Updated on 2024/02/01

写真a

 
TSUDA Toshihide
 
Organization
Faculty of Environmental, Life, Natural Science and Technology Professor
Position
Professor
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Degree

  • M.D. and Ph.D. ( Okayama University )

Research Interests

  • 環境汚染における発がん

  • 医学情報の21世紀のあり方

  • 疫学理論

  • Causal Inference in Environmental Epidemiology

  • 根拠に基づく医学

  • 因果推論

  • Environmental Medicine

  • Epidemiology

  • 環境医学

  • 疫学

  • Evidence Based Medicine

  • Causal Inference

  • Numerical method and Japanese medical research

Research Areas

  • Environmental Science/Agriculture Science / Radiation influence  / Carcinogenisity in Humans due to environmental pollution

  • Humanities & Social Sciences / Philosophy and ethics  / Causal Inference in Environmental Epidemiology

  • Humanities & Social Sciences / Sociology of science, history of science and technology  / Evolution of the infrastructure in medical evidence

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

  • Life Science / Ecology and environment  / Evidence in Medical Science

  • Environmental Science/Agriculture Science / Environmental impact assessment

  • Humanities & Social Sciences / Philosophy and ethics

  • Environmental Science/Agriculture Science / Environmental policy and social systems

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

  • Life Science / Hygiene and public health (laboratory)

  • Life Science / Medical management and medical sociology

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Education

  • Okayama University    

    - 1989

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  • Okayama University   医学研究科   衛生学

    - 1989

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    Country: Japan

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  • Okayama University   医学部   医学科

    - 1985

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    Country: Japan

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  • Okayama University    

    - 1985

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Research History

  • Okayama University Graduate Schools of Environmental Life Natural Sciences   環境生態学講座   MD and PhD

    2022.4

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    Country:Japan

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  • - Occupational Physician,Occupational Safety and Health,Administrative Center,Okayama University

    2005

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  • - 岡山大学 大学院環境学研究科 教授

    2005

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  • - 岡山大学本部安全衛生委員会 産業医

    2005

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  • - 岡山大学環境生命科学研究科 教授

    2005

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  • - Professor,Okayama University The Graduate School of Environmental Science

    2005

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  • - Professor,Graduate School of Environmental and life Science,Okayama University

    2005

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  • - Comittee Member of IRB,Institutional Review Board,University Hospital of Medicine and Dentistry,Okayama University

    2004

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  • - 岡山大学岡山大学病院治験審査委員会 治験審査委員

    2004

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  • Professor,Department of Hygiene, Okayama University Graduate School of Medical and Dental Science

    2001 - 2004

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  • 岡山大学大学院医歯学総合研究科長寿社会医学専攻衛生学 講師

    2001 - 2004

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  • Senior Assistant Professor,Department of Hygiene, Okayama University School of Medicine

    1995 - 2001

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  • Okayama University   Medical School

    1995 - 2001

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  • Assistant Professor,Okayama University School of Medicine

    1990 - 1995

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  • Okayama University   Medical School

    1990 - 1995

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Professional Memberships

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Committee Memberships

  • Japanese Society of Psychiatry and Neurology   Member of the Law Commission  

    1995.1 - 2023.7   

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    Committee type:Academic society

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  • Japanese Society for Hygiene   Expart  

       

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    Committee type:Academic society

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Papers

  • Demonstrating the undermining of science and health policy after the Fukushima nuclear accident by applying the Toolkit for detecting misused epidemiological methods. Reviewed

    Tsuda T, Miyano Y and Yamamoto E

    Environmental Health   21   77   2022.8

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

    DOI: https://doi.org/10.1186/s12940-022-00884-6

  • Demonstrating the undermining of science and health policy after the Fukushima nuclear accident by applying the Toolkit for detecting misused epidemiological methods Reviewed

    Toshihide Tsuda, Yumiko Miyano, Eiji Yamamoto

    Environmental Health   21 ( 1 )   1 - 22   2022.8

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

    Abstract

    It is well known that science can be misused to hinder the resolution (i.e., the elimination and/or control) of a health problem. To recognize distorted and misapplied epidemiological science, a 33-item “Toolkit for detecting misused epidemiological methods” (hereinafter, the Toolkit) was published in 2021. Applying the Toolkit, we critically evaluated a review paper entitled, “Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in the case of a future nuclear accident” in Environment International in 2021, published by the SHAMISEN (Nuclear Emergency Situations - Improvement of Medical and Health Surveillance) international expert consortium. The article highlighted the claim that overdiagnosis of childhood thyroid cancers greatly increased the number of cases detected in ultrasound thyroid screening following the 2011 Fukushima nuclear accident. However, the reasons cited in the SHAMISEN review paper for overdiagnosis in mass screening lacked important information about the high incidence of thyroid cancers after the accident. The SHAMISEN review paper ignored published studies of screening results in unexposed areas, and included an invalid comparison of screenings among children with screenings among adults. The review omitted the actual state of screening in Fukushima after the nuclear accident, in which only nodules > 5 mm in diameter were examined. The growth rate of thyroid cancers was not slow, as emphasized in the SHAMISEN review paper; evidence shows that cancers detected in second-round screening grew to more than 5 mm in diameter over a 2-year period. The SHAMISEN consortium used an unfounded overdiagnosis hypothesis and misguided evidence to refute that the excess incidence of thyroid cancer was attributable to the nuclear accident, despite the findings of ongoing ultrasound screening for thyroid cancer in Fukushima and around Chernobyl. By our evaluation, the SHAMISEN review paper includes 20 of the 33 items in the Toolkit that demonstrate the misuse of epidemiology. The International Agency for Research on Cancer meeting in 2017 and its publication cited in the SHAMISEN review paper includes 12 of the 33 items in the Toolkit. Finally, we recommend a few enhancements to the Toolkit to increase its utility.

    File: Tsuda2022Environmental Health0f81e5bb-1669-40e1-ba1a-e2a35b1c1ba8.pdf

    DOI: 10.1186/s12940-022-00884-6

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    Other Link: https://link.springer.com/article/10.1186/s12940-022-00884-6/fulltext.html

  • Mistaken information can lead only to misguided conclusions and policies: a commentary regarding Schüz et al.’s response Reviewed

    Toshihide Tsuda, Yumiko Miyano, Eiji Yamamoto

    Environmental Health   22 ( 62 )   1 - 6   2023.11

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

    File: Tsuda2023EnvironmentalHealths12940-023-01013-7.pdf

    DOI: 10.1186/s12940-023-01013-7

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  • A population-based longitudinal study on glycated hemoglobin levels and new-onset chronic kidney disease among non-diabetic Japanese adults. International journal

    Yukari Okawa, Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Takashi Yorifuji

    Scientific reports   13 ( 1 )   13770 - 13770   2023.8

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

    Chronic kidney disease (CKD) is a major global public health problem. Recent studies reported that diabetes and prediabetes are risk factors for developing CKD; however, the exact glycated hemoglobin (HbA1c) cut-off value for prediabetes remains controversial. In this study, we aimed to examine the relationship between HbA1c levels and subsequent CKD development in greater detail than previous studies. Longitudinal data of annual checkups of 7176 Japanese non-diabetic people (male: 40.4%) from 1998 to 2022 was analyzed. HbA1c values were categorized into < 5.0%, 5.0-5.4%, 5.5-5.9%, and 6.0-6.4%. CKD was defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m2. The descriptive statistics at study entry showed that higher HbA1c values were associated with male, older, overweight or obese, hypertensive, or dyslipidemic people. During a mean follow-up of 7.75 person-years, 2374 participants (male: 40.0%) developed CKD. The Weibull accelerated failure time model was selected because the proportional hazards assumption was violated. The adjusted time ratios of developing CKD for HbA1c levels of 5.5-5.9% and 6.0-6.4% compared with 5.0-5.4% were 0.97 (95% confidence interval: 0.92-1.03) and 1.01 (95% confidence interval: 0.90-1.13), respectively. There was no association between HbA1c in the prediabetic range and subsequent CKD development.

    DOI: 10.1038/s41598-023-40300-8

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  • Preparedness for measles among Japanese travelers to India after the COVID-19 pandemic

    Michiyo Yamakawa, Yuko Tanaka, Akiko Tokinobu, Toshihide Tsuda

    Journal of Travel Medicine   2023.6

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

    Highlight

    After the COVID-19 pandemic, over half of Japanese budget travellers to India did not adequately prepare for measles. Most of those who visited a clinic for travel vaccination missed the opportunity to get vaccinated against measles. For the summer, urgent efforts to ensure travellers’ preparation for measles are required.

    DOI: 10.1093/jtm/taad086

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

    Michiyo Yamakawa, Toshihide Tsuda, Keiko Wada, Chisato Nagata, Etsuji Suzuki

    PLOS ONE   18 ( 2 )   e0279426 - e0279426   2023.2

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    Publishing type:Research paper (scientific journal)   Publisher:Public Library of Science (PLoS)  

    Despite an increasing number of students studying abroad worldwide, evidence about health risks while they are abroad is limited. Diarrhea is considered the most common travelers’ illness, which would also apply to students studying abroad. We examined diarrhea and related personal characteristics among Japanese students studying abroad. Japanese university students who participated in short-term study abroad programs between summer 2016 and spring 2018 were targeted (n = 825, 6–38 travel days). Based on a 2-week-risk of diarrhea (passing three or more loose or liquid stools per day) among travelers by country, the destination was separated into intermediate- and low-risk countries. After this stratification, the associations between personal characteristics and diarrhea during the first two weeks of their stay were evaluated using logistic regression models. Among participants in intermediate-risk countries, teenagers, males and those with overseas travel experience were associated with an elevated risk of diarrhea; the odds ratios (95% confidence intervals) were 2.42 (1.08–5.43) for teenagers (vs. twenties), 1.93 (1.08–3.45) for males (vs. females) and 2.37 (1.29–4.33) for those with overseas experience (vs. none). Even restricting an outcome to diarrhea during the first week did not change the results substantially. The same tendency was not observed for those in the low-risk countries. Teenage students, males and those with overseas travel experience should be cautious about diarrhea while studying abroad, specifically in intermediate-risk countries.

    DOI: 10.1371/journal.pone.0279426

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  • Physical activity and incident dementia in older Japanese adults: The Okayama study. Reviewed International journal

    Yangyang Liu, Toshiharu Mitsuhashi, Michiyo Yamakawa, Megumi Sasai, Toshihide Tsuda, Hiroyuki Doi, Jun Hamada

    International journal of geriatric psychiatry   34 ( 10 )   1429 - 1437   2019.10

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

    OBJECTIVE: To evaluate the association between regular physical activity and the risk of incident dementia in older Japanese adults. METHODS: This was a retrospective cohort study performed in Okayama City, Japan. Overall, 51 477 older Japanese adults were followed from 2008 to 2014. A health checkup questionnaire was used to assess regular physical activity. The Dementia Scale of long-term care insurance was used as a measure of incident dementia. Cox proportional hazard models were used to calculate adjusted hazard ratios, with their 95% confidence intervals, for the incidence of dementia across the categories of physical activity. RESULTS: During a 7-year follow-up, 13 816 subjects were considered as having incident dementia. Compared with participants who performed physical activity less than or equal to one time per week, the multivariate adjusted hazard ratio values (95% confidence intervals) for participants who performed physical activity greater than or equal to two times per week but not every day and those who performed physical activity every day were 0.79 (0.75-0.84) and 0.94 (0.89-0.98), respectively. The interaction of physical activity and sex was statistically significant (P < .01). In subgroup analysis, the multivariate-adjusted hazard ratio values (95% confidence intervals) remained low, at 0.76 (0.70-0.84) in males and 0.81 (0.76-0.87) in females who performed physical activity greater than or equal to two times per week but not every day; they were 0.82 (0.76-0.89) in males and 1.01 (0.95-1.07) in females who performed physical activity every day. CONCLUSIONS: Regular physical activity could reduce the risk of incident dementia in older Japanese adults, except females who performed physical activity every day.

    DOI: 10.1002/gps.5135

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  • Alcohol consumption and incident dementia in older Japanese adults: The Okayama Study. Reviewed

    Yangyang Liu, Toshiharu Mitsuhashi, Michiyo Yamakawa, Megumi Sasai, Toshihide Tsuda, Hiroyuki Doi, Jun Hamada

    Geriatrics & gerontology international   19 ( 8 )   740 - 746   2019.8

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    AIM: To evaluate the association between the amount and frequency of alcohol consumption and incident dementia in older Japanese adults using large sample size data over a long follow-up period. METHODS: This was a retrospective cohort study carried out in Japan. A total of 53 311 older adults were followed from 2008 to 2014. A health checkup questionnaire was used to assess the amount and frequency of alcohol consumption. The Dementia Scale of long-term care insurance was used as a measure of incident dementia. Cox proportional hazards models were used to calculate adjusted hazard ratios, with their 95% confidence intervals, for the incidence of dementia across the categories of alcohol consumption by sex. RESULTS: During a 7-year follow-up period, 14 479 participants were regarded as having incident dementia. Compared with non-drinkers, the multivariate adjusted hazard ratios for participants with alcohol consumption ≤2 units per day, occasionally (0.88, 95% CI 0.81-0.96 in men and 0.84, 95% 0.79-0.90 in women) and daily (0.79, 95% 0.73-0.85 in men and 0.87, 95% 0.78-0.97 in women) were statistically significant, and the difference between occasional and daily consumption was only statistically significant in men; however, for participants with alcohol consumption >2 units per day, occasionally (0.91, 95% 0.71-1.16 in men and 1.09, 95% 0.72-1.67 in women) and daily (0.89, 95% 0.81-1.00 in men and 1.16, 95% 0.84-1.81 in women) were not significant. CONCLUSIONS: Alcohol consumption of ≤2 units per day, occasionally or daily, could reduce the risk of incident dementia, with greater benefit for men with such daily consumption. Geriatr Gerontol Int 2019; 19: 740-746.

    DOI: 10.1111/ggi.13694

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  • Japanese tourists travelling in India have poor pre-travel preparedness. Reviewed

    Tokinobu A, Yamakawa M, Tsuda T, Matsushita N, Hashizume M

    Travel medicine and infectious disease   33   101417 - 101417   2019.5

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    DOI: 10.1016/j.tmaid.2019.05.003

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  • Measles vaccination status among Japanese university students participating in short-term study abroad programs

    Michiyo Yamakawa, Megumi Sasai, Mayumi Ono, Toshihide Tsuda

    Travel Medicine and Infectious Disease   27   131 - 132   2019.1

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

    DOI: 10.1016/j.tmaid.2018.10.008

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  • Combined effects of body mass index and unhealthy behaviors on disability in older Japanese adults: the Okayama study. Reviewed International journal

    Yangyang Liu, Toshiharu Mitsuhashi, Michiyo Yamakawa, Megumi Sasai, Toshihide Tsuda, Hiroyuki Doi, Jun Hamada

    PeerJ   7   e8146   2019

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    Background: Body mass index (BMI) is a significant predictor of functional disability in older adults. However, when evaluated, the association between BMI and incident functional disability, considering behaviors only as covariates or not, may not be appropriate. The primary purpose of the study was to investigate the combined effects of BMI and unhealthy behaviors on the risk of incident functional disability. Methods: This was a retrospective cohort study that took place in Okayama City, Japan. Data on BMI and unhealthy behaviors were obtained using the health check-up questionnaire. The certification of Long-Term Care Insurance was used to measure functional disability. Cox proportional hazard models were used; adjusted hazard ratios (HRs) with 95% confidence interval (CI) were calculated for incidence of functional disability across categories of BMI and number of unhealthy behaviors. Results: The relationship between BMI and incident functional disability was U-shaped (HR = 1.18, 95% CI [1.11-1.25], among the underweight range; and 1.26 [1.19-1.34] among the obesity range), and its risk was significantly higher within the normal-to-overweight range of BMI values with co-occurring unhealthy behaviors (with normal weight range and one, 1.17 [1.01-1.21]; two, 1.29 [1.18-1.41]; and three or four unhealthy behaviors 1.38 [1.24-1.54]; as well as among overweight range and one, 1.16 [1.05-1.27]; two, 1.26 [1.15-1.38]; and three or four unhealthy behaviors, 1.47 [1.31-1.64]). In each BMI category, the risk of incident functional disability increased with increasing number of unhealthy behaviors (p < 0.05 for linear tread), with the highest risk (1.87 [1.58-2.20]) occurring in combination with at least three unhealthy behaviors with BMI ≥ 27.5, for both sexes (2.20 [1.64-2.92] in men and 1.66 [1.35-2.04] in women). Conclusion: It is necessary to consider the combined effects of BMI and behaviors on incident functional disability. Furthermore, interventions targeting multiple behaviors should be considered as such interventions may offer greater benefits than simple interventions.

    DOI: 10.7717/peerj.8146

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  • Association of early daycare attendance with allergic disorders in children: a longitudinal national survey in Japan. Reviewed International journal

    Tokinobu A, Yorifuji T, Yamakawa M, Tsuda T, Doi H

    Archives of environmental & occupational health   75 ( 1 )   1 - 9   2018.12

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    The association between early daycare attendance and risk of allergic diseases remains inconclusive. Therefore, we examined the association among Japanese children on a long-term basis using a nationwide longitudinal survey data. We estimated the association between daycare attendance at age 6 or 18 months and allergy development using information on outpatient visits for atopic dermatitis (AD), food allergy (FA), and asthma and admission for asthma up to 12 years of age as a proxy for developing these diseases, with multilevel logistic regression. Early daycare attendance was associated with increased odds of AD at ages 2.5-3.5 years: the adjusted odds ratio (OR) was 1.34 [95% CI: 1.21, 1.47]. The association with FA was equivocal. The odds of asthma was increased before age 3.5 years and afterwards decreased: the adjusted ORs were 1.60 [1.44, 1.77] for ages 1.5-2.5 years and 0.77 [0.69, 0.87] for ages 5.5-7 years. The effect of early daycare attendance depends on the type of allergies.

    DOI: 10.1080/19338244.2018.1535481

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  • 肥満に対するアーユルヴェーダ療法の効果と安全性 システマティックレビューとメタアナリシスによる検討

    時信 亜希子, 関 隆志, 津田 敏秀

    日本統合医療学会誌   11 ( 2 )   249 - 249   2018.9

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    Language:Japanese   Publisher:(一社)日本統合医療学会  

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  • 舌清掃による消化力改善効果の検討

    時信 亜希子, 頼藤 貴志, 津田 敏秀

    アーユルヴェーダ研究   ( 48 )   95 - 97   2018.4

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    Language:Japanese   Publisher:(一社)日本アーユルヴェーダ学会  

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  • Effects of tongue cleaning on Ayurvedic digestive power and oral health-related quality of life: A randomized cross-over study Reviewed

    A. Tokinobu, T. Yorifuji, M. Sasai, H. Doi, T. Tsuda

    Complementary Therapies in Medicine   36   9 - 13   2018.2

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

    DOI: 10.1016/j.ctim.2017.11.011

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  • Re: Associations between childhood thyroid cancer and external radiation dose after the Fukushima Daiichi Nuclear Power Plant accident Reviewed

    Tsuda T, Tokinobu A, Yamamoto E, Suzuki E

    Epidemiology   29 ( 6 )   e56 - e57   2018

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

    DOI: 10.1097/EDE.0000000000000898

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  • Epidemiology of health problems among passengers on world cruises departing from Japan (in Japanese) Invited Reviewed

    Sasai M, Yamakawa M, Kasai Y, Tsuda T

    Japanese Journal of Travel and Health   11 ( 2 )   81 - 88   2018

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

    Yamakawa M, Sasai M, Kasai Y, Tsuda T, Suzuki E

    Travel Med Infect Dis   23 ( May-Jun )   56 - 63   2018

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:ELSEVIER SCI LTD  

    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 ( > 60 years) and passengers with fewer roommates had an elevated risk of health seeking behavior for diarrhea, although passengers aged < 20 years had an elevated risk on one cruise. After controlling for covariates (including cruise), significant associations remained for passengers aged > 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.

    DOI: 10.1016/j.tmaid.2018.01.004

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  • Erratum to: Ethical Issues Related to the Promotion of a "100 mSv Threshold Assumption" in Japan after the Fukushima Nuclear Accident in 2011: Background and Consequences. Reviewed

    Tsuda T, Lindahl L, Tokinobu A

    Current environmental health reports   4 ( 3 )   383   2017.9

  • Ethical Issues Related to the Promotion of a "100 mSv Threshold Assumption" in Japan after the Fukushima Nuclear Accident in 2011: Background and Consequences. International journal

    Toshihide Tsuda, Lena Lindahl, Akiko Tokinobu

    Current environmental health reports   4 ( 2 )   119 - 129   2017.6

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

    PURPOSE OF REVIEW: This article describes the debates in Japan regarding the 100 mSv threshold assumption and ethical issues related to it, and explores the background to distorted risk information and absence of risk communication in Japan. Then we seek proper risk communication based on scientific evidence. RECENT FINDINGS: On March 11, 2011 an accident occurred at the Fukushima Daiichi Nuclear Power Plant due to the Great East Japan Earthquake. Since then a number of misunderstandings have become common in Japan as a result of public statements by the Japanese and local governments that have no basis in medical science or are contradictory to medical science. Consequently, not only the population of Fukushima Prefecture, but also others, have been subjected to unnecessary exposure to radiation, against the As Low As Reasonably Achievable (ALARA) principle. The number of cases of thyroid cancer has increased by one or two orders of magnitude since the accident in Fukushima. However, the population has hardly been given any correct information from the central and local governments, medical societies, and media. The center of this problem is a statement on radiation-induced cancer (including thyroid cancer) made by the Japanese Government and Japanese medical academic societies indicating that "exposure of less than 100 mSv gives rise to no excess risk of cancer, and even if there is some resulting cancer it will be impossible to detect it" (this will be referred to as "the 100 mSv threshold assumption" from now onward). They have been saying this since April 2011 and have made no effort to correct it. Many Japanese began to notice this but correct information on radiation protection has reached only one part of the population. Risk communication should be based on scientific evidence, and providing it as information for the public is a key element. In Japan, governments and academic societies tried to communicate with the public without doing it. Ethical problems after the accident in Fukushima can be understood from the consequences of the mistakes in both risk information and risk communication in Japan after 2011.

    DOI: 10.1007/s40572-017-0145-0

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  • A typology of four notions of confounding in epidemiology Reviewed

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    JOURNAL OF EPIDEMIOLOGY   27 ( 2 )   49 - 55   2017.2

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    Language:English   Publisher:ELSEVIER SCIENCE INC  

    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.

    DOI: 10.1016/j.je.2016.09.003

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  • Lack of Risk Communication on Health Effects of Radiation and Countermeasure in Fukushima Prefecture and Japan After the Accident: On Health Effects Due to Radiation Based on Medical Evidence

    TSUDA Toshihide

    TRENDS IN THE SCIENCES   22 ( 4 )   4_19 - 4_27   2017

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    Language:Japanese   Publisher:Japan Science Support Foundation  

    DOI: 10.5363/tits.22.4_19

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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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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Ovid Technologies (Wolters Kluwer Health)  

    DOI: 10.1097/ede.0000000000000468

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  • アーユルヴェーダ・シローダーラー療法(頭部滴油療法)の睡眠改善効果を検討するパイロット研究

    時信 亜希子, 頼藤 貴志, 津田 敏秀, 土居 弘幸

    日本統合医療学会誌   8 ( 3 )   156 - 156   2015.11

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    Language:Japanese   Publisher:(一社)日本統合医療学会  

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  • Intrauterine Exposure to Methylmercury and Neurocognitive Functions - Minamata disease – Reviewed International journal

    Takashi Yorifuji, Tsuguhiko Kato, Yoko Kado, Akiko Tokinobu, Michiyo Yamakawa, Toshihide Tsuda, Satoshi Sanada

    Archives of environmental & occupational health   70, 297-302 ( 5 )   297 - 302   2015.6

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    A large-scale food poisoning caused by methylmercury was identified in Minamata, Japan, in the 1950s. The severe intrauterine exposure cases are well known, although the possible impact of low-to-moderate methylmercury exposure in utero are rarely investigated. We examined neurocognitive functions among 22 participants in Minamata, mainly using an intelligence quotient test (Wechsler Adults Intelligent Scale III), in 2012/2013. The participants tended to score low on the Index score of processing speed (PS) relative to full-scale IQ, and discrepancies between PS and other scores within each participant were observed. The lower score on PS was due to deficits in digit symbol-coding and symbol search and was associated with methylmercury concentration in umbilical cords. The residents who experienced low-to-moderate methylmercury exposure including prenatal one in Minamata manifested deficits in their cognitive functions, processing speed in particular.

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  • Cancer and non-cancer excess mortality resulting from mixed exposure to polychlorinated biphenyls and polychlorinated dibenzofurans from contaminated rice oil: "Yusho" Reviewed

    Kashima, Saori, Yorifuji, Takashi, Tsuda, Toshihide, Eboshida, Akira

    INTERNATIONAL ARCHIVES OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH   88 ( 4 )   419 - 430   2015.5

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    In 1968, rice oil contaminated with polychlorinated biphenyls and polychlorinated dibenzofurans caused a severe outbreak of food poisoning in Japan and was termed locally as Yusho&quot; (oil disease). In our previous study, we found that area-based standardize

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  • A simple example as a pedagogical device? Reviewed

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    ANNALS OF EPIDEMIOLOGY   24 ( 7 )   560 - 561   2014.7

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  • Alternative Definitions of "Proportion Eliminated" Reviewed

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    EPIDEMIOLOGY   25 ( 2 )   308 - 309   2014.3

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  • Minamata Reviewed

    T. Yorifuji, T. Tsuda

    Encyclopedia of Toxicology: Third Edition   340 - 344   2014.1

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    The history of Minamata disease is presented in chronological order (from the first outbreak to the current situation). The history of the disease provides us with invaluable lessons for future public health strategies. First, prompt countermeasures should be taken when a cause is identified and should not be postponed until an etiologic agent is identified. Second, lack of investigation obscures the features as well as the expansion of the disease and unnecessarily confuses the situation. Third, the womb is the environment. Finally, social circumstances can induce disease.

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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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  • Regional impact of exposure to a polychlorinated biphenyl and polychlorinated dibenzofuran mixture from contaminated rice oil on stillbirth rate and secondary sex ratio Reviewed International journal

    Yorifuji, Takashi, Kashima, Saori, Tokinobu, Akiko, Kato, Tsuguhiko, Tsuda, Toshihide

    ENVIRONMENT INTERNATIONAL   59   12 - 15   2013.9

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    Yusho disease, a polychlorinated biphenyl (PCB) and polychlorinated dibenzofuran (PCDF) mixed poisoning caused by contaminated rice oil, occurred in Japan in 1968. The evidence on reproductive outcome is limited. We therefore evaluated the regional impact of the exposure to the PCB and PCDF mixture on stillbirth rate and secondary sex ratio among the residents in two severely affected areas. We selected the regionally-affected towns of Tamanoura (n = 4390 in 1970) and Naru (n = 6569) in Nagasaki Prefecture, Japan, for study. We obtained data on stillbirths (spontaneous/artificial) and live-born births (total/male/female) from 1958 to 1994. For a decade and a half after the exposure, an increase in the rate of spontaneous stillbirths coincided with a decrease in the male sex ratio. Compared with the years 1958-1967, the ratios for spontaneous stillbirth rates were 2.16 (95% confidence interval: 1.58 to 2.97) for 1968-1977 and 1.80(95% confidence interval: 1.25 to 2.60) for 1978-1987. The sex ratio (male proportion) was 0.483 (95% confidence interval: 0.457 to 0.508) in the first 10 years after exposure. Exposure to a mixture of PCBs and PCDFs affected stillbirth and sex ratio for a

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

    Suzuki E, Mitsuhashi T, Tsuda T, Yamamoto E

    BMC medical research methodology   13   101   2013.7

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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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  • Critical Appraisal of the 1977 Diagnostic Criteria for Minamata Disease Reviewed

    Takashi Yorifuji, Toshihide Tsuda, Sachiko Inoue, Soshi Takao, Masazumi Harada, Ichiro Kawachi

    ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH   68 ( 1 )   22 - 29   2013.1

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    Large-scale food poisoning caused by methylmercury was identified in Minamata, Japan, in the 1950s (Minamata disease). Although the diagnostic criteria for the disease remain current, few studies have been carried out to assess the diagnostic accuracy of the criteria. From a 1971 population-based investigation, data from 2 villages were selected: Minamata (high-exposure area; n = 779) and Ariake (low-exposure area; n = 755). The authors examined the prevalence of neurologic signs characteristic of methylmercury poisoning and the validity of the criteria. A substantial number of residents in the exposed area exhibited neurologic signs even after excluding officially certified patients. Using paresthesia of the extremities as the gold standard of diagnosis, the criteria had a sensitivity of 66%. The current diagnostic criteria as well as the official certification system substantially underestimate the incidence of Minamata disease.

