5 - 2008.11.7

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukuoka  

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  • Association between physical activity and cause-specific mortality in the elderly

    Ueshima K, Yorifuji T, Suzuki E, Takao S, Sugiyama M, Doi H

    The 67th Annual Meeting of Japanese Society of Public Health  2008.11.7 

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    Event date: 2008.11.5 - 2008.11.7

    Language:Japanese  

    Venue:Fukuoka  

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  • Association between community-level social participation and self-rated health in Shizuoka prefecture

    Takao S, Yorifuji T, Suzuki E, Komatsu H, Sugiyama M, Doi H

    The 67th Annual Meeting of Japanese Society of Public Health  2008.11.6 

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    Event date: 2008.11.5 - 2008.11.7

    Language:Japanese  

    Venue:Fukuoka  

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  • Association between sleep duration and cause-specific mortality among the elderly people in Shizuoka prefecture: SEC project 22

    Sugiyama M, Doi H, Takao S, Yorifuji T, Suzuki E

    The 67th Annual Meeting of Japanese Society of Public Health  2008.11.6 

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    Event date: 2008.11.5 - 2008.11.7

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukuoka  

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  • Association between suspended particulate matter and all-cause and cause-specific mortality

    Yorifuji T, Kashima S, Tsuda T, Suzuki E, Takao S, Sugiyama M, Doi H

    The 67th Annual Meeting of Japanese Society of Public Health  2008.11.5 

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    Event date: 2008.11.5 - 2008.11.7

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Fukuoka  

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  • Long-term exposure to particulate matter and all-cause and cause-specific morality in Japan: Shizuoka Study International conference

    Yorifuji T, Kashima S, Suzuki E, Takao S, Tsuda T, Sugiyama M, Doi H

    20th Annual Conference of the International Society for Environmental Epidemiology  2008.10.16 

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    Event date: 2008.10.12 - 2008.10.16

    Language:English   Presentation type:Poster presentation  

    Venue:Pasadena, CA  

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  • A report of an outbreak of influenza infection in a manufacturing facility

    Tsuda T, Doi H, Takao S, Komatsu H, Ueshima K, Iwase T, Suzuki E

    The 81st Annual Meeting of Japan Society for Occupational Health  2008.6.27 

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    Event date: 2008.6.24 - 2008.6.28

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Sapporo, Hokkaido  

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  • Development and assessment of subsequent measures of health checkup based on risk management in the workplace: report of a trial of two cases

    Takao S, Suzuki E, Kamizato E, Komatsu H, Ueshima K, Iwase T, Doi H

    The 81st Annual Meeting of Japan Society for Occupational Health  2008.6.26 

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    Event date: 2008.6.24 - 2008.6.28

    Language:Japanese   Presentation type:Poster presentation  

    Venue:Sapporo, Hokkaido  

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  • Association between social network at work and self-rated health among Japanese workers

    Suzuki E, Takao S, Doi H

    The 81st Annual Meeting of Japan Society for Occupational Health  2008.6.25 

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    Event date: 2008.6.24 - 2008.6.28

    Language:Japanese  

    Venue:Sapporo, Hokkaido  

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  • Total mercury content in the hair and neurological signs International conference

    Yorifuji T, Suzuki E, Takao S, Tsuda T, Harada M

    19th Annual Conference of the International Society for Environmental Epidemiology  2007.9 

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    Event date: 2007.9.5 - 2007.9.9

    Language:English   Presentation type:Poster presentation  

    Venue:Mexico City  

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  • Evaluation of self-control program for better quality of sleep using mobile phones: randomized controlled trial International conference

    Suzuki E, Tsuchiya M, Hirokawa K, Taniguchi T, Mitsuhashi T, Kawakami N

    Ninth International Congress of Behavioral Medicine  2006.12.1 

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    Event date: 2006.11.29 - 2006.12.2

    Language:English   Presentation type:Poster presentation  

    Venue:Bangkok  

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  • AI, Data Science, and Causal Inference