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  • Asian dust and daily all-cause or cause-specific mortality in western Japan Reviewed

    Kashima, Saori, Yorifuji, Takashi, Tsuda, Toshihide, Eboshida, Akira

    OCCUPATIONAL AND ENVIRONMENTAL MEDICINE   69 ( 12 )   908 - 915   2012.12

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    Objective Desert dust, which is included in course particles, is considered to have potential toxicity. The effect modification of desert dust on associations between anthropogenic air pollution and mortality has been evaluated. However, the independent effects of Asian dust are less clear. Thus, we evaluated the effects of Asian dust on mortality independent of particulate matter (PM) in western Japan. Methods We obtained daily mean concentrations of Asian dust using Light Detection and Ranging measurements and suspended particulate matter (SPM) concentrations (approximately PM8) during March 2005 to December 2010. We then evaluated city-specific associations of Asian dust and SPM with daily mortality using a time-series analysis targeting 1 379 052 people aged 65 or above living in 47 cities. The city-specific results were then combined with a Bayesian-hierarchical model. Results Asian dust did not modify the effects of SPM on mortality. Meanwhile, Asian dust was adversely associated with mortality independent of SPM. The excess risk following a 10 mu/m(3) increase in mean of the current to the previous 2 days Asian dust concentration was 0.6% (95% CI 0.1 to 1.1) for heart diseas

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  • Influence of radiofrequency ablation of lung cancer on pulmonary function. Reviewed

    Tada A, Hiraki T, Iguchi T, Gobara H, Mimura H, Toyooka S, Kiura K, Tsuda T, Mitsuhashi T, Kanazawa S

    Cardiovascular and interventional radiology   35 ( 4 )   860 - 867   2012.8

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    The purpose of this study was to evaluate altered pulmonary function retrospectively after RFA.This retrospective study comprised 41 ablation sessions for 39 patients (22 men and 17 women; mean age, 64.8 years). Vital capacity (VC) and forced expiratory volume in 1 s (FEV1) at 1 and 3 months after RFA were compared with the baseline (i.e., values before RFA). To evaluate the factors that influenced impaired pulmonary function, univariate analysis was performed by using multiple variables. If two or more variables were indicated as statistically significant by univariate analysis, these variables were subjected to multivariate analysis to identify independent factors.The mean VC and FEV1 before RFA and 1 and 3 months after RFA were 3.04 and 2.24 l, 2.79 and 2.11 l, and 2.85 and 2.13 l, respectively. The values at 1 and 3 months were significantly lower than the baseline. Severe pleuritis after RFA was identified as the independent factor influencing impaired VC at 1 month (P = 0.003). For impaired FEV1 at 1 month, only severe pleuritis (P = 0.01) was statistically significant by univariate analysis. At 3 months, severe pleuritis (VC, P = 0.019; FEV1, P = 0.003) and an ablated parenchymal volume a parts per thousand yen20 cm(3) (VC, P = 0.047; FEV1, P = 0.038) were independent factors for impaired VC and FEV1.Pulmonary function decreased after RFA. RFA-induced severe pleuritis and ablation of a large volume of marginal parenchyma were associated with impaired pulmonary function.

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  • Does Open-air Exposure to Volatile Organic Compounds near a Plastic Recycling Factory Cause Health Effects? Reviewed

    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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  • Short-term effect of severe exposure to methylmercury on atherosclerotic heart disease and hypertension mortality in Minamata Reviewed

    Sachiko Inoue, Takashi Yorifuji, Toshihide Tsuda, Hiroyuki Doi

    SCIENCE OF THE TOTAL ENVIRONMENT   417   291 - 293   2012.2

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    Recent studies suggest potential adverse effects of methylmercury exposure on myocardial infarction and hypertension, although the evidence is still limited. We thus evaluated this association using age-standardized mortality ratios (ASMRs) in Minamata, where severe methylmercury poisoning had occurred. We obtained mortality data from annual vital statistics and demographic statistics from census. We then compared mortality of atherosclerotic heart disease including degenerative heart disease and hypertension in Minamatacity with those in Kumamoto Prefecture, which includes Minamata city, as a control. We estimated ASMRs and 95% confidence intervals (CIs) during the period from 1953 to 1970. ASMRs of atherosclerotic heart disease were continuously decreased during the period from 1953 to 1967. In contrast, the ASMR of hypertension was significantly elevated during the period from 1963 to 1967 (SMR= 1.38, CI; 1.06-1.80); but they decreased later. Although dilution is present in this ecological study, our study supports the notion that methylmercury exposure induces hypertension. (C) 2011 Elsevier B.V. All rights reserved.

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  • Residential proximity to major roads and placenta/birth weight ratio Reviewed

    Yorifuji, Takashi, Naruse, Hiroo, Kashima, Saori, Murakoshi, Takeshi, Tsuda, Toshihide, Doi, Hiroyuki, Kawachi, Ichiro

    SCIENCE OF THE TOTAL ENVIRONMENT   414   98 - 102   2012.1

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    Exposure to air pollution has been demonstrated to increase the risk of preterm birth and low birth weight. We examined whether proximity to major roads (as a marker of exposure to air pollution) is associated with increased placenta/birth weight ratio (as a biomarker of the placental transport function). Data on parental characteristics and birth outcomes were extracted from the database maintained by a major hospital in Shizuoka Prefecture, Japan. We restricted the analysis to mothers who delivered liveborn single births from 1997 to 2008 (n = 14,189). Using geocoded residential information, each birth was classified according to proximity to major roads. We examined the association between proximity to major roads and the placenta/birth weight ratio, using multiple linear regression. Proximity to major roads was associated with higher placenta/birth weight ratio. After adjusting for potential confounders, living within 200 m of a major road increased the ratio by 0.48% (95% CI = 0.15 to 0,80). In addition, proximity to major roads was associated with lower placenta weight and birth weight. These observed associations were stronger among participants living closer to major roads.

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  • Methyl Mercury Exposure at Niigata, Japan: Results of Neurological Examinations of 103 Adults Reviewed

    Kimio Maruyama, Takashi Yorifuji, Toshihide Tsuda, Tomoko Sekikawa, Hiroto Nakadaira, Hisashi Saito

    JOURNAL OF BIOMEDICINE AND BIOTECHNOLOGY   2012

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    Background. Large-scale poisonings caused by methyl mercury (MeHg) have occurred in Japan (Minamata in the 1950s and Niigata in the 1960s) and Iraq (in the 1970s). The current WHO neurological risk standard for adult exposure (hair level: 50 mu g/g) was based partly on evidence from Niigata which did not consider any cases who were diagnosed later and/or exposed to low level of MeHg (hair mercury level less than 50 mu g/g). Methods. Early in the Niigata epidemic in June 1965 there were two extensive surveys. From these two surveys, we examined 103 adults with hair mercury measurement who consulted two medical institutions. We compared the prevalence and the distribution of neurological signs related to MeHg poisoning between exposure categories. Result. We found 48 subjects with neurological signs related to MeHg poisoning who had hair mercury concentration less than 50 mu g/g. Among the neurological signs, sensory disturbance of the bilateral distal extremities was observed more frequently, followed by disequilibrium, hearing impairment, and ataxia, in groups with hair MeHg concentration both below 50 mu g/g and over 50 mu g/g. Conclusion. The present study suggests the possibility that exposure to MeHg at levels below the current WHO limits could cause neurologic signs, in particular, sensory disturbance.

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  • Long-term exposure to methylmercury and psychiatric symptoms in residents of Minamata, Japan Reviewed

    Takashi Yorifuji, Toshihide Tsuda, Sachiko Inoue, Soshi Takao, Masazumi Harada

    ENVIRONMENT INTERNATIONAL   37 ( 5 )   907 - 913   2011.7

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    Introduction: It is well-known that prenatal or postnatal exposure to methylmercury can produce neurological signs in adults and children, exemplified by a case of large-scale poisoning in Minamata, Japan, in the 1950s. However, evidence regarding whether pre- or postnatal exposure to methylmercury causes psychiatric symptoms (e.g., impairment of intelligence and mood and behavioral dysfunction) is still limited-excluding cases of fetal Minamata disease patients.
    Methods: We evaluated the effects of pre- or postnatal exposure to methylmercury on psychiatric symptoms using data derived from a 1971 population-based survey in Minamata and neighboring communities. We adopted residential areas as an exposure indicator and psychiatric symptoms as the outcome. Then, we estimated the adjusted prevalence odds ratio (POR) and confidence interval (Cl) of psychiatric symptoms in relation to residential area.
    Results: There were 904 participants in Minamata (high exposure area), 1700 in Goshonoura (middle exposure area), and 913 in Ariake (low exposure area). Compared to the Ariake area, participants in the Minamata area manifested psychiatric symptoms more frequently: PORs for impairment of intelligence and mood and behavioral dysfunction were 5.2 (95% Cl: 3.7-7.3) and 4.4 (95% Cl: 2.9-6.7), respectively. Furthermore, participants with psychiatric symptoms in the Minamata area more frequently had neurological signs. Peaks in prevalence of psychiatric symptoms occurred around age 20 and in older age adults in the area. These findings did not change when we excluded those who had been officially certified as Minamata disease patients by that time.
    Conclusions: The present study suggests a relationship between pre- or postnatal exposure to methylmercury and psychiatric symptoms among the general population in Minamata even after excluding officially certified patients. (C) 2011 Elsevier Ltd. All rights reserved.

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

    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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  • Residential Proximity to Major Roads and Preterm Births Reviewed

    Yorifuji, Takashi, Naruse, Hiroo, Kashima, Saori, Ohki, Shigeru, Murakoshi, Takeshi, Takao, Soshi, Tsuda, Toshihide, Doi, Hiroyuki

    EPIDEMIOLOGY   22 ( 1 )   74 - 80   2011.1

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    Background: Preterm births cause a large public-health burden, and air pollution is considered to be a potential risk factor. We evaluated the association between proximity to major roads (as an index for air pollution) and preterm births, classified by gestational age and specific clinical manifestations. Methods: Data on parental information and birth outcomes were extracted from the database maintained by the perinatal hospital in Shizuoka, Japan. We restricted the analysis to mothers who delivered liveborn single births from 1997 to 2008 (n = 14,226). Using the geocoded residential information, each birth was classified on its proximity to major roads. We estimated the multivariate-adjusted odds ratios and their 95% confidence intervals (CIs) for the association of proximity to major roads with preterm births, using logistic regression. Results: We found positive associations between proximity to major roads and preterm births at all gestational ages. Living within 200 m increased the risk of births before 37 weeks by 1.5 times (95% CI = 1.2-1.8), birth before 32 weeks by 1.6 times (1.1-2.4), and births before 28 weeks by 1.8 times (1.0-3.2). Proximity specifically increased th

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  • Environmental Factors and Seasonal Influenza Onset in Okayama City, Japan: Case-Crossover Study

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

    Acta Medica Okayama   65 ( 2 )   97 - 103   2011

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

    Suzuki E, Yamamoto E, Tsuda T

    Epidemiology   22 ( 1 )   131 - 132   2011

  • Outbreak of Salmonella Braenderup Infection Originating in Boxed Lunches in Japan in 2008

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

    Acta Medica Okayama   65 ( 2 )   63 - 69   2011

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  • Oseltamivir and Abnormal Behavior response

    Takashi Yorifuji, Etsuji Suzuki, Toshihide Tsuda

    EPIDEMIOLOGY   21 ( 6 )   916 - 916   2010.11

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  • 給食弁当を原因食品とするSalmonella Braenderupによる食中毒

    溝口 嘉範, 山本 英二, 津田 敏秀, 土居 弘幸, 中瀬 克己

    日本公衆衛生学会総会抄録集   69回   546 - 547   2010.10

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  • Increased risk of lung cancer mortality among residents near an asbestos product manufacturing plant. Reviewed

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

    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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  • Factors Affecting Appropriate Management of Patients with Sexually Transmitted Infections in Japan Reviewed

    Tomoe Kodama, Katsumi Nakase, Toshihide Tsuda, Takashi Yorifuji, Hiroyuki Doi

    ACTA MEDICA OKAYAMA   64 ( 3 )   171 - 179   2010.6

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    Physicians should educate patients with sexually transmitted infections (STIs) on measures to prevent reinfection and should also undertake human immunodeficiency virus (HIV) testing after diagnosis of STIs. These preventive measures are important, but it is not known to what extent these procedures are followed in Japan. We conducted a cross-sectional study to investigate the proportion of patients with STIs who received appropriate management from physicians, namely recommendation of HIV testing, encouragement of condom use and examination and/or treatment of sexual partners, to elucidate the factors affecting institution of each measure. From a mailshot of 566 physicians, 409 (72.3%) responded, with 176 diagnosing an STI in 967 patients. The proportions applying the 3 measures were low (recommendation of HIV testing: 27.0%; encouragement of condom use: 64.8%; examination of sexual partners: 17.5%), and were related to the sex of the patients and numbers of patients diagnosed by the physicians. Female patients received better care than male patients, particularly with respect to recommendation of HIV testing (odds ratio: 2.82). Physicians who diagnosed more than 20 STI patients tended not to provide appropriate management. These findings suggest the necessity for better physician management of patients for effective prevention of STIs.

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  • Effects of traffic-related outdoor air pollution on respiratory illness and mortality in children, taking into account indoor air pollution, in Indonesia Reviewed

    Kashima S, Yorifuji T, Tsuda T, Ibrahim J, Doi H

    Journal of Occupational and Environmental Medicine   52 ( 3 )   340 - 345   2010.3

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  • Long-term exposure to methylmercury and its effects on hypertension in Minamata Reviewed

    Yorifuji T, Tsuda T, Kashima S, Takao S, Harada M

    Environmental Research   110 ( 1 )   40 - 46   2010.1

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    Recent studies suggest potential adverse effects of methylmercury exposure on cardiovascular disease, although the evidence of association with hypertension is still inconsistent. Therefore, we evaluated the effects of methylmercury exposure on hypertension in Minamata. We used data derived from the 1971 population-based survey in Minamata and neighboring communities. We also utilized data on hair mercury content of the participants (derived from a 1960 investigation). We adopted two exposure indices (residential area and hair mercury content) and two hypertension outcomes (past history of hypertension and hypertension defined by measurements in the examination). Then, we estimated the adjusted prevalence odds ratio (POR) and its confidence interval (CI) of both hypertension outcomes in relation to residential area and hair mercury content. In the Minamata area (high exposure area), 87% (833) of the eligible population (aged >= 10 years) participated in the 1971 investigations. In the Goshonoura area (middle exposure area) and the Ariake area (low exposure area), 93% (1450) and 77% (755), respectively, of the eligible population participated. Compared with subjects in the Ariake area, the subjects in the Minamata area manifested hypertension more frequently, and PORs observed for two hypertension outcomes were 1.6 (95% CI: 1.2-2.1) and 1.4 (95% CI: 1.1-1.9), respectively. Furthermore, dose-response trends with hair mercury content were observed for both hypertension outcomes. The present finding supports the causal relationship between methylmercury exposure and hypertension. (C) 2009 Elsevier Inc. All rights reserved.

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  • Total Mercury Content in Hair and Neurologic Signs Historic Data From Minamata

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

    EPIDEMIOLOGY   20 ( 2 )   188 - 193   2009

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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

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

    The journal of obstetrics and gynaecology research   19 ( 6 )   S195   2008.11

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  • Health impact assessment of particulate matter in Tokyo, Japan Reviewed

    Takashi Yorifuji, Eiji Yamamoto, Toshihide Tsuda, Norito Kawakami

    Archives of Environmental and Occupational Health   60 ( 4 )   179 - 185   2005

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    Among industrialized countries, Japan still maintains an old set of guidelines for particulate matter (PM)
    therefore, we assessed the public health impacts of PM exposure in various situations using data from the Tokyo metropolitan area. Subjects were 7.8 million people aged older than 30 years. Based on a linear relationship between exposure and health effects, we estimated attributable cases of mortality caused by PM. Even at the recent exposure level, the number of deaths will occur after both short- and long-term exposure. When the guideline for PM2.5 (particles &lt
    2.5 μm in diameter) long-term exposure was set at 12 μg/m3, we could prevent 8% of all causes mortality or 6,700 deaths in the Tokyo metropolitan area per year. This assessment shows that guidelines for long-term exposure, especially for PM 2.5, should be recommended in Japan. Copyright © 2006 Heldref Publications.

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  • F305 原因確率とAction・Lnaction・Causal lnference

    津田 敏秀, 大津 忠弘, 高尾 総司, 茂見 潤, 馬場 園明, 三野 善央

    産業衛生学雑誌   44   516 - 516   2002

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    DOI: 10.1539/sangyoeisei.KJ00003947921

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  • Does smoking cessation improve mental health? Reviewed

    Yoshio Mino, Jun Shigemi, Tadahiro Otsu, Toshihide Tsuda, Akira Babazono

    Psychiatry and Clinical Neurosciences   54 ( 2 )   169 - 172   2000.4

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    There is a possibility that cessation of smoking improves mental health, but there are no studies that have demonstrated this. A cohort study was performed for 1 year in 18 males who spontaneously stopped smoking (cessation group) and 173 who continued to smoke (smoking group). The mental health state was evaluated using the Japanese version of the 30-item General Health Questionnaire (GHQ-30) before the cessation of smoking and 6 months and 1 year after smoking cessation. Changes in the GHQ score were compared between the cessation and smoking groups. In order to control the effects of confounding factors, multiple regression analyses were performed using the GHQ score after 6 months and 1 year as dependent variables. The GHQ score in the cessation group significantly decreased 6 months and 1 year after smoking cessation (P &lt
    0.04 and 0.01, respectively, by paired t-test). In the smoking group, the GHQ score slightly decreased. Repeated measure analysis of variance revealed that the decrease in the GHQ score in the cessation group was significantly larger than in the smoking group. Multiple regression analysis revealed significant effects of smoking cessation on mental health after controlling for other confounding factors. It can be concluded that smoking cessation may improve mental health.

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  • Stability of factor structure and correlation with perceived job stress in general health questionnaire: A three-wave survey over one year in Japanese workers Reviewed

    Jun Shigemi, Yoshio Mino, Toshihide Tsuda

    Journal of Occupational Health   42 ( 6 )   284 - 291   2000

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    A cross-sectional study was conducted to examine psychological symptoms and job stress in Japanese workers. To assess the stability of the relationship between the parameters for perceived job stress and mental health, two additional surveys were carried out six months and one year later. The surveys included demographic questions, the General Health Questionnaire (GHQ), and questions relating to perceived job stress to measure the worker's mental health and job stress. Factor analyses were conducted to clarify the factor structure of mental health. As for the GHQ, the 6 dominant factors were interpreted. These factors involved "Anxiety and depression", "Severe depression", "Lack of interpersonal network or social support", "Poor social activity", "Insomnia", and "Lack of a positive attitude". This structure was stable in the 2 follow up surveys. A multiple regression analysis was used to examine the relationship between extracted factors of the GHQ and job stress. The analysis showed that the factor "Anxiety and depression" had a significantly stable relationship with "Too much responsibility at work" and "Cannot keep up with new technology".

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  • Recovery from mental ill health in an occupational setting: A cohort study in Japan Reviewed

    Yoshio Mino, Jun Shigemi, Toshihide Tsuda, Nobufumi Yasuda, Akira Babazono, Paul Bebbington

    Journal of Occupational Health   42 ( 2 )   66 - 71   2000

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    Objectives: The purpose of this study is to clarify the degree of recovery from mental ill health in occupational settings and the nature of perceived job stress associated with recovery. Methods: A 1-year cohort study was carried out in 287 of 763 workers who scored 8 or more on the General Health Questionnaire (GHQ-30), and the proportion recovering during the year was compared according to the presence of individual perceived job stress items. To control confounding factors, multiple logistic analysis was used. Results: Recovery from mental ill health was observed in 48.7% after the first 6 months and in 66.1% after 1 year. During the first 6-month period, no identified job stress item was associated with recovery. During the second 6- month period, however, the odds ratio (95% confidence interval) between recovery and the absence of perceived job stress was 4.2 (1.3-13.1) for 'Too much responsibility', even after controlling for sex, age, the degree of family life satisfaction, physical health state, and the initial GHQ score. Conclusion: Relief from excessive responsibility might promote recovery in mentally ill workers.

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  • The Role of Perceived Job Stress in the Relationship between Smoking and the Development of Peptic Ulcers

    SHIGEMI Jun, MINO Yoshio, TSUDA Toshihide

    Journal of Epidemiology   9 ( 5 )   320 - 326   1999.11

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    Although smoking has been considered a risk factor in causing pepticulcers, no study has examined the effects of job stress on the relationship between peptic ulcers and smoking.To establish a link between gastric or duodenal ulcers over two years and a state of perceived job stress, a questionnaire, including questions on demographics, smoking, history of peptic ulcer and perceived job stress was conducted. Follow-up surveys were carried out every six months to accumulate the data for this analysis and the time span of this follow up study was two years. To examine the role of perceived job stress on the relationship between smoking and peptic ulcers, stratified analyses were performed.Some specific causes of perceived job stress such as "Too much competition, " "Schedule is too tight or pressed to work too hard" had high estimated relative risks: 2.13 with 95% confidence interval (CI) of 1.09 -4.16 and 2.50 with 95%Cl of 0.98 - 6.40, respectively. Stratified analyses suggested an effect-measure modification of perceived job stress in the relationship between peptic ulcers and smoking. Multiplicative and additive models suggest positive interaction between perceived job stress and smoking. These results suggest that specific perceived job stress is an effect modifier in the relationship between the history of the peptic ulcer and smoking. J Epidemiol, 1999 ; 9 : 320-326

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  • Perceived job stress and mental health in precision machine workers of Japan: A 2 year cohort study Reviewed

    Yoshio Mino, Jun Shigemi, Toshihide Tsuda, Nobufumi Yasuda, Paul Bebbington

    Occupational and Environmental Medicine   56 ( 1 )   41 - 45   1999

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    Objectives. To determine whether perceived job stress affects mental health in occupational settings. Methods. A 2 year cohort study was conducted. Initially, a survey including the general health questionnaire (GHQ) and a questionnaire about perceived job stress was carried out. Of 462 workers who initially showed a GHQ score of ≤ 7 310 were successfully followed up for 2 years. The 2 year risks of developing mental ill health (a GHQ score ≥ 8) were assessed relative to perceived job stress. To control for potential confounding factors, multiple logistic regression analyses were conducted. Results. The overall 2 year risk for developing mental ill health was high at 57.7%. Workers who reported aspects of perceived job stress showed a greater 2 year risk than those without stress. Multiple logistic regression analyses showed that some components of perceived job stress were associated with a higher 2 year risk, among which 'not allowed to make mistakes' showed the largest adjusted odds ratio (OR) (95% confidence interval (95% CI)) of 2.37 (1.32 to 4.29). 'Poor relationship with superior' had a significant effect on mental health only in women, with an adjusted OR (95% CI) of 3.79 (1.65 to 8.73). Conclusions. Certain specific items of perceived job stress seem to be associated with mental ill health in workers. These could broadly be described as job strain, or job demand items. The type of job stress that predicts mental health may be dependent on the characteristics of the workplace investigated.

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  • 23. 耐火煉瓦工場集積地域における肺癌の疫学調査について (平成10年度中国四国合同地方会)

    大津 忠弘, 津田 敏秀, 三野 善央, 茂見 潤, 青山 英康, 馬場園 明

    産業衛生学雑誌   41 ( 2 )   35 - 35   1999

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  • J306 A case-control study on the relationship between silica exposure, silicosis, and lung cancer

    Tsuda T.

    Sangyo Eiseigaku Zasshi   41   638 - 638   1999

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    DOI: 10.1539/sangyoeisei.KJ00001991392

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  • Expressed emotion of families and negative/depressive symptoms in schizophrenia: A cohort study in Japan Reviewed

    Yoshio Mino, Shimpei Inoue, Shinji Shimodera, Shuichi Tanaka, Toshihide Tsuda, Eiji Yamamoto

    Schizophrenia Research   34 ( 3 )   159 - 168   1998.11

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    This study investigated whether the Expressed Emotion (EE) status of families is associated with an increased risk of negative and depressive symptoms in schizophrenia. The subjects were 52 schizophrenic patients from mental hospitals in Kochi, Japan, who satisfied the DSM-III-R or ICD-9 criteria for schizophrenia. The Japanese version of the Camberwell Family Interview was administered to 73 key relatives of the patients within 2 weeks after admission. A certified rater evaluated the EE's status of each family, using an audiotaped interview and its transcript. Using cohort study design, the subjects were followed for 9 months after their discharge and were monitored for negative and depressive symptoms. Trained psychiatrists who were blind to the EE status of the patients' households administered the Brief Psychiatric Rating scale (BPRS) at discharge, and 9 months after discharge. Repeated-measures analyses of variance showed that EE effects were significant in Emotional withdrawal in all subjects, Depressive mood and Total depressive symptoms in non-relapsers. A multiple regression analyses revealed that EE's effect was significant only in Depressive mood in non- relapsers controlling confounding factors. In non-relapsers in positive symptoms, high EE families could make patients depressed. EE's effect on negative symptoms remains to be established.

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  • 集団食中毒事件における疫学調査方法に関する研修会

    津田 敏秀, 三野 善央, 茂見 潤, 荒木 英俊, 大津 忠弘, 岩浅 祐二郎, 中瀬 克己, 馬場園 明

    日本公衆衛生学会総会抄録集   57回   658 - 658   1998.10

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  • The effect of a redistribution system for health care for the elderly on the financial performance of health insurance societies in Japan

    Akira Babazono, Janet Weiner, Toshihide Tsuda, Yoshio Mino, Alan L. Hillman

    International Journal of Technology Assessment in Health Care   14 ( 3 )   458 - 466   1998

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    Health care for the elderly in Japan is financed through a pool to which all insurers contribute. We analyzed insurers' financial data to evaluate this redistribution system. Cost sharing affected financial performance substantially. The current formula for cost-sharing redistributes elderly health care costs unequally and should be changed.

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  • 疫学から見た作業関連性疾患と職業病:再論 (話題)

    津田 敏秀, 馬場園 明, 三野 善央, 松岡 宏明

    産業衛生学雑誌   40 ( 3 )   A52 - A55   1998

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  • The effect of subjective stress on mental health.

    Babazono A

    Sangyo Eiseigaku Zasshi   40   153 - 153   1998

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    DOI: 10.1539/sangyoeisei.KJ00001989982

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  • An epidemiological study on silica, silicosis, and lung cancer in the south east of Okayama Prefecture, Japan Reviewed

    T Tsuda, Y Mino, A Babazono, J Shigemi, T Otsu, E Yamamoto

    ADVANCES IN THE PREVENTION OF OCCUPATIONAL RESPIRATORY DISEASES   1153   211 - 215   1998

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    Background. In the south east of Okayama Prefecture, Japan, there have been reports on the high prevalence of silicosis among refractory brick production workers, and excess risk of lung cancer among the residents. Therefore, a population-based case-control study was conducted on the relationship between silica, silicosis, and lung cancer.
    Method. Cases and controls were obtained from death certificates from 1986 to 1993 in the area. The four control groups were the series of deaths from stomach cancer, liver cancer, colon cancer, and the other cancers. 186 lung cancer cases and 477 controls were analyzed. Age and smoking habits were adjusted by stratified analysis using the Mantel-Haenszel odds ratio estimates.
    Results. The age- and smoking-adjusted odds ratios were 1.72 (95% C.I. 0.95-3.17) for stomach cancer control, 1.84 (0.96-3.59) for liver cancer, 1.70 (0.81-3.89) for colon cancer, and 2.34 (1.35-4.25) for the other cancer on silica exposure, and 2.23 (1.14-4.16), 2.43 (1.17-5.37), 3.11 (1.26-10.34), and 2.68 (1.47-5.18) on silicosis, respectively.
    Conclusions. The results indicate the causal relationship between silica exposure and lung cancer. The excess risk of lung cancer in the area can partly be explained by the relationship.

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  • Expressed emotion among families and course of schizophrenia in Japan: A 2-year cohort study Reviewed

    Yoshio Mino, Shimpei Inoue, Shuichi Tanaka, Toshihide Tsuda

    Schizophrenia Research   24 ( 3 )   333 - 339   1997.4

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    A 2-year cohort study was conducted to determine whether expressed emotion (EE) in families is associated with relapse of schizophrenia in Japan. Key relatives of 52 schizophrenic patients were interviewed using the Camberwell Family Interview (CFI) and the patients were classified into high and low EE groups. The 2-year relapse risks were 71% (17/24) in the, high EE group and 37% (10/27) in the low EE group. The risk ratio was 1.9 and the 95% confidence interval (CI) ranged from 1.1 to 3.3. In the multiple logistic regression analysis, the odds ratio between families' EE and schizophrenic relapse was 4.6, controlling for other potential confounding factors. It was concluded that, in Japan, the families' EE is a good predictor for schizophrenic relapse within 2 years. This association between EE and relapse could be due to the strong difference in the first 9 months. The period during which EE's predictive validity for schizophrenic relapse is applicable may vary according to the society to which the patients and their families belong.

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  • The relationship between job stress and mental health at work Reviewed

    J Shigemi, Y Mino, T Tsuda, A Babazono, H Aoyama

    INDUSTRIAL HEALTH   35 ( 1 )   29 - 35   1997.1

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    In order to evaluate the relationship between job stress and mental health, a cross-sectional study was conducted using a questionnaire relating to demographics, subjective job stress and mental health state, The questionnaire consisted of a 30-item Japanese version of the General Health Questionnaire (GHQ) developed by Goldberg in addition to questions about subjective Job stress, to measure mental health and job stress conditions, respectively, All subjects were employees of an electronic company in Japan, Among 782 workers, 763 workers responded to the questionnaire satisfactorily (response rate was 97.6%), People whose GHQ score was more than 7 were classified as having psychiatric problems, while the remaining respondents were considered as having no mental health problems, We employed a multiple logistic regression analysis to estimate the relationship between subjective job stress and mental health, adjusting for gender, age, marital state, familial stress, and physical health state, Subjective job stress was significantly associated with the state of mental health, In particular, the items of ''too much trouble at work,'' ''too much responsibility,'' ''are not allowed to make mistakes,'' ''poor relationship with superiors,'' and ''cannot keep up with technology'' were significantly related to mental health.

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  • Causal inference in medicine: A reaction to the report, 'Incidence of Minamata Disease in Communities along the Agano River, Niigata, Japan - Patterns of the exposure and official diagnosis of patients' Reviewed

    Toshihide Tsuda, Yoshio Mino, Eiji Yamamoto, Hiroaki Matsuoka, Akira Babazono, Jun Shigemi, Masaya Miyai

    Japanese Journal of Hygiene   52 ( 2 )   511 - 526   1997

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    Kondo's 'Incidence of Minamata Disease in Communities along the Agano River, Niigata, Japan (Jap. J. Hyg. 51:599-611
    1996)' is critically reviewed. The data of the article were obtained from most of the residents living in the Agano river villages where Minamata disease was discovered in June, 1965. However, sampling proportions were much different between in the population base and in the cases. The method of identification of cases from the data and the reason for the difference were not clearly demonstrated. The citations of reference articles are insufficient despite the fact that other epidemiologic studies on methyl-mercury poisoning have been reported not only in Japan, but also around the world. His 'analysis of the recognized patients' is erroneous. Both the sampling scheme of information of hair mercury and the modeling of the analysis are based on Kondo' s arbitrary interpretation, not on epidemiologic theory. His 'analysis of the rejected applicants' is also erroneous. His calculations of the attributable proportion are incorrect and self-induced in both the assignments of data and analysis of data. Kondo has failed to study the epidemiologic theories in light of changes in the field. Therefore, his article is lacking in epidemiologic theory, a logical base and scientific inference. In Japan, epidemiologic methodology has rarely been used in studies on Minamata Disease in either Kumamoto and Niigata. The government has used neurologically specific diagnosis based on combinations of symptoms to judge the causality between each of symptoms and methyl-mercury poisoning. Epidemiologic data obtained in Minamata, Kumamoto in 1971 indicate that the criteria set by the government in 1977 have produced much more false-negative patients than false-positive patients. As a result, a huge number of symptomatic patients, including those with peripheral neuropathy or with constriction of the visual field, did not receive any help or compensation until 1995. The authors emphasize that the causal relationship between each symptom and methyl- mercury exposure should be reevaluated epidemiologically in Japan.

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  • Optimal Screening Interval for Gastric Cancer in Japan Reviewed

    Akira Babazono, Toshihide Tsuda, Yoshio Mino, Takanori Ogawa, Hideyasu Aoyama

    Journal of Epidemiology   5 ( 2 )   67 - 74   1995

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    Annual gastric cancer screening has been recommended for residents over the age of 40 in Japan. We conducted a cost-effectiveness study in order to determine an optimal screening interval in both genders using a cohort model. Hypothetical cohorts of 100,000 asymptomatic individuals aged 40 were assumed to have taken part in each strategy with a follow-up period of 20 years. In order to evaluate both the cost and effectiveness of the gastric cancer screening, a Markov modeling process was used. The incremental cost per year-of-life saved in gastric cancer screening, compared to no screening, illustrates a tendency toward a higher cost per year-of-life saved in both, shorter than and longer than 3-year screening intervals. Our results indicate that the recommended method of annual screening represents the least cost-effective option regarding both genders. The incremental cost per year-of-life saved of annual screening strategy was 2,764,000 yen ($25,127) for males and 3,753,000yen ($34,118) for females, compared to no screening. The figures of the incremental cost per year-of-life saved in the three year screening interval at 1,670,000 yen ($15,182) for males and 2,431,000yen ($22,100) for females clearly show this strategy as the most efficient solution in both genders, compared to no screening. However, the screening program on annual basis is not considered to be less efficient than other screening programs so far. The cost-effectiveness of gastric cancer is decreasing as its incidence decreases. It is very important for policy makers to pay attention to the incidence of diseases targeted by screening programs and to evaluate screening interval. J Epidemiol, 1995
    5: 67-74. © 1995, Japan Epidemiological Association. All rights reserved.

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  • 感情表出(Expressed Emotion)にもとづく分裂病の家族介入研究の効果判定-その技術と評価 Reviewed

    三野善央, 津田敏秀, 茂見潤, 谷原真一, 青山英康, 馬場園明

    日本公衆衛生雑誌   42 ( 9 )   301 - 312   1995

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  • Bias in an Observational Study on Population

    BABAZONO Akira, TSUDA Toshihide, MINO Yoshio

    Journal of health science   17   35 - 42   1995

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    Avoiding bias is essential in an observational study on population since bias leads to a misinterpretation of the magnitude of the effect on a result. Bias is classified into three categories; selection bias, infomation bias and confounding. Selection bias refers to a distortion in the estimate of effect resulting from the manner in which subjects are selected for the study population. Information bias refers to a distortion in the estimate of effect due to measurement error or misclassification of subjects on one or more variables. Confounding is the bias that results when the study factor effect is mixed, in the data. with the effects of extraneous variables. We must maintain the specific characteristics of each of those biases in mind in order to control them. It is not fair to insist that a study result is incorrect because of a small bias since it is impossible to rule out any bias completely when data are collected by observation. Direction of bias is very helpful in judging the study result when some bias is noticed. Neither selection bias nor information bias can be controlled during the data analytic phase. Both selection bias and information bias should be minimized in the reseatch design. Confounding can be controlled in either the research design or the data analytic phase.

    DOI: 10.15017/626

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    Other Link: http://hdl.handle.net/2324/626

  • Risk Factors for Low Birth Weight Infants in Japan Reviewed

    Akira Babazono, Toshihide Tsuda, Eiji Yamamoto, Yoshio Mino, Tsuneko Babazono, Yoshiki Kishi, Jun Sigemi, Takanori Ogawa, Hideyasu Aoyama

    Journal of Epidemiology   4 ( 2 )   91 - 98   1994

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    Prevalence of low birth weight infants in Japan has been increasing, although infant mortality is the lowest in the world. We conducted a population based case-control study to clarify risk factors for low birth weight infants in Japan. Information was obtained by questionnaire. The response rate was 78.9% from 402 cases and 804 controls. The majority of low birth weight infants belongs to full-term case group. This is considered to be an important factor for low infant mortality in Japan. We examined potential risk factors by a multiple logistic regression model. Lower maternal academic career and toxemia were identified as significant risk factors for pre-term low birth weight infants, while maternal shorter height, lower prepregnancy weight, maternal smoking and employment during pregnancy and hypertension were identified as significant risk factors for full-term low birth weight infants. The Japanese small physique and prevalent hypertension are considered to be causes for the high prevalence of low birth weight infants. J Epidemiol, 1994
    4: 91-98. © 1994, Japan Epidemiological Association. All rights reserved.

    DOI: 10.2188/jea.4.91

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  • The effect of a cost sharing provision in japan Reviewed

    Akira Babazono, Takanori Ogawa, Tsuneko Babazono, Hirohisa Hamada, Toshihide Tsuda, Hideyasu Aoyama

    Family Practice   8 ( 3 )   247 - 252   1991

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

    Babazono A, Ogawa T, Babazono T, Hamada H, Tsuda T and Aoyama H. The effect of a cost sharing provision in Japan. Family Practice 1991
    8: 247-252. This study evaluated the effect of a 10% cost sharing provision, introduced in October 1984, on demand for medical services. We analysed the data of 1701 health insurance societies, all of which joined the National Federation of Health Insurance Societies between 1983 and 1985. The case rate (per 1000 persons) and the number of serviced days (per case) were analysed as indicators of demand for inpatient, outpatient and dental medical services. The case rate was considered to bean indicator of the patient's behaviour, while the number of serviced days was influenced by the doctor's behaviour. Multiple linear regression analysis was used with each indicator to isolate the effect of the cost sharing provision, adjusted for other variables which influenced demand for medical services. The case rate was reduced significantly in all medical services. This means that a patient was discouraged from using a medical facility by the cost sharing provision. There was little difference among medical services. The number of serviced days was also reduced significantly in all medical services. There was a large difference among medical services. The effect on outpatient service was much greater than that on any other service. © 1991 Oxford University Press.

    DOI: 10.1093/fampra/8.3.247

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Books

  • 医学者は公害事件で何をしてきたのか

    岩波書店(岩波現代文庫)  2014  ( ISBN:9784006003111

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  • 医学的根拠とは何か

    岩波書店(岩波新書)  2013 

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  • Training Program on Food-Borne Disease Epidemiology

    Japan Food Hygiene Association  2012 

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  • 食中毒の疫学講座.

    日本食品衛生協会  2012 

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  • 新通史 日本の科学技術 第4巻: 世紀転換期の社会史/1995年~2011年

    原書房  2011 

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  • 医学と仮説-原因と結果の科学を考える-

    岩波書店  2011 

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  • The Science and Tchnology in Japan

    2011 

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  • Medicine and Hypothesis -Science on cause and outcome-

    Iwanami co. Ltd.  2011 

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  • 津田敏秀レビューアーの意見書と著者らの対応

    丸善  2009 

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  • 医学における因果関係の推論と原因確率.法と経済学叢書 Ⅷ〕サナ・ルー著 『法,疫学,市民社会:法政策における科学的手法の活用』

    木鐸社  2009 

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  • アスベストによる健康障害の疫学とリスクアセスメント―特に環境曝露による人体への影響に関して―.解説資料:石綿関係法施行状況調査.

    衆議院調査局環境調査室  2008 

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  • 平成17年度厚生労働科学研究費補助金(食品の安心・安全確保研究事業)食品の安全施策等に関する国際協調のあり方に関する研究、研究報告書

    2007 

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  • カネミ油症-過去・現在・未来-.

    緑風出版  2006 

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  • 悪魔のマーケティング-タバコ産業の真実-

    日経BP社  2005 

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  • 水俣学講義 第2集

    日本評論社  2005 

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  • 悪魔のマーケティング-タバコ産業が語った真実-

    日経BP社  2005 

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  • 医学者は公害事件で何をしてきたのか

    岩波書店  2004 

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  • 厚生労働科学研究研究費補助金、長寿科学総合研究事業研究報告書「老人疾患患者に及ぼす家族の感情表出の影響に関する研究」

    2003 

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  • 厚生労働科学研究研究費補助金、新興再興感染症研究事業研究報告書「経口細菌感染症の広域的・散発的発生時の実地疫学的・調査手法等の開発に関する研究」

    2003 

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  • 医学大事典

    医学書院,東京  2003 

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  • 市民のための疫学入門-医学ニュースから環境裁判まで-.

    緑風出版,東京  2003 

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  • 交代勤務と心血管系疾患メカニズムのレビュー.

    自治体労働安全衛生研究会  2002 

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  • 讀賣新聞

    2001 

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  • 毎日新聞

    2001 

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  • 筋骨格性障害と職場要因?アメリカ労働安全衛生研究所による腰部における職業関連性による筋骨格性障害に関する疫学的レビュー?

    2001 

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  • Chapter 15 Epidemiological Studies of Cancer in Arsenic Poisoning Patients

    Encyclopedis of Environmental Control Technology, Volume 7 High-Hazard Pollutants 

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  • Chapter 15 Epidemiological Studies of Cancer in Arsenic Poisoning Patients

    Encyclopedis of Environmental Control Technology, Volume 7 High-Hazard Pollutants 

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MISC

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

    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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    Language:English   Publisher:WILEY  

    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: &lt;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.

    DOI: 10.1111/ggi.12851

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  • Correlation between infectious disease and soil radiation in Japan: an exploratory study using national sentinel surveillance data

    S. Inaida, T. Tsuda, S. Matsuno

    EPIDEMIOLOGY AND INFECTION   145 ( 6 )   1183 - 1192   2017.4

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    Language:English   Publisher:CAMBRIDGE UNIV PRESS  

    We investigated the relationship between epidemics and soil radiation through an exploratory study using sentinel surveillance data (individuals aged &lt;20 years) during the last three epidemic seasons of influenza and norovirus in Japan. We used a spatial analysis method of a geographical information system (GIS). We mapped the epidemic spreading patterns from sentinel incidence rates. We calculated the average soil radiation [dm (mu Gy/h)] for each sentinel site using data on uranium, thorium, and potassium oxide in the soil and examined the incidence rate in units of 0.01 mu Gy/h. The correlations between the incidence rate and the average soil radiation were assessed. Epidemic clusters of influenza and norovirus infections were observed in areas with relatively high radiation exposure. A positive correlation was detected between the average incidence rate and radiation dose, at r = 0.61-0.84 (P &lt;0.01) for influenza infections and r = 0.61-0.72 (P &lt;0.01) for norovirus infections. An increase in the incidence rate was found between areas with radiation exposure of 0 &lt;dm &lt;0.01 and 0.154dm &lt;0.16, at 1.80 [95% confidence interval (CI) 1.47-2.12] times higher for influenza infection and 2.07 (95% CI 1.53-2.61) times higher for norovirus infection. Our results suggest a potential association between decreased immunity and irradiation because of soil radiation. Further studies on immunity in these epidemic-prone areas are desirable.

    DOI: 10.1017/S0950268816003034

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  • Evaluating the Effects of Air Pollution from a Plastic Recycling Facility on the Health of Nearby Residents

    Xin Zhao, Toshihide Tsuda, Hiroyuki Doi

    ACTA MEDICA OKAYAMA   71 ( 3 )   209 - 217   2017

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    Language:English   Publisher:OKAYAMA UNIV MED SCHOOL  

    We evaluated how exposure to airborne volatile organic compounds emitted from a plastic recycling facility affected nearby residents, in a cross-sectional study. Individuals&gt; 10 years old were randomly sampled from 50 households at five sites and given questionnaires to complete. We categorized the subjects by distance from the recycling facility and used this as a proxy measure for pollutant exposure. We sought to improve on a preceding study by generating new findings, improving methods for questionnaire distribution and collection, and refining site selection. We calculated the odds of residents living 500 or 900 m away from the facility reporting mucocutaneous and respiratory symptoms using a reference group of residents 2,800 m away. Self-reported nasal congestion (odds ratio=3.0, 95% confidence interval=1.02-8.8), eczema (5.1, 1.1-22.9), and sore throat (3.9, 1.1-14.1) were significantly higher among residents 500 m from the facility. Those 900 m away were also considerably more likely to report experiencing eczema (4.6, 1.4-14.9). Air pollution was found responsible for significantly increased reports of mucocutaneous and respiratory symptoms among nearby residents. Our findings confirm the effects of pollutants emitted from recycling facilities on residents' health and clarify that study design differences did not affect the results.

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

    Etsuji Suzuki, Toshihide Tsuda, Eiji Yamamoto

    Annals of epidemiology   28 ( 1 )   111 - 113   2017

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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.

    DOI: 10.1016/j.annepidem.2017.11.005

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  • Maternal smoking location at home and hospitalization for respiratory tract infections among children in Japan

    Michiyo Yamakawa, Takashi Yorifuji, Tsuguhiko Kato, Toshihide Tsuda, Hiroyuki Doi

    ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH   72 ( 6 )   343 - 350   2017

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    Language:English   Publisher:ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD  

    We examined the effects of maternal smoking location at home on hospitalization for respiratory tract infections among young children in Japan. We used the large nationwide population-based longitudinal survey and restricted study participants to children born after 37 gestational weeks and singleton births (n = 43,851). We evaluated the associations among children between the ages of 6 and 18months and between the ages of 18 and 30months, respectively. After adjusting for potential confounders, both maternal outdoor and indoor smoking were associated with the elevated risk. The adjusted odds ratios (95% confidence intervals) of maternal outdoor and indoor smoking (vs nonsmoking mothers) were 1.21 (1.01-1.44) and 1.18 (1.04-1.33), respectively, in children between the ages of 6 and 18months. We thus encourage a smoke-free home policy to protect children from second- and third-hand smoke exposure.

    DOI: 10.1080/19338244.2016.1255582

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  • 大学生が海外留学時に経験した症状とその関連要因の検討

    山川路代, 鈴木越治, 鈴木越治, 佐才めぐみ, 小野真由美, 津田敏秀, 中瀬克己

    日本熱帯医学会大会プログラム抄録集   58th(Web)   2017

  • Errors in causal inference: an organizational schema for systematic error and random error

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

    ANNALS OF EPIDEMIOLOGY   26 ( 11 )   788 - 793   2016.11

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    Language:English   Publisher:ELSEVIER SCIENCE INC  

    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.

    DOI: 10.1016/j.annepidem.2016.09.008

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  • Aflatoxins in Rice Artificially Contaminated with Aflatoxin-producing Aspergillus flavus under Natural Storage in Japan

    Satoshi Sugihara, Hiroyuki Doi, Masahiko Kato, Yoshihiro Mitoh, Toshihide Tsuda, Satoru Ikeda

    ACTA MEDICA OKAYAMA   70 ( 3 )   167 - 173   2016.6

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    Aflatoxin (AFT) contamination is frequent in foods grown in tropical regions, including rice. Although AFTs are generally not found in temperate-region foods, global warming has affected typical temperate-region climates, potentially permitting the contamination of foods with AFT-producing Aspergillus flavus (A. flavus). Here we investigated the AFT production in rice during storage under natural climate conditions in Japan. We examined AFTs in brown rice and rough rice artificially contaminated with A. flavus for 1 year in Japan, and we subjected AFTs in white rice to the same treatment in airtight containers and examined the samples in warm and cold seasons, simulating the storage of white rice in general households. In the brown rice, AFTs increased after 2 months (March) and peaked after 9 months (October). The AFT contamination in the rough rice was minimal. After the polishing and cooking of the brown rice, AFTs were undetectable. In the white rice stored in airtight containers, AFTs increased after 1 month (August) and peaked after 2 months (September). Minimal AFTs were detected in the cold season. Thus, AFT contamination in rice may occur in temperate regions following A. flavus contamination. The storage of rice as rough rice could provide be useful for avoiding AFT contamination.

    DOI: 10.18926/AMO/54415

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  • Thyroid Cancer Detection by Ultrasound Among Residents Ages 18 Years and Younger in Fukushima, Japan: 2011 to 2014

    Toshihide Tsuda, Akiko Tokinobu, Eiji Yamamoto, Etsuji Suzuki

    EPIDEMIOLOGY   27 ( 3 )   316 - 322   2016.5

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    Language:English   Publisher:LIPPINCOTT WILLIAMS & WILKINS  

    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.

    DOI: 10.1097/EDE.0000000000000385

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  • Rejoinder: The Authors Respond

    Markku Sallmen, Jens Peter Bonde, Marja-Liisa Lindbohm, Petter Kristensen

    EPIDEMIOLOGY   27 ( 3 )   462 - 463   2016.5

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    Language:English   Publisher:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1097/EDE.0000000000000458

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  • Re: Thyroid Cancer Among Young People in Fukushima Response

    Toshihide Tsuda, Akiko Tokinobu, Eiji Yamamoto, Etsuji Suzuki

    EPIDEMIOLOGY   27 ( 3 )   E21 - E23   2016.5

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    Language:English   Publishing type:Rapid communication, short report, research note, etc. (scientific journal)   Publisher:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1097/EDE.0000000000000468

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  • 岡山市健康寿命に関連する要因分析業務

    山川路代, 佐才めぐみ, 津田敏秀

    受託事業報告書   2016.3

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  • Effects of Ayurvedic Oil-Dripping Treatment with Sesame Oil vs. with Warm Water on Sleep: A Randomized Single-Blinded Crossover Pilot Study

    Akiko Tokinobu, Takashi Yorifuji, Toshihide Tsuda, Hiroyuki Doi

    JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE   22 ( 1 )   52 - 58   2016.1

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    Language:English   Publisher:MARY ANN LIEBERT, INC  

    Objectives: Ayurvedic oil-dripping treatment (Shirodhara) is often used for treating sleep problems. However, few properly designed studies have been conducted, and the quantitative effect of Shirodhara is unclear. This study sought to quantitatively evaluate the effect of sesame oil Shirodhara (SOS) against warm water Shirodhara (WWS) on improving sleep quality and quality of life (QOL) among persons reporting sleep problems. Methods: This randomized, single-blinded, crossover study recruited 20 participants. Each participant received seven 30-minute sessions within 2 weeks with either liquid. The washout period was at least 2 months. The Shirodhara procedure was conducted by a robotic oil-drip system. The outcomes were assessed by the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, Epworth Sleepiness Scale (ESS) for daytime sleepiness, World Health Organization Quality of Life 26 (WHO-QOL26) for QOL, and a sleep monitor instrument for objective sleep measures. Changes between baseline and follow-up periods were compared between the two types of Shirodhara. Analysis was performed with generalized estimating equations. Results: Of 20 participants, 15 completed the study. SOS improved sleep quality, as measured by PSQI. The SOS score was 1.83 points lower (95% confidence interval [CI], -3.37 to -0.30) at 2-week follow-up and 1.73 points lower (95% CI, -3.84 to 0.38) than WWS at 6-week follow-up. Although marginally significant, SOS also improved QOL by 0.22 points at 2-week follow-up and 0.19 points at 6-week follow-up compared with WWS. After SOS, no beneficial effects were observed on daytime sleepiness or objective sleep measures. Conclusions: This pilot study demonstrated that SOS may be a safe potential treatment to improve sleep quality and QOL in persons with sleep problems.

    DOI: 10.1089/acm.2015.0018

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  • Epidemiological studies of neurological signs and symptoms and blood pressure in populations near the industrial methylmercury contamination at Minamata, Japan

    Takashi Yorifuji, Toshihide Tsuda

    ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH   71 ( 4 )   231 - 236   2016

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    Language:English   Publisher:ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD  

    Severe methylmercury exposure occurred in Minamata, Japan. Only a limited number of epidemiological studies related to that exposure have been carried out. The evidence that methylmercury is cardiotoxic is very limited, and these studies provide only minimal support for that hypothesis. We therefore analyzed the data both from an investigation in Minamata and neighboring communities in 1971 and an investigation in 1974 in another area simultaneously. We included a total of 3,751 participants. We examined the association of residential area with neurological signs or blood pressure using logistic regression or multiple linear regression models, adjusting for sex and age. We found that the prevalence of neurological signs and symptoms was elevated in the Minamata area (high-exposure), followed by the Goshonoura area (medium-exposure). Moreover, blood pressure was elevated in residents of the Minamata area.

    DOI: 10.1080/19338244.2015.1084261

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  • 記述統計の結果を報告する際の検定の扱いについて CONSORT 2010声明とSTROBE声明を踏まえて

    鈴木 越治, 三橋 利晴, 高尾 総司, 津田 敏秀

    産業衛生学雑誌   57 ( 臨増 )   466 - 466   2015.5

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  • Health Impact Assessment of PM10 and PM2.5 in 27 Southeast and East Asian Cities

    Yorifuji Takashi, Bae Sanghyuk, Kashima Saori, Tsuda Toshihide, Doi Hiroyuki, Honda Yasushi, Kim Ho, Hong Yun-Chul

    Journal of occupational and environmental medicine   57 ( 7 )   e007184 - 756   2015

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    Language:English   Publisher:Lippincott Williams & Wilkins  

    DOI: 10.1097/JOM.0000000000000485

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  • Long-Term Effects of Breastfeeding on Children's Hospitalization for Respiratory Tract Infections and Diarrhea in Early Childhood in Japan. International journal

    Michiyo Yamakawa, Takashi Yorifuji, Tsuguhiko Kato, Sachiko Inoue, Akiko Tokinobu, Toshihide Tsuda, Hiroyuki Doi

    Maternal and child health journal   19 ( 9 )   196 - 201   2015

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    Whether or not the protective effects of breastfeeding last during or after a shift to a weaning diet is not clear. In the present study, we examined the effects of breastfeeding on hospitalization for respiratory tract infections and diarrhea in early childhood in Japan. Data were extracted from a nationwide longitudinal survey of Japanese children. We restricted the study participants to singleton children who were born after 37 gestational weeks and whose information on feeding practice during infancy were included (n = 43,367). We used logistic regression models to evaluate the associations of breastfeeding with hospitalization for the two diseases among young children (i.e., between ages 6 and 18 months, between ages 18 and 30 months, and between ages 30 and 42 months, respectively), adjusting for children's factors (sex, birth weight, childcare attendance and presence of siblings) and maternal factors (educational attainment and smoking status). Breastfeeding compared with infant formula was not associated with reduced risk of hospitalization for diarrhea during the periods we examined. Although breastfeeding was not associated with reduced risk of hospitalization for respiratory tract infections between ages 6 and 18 months, breastfeeding showed protective effects after that period: the adjusted odds ratios (95% confidence intervals) of exclusive breastfeeding were 0.82 (0.66-1.01) between ages 18 and 30 months and 0.76 (0.58-0.99) between ages 30 and 42 months. Breastfeeding may have long-term protective effects on hospitalization for respiratory tract infections after infancy, but not for diarrhea.

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  • EXTENDED CAUSAL DIAGRAMS INTEGRATING RESPONSE TYPES AND OBSERVED VARIABLES.

    Etsuji Suzuki, Toshiharu Mitsuhashi, Toshihide Tsuda, Eiji Yamamoto

    AMERICAN JOURNAL OF EPIDEMIOLOGY   177   S100 - S100   2013.6

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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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  • Long-term exposure to traffic-related air pollution and the risk of death from hemorrhagic stroke and lung cancer in Shizuoka, Japan

    Yorifuji T, Kashima S, Tsuda T, Ishikawa-Takata K, Ohta T, Tsuruta K, Doi H

    Sci Total Environ.   443   397 - 402   2013

  • Study on the factors determining home death of patients during home care: A historical cohort study at a home care support clinic

    Seiji Kawagoe, Toshihide Tsuda, Hiroyuki Doi

    Geriatrics Gerontology International   13 ( 4 )   874 - 880   2013

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  • Is there a carcinogenic effect from exposure to less than 100 mSv? Presence or absence of statistical significance and effect

    Tsuda T, Yamamoto E, Suzuki E

    Science Journal KAGAKU   83 ( 7 )   735 - 742   2013

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  • 中国地方5県における男女別の黄砂の死亡への影響評価

    鹿嶋小緒里, 頼藤貴志, 津田敏秀, 村上玄樹, 烏帽子田彰

    日本公衆衛生学会総会抄録集   71st   578 - 578   2012.10

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  • Frequency of Antenatal Care Visits and Neonatal Mortality in Indonesia

    Juliani Ibrahim, Takashi Yorifuji, Toshihide Tsuda, Saori Kashima, Hiroyuki Doi

    JOURNAL OF TROPICAL PEDIATRICS   58 ( 3 )   184 - 188   2012.6

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    Objective: To examine the relationship between frequency of antenatal care visits, as a whole and in each trimester, and neonatal mortality in Indonesia. Subjects: 13 055 single births from the fifth Indonesia Demographic Health Survey in 2006-07. Methods: Estimate adjusted odds ratios (ORs) and their 95% confidence intervals (95% CIs). Results: Pregnant women who had more antenatal care visits experienced a lower risk of neonatal mortality and more benefit in the last trimester: the ORs against the 0-1 visit group, were 0.76 (95% CI 0.45-1.29) for 2 visits group, 0.54 (95% CI 0.33-0.87) for 3 visits group and 0.31 (95% CI 0.17-0.57) for 4 visits group, respectively. Individual ORs as a whole period were not significant, but ORs declined markedly at 7 visits or more. Conclusion: The results may provide a valuable recommendation for the care of pregnant women in Indonesia.

    DOI: 10.1093/tropej/fmr067

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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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    DOI: 10.1539/joh.11-0202-OA

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  • 母親の労働時間と小児の過体重の関連 追加報告

    三橋 利晴, 鈴木 越治, 高尾 総司, 津田 敏秀, 土居 弘幸

    産業衛生学雑誌   54 ( 臨増 )   362 - 362   2012.5

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  • On the Relations Between Excess Fraction, Attributable Fraction, and Etiologic Fraction

    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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  • 肺と心臓の共通の敵,タバコの害について識る.

    Heart View   16 ( 3 )   58(266)-63(271)   2012

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  • Adverse effects of cigarette smoking - The common enemy against lung and heart in humans.

    16 ( 3 )   58(266)-63(271)   2012

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  • 日本における大気汚染の健康影響評価と政策評価研究

    頼藤貴志, 鹿嶋小緒里, 津田敏秀, 土居弘幸

    環境と公害   42 ( 2 )   65 - 69   2012

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  • Acute non-cancer mortality excess after polychlorinated biphenyls and polychlorinated dibenzofurans mixed exposure from contaminated rice oil: Yusho

    Saori Kashima, Takashi Yorifuji, Toshihide Tsuda

    SCIENCE OF THE TOTAL ENVIRONMENT   409 ( 18 )   3288 - 3294   2011.8

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    In Japan in 1968, rice-oil contaminated by polychlorinated biphenyls and polychlorinated dibenzofurans caused severe food poisoning, termed "Yusho" (oil disease). Several previous studies attempted to evaluate the effects targeting officially-certified Yusho patients. However, these studies have several limitations such as the left-truncated nature of the registry or residual confounding arising from the referent population selection. We thus conducted an area-based standardized mortality ratios (SMRs) study using vital statistics. A severely affected area (Tamanoura area) was adopted as the exposure group, with a reference population from Nagasaki prefecture in Kyushu, which included the Tamanoura. A large number of residents in Tamanoura were exposed to the rice-oil (28% of all the certified cases as of 2009). We estimated SMRs of non-cancer and cancer diseases for the years 1968-2002. Shortly after the exposure, SMRs of all causes, diabetes mellitus, cardiovascular disease, pneumonia/bronchitis, and bronchus/lung cancer were elevated. In particular, SMRs of heart disease were 1.97 [95% confidence intervals (CI): 1.09-3.56] in 1968, 2.05 (95% Cl: 1.16-3.60) in 1969, and 1.89 (95% CI: 1.05-3.41) in 1975. However, we did not observe clear increase in SMRs more than 10 years after the exposure. This study provides further evidence in Yusho, especially on acute effects on non-cancer mortality. (C) 2011 Elsevier B.V. All rights reserved.