    SUZUKI Etsuji

    2019.11.28  Okayama University

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    Language:Japanese   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

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  • How could the sufficient-cause model advance our understanding of etiology? Invited

    Suzuki E

    2019.3.7  Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute

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    Language:Japanese   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Aichi  

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  • How could the sufficient-cause model advance our understanding of etiology? Invited International conference

    Suzuki E

    2018.5.10  Department of Epidemiology, Biostatistics and Occupational Health, McGill University

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    Language:English   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Montreal, QC  

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  • Sufficient-cause model and potential-outcome model Invited International conference

    Suzuki E

    2017.10.6  Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill

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    Language:English   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Chapel Hill, NC  

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  • How could the sufficient-cause model deepen our understanding of causality? Invited International conference

    Suzuki E

    2017.10.4  Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University

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    Language:English   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Boston, MA  

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  • Thyroid cancer under 19 in Fukushima: The fifth report – the 2nd round screening International conference

    Tsuda T, Suzuki E, Tokinobu A, Yamamoto E

    29th Annual Conference of the International Society for Environmental Epidemiology  2017.9 

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    Language:English   Presentation type:Poster presentation  

    Venue:Sydney, Australia  

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  • Sufficient-cause model and potential-outcome model Invited

    Suzuki E

    2015.2.3  Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo

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    Language:Japanese   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Tokyo  

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  • Causal inference in medicine Invited International conference

    Suzuki E

    2011.2.18  Mount Sinai School of Medicine

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    Language:English   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:New York, NY  

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  • Causal inference in medicine Invited International conference

    Suzuki E

    2011.1.21  Institut national de la santé et de la recherche médicale (Inserm), U1018, Research Unit in Epidemiology and Population Health

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    Language:English   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Paris  

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  • Causal inference in medicine Invited International conference

    Suzuki E

    2011.1.19  Cancer Epidemiology Unit, University of Turin

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    Language:English   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Turin  

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  • Causal inference in medicine Invited International conference

    Suzuki E

    2010.2.15  Institut national de la santé et de la recherche médicale (Inserm), U707, Research Unit in Epidemiology, Information Systems, and Modeling

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    Language:English   Presentation type:Public lecture, seminar, tutorial, course, or other speech  

    Venue:Paris  

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Awards

  • 2022 Best Paper Award (Silver)

    2022.11   The Japanese Society for Neuroendovascular Therapy (JSNET)   Trends in incidence of intracranial and spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan. Stroke. 2021;52(4):1455–1459. (doi: 10.1161/STROKEAHA.120.032052)

    Murai S, Hiramatsu M, Suzuki E, Ishibashi R, Takai H, Miyazaki Y, Takasugi Y, Yamaoka Y, Nishi K, Takahashi Y, Haruma J, Hishikawa T, Yasuhara T, Chin M, Matsubara S, Uno M, Tokunaga K, Sugiu K, Date I

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    Award type:Award from Japanese society, conference, symposium, etc.  Country:Japan

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  • Excellent Oral Presentation Award

    2022.6   The 28th Annual Meeting of the Japanese Association of Cardiac Rehabilitation   Hourly association between ambient temperature and cardiovascular emergency calls: risk awareness and measures against high temperature in exercise therapy

    Fujimoto R, Suzuki E, Nakamura K, Oka T, Ito H, Yorifuji T

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    Award type:Award from Japanese society, conference, symposium, etc.  Country:Japan

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  • Young Investigator Award

    2021.6   The 116th and 118th Meeting of Chugoku and Shikoku Regional Association, The Japanese Circulation Society   Hourly temperature in summer and emergency ambulance calls due to ischemic heart diseases in the elderly

    Fujimoto R, Suzuki E, Nakamura K, Yorifuji T, Ito H

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    Award type:Award from Japanese society, conference, symposium, etc.  Country:Japan

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  • Excellent Abstract Award

    2021.2   The 48th Annual Meeting of the Japanese Society of Intensive Care Medicine   Body mass index and ventilator dependence in critically ill patients: a cohort study using a nationwide database