    DOI: 10.1016/j.scitotenv.2011.05.038

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  • Environmental Health Research Implications of Methylmercury

    Toshihide Tsuda, Takashi Yorifuji, Masazumi Harada

    ENVIRONMENTAL HEALTH PERSPECTIVES   119 ( 7 )   A284 - A284   2011.7

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    DOI: 10.1289/ehp.1103580

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  • IDENTIFICATION OF OPERATING MEDIATION AND MECHANISM IN THE SUFFICIENT-COMPONENT CAUSE FRAMEWORK

    E. Suzuki, E. Yamamoto, T. Tsuda

    AMERICAN JOURNAL OF EPIDEMIOLOGY   173 ( 5 )   S184 - S184   2011.6

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    DOI: 10.1007/s10654-011-9568-3

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  • Cancer excess after arsenic exposure from contaminated milk powder

    YORIFUJI Takashi, TSUDA Toshihide, DOI Hiroyuki, GRANDJEAN Philippe

    16 ( 3 )   164 - 170   2011.5

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  • 日本の病院におけるソーシャル・ネットワークと看護師の主観的不健康

    岩瀬 敏秀, 三橋 利晴, 高尾 総司, 津田 敏秀, 土居 弘幸

    産業衛生学雑誌   53 ( 臨増 )   500 - 500   2011.5

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  • 母親の就業時間と小児の肥満の関連

    三橋 利晴, 鈴木 越治, 高尾 総司, 津田 敏秀

    産業衛生学雑誌   53 ( 臨増 )   552 - 552   2011.5

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  • Residential proximity to heavy traffic and birth weight in Shizuoka, Japan

    Saori Kashima, Hiroo Naruse, Takashi Yorifuji, Shigeru Ohki, Takeshi Murakoshi, Soshi Takao, Toshihide Tsuda, Hiroyuki Doi

    ENVIRONMENTAL RESEARCH   111 ( 3 )   377 - 387   2011.4

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    An association between exposure to traffic-related air pollution and reduced birth weight has been suggested. However, previous studies have failed to adjust for maternal size, which is an indicator of individual genetic growth potential. Therefore, we evaluated the association of air pollution with birth weight, term low birth weight (term-LBW), and small for gestational age (SGA), with adjustment for maternal size. Individual data were extracted from a database that is maintained by a maternal and perinatal care center in Shizuoka, japan. We identified liveborn singleton births (n=14,204). Using geocoded residential information, each birth was assigned a number of traffic-based exposure indicators: distance to a major road; distance-weighted traffic density; and estimated concentration of nitrogen dioxide by land use regression. The multivariate adjusted odds ratios and their 95% confidence intervals (CIs) for the associations between exposure indicators and outcomes were then estimated using logistic regression models. Overall, exposure indicators of air pollution showed no clear pattern of association. Although there are many limitations, we did not find clear associations between birth-weight-related outcomes and the three markers of traffic-related air pollution. (C) 2011 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.envres.2011.02.005

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  • The History of Minamata Disease and Public Health Policy

    Toshihide Tsuda, Takashi Yorifuji

    EPIDEMIOLOGY   22 ( 1 )   S99 - S99   2011.1

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

    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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  • Epidemiology of Congenital Minamata Disease Patients

    Masazumi Harada, Takashi Yorifuji, Toshihide Tsuda

    EPIDEMIOLOGY   22 ( 1 )   S100 - S100   2011.1

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  • Recent Findings in Minamata Disease From a Population-based Study Conducted in 1971

    Takashi Yorifuji, Toshihide Tsuda, Masazumi Harada

    EPIDEMIOLOGY   22 ( 1 )   S99 - S100   2011.1

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  • Acute and Long-term Excess Mortality After Polychlorinated Biphenyls and Polychlorinated Dibenzofurans Mixed Exposure From Contaminated Rice Oil: Yusho

    Saori Kashima, Takashi Yorifuji, Toshihide Tsuda

    EPIDEMIOLOGY   22 ( 1 )   S239 - S239   2011.1

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

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

    EPIDEMIOLOGY   22 ( 1 )   S76 - S76   2011.1

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    DOI: 10.1097/01.ede.0000391895.33567.d5

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  • An epidemiological study of children with status epilepticus in Okayama, Japan: incidence, etiologies, and outcomes

    Nishiyama I, Ohtsuka Y, Tsuda T, Kobayashi K, Inoue H, Narahara K, Shiraga H, Kimura T, Ogawa M, Terasaki T, Ono H, Tanaka T

    Epilepsy Res   96 ( 1-2 )   89 - 95   2011

  • The authors respond

    Takashi Yorifuji, Etsuji Suzuki, Toshihide Tsuda

    Epidemiology   21 ( 6 )   916   2010.11

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    DOI: 10.1097/EDE.0b013e3181f32842

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  • Unusual Cancer Excess After Neonatal Arsenic Exposure From Contaminated Milk Powder

    Takashi Yorifuji, Toshihide Tsuda, Philippe Grandjean

    JOURNAL OF THE NATIONAL CANCER INSTITUTE   102 ( 5 )   360 - 361   2010.3

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    DOI: 10.1093/jnci/djp536

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

    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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  • Training Program on Food-Borne Disease Epidemiology 19. Case-Control Study (3). Multi-Prefectural Disease Outbreaks which are Difficult to be Investigated by a Classical Method

    Food Sanitation Research   60 ( 4 )   29 - 38   2010

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  • Training Program on Food-Borne Disease Epidemiology 18. "Cause" of Food Borne Disease and Recall

    Food Sanitation Research   60 ( 3 )   37 - 46   2010

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  • Training Program on Food-Borne Disease Epidemiology 17. Bias in Epidemiology: Type, Magnitude, Direction, and its Countermeasure

    Food Sanitation Research   60 ( 2 )   39 - 46   2010

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  • Training Program on Food-Borne Disease Epidemiology 16. Bias in Epidemiology: Type, Magnitude, Direction, and its Countermeasure The First Part

    Food Sanitation Research   60 ( 1 )   47 - 55   2010

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    Food Sanitation Research   60 ( 5 )   47 - 56   2010

  • 食中毒の疫学研修講座18.食中毒の「原因」と回収問題.食品衛生研究2010;60(3):37-46.

    津田 敏秀, 槌田 浩明, 中瀬 克己, 溝口 嘉範, 山本 英二, 土居 弘幸, 土橋 酉紀, 頼藤 貴志, 鈴木 越治, 鹿嶋 小緒里, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   60 ( 3 )   37 - 46   2010

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  • 食中毒の疫学研修講座17.疫学研究におけるバイアスの種類、その影響の程度と方向、およびその対策:後編.

    津田 敏秀, 槌田 浩明, 中瀬 克己, 溝口 嘉範, 山本 英二, 土居 弘幸, 土橋 酉紀, 頼藤 貴志, 鈴木 越治

    食品衛生研究   60 ( 2 )   39 - 46   2010

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  • 食中毒の疫学研修講座16.疫学研究におけるバイアスの種類、その影響の程度と方向、およびその対策:前編.

    津田 敏秀, 槌田 浩明, 中瀬 克己, 溝口 嘉範, 山本 英二, 土居 弘幸, 土橋 酉紀, 頼藤 貴志, 鈴木 越治, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   60 ( 1 )   47 - 55   2010

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  • Training Program on Food-Borne Disease Epidemiology 21: Closing Remarks on the Serial

    Food Sanitation Research   60 ( 6 )   33 - 44   2010

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  • 食中毒の疫学研修講座21.連載を終わるにあたって.食品衛生研究2010;60(6):33-44.

    中瀬 克己, 槌田 浩明, 溝口 嘉範, 山本 英二, 津田 敏秀, 鹿嶋 小緒里, 土橋 酉紀, 頼藤 貴志, 鈴木 越治, 土居 弘幸, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   60 ( 6 )   33 - 44   2010

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  • 記述疫学と地理情報システム

    鹿嶋 小緒里, 土橋 酉紀, 頼藤 貴志, 鈴木 越治, 土居 弘幸, 槌田 浩明, 中瀬 克己, 溝口 嘉範, 山本 英二, 津田 敏秀, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   60 ( 5 )   47 - 56   2010

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  • 食中毒の疫学研修講座19.古典的調査法では対応できない広域散発事例.

    中瀬 克己, 槌田 浩明, 溝口 嘉範, 津田 敏秀, 山本 英二, 土居 弘幸, 土橋 酉紀, 頼藤 貴志, 鈴木 越治, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   60 ( 4 )   29 - 38   2010

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  • Does tumor type affect local control by radiofrequency ablation in the lungs? International journal

    Takao Hiraki, Hideo Gobara, Hidefumi Mimura, Yoshifumi Sano, Toshihide Tsuda, Toshihiro Iguchi, Hiroyasu Fujiwara, Ryotaro Kishi, Yusuke Matsui, Susumu Kanazawa

    European journal of radiology   74巻 ( 1号 )   136 - 141   2010

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    OBJECTIVE: : To retrospectively evaluate the effect of tumor type on local control by radiofrequency ablation in the lungs. MATERIALS AND METHODS: : This study included 252 lung tumors (mean size, 13.5mm) in 105 patients (73 men and 32 women; mean age, 66.6 years) who underwent radiofrequency ablation with a multitined expandable electrode. Those tumors comprised five tumor types: primary lung cancer (n=35) and pulmonary metastases from colorectal cancer (n=117), lung cancer (n=23), renal cell carcinoma (n=49), and hepatocellular carcinoma (n=28). Local control was evaluated with contrast-enhanced computed tomography. The overall local control rates were estimated as well as those for each tumor type using the Kaplan-Meier analysis. Local control rates for a given tumor type were compared with those for the four other types. Then, multivariate multilevel analysis was performed using the variables of tumor type, tumor size, contact with a vessel or bronchus, and procedure period. RESULTS: : The overall local control rates were 97%, 86%, 81%, and 76% at 6, 12, 18, and 24 months, respectively. Local control rates varied among the tumor types, and metastatic colorectal cancer showed significantly (P=.023) higher local control rates than those of the four other types. However, multivariate analysis indicated that the relative risk of local progression for a given tumor type was comparable to the risks for the four other types. CONCLUSION: : Tumor type per se did not significantly influence local control.

    DOI: 10.1016/j.ejrad.2009.01.026

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  • What has methylmercury in umbilical cords told us? - Minamata disease

    Takashi Yorifuji, Saori Kashima, Toshihide Tsuda, Masazumi Harada

    SCIENCE OF THE TOTAL ENVIRONMENT   408 ( 2 )   272 - 276   2009.12

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    Severe methylmercury poisoning occurred in Minamata and neighboring communities in the 1950s and 1960s. The exposed patients manifested neurological signs, and some patients exposed in utero were born with so-called congenital Minamata disease. In a previous report, Nishigaki and Harada evaluated the methylmercury concentrations in the umbilical cords of inhabitants and demonstrated that methylmercury actually passed through the placenta (Nishigaki and Harada, 1975). However, the report involved a limited number of cases (only 35) and did not quantitatively evaluate the regional differences in the transition of methylmercury exposure. Therefore, in the present study, we evaluated the temporal and spatial distributions of methylmercury concentrations in umbilical cords, with an increased number of participants and additional descriptive analyses. Then, we examined whether the methylmercury concentrations corresponded with the history of the Minamata disease incident. A total of 278 umbilical cord specimens collected after birth were obtained from babies born between 1925 and 1980 in four study areas exposed to methylmercury. Then. we conducted descriptive analyses, and drew scatterplots of the methylmercury concentrations of all the participants and separated by the areas. In the Minamata area, where the first patient was identified in 1956, the methylmercury concentration reached a peak around 1955. Subsequently, about 5 years later, the concentrations peaked in other exposed areas with the expected exposure distribution corresponding with acetaldehyde production (the origin of methylmercury). This historical incident several decades ago in Minamata and neighboring communities clearly shows that regional pollution affected the environment in utero. Furthermore, the temporal and spatial distributions of the methylmercury concentrations in the umbilical cords tell us the history of the Minamata disease incident. (C) 2009 Elsevier B.V. All rights reserved.

    DOI: 10.1016/j.scitotenv.2009.10.011

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  • Oseltamivir and Abnormal Behaviors True or Not?

    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.

    DOI: 10.1097/EDE.0b013e3181a3d3f6

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  • UNSCEAR 2006 inadequately cited "A case control study of multiple myeloma at four nuclear facilities" (Ann Epidemiol 2000; 10: 144-153. by Wing S et al.)

    Toshihide Tsuda, Eiji Yamamoto, Takashi Yorifuji

    ANNALS OF EPIDEMIOLOGY   19 ( 7 )   519 - 519   2009.7

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    DOI: 10.1016/j.annepidem.2009.02.007

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  • Minamata disease: Catastrophic poisoning due to a failed public health response

    Toshihide Tsuda, Takashi Yorifuji, Soshi Takao, Masaya Miyai, Akira Babazono

    JOURNAL OF PUBLIC HEALTH POLICY   30 ( 1 )   54 - 67   2009.4

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    We present the history of Minamata disease in a chronological order from the public health point of view. Because the appropriate public health response - to investigate and control the outbreak - as set out in the Food Sanitation Act was not conducted, no one knew how many became ill following the outbreak. Exposure could not be stopped. In our discussion, we offer two reasons as to why the Japanese public health agencies did not apply the Act: social circumstances in the 1950s and 1960s that placed emphasis on industrial development, and the Japanese medical community&apos;s lack of knowledge about the Act. The history of Minamata disease shows us the consequences when public health responses are not implemented. Minamata disease should be an invaluable lesson for future public health responses.

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  • Application of land use regression to regulatory air quality data in Japan

    Saori Kashima, Takashi Yorifuji, Toshihide Tsuda, Hiroyuki Doi

    SCIENCE OF THE TOTAL ENVIRONMENT   407 ( 8 )   3055 - 3062   2009.4

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    A land use regression (LUR) model has been used successfully for predicting traffic-related pollutants, although its application has been limited to Europe and North America. Therefore, we modeled traffic-related pollutants by LUR then examined whether LUR models could be constructed using a regulatory monitoring network in Shizuoka, Japan. We used the annual-mean nitrogen dioxide (NO(2)) and suspended particulate matter (SPM) concentrations between April 2000 and March 2006 in the study area. SPM accounts for particulate matter with an aerodynamic diameter less than 8 mu m (PM8). Geographic variables that are considered to predict traffic-related pollutants were classified into four groups: road type, traffic intensity, land use, and physical component. Using geographical variables, we then constructed a model to predict the monitored levels of NO(2) and SPM. The mean concentrations of NO(2) and SPM were 35.75 mu g/m(3) (standard deviation of 11.28) and 28.67 mu g/m(3) (standard deviation of 4.73), respectively. The final regression model for the NO(2) concentration included five independent variables. R(2) for the NO(2) model was 0.54. On the other hand, the regression model for the SPM concentration included only one independent variable. R(2) for the SPM model was quite low (R(2) = 0.11). The present study showed that even if we used regulatory monitoring air quality data, we could estimate NO(2) moderately well. This result could encourage the wide use of LUR models in Asian countries. (C) 2008 Elsevier B.V. All rights reserved.

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  • Minamata disease: Catastrophic poisoning due to a failed public health response

    Toshihide Tsuda, Takashi Yorifuji, Soshi Takao, Masaya Miyai, Akira Babazono

    Journal of Public Health Policy   30 ( 1 )   54 - 67   2009.4

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    We present the history of Minamata disease in a chronological order from the public health point of view. Because the appropriate public health response - to investigate and control the outbreak - as set out in the Food Sanitation Act was not conducted, no one knew how many became ill following the outbreak. Exposure could not be stopped. In our discussion, we offer two reasons as to why the Japanese public health agencies did not apply the Act: social circumstances in the 1950s and 1960s that placed emphasis on industrial development, and the Japanese medical communitys lack of knowledge about the Act. The history of Minamata disease shows us the consequences when public health responses are not implemented. Minamata disease should be an invaluable lesson for future public health responses. © 2009 Palgrave Macmillan.

    DOI: 10.1057/jphp.2008.30

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  • ANALYSIS OF FACTORS ASSOCIATED WITH RADIATION-INDUCED BRONCHIOLITIS OBLITERANS ORGANIZING PNEUMONIA SYNDROME AFTER BREAST-CONSERVING THERAPY

    Norihisa Katayama, Shuhei Sato, Kuniaki Katsui, Mitsuhiro Takemoto, Toshihide Tsuda, Atsushi Yoshida, Tsuneharu Morito, Tomio Nakagawa, Akifumi Mizuta, Takahiro Waki, Harutaka Niiya, Susumu Kanazawa

    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS   73 ( 4 )   1049 - 1054   2009.3

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    Purpose: To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy.
    Methods and Materials: A total or 702 women with breast cancer who received radiotherapy after breast-conserving surgery at seven institutions between July 1995 and December 2006 were analyzed. In all patients, the whole breast was irradiated with two tangential photon beams. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months, (2) general and/or respiratory symptoms lasting for 2 weeks, (3) radiographs showing lung infiltration outside the radiation port, and (4) no evidence of a specific cause.
    Results: Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Eleven patients (68.8%) were administered steroids. The duration of steroid administration ranged from 1 week to 3.7 years (median, 1.1 years). Multivariate analysis revealed that age ( &gt;= 50 years; odds ratio [OR] 8.88; 95% confidence interval [CI] 1.16-67.76; P = 0.04) and concurrent endocrine therapy (OR 3.05; 95% CI 1.094.54; p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was :50 years and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome.
    Conclusions: Age (&gt;= 50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Physicians should carefully follow patients who received breast-conserving therapy, especially those who are older than 50 years and received concurrent endocrine therapy during radiotherapy. (C) 2009 Elsevier Inc.

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  • 食中毒の疫学研修講座13.症例対照研究(1):対照の取り方と食中毒事件対策.

    津田 敏秀, 槌田 浩明, 中瀬 克己, 溝口 嘉範, 山本 英二, 土居 弘幸, 土橋 酉紀, 頼藤 貴志

    食品衛生研究   59 ( 10 )   25 - 33   2009

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  • 食中毒の疫学研修講座12.統計疫学入門:補足編.

    津田 敏秀, 槌田 浩明, 溝口 嘉範, 中瀬 克己, 山本 英二, 土橋 酉紀, 頼藤 貴志, 土居 弘幸, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   59 ( 9 )   41 - 45   2009

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  • 食中毒の疫学研修講座11.統計疫学入門:信頼区間と検定.

    津田 敏秀, 槌田 浩明, 溝口 嘉範, 中瀬 克己, 山本 英二, 土橋 酉紀, 頼藤 貴志, 土居 弘幸

    食品衛生研究   59 ( 8 )   53 - 61   2009

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  • Training program on outbreak epidemiology (10) Field epidemiology training program-Japan

    Food sanitation research   59 ( 7 )   53 - 59   2009

  • 食中毒の疫学研修講座14.メディアとの連携-食中毒疫学調査と対策は疫学と調査法の理解だけではできない-.食品衛生研究2009;59(11):29-38.

    津田 敏秀, 槌田 浩明, 中瀬 克己, 溝口 嘉範, 山本 英二, 土居 弘幸, 土橋 酉紀, 頼藤 貴志

    食品衛生研究   59 ( 11 )   29 - 39   2009

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  • Training program on food-borne disease epidemiology (5) Introduction to Japanese version of Epi Info software for epidemic studies

    Food sanitation research   59 ( 2 )   17 - 26   2009

  • Implications for future adverse effect studies of neuraminidase inhibitors (Rapid response to Neuraminidase inhibitors for preventing and treatinginfluenza in healthy adults: systematic review and meta-analysis byJefferson et al. BMJ 2009; 339: b5106).

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

    BMJ   2009

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  • Total hair mercury content and neurological signs in Minamata and neighboring communities.

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

    Epidemiology   2009

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  • Causal Inference in Medicine Part I : Counterfactual Models-An Approach to Clarifying Discussions in Research and Applied Public Health

    SUZUKI Etsuji, KOMATSU Hirokazu, YORIFUJI Takashi, YAMAMOTO Eiji, DOI Hiroyuki, TSUDA Toshihide

    Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene)   64 ( 4 )   786 - 795   2009

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    A central problem in natural science is identifying general laws of cause and effect. Medical science is devoted to revealing causal relationships in humans. The framework for causal inference applied in epidemiology can contribute substantially to clearly specifying and testing causal hypotheses in many other areas of biomedical research. In this article, we review the importance of defining explicit research hypotheses to make valid causal inferences in medical studies. In the counterfactual model, a causal effect is defined as the contrast between an observed outcome and an outcome that would have been observed in a situation that did not actually happen. The fundamental problem of causal inference should be clear; individual causal effects are not directly observable, and we need to find general causal relationships, using population data. Under an "ideal" randomized trial, the assumption of exchangeability between the exposed and the unexposed groups is met; consequently, population-level causal effects can be estimated. In observational studies, however, there is a greater risk that the assumption of conditional exchangeability may be violated. In summary, in this article, we highlight the following points: (1) individual causal effects cannot be inferred because counterfactual outcomes cannot, by definition, be observed; (2) the distinction between concepts of association and concepts of causation and the basis for the definition of confounding; (3) the importance of elaborating specific research hypotheses in order to evaluate the assumption of conditional exchangeability between the exposed and unexposed groups; (4) the advantages of defining research hypotheses at the population level, including specification of a hypothetical intervention, consistent with the counterfactual model. In addition, we show how understanding the counterfactual model can lay the foundation for correct interpretation of epidemiologic evidence.<br>

    DOI: 10.1265/jjh.64.786

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  • Causal Inference in Medicine Part I : Counterfactual Models-An Approach to Clarifying Discussions in Research and Applied Public Health

    SUZUKI Etsuji, KOMATSU Hirokazu, YORIFUJI Takashi, YAMAMOTO Eiji, DOI Hiroyuki, TSUDA Toshihide

    Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene)   64 ( 4 )   786 - 795   2009

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    A central problem in natural science is identifying general laws of cause and effect. Medical science is devoted to revealing causal relationships in humans. The framework for causal inference applied in epidemiology can contribute substantially to clearly specifying and testing causal hypotheses in many other areas of biomedical research. In this article, we review the importance of defining explicit research hypotheses to make valid causal inferences in medical studies. In the counterfactual model, a causal effect is defined as the contrast between an observed outcome and an outcome that would have been observed in a situation that did not actually happen. The fundamental problem of causal inference should be clear; individual causal effects are not directly observable, and we need to find general causal relationships, using population data. Under an "ideal" randomized trial, the assumption of exchangeability between the exposed and the unexposed groups is met; consequently, population-level causal effects can be estimated. In observational studies, however, there is a greater risk that the assumption of conditional exchangeability may be violated. In summary, in this article, we highlight the following points: (1) individual causal effects cannot be inferred because counterfactual outcomes cannot, by definition, be observed; (2) the distinction between concepts of association and concepts of causation and the basis for the definition of confounding; (3) the importance of elaborating specific research hypotheses in order to evaluate the assumption of conditional exchangeability between the exposed and unexposed groups; (4) the advantages of defining research hypotheses at the population level, including specification of a hypothetical intervention, consistent with the counterfactual model. In addition, we show how understanding the counterfactual model can lay the foundation for correct interpretation of epidemiologic evidence.<br>

    DOI: 10.1265/jjh.64.786

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  • 昭和52年判断条件と認定問題と原因確率.

    津田敏秀

    法と民主主義   2009

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  • 食中毒の疫学研修講座9.調査デザインと調査方針.

    槌田浩明, 中瀨克己, 溝口嘉範, 山本英二, 津田敏秀, 土居弘幸, 土橋酉紀

    食品衛生研究   59 ( 6 )   33 - 41   2009

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  • 食中毒の疫学研修講座4.調査票作成およびデータ収集の留意点.

    槌田浩明, 中瀬克巳, 溝口嘉範, 山本英二, 津田敏秀, 土橋酉紀, 土居弘幸

    食品衛生研究   59 ( 1 )   47 - 55   2009

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  • 食中毒の疫学研修講座15.症例対照研究(2):スギヒラタケによる脳症の発生.食品衛生研究2009;59(12):55-66.

    津田敏秀, 津田敏秀, 槌田浩明, 槌田浩明, 中瀬克己, 中瀬克己, 溝口嘉範, 溝口嘉範, 山本英二, 山本英二, 土居弘幸, 土居弘幸, 土橋酉紀, 土橋酉紀, 頼藤貴志, 頼藤貴志

    食品衛生研究   59 ( 12 )   55 - 66   2009

  • 食中毒の疫学研修講座 8.観光船での汚染された弁当による集団食中毒事例(後編).

    山本英二, 中瀬克巳, 槌田浩明, 溝口嘉範, 津田敏秀, 土橋酉紀, 土居弘幸

    食品衛生研究   59 ( 5 )   41 - 48   2009

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  • 食中毒の疫学研修講座 7.観光船での汚染された弁当による集団食中毒事例(前編).

    山本英二, 中瀬克巳, 槌田浩明, 溝口嘉範, 津田敏秀, 土橋酉紀, 土居弘幸

    食品衛生研究   59 ( 4 )   29 - 37   2009

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  • 食中毒の疫学研修講座6.疫学統計ソフトEpi InfoTMの使い方.

    山本英二, 中瀬克巳, 槌田浩明, 溝口嘉範, 津田敏秀, 土橋酉紀, 土居弘幸

    食品衛生研究   59 ( 3 )   35 - 43   2009

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  • 食中毒の疫学研修講座5.疫学統計ソフトEpi InfoTM日本語版の紹介,インストールおよび基礎.

    山本英二, 中瀬克巳, 槌田浩明, 溝口嘉範, 津田敏秀, 土橋酉紀, 土居弘幸

    食品衛生研究   59 ( 2 )   17 - 26   2009

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  • 食中毒の疫学研修講座15.症例対照研究(2):スギヒラタケによる脳症の発生.

    津田敏秀, 槌田浩明, 溝口嘉範, 中瀬克巳, 山本英二, 土居弘幸, 土橋酉紀, 頼藤貴志

    食品衛生研究   59 ( 12 )   2009

  • Training program on food-borne disease epidemiology (14) Media and the public: strategies for outbreak investigation and counter measure other than epidemiology

    Food sanitation research   59 ( 11 )   29 - 39   2009

  • 食中毒の疫学研修講座10.実地疫学専門家養成コースFETP-Jと自治体でのアウトブレイク調査.

    土橋酉紀, 土居弘幸, 頼藤貴志, 中瀬克巳, 槌田浩明, 溝口嘉範, 山本英二, 津田敏秀

    食品衛生研究   59 ( 7 )   53 - 59   2009

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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

    SUZUKI Etsuji, KOMATSU Hirokazu, YORIFUJI Takashi, YAMAMOTO Eiji, DOI Hiroyuki, TSUDA Toshihide

    Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene)   64 ( 4 )   796 - 805   2009

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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>

    DOI: 10.1265/jjh.64.796

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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

    SUZUKI Etsuji, KOMATSU Hirokazu, YORIFUJI Takashi, YAMAMOTO Eiji, DOI Hiroyuki, TSUDA Toshihide

    Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene)   64 ( 4 )   796 - 805   2009

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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>

    DOI: 10.1265/jjh.64.796

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  • 水俣病における医学的問題と日本精神神経学会の取り組み.第104回日本精神神経学会総会教育講演.

    津田敏秀

    精神神経学雑誌   2009

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  • 食中毒の疫学研修講座13.症例対照研究(1):対照の取り方と食中毒事件対策.

    津田敏秀, 槌田浩明, 溝口嘉範, 中瀬克巳, 山本英二, 土居弘幸, 土橋酉紀, 頼藤貴志

    食品衛生研究   59 ( 10 )   25 - 33   2009

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  • 食中毒の疫学研修講座12.統計疫学入門:補足編.食

    津田敏秀, 槌田浩明, 溝口嘉範, 中瀬克巳, 山本英二, 土橋酉紀, 頼藤貴志, 土居弘幸

    食品衛生研究   59 ( 9 )   41 - 45   2009

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  • 食中毒の疫学研修講座11.統計疫学入門:信頼区間と検定.

    津田敏秀, 槌田浩明, 溝口嘉範, 中瀬克巳, 山本英二, 土橋酉紀, 頼藤貴志, 土居弘幸

    食品衛生研究   59 ( 8 )   53 - 61   2009

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  • Minamata Disease. –A catastrophic poisoning due to failure of appropriate public health response.

    Tsuda Toshihide, Yorifuji Takashi, Takao Soshi, Miyai Masaya, Babazono Akira

    Journal of Public Health Policy   2009

  • Minamata disease: Catastrophic poisoning due to a failed public health response.

    Toshihide Tsuda, Takashi Yorifuji, Soshi Takao, Masaya, Miyai, Akira Babazono

    Journal of Public Health Policy 2009; 30: 54-67.   2009 ( 30 )   54 - 67   2009

  • 食中毒の疫学研修講座 7.観光船での汚染された弁当による集団食中毒事例(前編).

    山本 英二, 中瀬 克己, 槌田 浩明, 溝口 嘉範, 津田 敏秀, 土橋 酉紀, 土居 弘幸, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   59 ( 4 )   29 - 37   2009

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  • Training Program on Food-Borne Disease Epidemiology 8. A Study on a Food-Borne Disease Outbreak by Contaminated Lunch Boxes Distributed in a Sightseein Ship <II>

    Food Sanitation Research   59 ( 5 )   41 - 48   2009

  • Training Program on Food-Borne Disease Epidemiology 7. AStudy on a Food-Borne Disease Outbreak by Contaminated Lunch Boxes Distributed in a Sightseeing Ship <I>

    Food Sanitation Research   59 ( 4 )   29 - 37   2009

  • Training Program on Food-Borne Epidemiology 6. Introduction to Japanese Version of Epi InfoTM Software for Epidemic Studies

    Food Sanitation Research   59 ( 3 )   35 - 43   2009

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  • Training Program on Food-Borne Disease Epidemiology 4. Check Points for Creating Questionnaires and Data Collection

    Food Sanitation Research   59 ( 1 )   47 - 55   2009

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  • Training Program on Food-Borne Disease Epidemiology 11. Primary Statistics in Epidemiology: Confidence Interval and Statistical Testing

    Food Sanitation Research   59 ( 8 )   53 - 61   2009

  • Training Program on Outbreak Epidemiology 10. Field Epidemiology Training Program-Japan.

    Food Sanitation Research   59 ( 7 )   53 - 59   2009

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  • Training Program on Food-Borne Disease Epidemiology 5. Introduction to Japanese Version of Epi InfoTM Software for Epidemic Studies.

    Food Sanitation Research   59 ( 2 )   17 - 26   2009

  • Training Program on Food-Borne Epidemiology 9. Study Designs and Practices

    Food Sanitation Research   59 ( 6 )   33 - 41   2009

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  • Traing Program on Food-Borne Disease Epidemiology 14. Media and the Public. -Strategies for Outbreak Investigation and Countermeasure othe than Epidemiology-

    Food Sanitation Research   59 ( 11 )   29 - 39   2009

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  • Training Program on Food-Borne Epidemiology 13. Case Control Study (1): Control Selection and Countermeasure in Food Poisoning Incident

    Food Sanitation Research   59 ( 10 )   25 - 33   2009

  • Training Program on Food-Borne Disease Epidemiology 12. Primary Statistics in Epidemiology: Supplementary Explanation

    Food Sanitation Research   59 ( 9 )   41 - 45   2009

  • Total hair mercury content and neurological signs in Minamata and neighboring communities.

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

    Epidemiology   in press   2009

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  • 食中毒の疫学研修講座6.疫学統計ソフトEpi InfoTMの使い方.

    山本 英二, 中瀬 克己, 槌田 浩明, 溝口 嘉範, 津田 敏秀, 土橋 酉紀, 土居 弘幸, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   59 ( 3 )   35 - 43   2009

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  • 食中毒の疫学研修講座4.調査票作成およびデータ収集の留意点.

    槌田 浩明, 中瀬 克己, 溝口 嘉範, 山本 英二, 津田 敏秀, 土居 弘幸, 土橋 酉紀, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   59 ( 1 )   47 - 55   2009

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  • Training Program on Food-Borne Disease Epidemiology 15. Case-Control Study (2): Encephalopahy Induced by Ingesting Pleurotus Mashroom

    Food Sanitation Research   59 ( 12 )   55 - 66   2009

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  • 食中毒の疫学研修講座9.調査デザインと調査方針.

    槌田 浩明, 中瀬 克己, 溝口 嘉範, 山本 英二, 津田 敏秀, 土居 弘幸, 土橋 酉紀

    食品衛生研究   59 ( 6 )   33 - 41   2009

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  • 食中毒の疫学研修講座 8.観光船での汚染された弁当による集団食中毒事例(後編).

    山本英二, 山本英二, 中瀬克己, 中瀬克己, 槌田浩明, 槌田浩明, 溝口嘉範, 溝口嘉範, 津田敏秀, 津田敏秀, 土橋酉紀, 土橋酉紀, 土居弘幸, 土居弘幸

    食品衛生研究   59 ( 5 )   41 - 48   2009

  • Factors affecting the choice of suicide method in Okayama: a database analysis from a forensic perspective

    Kamizato Eigo, Yoshitome Kei, Yamamoto Yuji, Iwase Toshihide, Tsuda Toshihide, Miyaishi Satoru, Doi Hiroyuki

    Acta Medica Okayama   63 ( 4 )   177 - 186   2009

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    DOI: 10.18926/AMO/31815

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    Other Link: http://search.jamas.or.jp/link/ui/2010097224

  • Implications for future adverse effect studies of neuraminidase inhibitors

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

    British Medical Journal   2009

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  • 大気汚染疫学の最新知見

    頼藤貴志, 浦久保雄介, 津田敏秀

    環境と公害   38 ( 3 )   11 - 16   2009

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  • Preliminary retrospective investigation of FDG-PET/CT timing in follow-up of ablated lung tumor

    Fumiyo Higaki, Yoshihiro Okumura, Shuhei Sato, Takao Hiraki, Hideo Gobara, Hidefumi Mimura, Shiro Akaki, Toshihide Tsuda, Susumu Kanazawa

    ANNALS OF NUCLEAR MEDICINE   22 ( 3 )   157 - 163   2008.4

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    Objective The aim of this study was to clarify the most appropriate follow-up initiation time point for positron emission tomography (PET)/computed tomography (CT) following radio frequency ablation (RFA) of lung tumors, and the cutoff values of maximum standard uptake value (SUVmax) to evaluate local tumor progression.
    Methods We enrolled 15 patients (8 men, median age 62 years) with 60 tumors, who were treated with RFA of lung tumors and underwent fluorodeoxyglucose (FDG)-PET/CT following RFA. Local tumor progression was assessed by periodic chest CT images prior to and following intravenous administration of a contrast medium. The SUVmax of three periods, namely, 03 months, 3-6 months, and 6-9 months after RFA, was evaluated. The appropriate time point for follow-up initiation and the cutoff value of SUVmax were determined using receiver-operating characteristic (ROC) analysis.
    Results The median follow-up period was 357 days. Of 60 tumors, 10 showed local progression. The area under the ROC curve (Az) for the 6-9 months (P = 0.044) was the largest and almost equal to that of the 3-6 months (P = 0.024). Az for the 0-3 months was the smallest and statistically insignificant (P = 0.705). The cutoff value of 1.5 of SUVmax at 3-9 months after RFA showed 77.8% sensitivity and 85.7-90.5% specificity.
    Conclusions The appropriate follow-up initiation time point is at least 3 months following RFA. Thus, SUVmax is a useful and reliable predictive indicator.

    DOI: 10.1007/s12149-007-0113-0

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  • Preliminary retrospective investigation of FDG-PET/CT timing in follow-up of ablated lung tumor

    Fumiyo Higaki, Yoshihiro Okumura, Shuhei Sato, Takao Hiraki, Hideo Gobara, Hidefumi Mimura, Shiro Akaki, Toshihide Tsuda, Susumu Kanazawa

    ANNALS OF NUCLEAR MEDICINE   22 ( 3 )   157 - 163   2008.4

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    Objective The aim of this study was to clarify the most appropriate follow-up initiation time point for positron emission tomography (PET)/computed tomography (CT) following radio frequency ablation (RFA) of lung tumors, and the cutoff values of maximum standard uptake value (SUVmax) to evaluate local tumor progression.
    Methods We enrolled 15 patients (8 men, median age 62 years) with 60 tumors, who were treated with RFA of lung tumors and underwent fluorodeoxyglucose (FDG)-PET/CT following RFA. Local tumor progression was assessed by periodic chest CT images prior to and following intravenous administration of a contrast medium. The SUVmax of three periods, namely, 03 months, 3-6 months, and 6-9 months after RFA, was evaluated. The appropriate time point for follow-up initiation and the cutoff value of SUVmax were determined using receiver-operating characteristic (ROC) analysis.
    Results The median follow-up period was 357 days. Of 60 tumors, 10 showed local progression. The area under the ROC curve (Az) for the 6-9 months (P = 0.044) was the largest and almost equal to that of the 3-6 months (P = 0.024). Az for the 0-3 months was the smallest and statistically insignificant (P = 0.705). The cutoff value of 1.5 of SUVmax at 3-9 months after RFA showed 77.8% sensitivity and 85.7-90.5% specificity.
    Conclusions The appropriate follow-up initiation time point is at least 3 months following RFA. Thus, SUVmax is a useful and reliable predictive indicator.

    DOI: 10.1007/s12149-007-0113-0

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  • Preliminary retrospective investigation of FDG-PET/CT timing in follow-up of ablated lung tumor

    Fumiyo Higaki, Yoshihiro Okumura, Shuhei Sato, Takao Hiraki, Hideo Gobara, Hidefumi Mimura, Shiro Akaki, Toshihide Tsuda, Susumu Kanazawa

    ANNALS OF NUCLEAR MEDICINE   22 ( 3 )   157 - 163   2008.4

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    Language:English   Publisher:SPRINGER  

    Objective The aim of this study was to clarify the most appropriate follow-up initiation time point for positron emission tomography (PET)/computed tomography (CT) following radio frequency ablation (RFA) of lung tumors, and the cutoff values of maximum standard uptake value (SUVmax) to evaluate local tumor progression.
    Methods We enrolled 15 patients (8 men, median age 62 years) with 60 tumors, who were treated with RFA of lung tumors and underwent fluorodeoxyglucose (FDG)-PET/CT following RFA. Local tumor progression was assessed by periodic chest CT images prior to and following intravenous administration of a contrast medium. The SUVmax of three periods, namely, 03 months, 3-6 months, and 6-9 months after RFA, was evaluated. The appropriate time point for follow-up initiation and the cutoff value of SUVmax were determined using receiver-operating characteristic (ROC) analysis.
    Results The median follow-up period was 357 days. Of 60 tumors, 10 showed local progression. The area under the ROC curve (Az) for the 6-9 months (P = 0.044) was the largest and almost equal to that of the 3-6 months (P = 0.024). Az for the 0-3 months was the smallest and statistically insignificant (P = 0.705). The cutoff value of 1.5 of SUVmax at 3-9 months after RFA showed 77.8% sensitivity and 85.7-90.5% specificity.
    Conclusions The appropriate follow-up initiation time point is at least 3 months following RFA. Thus, SUVmax is a useful and reliable predictive indicator.

    DOI: 10.1007/s12149-007-0113-0

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  • Causal interpretation based on DAGs

    Etsuji Suzuki, Hirokazu Komatsu, Takashi Yorifuji, Toshihide Tsuda,

    EPIDEMIOLOGY   19 ( 2 )   361 - 361   2008.3

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    Language:English   Publishing type:Rapid communication, short report, research note, etc. (scientific journal)   Publisher:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1097/EDE.0b013e31816379b1

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  • Causal interpretation based on DAGs

    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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  • Causal interpretation based on DAGs

    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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  • Long-term exposure to methylmercury and neurologic signs in Minamata and neighboring communities

    Takashi Yorifuji, Toshihide Tsuda, Soshi Takao, Masazumi Harada

    EPIDEMIOLOGY   19 ( 1 )   3 - 9   2008.1

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    Background: It is well known that large-scale poisonings caused by methylmercury occurred in Japan (Minamata, in the 1950s) and Iraq. However, in contrast to Iraq, there have been few sound epidemiologic studies in Minamata. We evaluated the effect of methylmercury on neurologic signs using data from a 1971 population-based study.
    Methods: Villages in 3 areas were selected for study: the Minamata area (a high-exposure area), the Goshonoura area (a medium-exposure area), and the Ariake area (a low-exposure area). We used place of residence as the-exposure indicator. We examined associations between methylmercury exposure and the following neurologic signs measured on clinical examination: paresthesia of whole body, paresthesia of extremities, paresthesia around the mouth, ataxia, dysarthria, tremors, and pathologic reflexes.
    Results: Total population was 1120 in the high-exposure villages, 1845 in the medium-exposure villages, and 1165 in the low-exposure villages. In the Minamata area, 87% (n = 833) of the eligible population (age 10 years and older) participated in the 1971 investigations, in the Goshonoura area, 93% (n = 1450), and in the Ariake area, 77% (n = 755). Compared with subjects in the Ariake area, the subjects in the Minamata area manifested neurologic signs more frequently. The highest prevalence odds ratio was observed for paresthesia around the mouth (110; 95% confidence interval = 16-820). Although residents in the Goshonoura area had been exposed less heavily than those in the Minamata area, Goshonoura residents also had increased prevalence of neurologic signs.
    Conclusion: Long-term exposure to methylmercury has a strong adverse impact on neurologic signs among residents in a local community.

    DOI: 10.1097/EDE.0b013e31815c09d2

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  • Long-term exposure to methylmercury and neurologic signs in Minamata and neighboring communities

    Takashi Yorifuji, Toshihide Tsuda, Soshi Takao, Masazumi Harada

    EPIDEMIOLOGY   19 ( 1 )   3 - 9   2008.1

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    Background: It is well known that large-scale poisonings caused by methylmercury occurred in Japan (Minamata, in the 1950s) and Iraq. However, in contrast to Iraq, there have been few sound epidemiologic studies in Minamata. We evaluated the effect of methylmercury on neurologic signs using data from a 1971 population-based study.
    Methods: Villages in 3 areas were selected for study: the Minamata area (a high-exposure area), the Goshonoura area (a medium-exposure area), and the Ariake area (a low-exposure area). We used place of residence as the-exposure indicator. We examined associations between methylmercury exposure and the following neurologic signs measured on clinical examination: paresthesia of whole body, paresthesia of extremities, paresthesia around the mouth, ataxia, dysarthria, tremors, and pathologic reflexes.
    Results: Total population was 1120 in the high-exposure villages, 1845 in the medium-exposure villages, and 1165 in the low-exposure villages. In the Minamata area, 87% (n = 833) of the eligible population (age 10 years and older) participated in the 1971 investigations, in the Goshonoura area, 93% (n = 1450), and in the Ariake area, 77% (n = 755). Compared with subjects in the Ariake area, the subjects in the Minamata area manifested neurologic signs more frequently. The highest prevalence odds ratio was observed for paresthesia around the mouth (110; 95% confidence interval = 16-820). Although residents in the Goshonoura area had been exposed less heavily than those in the Minamata area, Goshonoura residents also had increased prevalence of neurologic signs.
    Conclusion: Long-term exposure to methylmercury has a strong adverse impact on neurologic signs among residents in a local community.

    DOI: 10.1097/EDE.0b013e31815c09d2

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  • Long-term exposure to methylmercury and neurologic signs in Minamata and neighboring communities

    Takashi Yorifuji, Toshihide Tsuda, Soshi Takao, Masazumi Harada

    Epidemiology   19 ( 1 )   3 - 9   2008.1

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    BACKGROUND: It is well known that large-scale poisonings caused by methylmercury occurred in Japan (Minamata, in the 1950s) and Iraq. However, in contrast to Iraq, there have been few sound epidemiologic studies in Minamata. We evaluated the effect of methylmercury on neurologic signs using data from a 1971 population-based study. METHODS: Villages in 3 areas were selected for study: the Minamata area (a high-exposure area), the Goshonoura area (a medium-exposure area), and the Ariake area (a low-exposure area). We used place of residence as the exposure indicator. We examined associations between methylmercury exposure and the following neurologic signs measured on clinical examination: paresthesia of whole body, paresthesia of extremities, paresthesia around the mouth, ataxia, dysarthria, tremors, and pathologic reflexes. RESULTS: Total population was 1120 in the high-exposure villages, 1845 in the medium-exposure villages, and 1165 in the low-exposure villages. In the Minamata area, 87% (n=833) of the eligible population (age 10 years and older) participated in the 1971 investigations, in the Goshonoura area, 93% (n = 1450), and in the Ariake area, 77% (n = 755). Compared with subjects in the Ariake area, the subjects in the Minamata area manifested neurologic signs more frequently. The highest prevalence odds ratio was observed for paresthesia around the mouth (110
    95% confidence interval = 16-820). Although residents in the Goshonoura area had been exposed less heavily than those in the Minamata area, Goshonoura residents also had increased prevalence of neurologic signs. CONCLUSION: Long-term exposure to methylmercury has a strong adverse impact on neurologic signs among residents in a local community. © 2008 Lippincott Williams &amp
    Wilkins, Inc.

    DOI: 10.1097/EDE.0b013e31815c09d2

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  • Long-term exposure to methylmercury and neurologic signs in Minamata and neighboring communities

    Takashi Yorifuji, Toshihide Tsuda, Soshi Takao, Masazumi Harada

    EPIDEMIOLOGY   19 ( 1 )   3 - 9   2008.1

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    Background: It is well known that large-scale poisonings caused by methylmercury occurred in Japan (Minamata, in the 1950s) and Iraq. However, in contrast to Iraq, there have been few sound epidemiologic studies in Minamata. We evaluated the effect of methylmercury on neurologic signs using data from a 1971 population-based study.
    Methods: Villages in 3 areas were selected for study: the Minamata area (a high-exposure area), the Goshonoura area (a medium-exposure area), and the Ariake area (a low-exposure area). We used place of residence as the-exposure indicator. We examined associations between methylmercury exposure and the following neurologic signs measured on clinical examination: paresthesia of whole body, paresthesia of extremities, paresthesia around the mouth, ataxia, dysarthria, tremors, and pathologic reflexes.
    Results: Total population was 1120 in the high-exposure villages, 1845 in the medium-exposure villages, and 1165 in the low-exposure villages. In the Minamata area, 87% (n = 833) of the eligible population (age 10 years and older) participated in the 1971 investigations, in the Goshonoura area, 93% (n = 1450), and in the Ariake area, 77% (n = 755). Compared with subjects in the Ariake area, the subjects in the Minamata area manifested neurologic signs more frequently. The highest prevalence odds ratio was observed for paresthesia around the mouth (110; 95% confidence interval = 16-820). Although residents in the Goshonoura area had been exposed less heavily than those in the Minamata area, Goshonoura residents also had increased prevalence of neurologic signs.
    Conclusion: Long-term exposure to methylmercury has a strong adverse impact on neurologic signs among residents in a local community.

    DOI: 10.1097/EDE.0b013e31815c09d2

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  • 食中毒の疫学研修講座3.疫学調査の流れと基本-納豆オクラ事例 2-.

    溝口嘉範, 中瀬克巳, 槌田浩明, 山本英二, 土橋酉紀, 土居弘幸, 津田敏秀

    食品衛生研究   58 ( 12 )   33 - 42   2008

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  • Mecal Issues in the Minamata Disease Incident, and the Approach by the Japanese Society for Psyciatry and Neurology

    Psychiatria et Neurologia Japonica   110 ( 11 )   1120 - 1125   2008

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  • Training Program on Food-Borne Disease Epidemiology 1. Introdution of the Course Program and its Importance

    Food Sanitation Research   58 ( 10 )   7 - 15   2008

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  • Electromagnetic Field and high-voltage transmission line- What is the problem? - WHO's Recommendation and the Japanese Bureaucracy

    The World   779 ( 5 )   185 - 194   2008

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  • アスベストによる健康障害の疫学とリスクアセスメント―特に環境曝露による人体への影響に関して―.

    津田敏秀

    衆議院調査局環境調査室、解説資料:石綿関係法施行状況調査.   2008

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  • アスベストによる健康障害の疫学とリスクアセスメント―特に環境曝露による人体への影響に関して―.

    津田敏秀

    衆議院調査局環境調査室、解説資料:石綿関係法施行状況調査.   2008

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  • Training Program on Food-Borne Disease Epidemiology 3. Flow and Base of Epidemiologic Investigation- the Natto-Okra Incident 2

    Food Sanitation Research   58 ( 12 )   33 - 42   2008

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  • Training Program on Food-Borne Disease Epidemiology 2. Flow and Base of Epidemiologic Investigation- the Natto-Okra Incident 1.

    Food Sanitation Research   58 ( 11 )   49 - 60   2008

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  • 電磁波と高圧送電線・何が問題なのか-WHOの勧告と日本政府の対応.

    世界   779 ( 5 )   185 - 194   2008

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  • Analysis of factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy

    N. Katayama, S. Sato, K. Katsui, M. Takemoto, A. Yoshida, T. Morito, T. Nakagawa, A. Mizuta, H. Niiya, S. Kanazawa

    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS   72 ( 1 )   S188 - S188   2008

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  • 食品衛生法を眠らせるな.

    津田敏秀

    朝日新聞   2008

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  • Training program on food-borne disease epidemiology (2)

    Food sanitation research   58 ( 11 )   49 - 60   2008

  • 水俣病における医学的問題と日本精神神経学会の取り組み.第104回日本精神神経学会総会教育講演.

    精神神経学雑誌   110 ( 11 )   1120 - 1125   2008

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  • Training program on food-borne disease epidemiology (1) Introduction of the course program and its importance

    Food sanitation research   58 ( 10 )   7 - 15   2008

  • 食品衛生法を眠らせるな.

    津田敏秀

    朝日新聞   2008

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  • 食中毒の疫学研修講座3.疫学調査の流れと基本-納豆オクラ事例 2

    溝口 嘉範, 中瀬 克己, 槌田 浩明, 山本 英二, 津田 敏秀, 土居 弘幸, 土橋 酉紀, 岡山食中毒の疫学研修プログラム研究会

    食品衛生研究   58 ( 12 )   33 - 42   2008

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    Language:Japanese   Publisher:(公社)日本食品衛生協会  

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  • 電磁波と高圧送電線・何が問題なのか-WHOの勧告と日本政府の対応.

    津田敏秀

    世界   ( 779 )   185 - 194   2008

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  • 食中毒の疫学研修講座2.疫学調査の流れと基本-納豆オクラ事例 1-.

    溝口嘉範, 中瀬克巳, 槌田浩明, 山本英二, 土橋酉紀, 土居弘幸, 津田敏秀

    食品衛生研究   58 ( 11 )   49 - 60   2008

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  • 食中毒の疫学研修講座1.研修の現状と必要性-連載をはじめるにあたって-.

    中瀬克巳, 槌田浩明, 溝口嘉範, 山本英二, 土橋酉紀, 津田敏秀

    食品衛生研究   58 ( 10 )   7 - 15   2008

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  • 電磁波と高圧送電線・何が問題なのか-WHOの勧告と日本政府の対応.

    津田敏秀

    世界   2008

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  • 電磁波と高圧送電線・何が問題なのか-WHOの勧告と日本政府の対応.

    津田敏秀

    世界   2008

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  • EBMにおいてエビデンスを吟味する.

    津田敏秀

    大阪保険医雑誌   2008

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  • 22pTV-5 Causality and Philosophy of Science in Environmental Science

    Tsuda Toshihide

    Meeting abstracts of the Physical Society of Japan   62 ( 2 )   413 - 413   2007.8

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  • Age standardized cancer mortality ratios in areas heavily exposed to methyl mercury

    Takashi Yorifuji, Toshihide Tsuda, Norito Kawakami

    INTERNATIONAL ARCHIVES OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH   80 ( 8 )   679 - 688   2007.8

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    Objective Methyl-mercury (MeHg) was discharged from a chemical factory in Minamata, and consequently spread throughout the Shiranui Sea in Kumamoto, Japan. Although many studies have focused on MeHg-induced neurological disorders, the association between MeHg and malignant neoplasms has not been adequately investigated. Therefore, we explored this association using the age standardized mortality ratio (ASMR) in an ecologic study over a wide area allowing for a long empirical induction period.
    Methods The subjects were residents in areas around the Shiranui Sea. We divided these areas into exposure groups 1 (Minamata and Ashikita regions) and 2 (Amakusa region). Exposure group 1 was contaminated from the late 1930s, and exposure group 2 was contaminated from the late 1950s. In addition, exposure group 1 was contaminated more heavily than exposure group 2. There were 92,525 and 152,541 residents in each group in 1960, respectively. We analyzed the cancer ASMR in both exposure groups using data from two reference populations (Japan and Kumamoto prefecture) from 1961 to 1997. There were 94,301,494 and 1,856,192 people in each reference group in 1960, respectively. We abstracted population and mortality data from the censuses and the vital statistics of the prefecture and Japan.
    Results An increased leukemia ASMR and a decreased gastric cancer ASMR were observed in both exposure groups, while other ASMRs were around unity and less precise. Furthermore, the leukemia ASMRs were elevated differently between the two exposure groups: the leukemia ASMR was already elevated early in the study period in exposure group 1 and increased gradually in exposure group 2.
    Conclusion While the negative association between MeHg and gastric cancer might be explained by salt intake, the positive association between MeHg and leukemia could not be explained by potential confounders. Despite some limitations mainly due to its ecologic design, this study indicates the necessity of an individual-level study evaluating the association between MeHg and leukemia in regions with exposure to MeHg.

    DOI: 10.1007/s00420-007-0179-y

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  • An epidemiological study of children with status epilepticus in Okayama, Japan

    Itsuko Nishiyama, Yoko Ohtsuka, Toshihide Tsuda, Hideo Inoue, Taiji Kunitomi, Hiroshi Shiraga, Takafumi Kimura, Kiyoshi Fujimoto

    EPILEPSIA   48 ( 6 )   1133 - 1137   2007.6

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    Background: The incidence of status epilepticus (SE) in Asian children, including Japanese, has not been reported.
    Methods: In 2003, we performed an epidemiological study of SE on Japanese children (31 days or older to &lt; 15 years of age) in Okayama City by ascertaining all lifetime first episodes of SE.
    Results: Thirty-seven patients (22 males and 15 females) were identified. The annual incidence of SE was 38.8 per 100,000 population (95% CI: 24.5-49.5). Febrile SE in the absence of CNS infection accounted for 17. Acute symptomatic etiologies other than febrile SE were observed in eight patients, including three cases of influenza encephalitis/encephalopathy. Five were classified as remote symptomatic and the remaining seven as cryptogenic. The highest incidence (155.1/100,000) was seen in the age range of 31 days or older to &lt; 1 year, followed by 101.5/100,000 in the age range of one year, and the incidence decreased after eight years. In 26 of the 37 patients, SE was their first seizure. As for seizure types, 32 had convulsive SE, including tonic status in one. Five others showed nonconvulsive SE, including complex partial SE in four and absence status in one. No one died of SE. Two patients who brought on SE because of influenza encephalitis/encephalopathy suffered from motor disturbance with or without mental disturbance after SE.
    Conclusions: The incidence of SE tended to be higher in Japanese children than reported in Caucasians. The Japanese had an age-specific incidence pattern similar to that of Caucasians.

    DOI: 10.1111/j.1528-1167.2007.01106.x

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  • 論文の批判的吟味・長期間の携帯電話使用と脳腫瘍.

    津田敏秀

    物性研究   2007

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  • Standardized cancer mortality ratios in areas heavily exposed to methyl mercury.

    Yorifuji T, Tsuda T, Kawakami N

    Int Arch Occup Environ Health 2007   80、679-688.   2007

  • 論文の批判的吟味・長期間の携帯電話使用と脳腫瘍.

    津田敏秀

    物性研究   2007

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  • Risk factors for local progression after percutaneous radiofrequency ablation of lung tumors - Evaluation based on a preliminary review of 342 tumors

    Takao Hiraki, Jun Sakurai, Toshihide Tsuda, Hideo Gobara, Yoshifumi Sano, Takashi Mukai, Soichiro Hase, Toshihiro Iguchi, Hiroyasu Fujiwara, Hiroshi Date, Susumu Kanazawa

    CANCER   107 ( 12 )   2873 - 2880   2006.12

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    BACKGROUND. The purpose of the study was to retrospectively evaluate the risk factors for local progression after percutaneous radiofrequency (AF) ablation of lung tumors.
    METHODS. The study included 128 patients (77 men, 51 women; mean age, 61.3 years) with 342 tumors (25 primary and 317 metastatic lung neoplasms; mean long-axis diameter, 1.7 cm) treated with RF ablation. The overall primary, and secondary technique effectiveness rates were estimated using Kaplan-Meier analysis. Multiple variables were analyzed using the log-rank test, followed by multivariate multilevel analysis to determine independent risk factors for local progression. The primary and secondary technique effectiveness rates were again estimated when considering only tumors without independent risk factors.
    RESULTS. The median follow-up period was 12 months (range, 6-47 months). The overall primary and secondary technique effectiveness rates were 72% and 84% at 1 year, 60% and 71% at 2 years, and 58% and 66% at 3 years, respectively. Larger turner size (hazard ratio [HR], 1.97; 95% confidence interval [95% CI], 1.47-2.65; P &lt;.00001) and the use of an internally cooled electrode (HR, 2.32; 95% CI, 1.10-4.90; P=.027) were assessed as independent risk factors for local progression. The primary and secondary technique effectiveness rates when considering tumors smaller than 2 cm and treated with a multitined expandable electrode were 89% and 89% at 1 year and 66% and 78% at 2 years, respectively.
    CONCLUSIONS. Larger tumor size and the use of an internally cooled electrode were independent risk factors for local progression after RF ablation of lung tumors.