    Fujinaga J, Suzuki E, Irie H, Onodera M

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    Award type:Award from Japanese society, conference, symposium, etc.  Country:Japan

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  • Journal of Epidemiology, Best Reviewer 2018

    2019.1   Japan Epidemiological Association  

    SUZUKI Etsuji

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    Award type:Honored in official journal of a scientific society, scientific journal  Country:Japan

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  • Takemi Encouraging Prize

    2015.12   Transition of inequalities in health in Japan and the contributing factors, and establishment of methods to identify bias and its control

    SUZUKI Etsuji

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    Award type:Award from publisher, newspaper, foundation, etc.  Country:Japan

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  • Best Poster Award

    2008.11   The 67th Annual Meeting of Japanese Society of Public Health  

    SUZUKI Etsuji

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    Award type:Award from Japanese society, conference, symposium, etc.  Country:Japan

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Research Projects

  • Causal analysis study and AI: development of programs to reduce health inequalities and application to real world data

    Grant number:19KK0418  2022.04 - 2025.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Fund for the Promotion of Joint International Research (Fostering Joint International Research (A))  Fund for the Promotion of Joint International Research (Fostering Joint International Research (A))

    Etsuji Suzuki

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    Authorship:Principal investigator  Grant type:Competitive

    Grant amount:\15210000 ( Direct expense: \11700000 、 Indirect expense:\3510000 )

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  • Development of propensity score models in large epidemiologic studies: causal inference and AI

    Grant number:20K10471  2020.04 - 2023.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)  Grant-in-Aid for Scientific Research (C)

    Etsuji Suzuki, Takashi Yorifuji, Tomohiro Shinozaki

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    Authorship:Principal investigator  Grant type:Competitive

    Grant amount:\4290000 ( Direct expense: \3300000 、 Indirect expense:\990000 )

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  • Evaluation of health effects of environmental policies for air pollution using big data

    Grant number:20K10499  2020.04 - 2023.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)  Grant-in-Aid for Scientific Research (C)

    Toshihide Tsuda, Takashi Yorifuji, Etsuji Suzuki, Saori Kashima

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    Authorship:Coinvestigator(s)  Grant type:Competitive

    Grant amount:\4160000 ( Direct expense: \3200000 、 Indirect expense:\960000 )

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  • Short-term and long-term health effects of transboundary air pollution (Asian dust) in East Asian regions.

    Grant number:18K10104  2018.04 - 2022.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)  Grant-in-Aid for Scientific Research (C)

    Saori Kashima, Takashi Yorifuji, Etsuji Suzuki

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    Authorship:Coinvestigator(s)  Grant type:Competitive

    Grant amount:\4420000 ( Direct expense: \3400000 、 Indirect expense:\1020000 )

    本年度は、①解析データセット作成、② 短期影響評価に関するデータ解析作業を実施した。まず、①解析データの作成では、前年度に厚生労働省へ入手申請したヘルスアウトカムデータが本年度に到着し、それら死亡個票と総務省より入手した救急搬送データを用いて解析に必要なヘルスアウトカムのデータセット作成を行った。加えて、曝露データである日本の時間別大気汚染濃度および越境型大気汚染濃度(主に黄砂)の曝露データセット作成を行った。次に、それら曝露データとヘルスアウトカムデータを結合し、短期影響評価のための時系列解析用のデータセットを作成し、おおむね解析データセット作成に関する作業は完了した。加えて、昨年度作成した日本全土の微小粒子状物質(PM2.5)の濃度予測モデル(Land Use regression model:LUR)に加えて、二酸化窒素(NO2)の日本全土の測定局濃度を収集し、そのデータを元に濃度予測モデル(NO2 LUR model)の作成を行った。加えて同日本全土モデルと、地域限定モデルの濃度予測精度について比較を行った。②の解析作業は、作成が完了したデータセットを用いて、まずは越境型大気汚染による短期健康影響評価を実施すべく解析作業を行っており、現在進行中である。曝露モデル作成に関しては、2020年8月に開催された2020年 第32回国際環境疫学学会(International Society for Environmental Epidemiology)総会議において、日本全土の二酸化窒素濃度予測モデル(NO2 LUR model)に関して発表を行い、アジアの越境型大気汚染による健康影響について、世界の研究者とオンラインで情報交換および議論を行った。