    DOI: 10.1002/cncr.22333

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  • A reason why the number of patients of Minamata disease is still unknown - The 50th year of Minamata disease since the first notification in 1956

    T. Tsuda, M. Harada, M. Miyai, A. Babazono, E. Yamamoto, H. Matsuoka, T. Yorifuji, Y. Mino

    EPIDEMIOLOGY   17 ( 6 )   S494 - S494   2006.11

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  • Effects of stress management at workplace on depressive symptoms, a randomized controlled trial

    Y Mino, S Shimodera, A Babazono, T Tsuda, N Yasuda

    JOURNAL OF AFFECTIVE DISORDERS   91   S81 - S81   2006.3

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  • 産業医と疫学.認定産業医9.

    津田敏秀

    日本医事新報   ( 4283 )   43 - 45   2006

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    Other Link: http://search.jamas.or.jp/link/ui/2006252948

  • Can stress management at the workplace prevent depression? A randomized controlled trial

    Y Mino, A Babazono, T Tsuda, N Yasuda

    PSYCHOTHERAPY AND PSYCHOSOMATICS   75 ( 3 )   177 - 182   2006

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    Background. Stress, mental health and depression at the workplace have emerged as common and significant problems. The effectiveness of a stress-management program at the workplace was investigated. Methods: The effectiveness of a stress-management program was examined in workers at a highly stressful workplace using a randomized controlled trial. The 58 workers in the office were randomly assigned into a stress-management group (n = 28) and a control group (n = 30). The stress-management program included lectures on the perception of stress, measures to cope with it, stress-management recording sheets, and e-mail counseling. This program was based on the cognitive behavioral approach. The stress-management program was carried out for 3 months, and perceived work-related stress and psychological symptoms were evaluated using: General Health Questionnaire (GHQ)-30, Center for Epidemiologic Study for Depression (CES-D), the Questionnaire of Work-Related Stress and the Effort-Reward Imbalance Questionnaire. Twenty-one out of the 28 in the stressmanagement group and all in the control group were successfully followed up. Results: In the stress-management group, a significant improvement in the depressive symptoms was observed, compared with the control group in CES-D (p = 0.003 by two-tailed paired t-test, and p = 0.042 by repeated measure analysis of variance). In the multiple regression analysis, the effect of stress management on depressive symptoms at follow-up was significant (p = 0.041), controlling for potential confounding factors. However, the alleviation of perceived occupational stress was limited. Conclusions:A stress-management program based on the cognitive behavioral approach at the workplace may have potential for the prevention of depression.

    DOI: 10.1159/000091775

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  • 水俣病事件における医学的問題の概略

    津田敏秀

    解説資料:水俣病問題の概要An outline of the Minamata Disease Problem   2006

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  • 認定制度は崩壊.水俣病公式確認50年.

    津田敏秀

    朝日新聞   2006

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  • 食中毒だ!!とわかるまで.

    津田敏秀

    食と健康   2006

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  • Understanding the Impact of Health Policy : 10% Co-payments for Medical Services Reduce Compliance with Necessary Care Among Elderly Patients with Chronic Disease in Japan

    BABAZONO Akira, MIYAZAKI Motonobu, UNE Hiroshi, YAMAMOTO Eiji, TSUDA Toshihide, MINO Yoshio, HILLMAN Alan L.

    Journal of health science   28   15 - 23   2006

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    Language:English   Publisher:Kyushu University  

    DOI: 10.15017/10769

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    Other Link: http://hdl.handle.net/2324/10769

  • Health care policy-making in Japan: The Impact of the increase co-payments on use of services by patients with chronic illness

    Babazono A, Miyazaki M, Une H, Yamamoto E, Tsuda T, Mino Y, Hillman AL

    Japanese Journal of Health Promotion   8   89 - 96   2006

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  • A prospective study on the influences of workplace stress on mental health

    A Babazono, Y Mino, J Nagano, T Tsuda, T Araki

    JOURNAL OF OCCUPATIONAL HEALTH   47 ( 6 )   490 - 495   2005.11

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    The purpose of this study was to clarify the influences of subjective stress in the workplace on mental health according to work contents in subjects without mental health problems. In a survey in fiscal 1997, 1,246 (84.6%) of all 1,363 workers of a manufacturing company in Japan, responded to a questionnaire including questions on subjective stress and GHQ60, and 1,135 workers answered all questions (effective response rate, 83.3%). In fiscal 1997, there were 705 "mentally healthy" workers with a GHQ score of &lt;= 16. Of the 705 workers, 603 (85.5%) could be followed up by another survey 2 yr later (fiscal 1999). According to the contents of the work, multiple logistic regression analysis was performed using the status of mental health in fiscal 1999 as a dependent variable and subjective workplace stress, sex, age, smoking, and alcohol usage in fiscal 1997 as explanatory variables. The statistically significant items relating to problematic mental health for "factory work" were "too much competition", "feel pressed for time", and "cannot keep up with new technology" (Table 4). For "too much competition", the odds ratios (95% CI) of "always" and "sometimes" to "do not feel" were 4.04 (1.39-11.76) and 1.85 (0.92-3.70), respectively. For "feel pressed for time", the odds ratios (95% CI) of "always" and "sometimes" to "do not feel" were 2.40 (1.08-5.35) and 0.98 (0.46-2.06), respectively. For "cannot keep up with new technology", the odds ratio (95% CI) of "always" and "sometimes" to "do not feel" were 6.54 (0.37-116.36) and 2.52 (1.34-4.77), respectively. The statistically significant items relating to problematic mental health for "research and development or office work" were "too much trouble at work" and "feel pressed for time". For "too much trouble at work", the odds ratios (95% CI) of "always" and "sometimes" to "do not feel" were 3.92 (1.41-10.93) and 1.44 (0.67-3.09), respectively. For "feel pressed for time", the odds ratios (95% CI) of "always" and "sometimes" to "do not feel" were 2.69 (1.04-6.93) and 2.09 (0.94-4.67), respectively. Our study suggests that subjective stress items aggravating mental health are different among work contents. If we could identify items of workplace stress influencing mental health by work contents, we could utilize the results for a mental health promotion program.

    DOI: 10.1539/joh.47.490

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  • Health impact assessment of particulate matter in Tokyo, Japan

    Takashi Yorifuji, Eiji Yamamoto, Toshihide Tsuda, Norito Kawakami

    ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH   60 ( 4 )   179 - 185   2005.7

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    Among industrialized countries, Japan still maintains an old set of guidelines for particulate matter (PM); therefore, we assessed the public health impacts of PM exposure in various Situations using data from the Tokyo metropolitan area. Subjects were 7.8 million people aged older than 30 years. Based on a linear relationship between exposure and health effects, we estimated attributable cases of mortality caused by PM. Even at the recent exposure level, the number of deaths will occur after both short- and long-term exposure. When the guideline for PM2.5 (particles &lt; 2.5 mu m in diameter) long-term exposure was set at 12 mu g/m3, we could prevent 8% of all causes mortality or 6,700 deaths in the Tokyo metropolitan area per year. This assessment shows that guidelines for long-term exposure, especially for PM2.5, should be recommended in Japan.

    DOI: 10.3200/AEOH.60.4.179-185

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  • Effects of the increase in co-payments from 20 to 30 percent on the compliance rate of patients with hypertension or diabetes mellitus in the Employed Health Insurance System

    Akira Babazono, Motonobu Miyazaki, Takuya Imatoh, Hiroshi Une, Eiji Yamamoto, Toshihide Tsuda, Kiyoshi Tanaka, Shinichi Tanihara

    International Journal of Technology Assessment in Health Care   21 ( 2 )   228 - 233   2005.3

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    Objectives: How to contain medical expenditures is a universal problem. The Japanese government has increased patient co-payments to control it. The purpose of this study is to clarify whether the increase in co-payments to 30 percent prevented patients with hypertension or diabetes mellitus from receiving necessary care in the Employee Health Insurance System. Methods: The subjects were 211 patients with hypertension and 66 patients with diabetes mellitus who regularly visited physicians from October 2001 to March 2002 and were defined as a cohort that needed health care, and their medical indicators were examined between April and September 2002 (prestage) and between April and September 2003 (poststage). Results: In the hypertensive patients with no complications, the compliance rate was 89.9 percent and 88.0 percent in the prestage, and poststage, respectively, showing no significant change. In the hypertensive patients with complications, the compliance rate was 90.5 percent and 92.1 percent in the prestage and poststage, respectively, showing no significant change. In the diabetic patients with complications, the compliance rate was 77.5 percent and 79.2 percent, in the prestage and poststage, respectively, with no significant change. In the diabetic patients with no complications, however, the compliance rate was 83.7 percent and 66.7 percent, in the prestage and poststage, respectively. A significant decrease was observed among diabetic patients without complications. Conclusions: Increasing co-payments reduced necessary preventive care in diabetic patients without complications. Copyright © 2005 Cambridge University Press.

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  • The relationship between epidermal growth factor receptor mutations and clinicopathologic features in non-small cell lung cancers

    M Tokumo, S Toyooka, K Kiura, H Shigematsu, K Tomii, M Aoe, K Ichimura, T Tsuda, M Yano, K Tsukuda, M Tabata, H Ueoka, M Tanimoto, H Date, AF Gazdar, N Shimizu

    CLINICAL CANCER RESEARCH   11 ( 3 )   1167 - 1173   2005.2

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    Purpose: Recent studies reported that clinical responsiveness to gefitinib was associated with somatic mutation of epidermal growth factor receptor (EGFR) gene in non-small cell lung cancers (NSCLC). Here, we investigated the relationship between EGFR mutation and clinicopathologic features.
    Experimental Design: EGFR mutational status of 120 NSCLCs was determined mainly in EGFR exons 18 to 21 by direct sequence and correlated with clinicopathologic parameters.
    Results: EGFR mutations were present in 38 cases (32%) and the majority of mutations were in-frame deletions of exon 19 (19 cases) and a missense mutation in exon 21 (18 cases). EGFR mutations were frequently associated with adenocarcinoma (P &lt; 0.0001), never smoker (P &lt; 0.0001), and female gender (P = 0.0001). Of interest, increasing smoke exposure was inversely related to the rate of EGFR mutation (P &lt; 0.0001). Multivariate analysis showed that smoking and histology were independent variables. Furthermore, gender difference was observed for the mutational location (P = 0.01) dominance of exon 19 for males and exon 21 for females. Twenty-one cases were treated with gefitinib and found that EGFR mutation was significantly related to gefitinib responsiveness (P = 0.002). In addition, median survival times of patients with and without EGFR mutations treated with gefitinib were 25.1 and 14.0 months, respectively. Patients with EGFR mutations had approximately 2-fold survival advantage; however, the difference was not significant.
    Conclusions: We show that EGFR mutations were significantly related to histology and smoke exposure and were a strong predictive factor for gefitinib responsiveness in NSCLC.

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  • Clostridium perfringens foodborne outbreak due to braised chop suey supplied by chafing dish

    H Ochiai, T Ohtsu, T Tsuda, H Kagawa, T Kawashita, S Takao, A Tsutsumi, N Kawakami

    ACTA MEDICA OKAYAMA   59 ( 1 )   27 - 32   2005.2

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    On February 13, 2002, a public health center in Hiroshima Prefecture, Japan, was notified that many individuals living at the Japan Maritime Self-Defence Force base had symptoms resembling those of food poisoning. Self-administered questionnaires requesting information regarding meal consumption and symptoms were distributed to all 281 members at the base. A case of the illness was defined as a member who had had watery or mucousy stool, or loose stool with abdominal cramps, more than twice a day after consuming dinner on February 12. Control of the illness was defined as a member with no symptoms. The dinner on February 12 was significantly associated with the illness (Mantel-Haenszel odds ratio: 3.59, 95% confidence interval: 1.06-12.20). A case-control study showed that, among the food supplied at dinner on February 12, the braised chop suey was significantly associated with the illness (odds ratio: 12.30, 95% confidence interval: 1.90-521.00). The braised chop suey had been stored in a chafing dish. An environmental investigation indicated that Clostridium perfringens (C. perfringens) in the chafing dish proliferated under an inappropriate heat-retention temperature, and the contaminated braised chop suey could have caused the food poisoning. This study demonstrated that the recommended heat-retention temperature (over 65 degreesC) should be confirmed thoroughly.

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  • 「関西水俣病訴訟」上告審判決.

    津田敏秀

    科学   75 ( 1 )   7 - 9   2005

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  • 大食中毒事件と病因物質.

    津田敏秀

    メディカル朝日   2005

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  • 日本の医学医療の現状と科学.

    津田敏秀

    科学   2005

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  • 人体への影響調査は被害拡大防止に有効.

    津田敏秀

    建築ジャーナル   2005

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  • 日本の医学医療と公害事件-認定審査会は原理的に個人の「認定」に関する新しい知見をもたらさない.

    津田敏秀

    科学   75 ( 5 )   586 - 591   2005

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  • 解決に、疫学が役立つ課題は数多い.

    津田敏秀

    メディカル朝日   2005

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  • アスベストと疫学、応用科学の存在考え直す時.

    津田敏秀

    朝日新聞   2005

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  • Dose effect of smoking on aberrant methylation in non-small cell lung cancers

    S Toyooka, M Suzuki, T Tsuda, KO Toyooka, R Maruyama, K Tsukuda, Y Fukuyama, T Iizasa, T Fujisawa, N Shimizu, JD Minna, AF Gazdar

    INTERNATIONAL JOURNAL OF CANCER   110 ( 3 )   462 - 464   2004.6

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    DOI: 10.1002/ijc.20125

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  • 小学校で発生した麻疹集団感染事例

    大津忠弘, 万代素子, 二宮忠矢, 松下明, 高尾総司, 落合裕隆, 津田敏秀, 中瀬克己

    日本衛生学雑誌   59 ( 2 )   145   2004.3

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  • ウエルシュ菌による食中毒アウトブレイク事例についての疫学調査

    落合裕隆, 大津忠弘, 香川治子, 河下寿昭, 津田敏秀, 高尾総司, 堤明純, 中瀬克己, 川上憲人

    日本衛生学雑誌   59 ( 2 )   146   2004.3

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  • Prognosis after withdrawal of antiepileptic drugs in childhood-onset cryptogenic localization-related epilepsies

    H Ohta, Y Ohtsuka, T Tsuda, E Oka

    BRAIN & DEVELOPMENT   26 ( 1 )   19 - 25   2004.1

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    The purpose of this study was to clarify the risk factors of relapse following discontinuation of AEDs in patients with childhood-onset cryptogenic localization-related epilepsies. The subjects were 82 patients who fulfilled the following criteria: (1) age at first visit of less than 15 years, (2) follow-up period of more than 5 years, (3) suffering from cryptogenic localization-related epilepsies, and (4) the patient underwent AED withdrawal during the follow-up period. As a basic principle, we decided to start withdrawing AEDs when both of the following two conditions were met: (1) the patient had a seizure-free period of 3 years or more, and (2) there were no epileptic discharges on EEGs just prior to the start of withdrawal. Seizures recurred in eight of the 82 patients (9.8%). Univariate analysis revealed that the following factors were correlated with higher rates of seizure relapse: 6 years of age or higher at onset of epilepsy; 15 years of age or higher at the start of AED withdrawal, 5 years or more from the start of AED treatment to seizure control; five or more seizures before seizure control; and two or more AEDs administered before seizure control. Among these risk factors, 6 years of age or higher at onset and 5 years or more from the start of AED treatment to seizure control were determined by multivariate analysis to be independent risk factors for relapse. Thus, we conclude that the physician should be more careful in discontinuing AEDs in these higher-risk patients groups, and more generous in discontinuing AEDs in lower-risk groups. (C) 2003 Elsevier B.V. All rights reserved.

    DOI: 10.1016/S0387-7604(03)00089-5

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  • A study on a reduction in visits to physicians after introduction of 30% co-payments in the employee health insurance in Japan

    A Babazono, M Miyazaki, H Une, E Yamamoto, T Tsuda, Y Mino

    INDUSTRIAL HEALTH   42 ( 1 )   50 - 56   2004.1

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    The purpose of the study is to evaluate influences of the introduction of 30% co-payments on potential visit behavior using a questionnaire in order to determine whether "employment state of the spouse" and "number of dependent children", as indicators of economic backgrounds, affect visits to physicians in a health insurance society. The subjects were 1,674 insured consisting of 1,165 males and 509 females, who underwent a regular health examination in July 2002, in a health insurance society. In the survey, they were asked whether the subject "will reduce" or "will not reduce" visits to physicians due to the increase in co-payments in the health insurance system scheduled in 2003. Multivariate analyses showed that "employment state of the spouse" was significantly related to the reduction in visits for myocardial infarction or stroke, cancer or heart disease, and hypertension and diabetes mellitus. Concerning "number of dependent children", it was related to the risk of reducing visits to physicians for myocardial infarction or stroke, trauma or fracture, cancer or heart disease, and low back pain or knee pain. Finally, upper limit expenditures of co-payments of physicians to visits due to hypertension and diabetes mellitus were related to "number of dependent children". The study results suggest that "employment state of the spouse" and "number of dependent children" are significant factors to affect potential visits to physicians after the introduction of 30% co-payments.

    DOI: 10.2486/indhealth.42.50

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  • Does seropositivity for Helicobacter pylori antibodies increase outpatient costs for gastric and duodenal ulcer or inflammation?

    A Babazono, M Miyazaki, H Une, E Yamamoto, T Tsuda, Y Mino, AL Hillman

    PHARMACOECONOMICS   22 ( 15 )   975 - 983   2004

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    Background: Helicobacter pylori is regarded as an important cause of both peptic ulcer and chronic gastritis. in particular, seropositivity is highest in patients with duodenal ulcer. No studies have determined whether there are differences in the direct medical costs associated with gastric/duodenal ulcer or inflammation, between seropositive and seronegative patients.
    Objective: To examine the relationship between seropositivity for H. pylori and outpatient visits and direct medical costs for gastric/duodenal ulcer or inflammation in Japan from the perspective of the payor and patients.
    Methods: Participants were males (n = 653) who worked for an agricultural co-operative in Fukuoka Prefecture, attended an annual health examination (including a written lifestyle and medical survey), belonged to the same health insurance society consistently for 4 years from April 1996 to March 2000, and provided a blood sample. The survey asked about lifestyle, including smoking and drinking, and past medical history. We retrospectively analysed the annual number of outpatient visits per person and outpatient medical cost (Yen [] 2000 values) per person for visits relating to gastric or duodenal ulcer or inflammation using International Classification of Diseases (9th edition) - Clinical Modification codes. We assessed for potential confounding factors using analysis of covariance and the chi-square test.
    Results: The annual outpatient incidence of disease, the number of visits to physicians, and the medical costs for gastric or duodenal ulcer or inflammation were about 2-fold greater in individuals with antibodies to H. pylori compared with those without antibodies.
    Conclusion: Population-based studies and/or randomised controlled clinical trials that target high-risk groups and account for the unique way in which data are collected in Japan are needed to determine whether medical costs for gastric and duodenal ulcer might be reduced by treating asymptomatic patients who have antibodies to H. pylori.

    DOI: 10.2165/00019053-200422150-00002

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  • 食中毒事件としての水俣病事件.

    津田敏秀

    環境と公害   2004

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  • 関西水俣病訴訟・最高裁判決を考える.

    津田敏秀

    神戸新聞   2004

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  • 食中毒事件にあたり患者数の年次推移に関する一考察

    谷原真一, 山部清子, 大津忠弘, 津田敏秀, 中村好一, 藤田委由

    経口細菌感染症の広域的・散発的発生時の実地疫学的・調査手法等の開発に関する研究平成15年度総括・分担研究報告書   203-206   2004

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  • 福山市における麻疹流行と予防接種実施状況について 第1報・その2

    大津忠弘, 吉井健哲, 田中知徳, 高尾総司, 落合裕隆, 谷原真一, 津田敏秀, 中瀬克己

    日本公衆衛生学会総会抄録集   62nd   818   2003.10

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  • 福山市における麻疹流行と予防接種実施状況について 第1報・その1

    吉井健哲, 大津忠弘, 田中知徳, 高尾総司, 落合裕隆, 谷原真一, 津田敏秀, 中瀬克己

    日本公衆衛生学会総会抄録集   62nd   818   2003.10

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  • Stress management in an occupational setting: a randomized controlled trial

    Y Mino, A Babazono, T Tsuda, N Yasuda, Y Yonekura

    JOURNAL OF PSYCHOSOMATIC RESEARCH   55 ( 2 )   149 - 149   2003.8

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  • Effects of an increase in patient copayments on medical service demands of the insured in Japan

    Akira Babazono, Toshihide Tsuda, Eiji Yamamoto, Yoshio Mino, Hiroshi Une, Alan L. Hillman

    International Journal of Technology Assessment in Health Care   19 ( 3 )   465 - 475   2003.6

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    Objectives: To examine quantitatively the effects of an increase in patient copayments from 10% to 20% on the demand for medical services in Japan. Methods: The subjects of the study were the employees insured by the 1,797 health insurance societies, belonging to the National Federation of Health Insurance Societies, in 1996 and 1998. Indicators of medical service demands analyzed include the inpatient, outpatient, and dental case rates, the number of serviced days per case, the medical cost per day and the medical cost per insured. Results: When the effects of an increase in patient copayments from 10% to 20% were evaluated, taking into account the average age, the average monthly salary, the total number, the gender (male-to-female) ratio and the dependent ratio of the insured, the estimated change in the case rate was -6. 96% for inpatient, -4.79% for outpatient, and -5.77% for dental care. The estimated change in the number of serviced day per case was -4.66% for inpatient, -5.67% for outpatient, and -1.82% for dental care. The estimated change in the medical cost per day was -3.15% for inpatient, -13.00% for outpatient, and -11.48% for dental care. The estimated change in the medical cost per insured was -14.08% for inpatient, -21.54% for outpatient, and -18.11% for dental care. Conclusions: The increase in patient copayments from 10% to 20% enabled insurers to substantially reduce medical costs by cost shifting from the insurer to the insured, with resultant changes in the case rate and the number of service days per case.

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  • Comparison of Tc-99m-GSA scintigraphy with hepatic fibrosis and regeneration in patients with hepatectomy

    T Iguchi, S Sato, Y Kouno, Y Okumura, S Akaki, T Tsuda, K Kobayashi, S Kanazawa, Y Hiraki

    ANNALS OF NUCLEAR MEDICINE   17 ( 3 )   227 - 233   2003.5

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    Objective: Liver regeneration after hepatectomy is correlated with liver fibrosis. Retrospectively, we compared three quantitative indices (HH15, LHL15 and LU15) of Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (Tc-99m-GSA) liver scintigraphy with liver fibrosis; in particular, we compared the HH15 index and the rate of remnant liver regeneration. Methods: Fifty-three patients who had undergone hepatectomy were enrolled in this study. The non-neoplastic parts of their resected. specimens were divided into 5 groups (F0-F4) according to the degree of liver fibrosis, as determined using the New Inuyama classification system: F0, no fibrosis (n = 12); F1, portal fibrosis widening (n = 12); F2, portal fibrosis widening with bridging fibrosis (n = 14); F3, bridging fibrosis plus lobular distortion (n = 7); F4, liver cirrhosis (n = 8). Results: When the cases were divided into a no or mild fibrosis group (170 and F1) and a moderate or severe fibrosis or cirrhosis group (F2, F3 and F4), all of the indices were significantly different between the two groups. In this analysis, the areas (Az) under the receiver operating characteristic (ROC) curves for the HH15 and LHL15 indices were very similar, while the Az for the LU15 index was smaller. An HH15 index equal to 0.52 was the most accurate, producing a 79.3% sensitivity and a 75.0% specificity rating. When 18 patients that had received a CT scan one month after hepatectomy were divided into 2 groups according to their HH15 value (group A, HH15 less than or equal to 0.52; group B, HH15 &gt; 0.52), group A exhibited a better regeneration rate. Conclusion: Tc-99m-GSA scintigraphy is well correlated with liver fibrosis and may be useful for non-invasive, preoperative evaluations of liver fibrosis. The HH15 index, in particular, may be useful for predicting the rate of liver regeneration after hepatectomy.

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  • 職業がんとイニシエーター・プロモーター

    津田 敏秀, 大津 忠弘, 高尾 総司, 茂見 潤, 馬場園 明, 三野 善央

    産業衛生学雑誌 = Journal of occupational health   45   603 - 603   2003.3

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  • The TP53 gene, tobacco exposure, and lung cancer

    S Toyooka, T Tsuda, AF Gazdar

    HUMAN MUTATION   21 ( 3 )   229 - 239   2003.3

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    Of the various genetic alterations in lung cancer, the abnormalities of the TP53 gene (p53) are among the most frequent and important events. Because of its importance, many aspects of TP53 have been studied, including preneoplastic lesions and TP53 as a marker for early detection and prognosis and as a therapeutic option. We summarize recent knowledge of TP53 in lung cancer with a special emphasis on the relationship between smoking exposure (e.g, cigarette, etc.) and specific mutational pattern of TP53 by analyzing the latest version of the International Agency for Research on Cancer (IARC) database on TP53 mutations in human cancer. Our analysis confirmed several other studies showing significant differences in the frequencies of G:C to T:A transversions between ever-smokers and never-smokers. Furthermore, when comparing the mutational spectrum by gender, important differences were noted between male and female never smokers. We concluded that the previously noted G:C to T.A transversions were mainly due to female smokers having a high frequency of these changes compared to female never smokers. There was no relationship between adenocarcinomas and squamous cell carcinomas independent of gender. We also examined the seven codons which have been previously identified as hot spots, that is, the sites of frequent G:C to TA transversions in smoking,related lung cancers. However, there was no specific codon which was strongly related to smoke exposure despite a moderate relationship. We considered the term "warmspot" may be more appropriate. While mutations of TP53 are frequent in lung cancers, further investigation is necessary to understand their role for lung carcinogenesis, especially as they relate to gender differences, and to translate our laboratory knowledge to clinical applications.

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  • 食中毒事件当たり患者数の年次推移に関する一考察.

    谷原真一, 山部清子, 大津忠弘, 津田敏秀, 中村好一, 藤田委由

    厚生の指標   2003

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  • A case-control study of lung cancer in relation to silica exposure and silicosis in a rural area in Japan

    T Tsuda, Y Mino, A Babazono, J Shigemi, T Otsu, E Yamamoto, S Kanazawa

    ANNALS OF EPIDEMIOLOGY   12 ( 5 )   288 - 294   2002.7

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    PURPOSE: In southeast Okayama Prefecture, Japan, there have been reports of a high prevalence of silicosis among refractory brick production workers. Recently, a high mortality rate of lung cancer among the local residents has been observed. Therefore, a population based case-control study was conducted concerning the relationship between silica, silicosis, and lung cancer using multiple cancer controls.
    METHODS: Cases and controls were restricted to male subjects and information was obtained from death certificates from 1986 to 1993 in the area. Three categories of deceased control groups were selected: a series of deaths from liver cancer, colon cancer, and cancers of other organs, which was assumed not to be related to silica exposure. Age and smoking habits were adjusted by stratified analysis using the Mantel-Haenszel odds ratio estimates. Unconditional logistic regression analysis was also conducted to control potential confounding factors; such as age and smoking habits.
    RESULTS: The age-, smoking-adjusted odds ratios were 1.94 (0-94-4-43) for the colon cancer control group, 2.13 (1.19-3.85) for the other cancer control group related to silica exposure, and 2.94 (1.30-8.90) and 2.69 (1.43-5.37) related to silicosis, respectively. The direct weighted average using the estimates for colon and the other cancer controls was 2.06 (1.29-3.29) for silica exposure, and 2.77 (1.60-4.77) for silicosis. Histological or cytological types of lung cancer cases were obtained from 64.1% of the subjects (118/ 184). As for the histologic type of lung cancer, small cell carcinoma was higher among those who had been silica-exposed workers than the unexposed lung cancer cases and the data from the general Japanese population. On chest x-ray findings, elevated lung cancer mortality compared with cancers other than lung cancer was demonstrated among patients without large opacities.
    CONCLUSIONS: Silica exposure increased the lung cancer mortality in the area. A high lung cancer mortality rate in the area could be explained by silica exposure and silicosis prevalence in this area. Ann Epidemiol 2002; 12:288-294. (C) 2002 Elsevier Science Inc. All rights reserved.

    DOI: 10.1016/S1047-2797(01)00271-X

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  • Smoking cessation support, a case report part 1

    TAKAO S

    Journal of occupational health   44 ( 0 )   689 - 689   2002.3

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    DOI: 10.1539/sangyoeisei.KJ00003948091

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  • 疫学と行政判断-サリドマイド事件を例にして-.

    津田敏秀

    薬のチェックは命のチェック   2 ( 7 )   69 - 73   2002

  • 疫学と根拠に基づく医学(EBM)から見た「脳死」問題

    津田敏秀, 大津忠弘, 茂見潤

    健康支援   4,2,107-110   2002

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    山本英二, 津田敏秀

    岡山理科大学紀要   38,71-76   2002

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  • 疫学と根拠に基づく医学(EBM)から見た「脳死」問題.

    津田敏秀, 大津忠弘, 茂見潤

    健康支援   2002

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  • Smoking cessation support, a case report part 2

    OHTSU T.

    SANGYO EISEIGAKU ZASSHI   44 ( 0 )   690 - 690   2002

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    DOI: 10.1539/sangyoeisei.KJ00003948092

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  • Pearl's Causality and Administrative Judgment

    Eiji "Yamamoto, Toshihide" Tsuda

    38   71 - 76   2002

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  • Effects of a one-hour educational program on medical students' attitudes to mental illness

    Y Mino, N Yasuda, T Tsuda, S Shimodera

    PSYCHIATRY AND CLINICAL NEUROSCIENCES   55 ( 5 )   501 - 507   2001.10

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    A new 1-h educational program was developed to change attitudes towards mental illness, and was conducted on 95 first-year medical students in order to investigate its effects on their attitudes towards mental illness, using a pre- and postquestionnaire study design. A similar study without the program was conducted on 94 first-year medical students as controls. After the program, more students replied that they would accept former patients on relatively close social distance items. Favorable attitudinal changes were observed in terms of 'psychiatric services', 'human rights of the mentally ill', 'patients' independence in social life', and 'cause and characteristics of mental illness'. In contrast, no significant change was observed in the control group. These results suggest that attitudes towards mental illness could be changed favorably by this program.

    DOI: 10.1046/j.1440-1819.2001.00896.x

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  • An outbreak of gastroenteritis due to small round structured virus among schoolchildren in Fukuyama City, Japan

    YOSHII Kentetsu

    56 ( 1 )   344 - 344   2001.4

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  • Smoking and mental health: Cross-sectional and cohort studies in an occupational setting in Japan

    Y Mino, J Shigemi, T Otsu, A Ohta, T Tsuda, N Yasuda, A Babazono, E Yamamoto

    PREVENTIVE MEDICINE   32 ( 4 )   371 - 375   2001.4

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    Background The relationship between smoking and mental health remains unclear.
    Methods. We carried out a cross-sectional study and a cohort study on the possible association of smoking and mental health in 782 workers. Using a questionnaire including the 30-item General Health Questionnaire (GHQ-30) and items related to the smoking state, the association between smoking and mental health was evaluated separately in males and females. The subjects were classified into smokers and nonsmokers, and changes in the GHQ score during a 2-year followup period were evaluated. To control potential confounding factors, multiple regression analyses were performed.
    Results. The cross-sectional study showed mo difference in the GHQ score between smokers and nonsmokers among males but a significantly higher GHQ score for smokers than nonsmokers among females, This difference among females was confirmed to be significant by multiple regression analysis. The S-year cohort study showed a decrease in the GHQ score in each group and no reduction in the difference in the GHQ score between smokers and nonsmokers among females.
    Conclusions. No difference was observed in mental health between smokers and nonsmokers in males. However, in females, smokers showed poorer mental health than nonsmokers, and this difference remained unchanged even after 2 years. (C) 2001 American Health Foundation and Academic Press.

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  • A case-control study of the relationships among silica exposure, gastric cancer and esophageal cancer

    TSUDA T.

    43   322 - 322   2001.3

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  • Screening Test for Diabetes in Annual Health Check-up-analysis by Occupation

    OTA A

    産業衛生学雑誌 = Journal of occupational health   43   717 - 717   2001.3

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  • A case-control study of the relationships among silica exposure, gastric cancer, and esophageal cancer

    T Tsuda, Y Mino, A Babazono, J Shigemi, T Otsu, E Yamamoto

    AMERICAN JOURNAL OF INDUSTRIAL MEDICINE   39 ( 1 )   52 - 57   2001.1

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    Background We examined the effect of silica exposure on gastric and esophageal cancer mortality using a cancer control series in a population setting.
    Methods Cases and controls were restricted to male subjects and were drawn from death certificates in the Tobi area of Japan. A control group was selected from a series of deaths due to colon cancer and cancers of other organs. The Japanese death certificate system is comprehensive because all deaths must be reported to the local office and death certificates are written by medical doctors. Age and smoking habits adjusted the Mantel-Haenszel odds ratios were estimated.
    Results For gastric cancer the age-, smoking-adjusted odds ratios were 1.22 (95% CI 0.74-2.01) for colon cancer and the other cancer control for silica exposure work, and 1.36 (95% CI 0.76-2.43) for silicosis. For esophageal cancel; the age- and smoking-adjusted odds ratios were 1.53 (95% CI 0.59-3.96) for the cancer control for silica exposure, and 2.33 (95% CI 0.87-6.23) for silicosis, respectively.
    Conclusions The results suggest that gastric and esophageal cancer were related to silica exposure and silicosis in the study area, although they did not reach a statistically significant level because of the small sample size. The estimated odds ratios were higher for esophageal cancer and silicotic patients. Am. J. Ind. Med. 39:52-57, 2001. (C) 2001 Wiley-Liss, Inc.

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  • Causal inference in medicine--decision making

    T. Tsuda, A. Babazono, J. Shigemi, T. Otsu, Y. Mino

    Sangyō eiseigaku zasshi = Journal of occupational health   43,161-173 ( 5 )   161 - 173   2001

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    In the field of occupational medicine, either when we consider some preventive plans or when we make decisions to compensate for occupational diseases, it has been necessary to discuss causality between work and disease. Furthermore, epidemiologic causality has recently been used in risk assessment in occupational and environmental settings. We have shown that the law of causality in medicine is recognized as probability and continuous variables. Such a law of causality has been recognized in the same way as probability in physics, too, and has been regarded as a model of science. Physicists and mathematicians had claimed the importance of probability in causal inference as well as the principle of uncertainty before it was discovered. We, then, explained Etiologic Fraction (EF), Attributable Proportion for the Exposed Population (APE), Probability of Causation (PC), and so on. The PC has been used to ascertain the conditional probability in an individual case of a disease having been caused by a particular prior exposure, by using the experience of exposed populations to determine the appropriate relative risk, and this has been used for compensation for exposed cases. Next the applicability of information from a population to individuals was presented. Third, we provided a brief historical aspect of epidemiology. The evolutions in Epidemiology have been very rapid, so we pointed out that, in Japan, we could observe many incommensurable phenomena in epidemiologists and physicians depending on the era which was studied by them. Fourth, we discussed judgement and political application based on epidemiologic evidence, using Yanagimoto's classification is also taken or not should be estimated and compared. We presented several examples of reasoning in judgements. Lastly, we discussed several tasks and assignments for the future of epidemiology.

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  • A case-control study of the relationships among silica exposure, gastric cancer, and esophageal cancer

    Toshihide Tsuda, Yoshio Mino, Akira Babazono, Jun Shigemi, Tadahiro Otsu, Eiji Yamamoto

    American Journal of Industrial Medicine   39 ( 1 )   52 - 57   2001

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    Background: We examined the effect of silica exposure on gastric and esophageal cancer mortality using a cancer control series in a population setting. Methods: Cases and controls were restricted to male subjects and were drawn from death certificates in the Tobi area of Japan. A control group was selected from a series of deaths due to colon cancer, and cancers of other organs. The Japanese death certificate system is comprehensive because all deaths must be reported to the local office and death certificates are written by medical doctors. Age and smoking habits adjusted the Mantel-Haenszel odds ratios were estimated. Results: For gastric cancer, the age-, smoking-adjusted odds ratios were 1.22 (95% CI 0.74-2.01)for colon cancer and the other cancer control for silica exposure work, and 1.36 (95% CI 0.76-2.43) for silicosis. For esophageal cancer, the age- and smoking-adjusted odds ratios were 1.53 (95% CI 0.59-3.96) for the cancer control for silica exposure, and 2.33 (95% CI 0.87-6.23) for silicosis, respectively. Conclusions: The results suggest that gastric and esophageal cancer were related to silica exposure and silicosis in the study area, although they did not reach a statistically significant level because of the small sample size. The estimated odds ratios were higher for esophageal cancer and silicotic patients. © 2001 Wiley-Liss, Inc.

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  • A case-control study of the relationships among silica exposure, gastric cancer, and esophageal cancer

    Toshihide Tsuda, Yoshio Mino, Akira Babazono, Jun Shigemi, Tadahiro Otsu, Eiji Yamamoto

    American Journal of Industrial Medicine   39 ( 1 )   52 - 57   2001

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    Background: We examined the effect of silica exposure on gastric and esophageal cancer mortality using a cancer control series in a population setting. Methods: Cases and controls were restricted to male subjects and were drawn from death certificates in the Tobi area of Japan. A control group was selected from a series of deaths due to colon cancer, and cancers of other organs. The Japanese death certificate system is comprehensive because all deaths must be reported to the local office and death certificates are written by medical doctors. Age and smoking habits adjusted the Mantel-Haenszel odds ratios were estimated. Results: For gastric cancer, the age-, smoking-adjusted odds ratios were 1.22 (95% CI 0.74-2.01)for colon cancer and the other cancer control for silica exposure work, and 1.36 (95% CI 0.76-2.43) for silicosis. For esophageal cancer, the age- and smoking-adjusted odds ratios were 1.53 (95% CI 0.59-3.96) for the cancer control for silica exposure, and 2.33 (95% CI 0.87-6.23) for silicosis, respectively. Conclusions: The results suggest that gastric and esophageal cancer were related to silica exposure and silicosis in the study area, although they did not reach a statistically significant level because of the small sample size. The estimated odds ratios were higher for esophageal cancer and silicotic patients. © 2001 Wiley-Liss, Inc.

    DOI: 10.1002/1097-0274(200101)39:1<52::AID-AJIM5>3.0.CO;2-C

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  • 喫煙とメンタルヘルスとの関連について-職域における調査より-

    大津忠弘, 三野善央, 茂見 潤, 太田充彦, 高尾総司, 津田敏秀, 安田誠史, 馬場園 明, 山本英二, 青山英康

    健康開発   2001

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  • 健康保険組合における老人医療費の負担指標に関する研究

    馬場園 明, 山本英二, 津田敏秀, 三野善央

    医療経済研究   9   5 - 22   2001

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  • 保健医療における因果関係の推論-疫学の立場からの科学哲学的考察-

    津田敏秀, 茂見 潤, 大津忠弘, 馬場園 明

    健康支援   2001

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  • 根拠に基づく医学(EBM)の根拠

    津田敏秀

    月刊保団連   ( 698 )   6 - 10   2001

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    Language:Japanese   Publisher:全国保険医団体連合会  

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  • Predictors and underlying causes of medically intractable localization-related epilepsy in childhood

    OHTSUKA Y.

    Pediatr Neurol   24   209 - 213   2001

  • 医学における因果関係の認識と合意

    津田 敏秀, 馬場園 明

    健康支援   2 ( 1 )   38 - 53   2000.9

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  • Achievement of Causal Inference in the Social Medicine in Japan

    TSUDA Toshihide, BABAZONO Akira, MINO Yoshio, YAMAMOTO Eiji, MIYAI Masaya, SHIGEMI Jun

    Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene)   55 ( 2 )   462 - 473   2000.7

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    As a condition to achieving an agreement of recognition on the causal relationship in medicine, we firstly explained Hume's problem and counterfactual model. We, however, emphasized that we believe in the existence of causality on medical issues in our daily lives. Therefore, we illustrated conditions when we usually believe in causality. On the other hand, we criticized two well-known key phrases, "lack of mechanism in epidemiology" and "black box in epidemiology", which have often been used in Japan for skeptic viewpoints against epidemiologic methods even if epidemiology is often used to elucidate a causal effect in medicine in the world. We emphasized that a priori determinations of levels for inference of mechanism is necessary. And, the level and feature of mechanism should be defined in concrete expressions. After explanation of these basic concepts, we mentioned a classic view on specific diseases and non-specific diseases which have not been sufficiently discussed enough yet in Japan. As an example, we used the statements in the Japanese Compensation Law for the Health Effect by Environmental Pollution. In Japan, the classification of these diseases has been confused with that between manifestational criteria of diseases and causal criteria of them. We described the basic concepts to illustrate the causal relationship between non-specific disease and its exposure by using attached figures. Actually, we cannot recognize disease occurrence as a specific disease for several reasons. We indicated that we can recognize the magnitude of effect by causal relationships in medicine as a quantitative continuous variable.

    DOI: 10.1265/jjh.55.462

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  • Achievement of Causal Inference in the Social Medicine in Japan

    TSUDA Toshihide, BABAZONO Akira, MINO Yoshio, YAMAMOTO Eiji, MIYAI Masaya, SHIGEMI Jun

    Japanese Journal of Hygiene   55 ( 2 )   462 - 473   2000.7

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    As a condition to achieving an agreement of recognition on the causal relationship in medicine, we firstly explained Hume's problem and counterfactual model. We, however, emphasized that we believe in the existence of causality on medical issues in our daily lives. Therefore, we illustrated conditions when we usually believe in causality. On the other hand, we criticized two well-known key phrases, "lack of mechanism in epidemiology" and "black box in epidemiology", which have often been used in Japan for skeptic viewpoints against epidemiologic methods even if epidemiology is often used to elucidate a causal effect in medicine in the world. We emphasized that a priori determinations of levels for inference of mechanism is necessary. And, the level and feature of mechanism should be defined in concrete expressions. After explanation of these basic concepts, we mentioned a classic view on specific diseases and non-specific diseases which have not been sufficiently discussed enough yet in Japan. As an example, we used the statements in the Japanese Compensation Law for the Health Effect by Environmental Pollution. In Japan, the classification of these diseases has been confused with that between manifestational criteria of diseases and causal criteria of them. We described the basic concepts to illustrate the causal relationship between non-specific disease and its exposure by using attached figures. Actually, we cannot recognize disease occurrence as a specific disease for several reasons. We indicated that we can recognize the magnitude of effect by causal relationships in medicine as a quantitative continuous variable.

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  • Achievement of Causal Inference in the Social Medicine in Japan

    TSUDA Toshihide, BABAZONO Akira, MINO Yoshio, YAMAMOTO Eiji, MIYAI Masaya, SHIGEMI Jun

    Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene)   55 ( 2 )   462 - 473   2000.7

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    As a condition to achieving an agreement of recognition on the causal relationship in medicine, we firstly explained Hume's problem and counterfactual model. We, however, emphasized that we believe in the existence of causality on medical issues in our daily lives. Therefore, we illustrated conditions when we usually believe in causality. On the other hand, we criticized two well-known key phrases, "lack of mechanism in epidemiology" and "black box in epidemiology", which have often been used in Japan for skeptic viewpoints against epidemiologic methods even if epidemiology is often used to elucidate a causal effect in medicine in the world. We emphasized that a priori determinations of levels for inference of mechanism is necessary. And, the level and feature of mechanism should be defined in concrete expressions. After explanation of these basic concepts, we mentioned a classic view on specific diseases and non-specific diseases which have not been sufficiently discussed enough yet in Japan. As an example, we used the statements in the Japanese Compensation Law for the Health Effect by Environmental Pollution. In Japan, the classification of these diseases has been confused with that between manifestational criteria of diseases and causal criteria of them. We described the basic concepts to illustrate the causal relationship between non-specific disease and its exposure by using attached figures. Actually, we cannot recognize disease occurrence as a specific disease for several reasons. We indicated that we can recognize the magnitude of effect by causal relationships in medicine as a quantitative continuous variable.

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  • The factors affecting change of mental health state among workers

    BABAZONO A

    42   546 - 546   2000.3

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  • Effects of perceived job stress on mental health. A longitudinal survey in a Japanese electronics company

    Jun Shigemi, Yoshio Mino, Tadahiro Ohtsu, Toshihide Tsuda

    European Journal of Epidemiology   16 ( 4 )   371 - 376   2000

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    We conducted a cohort study for 2 years to examine the causal relationship between perceived job stress and mental health. Questionnaire surveys, including a 30-item General Health Questionnaire (GHQ) and a questionnaire on perceived job stress were carried out every 6 months for 2 years. To clarify the causal relationship between job stress and mental health, we followed a group of workers who initially had a GHQ score ≤7. Out of 462 workers who were thought to be in a healthy mental state, 282 were successfully followed for 2 years. We considered subjects who developed unhealthy mental health states (GHQ score ≥8) as hazardous cases. To control potential confounding factors, proportional hazard analysis was done. The overall proportion hazardous cases detected in the development of an unhealthy mental health state over two years was 55.7%. Using Cox's proportional hazard model, workers who complained of perceived job stress had a greater hazard than those without job stress. In particular, the item 'poor relationship with superior' showed the largest adjusted hazard ratio [95% confidence interval (CI)] of 1.51 (1.06 - 2.15). The item 'too much trouble at work' also had a significant hazardous effect on mental health with an adjusted hazard ratio (95% CI) of 1.43 (1.00-2.04). Some specific items of perceived job stress could cause mental ill health in workers.

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  • Effects of perceived job stress on mental health. A longitudinal survey in a Japanese electronics company

    Jun Shigemi, Yoshio Mino, Tadahiro Ohtsu, Toshihide Tsuda

    European Journal of Epidemiology   16 ( 4 )   371 - 376   2000

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    We conducted a cohort study for 2 years to examine the causal relationship between perceived job stress and mental health. Questionnaire surveys, including a 30-item General Health Questionnaire (GHQ) and a questionnaire on perceived job stress were carried out every 6 months for 2 years. To clarify the causal relationship between job stress and mental health, we followed a group of workers who initially had a GHQ score ≤7. Out of 462 workers who were thought to be in a healthy mental state, 282 were successfully followed for 2 years. We considered subjects who developed unhealthy mental health states (GHQ score ≥8) as hazardous cases. To control potential confounding factors, proportional hazard analysis was done. The overall proportion hazardous cases detected in the development of an unhealthy mental health state over two years was 55.7%. Using Cox's proportional hazard model, workers who complained of perceived job stress had a greater hazard than those without job stress. In particular, the item 'poor relationship with superior' showed the largest adjusted hazard ratio [95% confidence interval (CI)] of 1.51 (1.06 - 2.15). The item 'too much trouble at work' also had a significant hazardous effect on mental health with an adjusted hazard ratio (95% CI) of 1.43 (1.00-2.04). Some specific items of perceived job stress could cause mental ill health in workers.

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  • 研究と人権問題委員会報告 昭和60年10月15日付「水俣病の判断条件に関する医学専門家会議の意見」に対する見解

    中島豊爾, 石井一, 衛藤俊邦, へぎ祐二, 津田敏秀, 名村出, 星野征光, 丸井規博, 山田了士

    精神神経学雑誌   101 ( 6 )   539 - 558   1999.6

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  • Evidence based evaluation on the governmental criteria on Minamata disease (methylmercury poisoning)

    TSUDA Toshihide

    54 ( 1 )   129 - 129   1999.4

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  • 病院でのO157集団感染の報告(その3) 原因調査について

    河本 幸子, 中瀬 克己, 津田 敏秀

    日本公衆衛生学会総会抄録集   57回   661 - 661   1998.10

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  • シリカ曝露は人体に肺がんを引き起こすか?--第9回国際職業性呼吸器疾患学術会議報告

    津田 敏秀

    労働の科学   53 ( 3 )   184 - 187   1998.3

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  • 散発事例及びさかのぼり調査の調査方法および食中毒患者の把握方法に関する研究

    柳川洋, 後藤敦, 津田敏秀, 土井由利子, 谷原真一

    食中毒予防方策のあり方に関する研究研究報告書   1-7   1998

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  • Health policy in transition terminal care and site of death in Japan Reviewed

    A. Babazono, J. Weiner, H. Hamada, T. Tsuda, Y. Mino, A. L. Hillman

    Journal of Health Services Research and Policy   3 ( 2 )   77 - 81   1998

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    Objectives: In Japan, hospitals have replaced homes as the predominant site of death, especially for the elderly. Site of death is a reliable indicator of where older people receive care before they die. We conducted a population-based study to identify the factors that determine site of death in a typical rural area in Japan. Methods: Study subjects were residents of Kawakami town, aged 70 years or older, who died during 1981 and 1990. Death certificates provided information on age, gender, cause of death, duration of illness before death, family members, family occupation, and site of death. Results: Among 455 subjects, 52.7% died at home, while 47.3% died in hospital. Multiple logistic regression analyses indicated that subjects with cancer were 6.1 times more likely to die in hospitals than those with other diseases. Subjects who died in their seventies were 2.3 times more likely to die in hospital than older subjects. Members of non-farming families were 1.7 times more likely to die in hospital than members of farming families. Gender, duration of illness, and the presence of spouse or children in the household were not significantly related to site of death according to multivariate analyses, although trends did exist. Conclusion: This case study illustrates the importance of developing geriatric care systems in Japan, utilizing alternatives to hospitals, such as nursing homes and formal home care. This is particularly true for patients with cancer. As the older population rapidly increases in Japan, the need for alternatives in geriatric care grows more critical.

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  • 主観的職場のストレスと精神的健康との間の関連についてハザードモデルの観点から

    茂見 潤, 三野 善央, 津田 敏秀

    産業ストレス研究 = Job stress research   5   47 - 47   1997.12

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  • PUBLIC HEALTH CENTER BASED EDUCATIONAL APPROACH FOR FAMILIES OF THE MENTALLY DISABLED IN JAPAN

    MINO Yoshio, OSHIMA Iwao, GOTO Masahiro, UEKI Hiroko, TSUDA Toshihide, MATSUOKA Hiroaki, OKAGAMI Kazuo

    Japanese journal of public health   44 ( 5 )   364 - 371   1997.5

  • The effect of mental health on disease occurrence

    BABAZONO A.

    39   S195   1997.4

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  • 疫学から見た作業関連性疾患と職業病

    津田 敏秀, 馬場 園明, 三野 善央, 松岡 宏明

    産業衛生学雑誌 = Journal of occupational health   39 ( 1 )   A19 - A20   1997.1

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  • 水俣病の40年目の「解決」に根拠を与えた2論文 (<特集(2)>水俣病・残された問題)

    津田 敏秀, 三野 善央, 松岡 宏明

    環境と公害   26 ( 3 )   48 - 55   1997.1

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  • A meta-analysis on the relationship between pneumoconiosis and lung cancer

    Toshihide Tsuda, Akira Babazono, Eiji Yamamoto, Yoshio Mino, Hiroaki Matsuoka

    Journal of Occupational Health   39 ( 4 )   285 - 294   1997

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    An excess of lung cancer deaths among pneumoconiosis patients has been noted for many years but there has not been agreement on the excess of lung cancer deaths among pneumoconiosis patients in Japan. A meta-analysis on the relationship between silicosis/pneumoconiosis and lung cancer mortality was conducted, by using 36 mortality studies published from 1950 to 1994. MEDICINE and other information sources were used for the information retrieval. After the critical appraisal, 32 eligible studies were identified. Study estimates were then pooled by using both the fixed effect model and the random effect model. An excess of lung cancer mortality among people with silicosis/pneumoconiosis was shown in all 32 studies. Although homogeneity among the studies was rejected (p&lt
    0.05) because the shape of the funnel plots assumed a symmetrical pyramidal shape, the summary rate ratio was estimated. The estimated rate ratio was 2.74 (95 percent confidence interval 2.60-2.90) in all 32 studies, and 2.77 (2.61-2.94) in 25 cohort studies. The random effect model results were almost the same as the fixed model results. The estimates in the Japanese studies were a little higher than the overall estimates, which indicated that lung cancer mortality was about three times higher among silicotic patients than among people in the control. This indicated a causal-relationship between silicosis and lung cancer. This means that lung cancer should be regarded as one of the important complications of silicosis/pneumoconiosis. We recommend further research on the relationship between silica exposure and lung cancer.

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  • A meta-analysis on the relationship between pneumoconiosis and lung cancer

    Toshihide Tsuda, Akira Babazono, Eiji Yamamoto, Yoshio Mino, Hiroaki Matsuoka

    Journal of Occupational Health   39 ( 4 )   285 - 294   1997

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    An excess of lung cancer deaths among pneumoconiosis patients has been noted for many years but there has not been agreement on the excess of lung cancer deaths among pneumoconiosis patients in Japan. A meta-analysis on the relationship between silicosis/pneumoconiosis and lung cancer mortality was conducted, by using 36 mortality studies published from 1950 to 1994. MEDICINE and other information sources were used for the information retrieval. After the critical appraisal, 32 eligible studies were identified. Study estimates were then pooled by using both the fixed effect model and the random effect model. An excess of lung cancer mortality among people with silicosis/pneumoconiosis was shown in all 32 studies. Although homogeneity among the studies was rejected (p&lt
    0.05) because the shape of the funnel plots assumed a symmetrical pyramidal shape, the summary rate ratio was estimated. The estimated rate ratio was 2.74 (95 percent confidence interval 2.60-2.90) in all 32 studies, and 2.77 (2.61-2.94) in 25 cohort studies. The random effect model results were almost the same as the fixed model results. The estimates in the Japanese studies were a little higher than the overall estimates, which indicated that lung cancer mortality was about three times higher among silicotic patients than among people in the control. This indicated a causal-relationship between silicosis and lung cancer. This means that lung cancer should be regarded as one of the important complications of silicosis/pneumoconiosis. We recommend further research on the relationship between silica exposure and lung cancer.

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  • Relation between the instrumental activities of daily living and physical fitness tests in elderly women

    H Uchida, Y Mino, T Tsuda, A Babazono, Y Kawada, H Araki, T Ogawa, H Aoyama

    ACTA MEDICA OKAYAMA   50 ( 6 )   325 - 333   1996.12

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    A cross-sectional study was conducted to quantitatively evaluate the relationship between the instrumental activities of daily living (IADL) and various physical fitness tests in elderly women living at home. The study focused on the total population of those women aged 65 years and over living in Y Town, Hyogo Prefecture, Japan, who visited a nursing home for day services. A total of 128 subjects were divided into two groups: dependent in IADL group (n = 49) and independent in IADL group (n = 79). The magnitude of the relation was evaluated by the odds ratio (OR). The following tests showed a significant decrease in IADL: knee-raising test [age-adjusted OR = 4.23, 95% confidence interval (CI) 1.81-9.87], height (age-adjusted OR = 4.09, 95% CI 1.75-9.56), grip strength (age-adjusted OR = 3.68, 95% CI 1.57-8.60), sit-and-reach test (age-adjusted OR = 2.76, 95% CI 1.20-6.34), and standing on one leg with closed eyes (age-adjusted OR = 2.56, 95% CI 1.09-5.97). Multivariate analysis using Hayashi's quantification method I indicated that knee-raising was the test most highly correlated with decreased IADL. These results suggest that measurement of knee-raising ability, muscle strength of the lower extremities and flexibility of hip joint could be the most useful factors to assess the level of instrumental self-support ability.

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  • 職場における精神の健康度と医療機関利用との関連

    馬場園 明, 山田 裕章, 津田 敏秀, 三野 善央

    日本公衆衛生学会総会抄録集   55 ( 2 )   881 - 881   1996.10

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  • 性行動を通じてのHIV感染予防のインディケーター

    中瀬 克己, 吉田 健男, 内野 英幸, 津田 敏秀

    日本公衆衛生学会総会抄録集   55 ( 3 )   515 - 515   1996.10

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  • 水俣地域での四肢末梢感覚障害の期待数

    津田 敏秀, 三野 善央, 松岡 宏明, 田中 美紀, 茂見 潤, 宮井 正彌, 馬場園 明

    日本公衆衛生学会総会抄録集   55 ( 2 )   928 - 928   1996.10

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  • 作業関連疾患の病因論-給食調理員の変形性手指間接症の例を用いて-

    津田 敏秀, 三野 善央, 松岡 宏明, 谷原 真一, 茂見 潤, 田島 隆興, 片岡 明彦, 馬場 園明

    産業衛生学雑誌 = Journal of occupational health   38   S423   1996.5

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  • 精神の健康状態の変化に職場の主観的ストレス感が及ぼす影響に関する調査

    谷原 真一, 茂見 潤, 馬場園 明, 三野 善央, 津田 敏秀, 松岡 宏明, 小河 孝則, 青山 英康

    産業衛生学雑誌 = Journal of occupational health   38   S257   1996.5

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  • Causal inference in medicine - A historical view in epidemiology

    Toshihide Tsuda, Akira Babazono, Yoshio Mino, Hiroaki Matsuoka, Eiji Yamamoto

    Japanese Journal of Hygiene   51 ( 2 )   558 - 568   1996

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    Language:Japanese   Publishing type:Book review, literature introduction, etc.   Publisher:Japanese Society for Hygiene  

    Changes of causal inference concepts in medicine, especially those having to do with chronic diseases, were reviewed. The review is divided into five sections. First, several articles on the increased academic acceptance of observational research are cited. Second, the definitions of confounder and effect modifier concepts are explained. Third, the debate over the so-called "criteria for causal inference" was discussed. Many articles have pointed out various problems related to the lack of logical bases for standard criteria, however, such criteria continue to be misapplied in Japan. Fourth, the Popperian and verificationist concepts of causal inference are summarized. Lastly, a recent controversy on meta-analysis is explained. Causal inference plays an important role in epidemiologic theory and medicine. However, because this concept has not been well-introduced in Japan, there has been much misuse of the concept, especially when used for conventional criteria.