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  • Identification of mechanisms of health inequalities from life-course perspective and global comparison: strategies to tackle health inequalities

    Grant number:17K17898  2017.04 - 2020.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Young Scientists (B)  Grant-in-Aid for Young Scientists (B)

    Etsuji Suzuki

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    Authorship:Principal investigator  Grant type:Competitive

    Grant amount:\4290000 ( Direct expense: \3300000 、 Indirect expense:\990000 )

    I developed a theory of variable selection when controlling for confounding bias, clarifying the significant concept of “covariate balance” for appropriate analyses. I illustrated that covariate balance is a sufficient, but not a necessary, condition for no confounding irrespective of the target population (i.e., population of research interest). Further, I assessed mechanisms and uncertainties in randomized controlled trials from a perspective of causal models, and showed how to describe propensity score (i.e., conditional probability that measures the propensity of individuals to receive exposure given the information available in the covariates) methods in the latest framework of causal diagrams.

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  • Evaluation of the effects of Asian dust on health outcomes in East Asian countries: Its double role as a direct cause and as an effect modifier

    Grant number:15K08776  2015.04 - 2019.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)  Grant-in-Aid for Scientific Research (C)

    Saori Kashima, Takashi Yorifuji, Etsuji Suzuki

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    Authorship:Coinvestigator(s)  Grant type:Competitive

    Grant amount:\4940000 ( Direct expense: \3800000 、 Indirect expense:\1140000 )

    Despite the recent increase of the observation days of Asian dust, health effects of desert dust are not well understood. We evaluated the health effects of Asian dust and found that Asian dust directly increased the risk of mortality and morbidity. Furthermore, Asian dust could modify the association between local air pollution and its adverse health effects. In addition, it was revealed that these effects differ depending on the attributes of individuals (e.g., age, gender, and medical history of disease).

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  • Global assessment of inequalities in cause-specific mortality based on the analysis of national data: implications for strategies to tackle health inequalities

    Grant number:26870383  2014.04 - 2017.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Young Scientists (B)  Grant-in-Aid for Young Scientists (B)

    Etsuji Suzuki

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    Authorship:Principal investigator  Grant type:Competitive

    Grant amount:\4030000 ( Direct expense: \3100000 、 Indirect expense:\930000 )

    I aimed to establish the methods for analysis and global assessment of health inequalities. I elucidated the nature of confounding bias that should be considered when assessing health inequalities, showing a typology of four notions of confounding. In addition, I provided a new organizational schema for errors that occur when assessing health inequalities. Furthermore, by focusing on social determinants of health (e.g., social capital) and their related environmental factors (e.g., desert dust), I revealed key features of health inequalities in Japan and examined the context of growing inequalities.

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  • Identification of vulnerable population to climate changes and establishment of effective preventive strategies

    Grant number:22390124  2010.04 - 2013.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)  Grant-in-Aid for Scientific Research (B)

    TSUDA Toshihide, YAMAMOTO Eiji, DOI Hiroyuki, YORIFUJI Takashi, KASHIMA Saori, SUZUKI Etsuji

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    Authorship:Coinvestigator(s)  Grant type:Competitive

    Grant amount:\7410000 ( Direct expense: \5700000 、 Indirect expense:\1710000 )

    To evaluate the impact of ambient temperature on morbidity, weconducted a time-series analysis by using the daily data of emergency ambulance dispatches for people aged 65 or older from 2006 to 2010 in Okayama city. After adjusting for a variety of covariates including suspended particulate matter and ozone, we found that an adjusted rate ratio for respiratory diseases (particularly, pneumonia and influenza) increased under heat environment. By contrast, an adjusted rate ratio for cardiovascular diseases (particularly, transient ischemic attack) increased under cold environment.

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Class subject in charge

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