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  • Causal inference in medicine - A historical view in epidemiology

    Toshihide Tsuda, Akira Babazono, Yoshio Mino, Hiroaki Matsuoka, Eiji Yamamoto

    Japanese Journal of Hygiene   51 ( 2 )   558 - 568   1996

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    Language:Japanese   Publishing type:Book review, literature introduction, etc.   Publisher:Japanese Society for Hygiene  

    Changes of causal inference concepts in medicine, especially those having to do with chronic diseases, were reviewed. The review is divided into five sections. First, several articles on the increased academic acceptance of observational research are cited. Second, the definitions of confounder and effect modifier concepts are explained. Third, the debate over the so-called "criteria for causal inference" was discussed. Many articles have pointed out various problems related to the lack of logical bases for standard criteria, however, such criteria continue to be misapplied in Japan. Fourth, the Popperian and verificationist concepts of causal inference are summarized. Lastly, a recent controversy on meta-analysis is explained. Causal inference plays an important role in epidemiologic theory and medicine. However, because this concept has not been well-introduced in Japan, there has been much misuse of the concept, especially when used for conventional criteria.

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  • Causal inference in medicine - A historical view in epidemiology

    Toshihide Tsuda, Akira Babazono, Yoshio Mino, Hiroaki Matsuoka, Eiji Yamamoto

    Japanese Journal of Hygiene   51 ( 2 )   558 - 568   1996

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    Language:Japanese   Publishing type:Book review, literature introduction, etc.   Publisher:Japanese Society for Hygiene  

    Changes of causal inference concepts in medicine, especially those having to do with chronic diseases, were reviewed. The review is divided into five sections. First, several articles on the increased academic acceptance of observational research are cited. Second, the definitions of confounder and effect modifier concepts are explained. Third, the debate over the so-called "criteria for causal inference" was discussed. Many articles have pointed out various problems related to the lack of logical bases for standard criteria, however, such criteria continue to be misapplied in Japan. Fourth, the Popperian and verificationist concepts of causal inference are summarized. Lastly, a recent controversy on meta-analysis is explained. Causal inference plays an important role in epidemiologic theory and medicine. However, because this concept has not been well-introduced in Japan, there has been much misuse of the concept, especially when used for conventional criteria.

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  • The US Health Care and the Reform

    Akira BABAZONO, Toshihide TSUDA, Yoshio MIND

    Japanese Journal of Hygiene   51 ( 3 )   666 - 676   1996

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    Securing access to medical services, controlling costs and improving quality are goals of health care system. Although they are all the same all over the country, each country has its own culture, health care system and health care problems. In the United States, employer-based and individual purchases of private health insurance coverage play a major role, although governmental programs such as Medicaid and Medicare exist for the poor and the elderly. Private health insurance had traditionally secured patients' freedom of choice of health care providers and physicians' professional freedom and had paid providers on a fee-for-service basis. Now, the U. S. has 40 million uninsured persons who do not have access to medical services, although it spends as much as its 14% of GNP on health care. In the early 1990s, this became a major political problem. President Clinton proposed the 'Health Security Act' which would enable any American to have access to comprehensive health care with managed competition to activate the health care market, but it was not enacted. Nevertheless, it is clear that managed care and managed competition will dominate and that traditional fee-for-service plan will be eroded in the health care market. Japan has a universal health care system. We do not have any uninsured or high medical costs. However, it is difficult to improve the quality of health care services within the present system. Japan can learn the system about disclosure of health care information from the managed care in the U. S.

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  • Determination of Inorganic Anions in Environmental Samples by Capillary Electrophoresis

    17   56 - 62   1995.12

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  • AIDSに関するリスク認識とコンドーム常用との関連

    中瀬 克己, 津田 敏秀, 長井 勇

    日本公衆衛生学会総会抄録集   54   1258 - 1258   1995.10

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  • 職場における精神の健康度に関する研究

    馬場園 明, 三野 善央, 津田 敏秀, 青山 英康

    日本公衆衛生学会総会抄録集   54   1406 - 1406   1995.10

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  • 農村部の高齢者における医療費の決定に関する定量的研究

    谷原 真一, 馬場 園明, 津田 敏秀, 三野 善央, 三村 啓爾, 茂見 潤, 松岡 宏明, 小河 孝則, 青山 英康

    日本公衆衛生学会総会抄録集   54   1113 - 1113   1995.10

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  • 産後の育児不安に関する調査

    谷名 菜穂子, 津田 敏秀, 三野 善央

    日本公衆衛生学会総会抄録集   54   987 - 987   1995.10

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  • Training in evaluation of expressed emotion using the Japanese version of the Camberwell Family Interview Reviewed

    Y. Mino, S. Tanaka, T. Tsuda, A. Babazono, S. Inoue, H. Aoyama

    Acta Psychiatrica Scandinavica   92 ( 3 )   183 - 186   1995.9

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    To evaluate the effect of training in rating expressed emotion (EE) using the Japanese version of the Camberwell Family Interview (CFI), interrater reliability between a certified rater and a trainee was examined. The material was 65 CFI interviews with the families of 46 schizophrenic patients. The two raters independently rated EE status, critical comments (CC), hostility (H), emotional overinvolvement (EOI), warmth (W) and positive remarks (PR). The interrater reliability was satisfactory with regard to EE status, CC, H, EOI and PR. In the category of W, however, the results were unsatisfactory, as there was no positive development of agreement over time. In fathers, the interrater reliability of W was lower than in other relationships. Use of interview transcripts could contribute to a more satisfactory interrater agreement in EOI, and this is recommended as a useful training tool in EE evaluation. Copyright © 1995, Wiley Blackwell. All rights reserved

    DOI: 10.1111/j.1600-0447.1995.tb09565.x

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  • A follow up study of effects of occupational stress on mental health among workers

    TANIHARA S.

    37   S384   1995.3

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  • Reevaluation of the relationship between pneumoconiosis and lung cancer

    BABAZONO A.

    37   S188   1995.3

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  • Effect of Physical Activity on physical Fittness among workers

    Chie SASAKI, Akira BABAZONO, Toshihide TSUDA, Yoshio MINO

    Japanses Journal of Hygiene   50 ( 4 )   876 - 885   1995

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    Language:Japanese   Publisher:The Japanese Society for Hygiene  

    We conducted a cross-sectional study to clarify the effects of physical activity on physical fitness. Physical fitness tests were offered to workers of companies manufacturing automobile parts from December, 1992 to December, 1993. The subjects were 1, 217 male and 600 female workers who participated in the physical fitness test. From this group, we analyzed 1, 048 male and 522 female workers who answered a physical activity questionnaire. The questionnaire included age, sex, working posture, physical activity during working time and physical activity during leisure time. The physical fitness tests were composed of grip strength, standing trunk flexion, foot balance with closed eyes, jumping reaction time and step tests. We classified the subjects into low performance group and high performance group for each test. In addition, we classified the subjects into different groups by age (16-29 years old, 30-49 years old and 50-69 years old), by working posture (standing and sitting), as well as by activity levels during working time and leisure time physical activities (inactive and active). Thus, we examined potential risk factors for the physical fitness by a multiple logistic regression model.<br>The results were as follows:<br>1. Standing work was a significant risk factor for grip strength, foot balance with closed eyes and jumping reaction time in male workers, and standing trunk flexion, foot balance with closed eyes, jumping reaction time and the step test in female workers.<br>2. Physical activity during working time was not related to physical fitness in male and female workers.<br>3. Inactivity during leisure time was a significant risk factor for standing trunk flexion, foot balance with closed eyes, jumping reaction time and the step test in male workers, and grip strength and foot balance with closed eyes in female workers.<br>4. Young age (16-29 years old) was a significant risk factor for grip strength, standing trunk flexion, foot balance with closed eyes, jumping reaction time and the step test in male and female workers. Middle age (30-49 years old) was a significant risk factor for foot balance with closed eyes and jumping reaction time in male workers, and standing trunk flexion, foot balance with closed eyes, jumping reaction time and the step test in female workers.

    DOI: 10.1265/jjh.50.876

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  • Comparisons of survival time estimates for niigata prefecture (japan) residents exposed to ingested arsenic

    Toshihide Tsuda, Eiji Yamamoto, Akira Babazono, Yoshio Mino, Yoshiki Kishi, Norio Kurumatani, Takanori Ogawa, Hideyasu Aoyama

    Applied Organometallic Chemistry   8 ( 3 )   237 - 244   1994

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    Survival analysis was used to analyze follow‐up data on an arsenic‐poisoned area, identified in 1959, in order to assess the effect of arsenic on survival time. The subjects were 443 residents of Namiki‐cho, Nakajo‐machi, Niigata Prefecture, Japan, who ingested well water contaminated with arsenic between 1955 and 1959. Their exposure to arsenic was only by ingestion of well water. We observed this historical cohort from October 1959 to February 1992. Survival time was calculated in two ways: from 1959 (the end of exposure) until death or until 1992 (the termination of follow‐up)
    or from birth until death or until 1992. The entire cohort was divided into two groups according to the arsenic concentration measured in the wells in 1959. Different survival curves of the two were drawn using the Kaplan–Meier method. The lifetime survival curves indicate that the lifetimes of arsenic‐exposed residents were significantly shorter than that of the low‐dose exposure group or of unexposed residents. From the differences in the estimated lifetime survival curves, the effect of arsenic on the mortality of the residents can be inferred. Copyright © 1994 John Wiley &amp
    Sons, Ltd.

    DOI: 10.1002/aoc.590080313

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  • An epidemiologic research design using the annual of the pathological autopsy cases in Japan

    T. Tsuda, E. Yamamoto, A. Babazono, Y. Mino, T. Ogawa, J. Shigemi, H. Aoyama

    Japanese Journal of Hygiene   49 ( 4 )   753 - 761   1994

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    Language:Japanese   Publishing type:Book review, literature introduction, etc.   Publisher:Japanese Society for Hygiene  

    Epidemiologic research designs using the Annual of the Pathological Autopsy Cases in Japan (APAC hereinafter) are discussed in this paper. The APAC data base has been recommended for use in epidemiologic research. However, it has not often been utilized for such research, even though it covers all pathological autopsy cases in Japan, perhaps because of different sampling proportions of each disease and because of the dead control series in APAC. First, we present epidemiologic measures in using the APAC. We show that the data base can be treated as a case-control design and that the magnitude of the exposure effect should be estimated by an odds ratio. Next, selection bias and information bias in using the APAC are discussed. The independence of the control series from the exposure is important in the determination of the control disease. Because this design is based on internal comparison, non-differential misclassification should be stressed more than differential misclassification.

    DOI: 10.1265/jjh.49.753

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  • An epidemiologic research design using the annual of the pathological autopsy cases in Japan

    T. Tsuda, E. Yamamoto, A. Babazono, Y. Mino, T. Ogawa, J. Shigemi, H. Aoyama

    Japanese Journal of Hygiene   49 ( 4 )   753 - 761   1994

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    Language:Japanese   Publishing type:Book review, literature introduction, etc.   Publisher:Japanese Society for Hygiene  

    Epidemiologic research designs using the Annual of the Pathological Autopsy Cases in Japan (APAC hereinafter) are discussed in this paper. The APAC data base has been recommended for use in epidemiologic research. However, it has not often been utilized for such research, even though it covers all pathological autopsy cases in Japan, perhaps because of different sampling proportions of each disease and because of the dead control series in APAC. First, we present epidemiologic measures in using the APAC. We show that the data base can be treated as a case-control design and that the magnitude of the exposure effect should be estimated by an odds ratio. Next, selection bias and information bias in using the APAC are discussed. The independence of the control series from the exposure is important in the determination of the control disease. Because this design is based on internal comparison, non-differential misclassification should be stressed more than differential misclassification.

    DOI: 10.1265/jjh.49.753

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  • Comparisons of survival time estimates for niigata prefecture (japan) residents exposed to ingested arsenic

    Toshihide Tsuda, Eiji Yamamoto, Akira Babazono, Yoshio Mino, Yoshiki Kishi, Norio Kurumatani, Takanori Ogawa, Hideyasu Aoyama

    Applied Organometallic Chemistry   8 ( 3 )   237 - 244   1994

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    Language:English  

    Survival analysis was used to analyze follow‐up data on an arsenic‐poisoned area, identified in 1959, in order to assess the effect of arsenic on survival time. The subjects were 443 residents of Namiki‐cho, Nakajo‐machi, Niigata Prefecture, Japan, who ingested well water contaminated with arsenic between 1955 and 1959. Their exposure to arsenic was only by ingestion of well water. We observed this historical cohort from October 1959 to February 1992. Survival time was calculated in two ways: from 1959 (the end of exposure) until death or until 1992 (the termination of follow‐up)
    or from birth until death or until 1992. The entire cohort was divided into two groups according to the arsenic concentration measured in the wells in 1959. Different survival curves of the two were drawn using the Kaplan–Meier method. The lifetime survival curves indicate that the lifetimes of arsenic‐exposed residents were significantly shorter than that of the low‐dose exposure group or of unexposed residents. From the differences in the estimated lifetime survival curves, the effect of arsenic on the mortality of the residents can be inferred. Copyright © 1994 John Wiley &amp
    Sons, Ltd.

    DOI: 10.1002/aoc.590080313

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  • An epidemiologic research design using the annual of the pathological autopsy cases in Japan

    T. Tsuda, E. Yamamoto, A. Babazono, Y. Mino, T. Ogawa, J. Shigemi, H. Aoyama

    Japanese Journal of Hygiene   49 ( 4 )   753 - 761   1994

     More details

    Language:Japanese   Publishing type:Book review, literature introduction, etc.   Publisher:Japanese Society for Hygiene  

    Epidemiologic research designs using the Annual of the Pathological Autopsy Cases in Japan (APAC hereinafter) are discussed in this paper. The APAC data base has been recommended for use in epidemiologic research. However, it has not often been utilized for such research, even though it covers all pathological autopsy cases in Japan, perhaps because of different sampling proportions of each disease and because of the dead control series in APAC. First, we present epidemiologic measures in using the APAC. We show that the data base can be treated as a case-control design and that the magnitude of the exposure effect should be estimated by an odds ratio. Next, selection bias and information bias in using the APAC are discussed. The independence of the control series from the exposure is important in the determination of the control disease. Because this design is based on internal comparison, non-differential misclassification should be stressed more than differential misclassification.

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  • Confounding Factors and Causal Relation in Environmental Problems

    TSUDA Toshihide, BABAZONO Akira, MINO Yoshie, TANIHARA Shinji

    Research on environmental disruption   24 ( 3 )   61 - 65   1994

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  • 9.塵肺症における肺癌の多発 : 日本病理剖検輯データのMortality Odds Ratioを用いた分析(一般論演,第36回中国四国合同産業衛生学会)

    来住 由樹, 濱田 裕久, 小河 孝則, 津田 敏秀, 三野 善央, 青山 英康, 山本 英二

    産業医学   35 ( 3 )   221 - 221   1993.5

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  • Depressive states in workers using computers

    Yoshio Mino, Toshihide Tsuda, Akira Babazono, Hideyasu Aoyama, Simpei Inoue, Hirotoshi Sato, Hirosh Ohara

    Environmental Research   63 ( 1 )   54 - 59   1993

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    There have been few reports investigating the depressive states in workers using computers. We describe the depressive states observed in workers using computers and discuss the sources of their occupational stresses. The first subject is a 34-year-old male manager of a manufacturing company who had customarily worked until 9 PM. In 1985, it became necessary for him to work until midnight
    symptoms of depression began to appear during this period, exacerbated after trouble with a computer. In 1986, he visited a psychiatrist and his condition was diagnosed as Major Depression according to DSM-III. The second subject is a 26-year-old male VDT (visual display terminal) operator in a general hospital. Before the onset, he had had to work until 8 PM and, at the end of each month, until midnight. Two months later, he became depressed and his condition was diagnosed as Major Depression according to DSM-III. The third subject is a 32-year-old male chief in the computer programming section of a bank. He had had to work until 8 PM, became depressed, and visited a psychiatrist who diagnosed his condition as Major Depression according to DSM-III. The authors discuss these cases from the standpoint of occupational stresses, as they are associated with work overload, and the important role these stresses played in the onset of the workers’ depressive states. © 1993 Academic Press.

    DOI: 10.1006/enrs.1993.1126

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  • Depressive states in workers using computers

    Yoshio Mino, Toshihide Tsuda, Akira Babazono, Hideyasu Aoyama, Simpei Inoue, Hirotoshi Sato, Hirosh Ohara

    Environmental Research   63 ( 1 )   54 - 59   1993

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    Language:English  

    There have been few reports investigating the depressive states in workers using computers. We describe the depressive states observed in workers using computers and discuss the sources of their occupational stresses. The first subject is a 34-year-old male manager of a manufacturing company who had customarily worked until 9 PM. In 1985, it became necessary for him to work until midnight
    symptoms of depression began to appear during this period, exacerbated after trouble with a computer. In 1986, he visited a psychiatrist and his condition was diagnosed as Major Depression according to DSM-III. The second subject is a 26-year-old male VDT (visual display terminal) operator in a general hospital. Before the onset, he had had to work until 8 PM and, at the end of each month, until midnight. Two months later, he became depressed and his condition was diagnosed as Major Depression according to DSM-III. The third subject is a 32-year-old male chief in the computer programming section of a bank. He had had to work until 8 PM, became depressed, and visited a psychiatrist who diagnosed his condition as Major Depression according to DSM-III. The authors discuss these cases from the standpoint of occupational stresses, as they are associated with work overload, and the important role these stresses played in the onset of the workers’ depressive states. © 1993 Academic Press.

    DOI: 10.1006/enrs.1993.1126

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  • Inorganic arsenic: A dangerous enigma for mankind

    Toshihide Tsuda, Akira Babazono, Takanori Ogawa, Hirohisa Hamada, Yoshio Mino, Hideyasu Aoyama, Norio Kurumatani, Tsuyoshi Nagira, Nobuyuki Hotta, Masazumi Harada, Shigemi Inomata

    Applied Organometallic Chemistry   6 ( 4 )   309 - 322   1992

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    Language:English   Publishing type:Book review, literature introduction, etc.  

    Human being have been using inorganic arsenic for a long time. Many reports on arsenic poisoning have been published: eg case reports, examination reports, post mortem reports, and epidemiological studies. Several aspects and features of arsenic poisoning are discussed in this report. Methods of inferring arsenic‐related disease, disease classification according to acute or chronic criteria, exposure route, interaction, confounding factors, and the oxidation state of arsenic are all discussed. The effects of arsenic are classified into skin, respiratory system, gastrointestinal tract, liver, cardiovascular system, nervous system, and bone marrow effects. Carcinogenicity is an important chronic effect of arsenic poisoning, so special attention is paid to it in this review. In Japan, there have been many incidents of arsenic poisoning. In this review, we often use data from these cases, such as the Morinaga powdered‐milk poisoning case, the Ube soy‐sauce poisoning case, the Toroku mine incident, and the Nakajo well‐water poisoning case. We emphasize here the necessity of planning follow‐up studies and total health care for patients exposed to arsenic. Copyright © 1992 John Wiley &amp
    Sons Ltd.

    DOI: 10.1002/aoc.590060403

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  • Historical cohort studies in three arsenic poisoning areas in japan

    Toshihide Tsuda, Takanori Ogawa, Akira Babazono, Hirohisa Hamada, Susumu Kanazawa, Yoshio Mino, Hideyasu Aoyaam, Eiji Yamamoto, Norio Kurumatani

    Applied Organometallic Chemistry   6 ( 4 )   333 - 341   1992

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    The results of historical cohort studies of three arsenic poisoning incidents in Japan are presented. The first episode was in a small mountainous community near an arsenic mine and refinery, at Toroku, where patients with chronic arsenism were certified by application of the Pollution Health Damage Compensation Law. The second area was in a small town, Namiki‐cho, near Nakajo‐machi, where wells were poisoned by arsenic produced in an arsenic(III) sulfide factory. As to the third cohort, eight residents of Nishikawa‐machi who ingested well‐water suffered arsenic poisoning about 35 years ago. The standardized mortality ratios were used in analyzing these data. Excesses of cancer mortality, especially lung cancer, were observed among the subjects in these areas. In Japan, there are many arsenic poisoning episodes, involving for example soy‐sauce poisoning, powdered‐milk poisoning and other incidents associated with arsenic mines. Thus it is necessary to clarify the chronic effects of arsenic in these areas. Copyright © 1992 John Wiley &amp
    Sons Ltd.

    DOI: 10.1002/aoc.590060405

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  • Historical cohort studies in three arsenic poisoning areas in japan

    Toshihide Tsuda, Takanori Ogawa, Akira Babazono, Hirohisa Hamada, Susumu Kanazawa, Yoshio Mino, Hideyasu Aoyaam, Eiji Yamamoto, Norio Kurumatani

    Applied Organometallic Chemistry   6 ( 4 )   333 - 341   1992

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    Language:English  

    The results of historical cohort studies of three arsenic poisoning incidents in Japan are presented. The first episode was in a small mountainous community near an arsenic mine and refinery, at Toroku, where patients with chronic arsenism were certified by application of the Pollution Health Damage Compensation Law. The second area was in a small town, Namiki‐cho, near Nakajo‐machi, where wells were poisoned by arsenic produced in an arsenic(III) sulfide factory. As to the third cohort, eight residents of Nishikawa‐machi who ingested well‐water suffered arsenic poisoning about 35 years ago. The standardized mortality ratios were used in analyzing these data. Excesses of cancer mortality, especially lung cancer, were observed among the subjects in these areas. In Japan, there are many arsenic poisoning episodes, involving for example soy‐sauce poisoning, powdered‐milk poisoning and other incidents associated with arsenic mines. Thus it is necessary to clarify the chronic effects of arsenic in these areas. Copyright © 1992 John Wiley &amp
    Sons Ltd.

    DOI: 10.1002/aoc.590060405

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  • Inorganic arsenic: A dangerous enigma for mankind

    Toshihide Tsuda, Akira Babazono, Takanori Ogawa, Hirohisa Hamada, Yoshio Mino, Hideyasu Aoyama, Norio Kurumatani, Tsuyoshi Nagira, Nobuyuki Hotta, Masazumi Harada, Shigemi Inomata

    Applied Organometallic Chemistry   6 ( 4 )   309 - 322   1992

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    Language:English   Publishing type:Book review, literature introduction, etc.  

    Human being have been using inorganic arsenic for a long time. Many reports on arsenic poisoning have been published: eg case reports, examination reports, post mortem reports, and epidemiological studies. Several aspects and features of arsenic poisoning are discussed in this report. Methods of inferring arsenic‐related disease, disease classification according to acute or chronic criteria, exposure route, interaction, confounding factors, and the oxidation state of arsenic are all discussed. The effects of arsenic are classified into skin, respiratory system, gastrointestinal tract, liver, cardiovascular system, nervous system, and bone marrow effects. Carcinogenicity is an important chronic effect of arsenic poisoning, so special attention is paid to it in this review. In Japan, there have been many incidents of arsenic poisoning. In this review, we often use data from these cases, such as the Morinaga powdered‐milk poisoning case, the Ube soy‐sauce poisoning case, the Toroku mine incident, and the Nakajo well‐water poisoning case. We emphasize here the necessity of planning follow‐up studies and total health care for patients exposed to arsenic. Copyright © 1992 John Wiley &amp
    Sons Ltd.

    DOI: 10.1002/aoc.590060403

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  • Relationship between alcohol use and depressive/anxiety symptoms among a general population: A review of literature

    Y. Mino, T. Tsuda, H. Aoyama, H. Ohara

    Japanese Journal of Alcohol Studies and Drug Dependence   27 ( 3 )   242 - 253   1992

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  • Relationship between alcohol use and depressive/anxiety symptoms among a general population: A review of literature

    Y. Mino, T. Tsuda, H. Aoyama, H. Ohara

    Japanese Journal of Alcohol Studies and Drug Dependence   27 ( 3 )   242 - 253   1992

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  • 新潟県中条町における慢性ヒ素中毒症患者の悪性新生物に関する死亡調査

    津田敏秀

    医学のあゆみ   159 ( 2 )   125 - 126   1991

  • AN EPIDEMIOLOGIC-STUDY ON CANCER IN CERTIFIED ARSENIC POISONING PATIENTS IN TOROKU

    T TSUDA, T NAGIRA, M YAMAMOTO, Y KUME

    INDUSTRIAL HEALTH   28 ( 2 )   53 - 62   1990

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    Language:English   Publisher:NATL INST INDUSTRIAL HEALTH  

    DOI: 10.2486/indhealth.28.53

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  • AN EPIDEMIOLOGIC-STUDY ON CANCER IN CERTIFIED ARSENIC POISONING PATIENTS IN TOROKU

    T TSUDA, T NAGIRA, M YAMAMOTO, Y KUME

    INDUSTRIAL HEALTH   28 ( 2 )   53 - 62   1990

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    Language:English   Publisher:NATL INST INDUSTRIAL HEALTH  

    DOI: 10.2486/indhealth.28.53

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  • Malignant neoplasms among residents who drank well water contaminated by arsenic from a King's Yellow factory

    T. Tsuda, T. Nagira, M. Yamamoto, N. Kurumatani, N. Hotta, M. Harada, H. Aoyama

    Journal of UOEH   11 ( Suppl. )   289 - 301   1989

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  • Malignant neoplasms among residents who drank well water contaminated by arsenic from a King's Yellow factory

    T. Tsuda, T. Nagira, M. Yamamoto, N. Kurumatani, N. Hotta, M. Harada, H. Aoyama

    Journal of UOEH   11 ( Suppl. )   289 - 301   1989

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  • 415. An epidemiological study on malignant neoplasms among arsenic poisoning patients in Nakajou-machi, Niigata prefecture (Report 2)(MUTAGEN AND CARCINOGEN,FREE COMMUNICATION,Proceedings of the 61st Annual Meeting of Japan Association of Industrial Health(Formerly Annual Meeting of Japan Society of Industrial Medicine))

    Tsuda T.

    Japanese journal of industrial health   30 ( 7 )   695 - 695   1988.12

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  • 416. A pathological study on lung cancer cases among patients poisoned by ingested arsenic(OTHER METALS,FREE COMMUNICATION,Proceedings of the 61st Annual Meeting of Japan Association of Industrial Health(Formerly Annual Meeting of Japan Society of Industrial Medicine))

    Nagira T.

    Japanese journal of industrial health   30 ( 7 )   696 - 696   1988.12

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  • Aresenic Poisoning Caused by Waste Water from an Orpiment Factory in Niigata--Re-examination after 28 Years

    HARADA Masazumi, HORITA Nobuyuki

    Research on environmental disruption   17 ( 3 )   58 - 65   1988

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  • Arsenic Poisoning Caused by Waste Water from an Orpiment Factory in Niigata-Re-Exmination After 28 Years

    HARADA Masazumi, HORITA Nobuyuki

    Research on Environmental Disruption   17 ( 3 )   58 - 65   1988

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  • 520. An epidemiological study on cancer in certified chronic arsenic poisoning patients in Toroku(MUTAGEN AND CARCINOGEN,Proceedings of the 60th Annual Meeting of Japan Association of Industrial Health(Formerly Annual Meeting of Japan Society of Industrial Medicine))

    Tsuda T.

    Japanese journal of industrial health   29 ( 7 )   694 - 694   1987.12

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  • Comparative Study of Subjective Fatigue between Automatic Transmission Bus Drivers and Manual Transmission Bus Drivers (共著)

    Ueno Mitsuo, Ieyasu Hidetaka, Tsuda Toshihide, Ogawa Takanori, Adachi Masamitsu

    Acta Medica Okayama   41 ( 5 )   229 - 232   1987.10

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    DOI: 10.18926/AMO/31751

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  • Comparative study of subjective fatigue between automatic transmission bus drivers and manual transmission bus drivers.

    Ueno Mitsuo, Ieyasu Hidetaka, Tsuda Toshihide, Ogawa Takanori, Adachi Masamitsu

    Acta Medica Okayama   41 ( 5 )   229 - 232   1987.10

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    DOI: 10.18926/AMO/31751

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  • A Case of Lung Cancer Associated with Chronic Arsenic Poisoning Caused by Neighborhood Exposure of As2O3 from Toroku Mine

    Toshihide Tsuda, Hideyasu Aoyama, Yufcinori Kume, Makoto Yamamoto, Tsuyosi Nagira

    Japanese Journal of Industrial Health   29 ( 3 )   222 - 223   1987

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  • A Case of Lung Cancer Associated with Chronic Arsenic Poisoning Caused by Neighborhood Exposure of As2O3 from Toroku Mine

    Toshihide Tsuda, Hideyasu Aoyama, Yufcinori Kume, Makoto Yamamoto, Tsuyosi Nagira

    Japanese Journal of Industrial Health   29 ( 3 )   222 - 223   1987

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  • An Epidemiological Study on Cancer in Certified Arsenic Poisoning Patients in Toroku

    Toshihide Tsuda, Yukinori Kume, Hideyasu Aoyama, Makoto Yamamoto, Tsuyoshi Nagira

    Japanese Journal of Industrial Health   29 ( 6 )   496 - 497   1987

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  • An Epidemiological Study on Cancer in Certified Arsenic Poisoning Patients in Toroku

    Toshihide Tsuda, Yukinori Kume, Hideyasu Aoyama, Makoto Yamamoto, Tsuyoshi Nagira

    Japanese Journal of Industrial Health   29 ( 6 )   496 - 497   1987

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  • A Case of Lung Cancer Associated with Chronic Arsenic Poisoning Caused by Neighborhood Exposure of As2O3 from Toroku Mine

    Toshihide Tsuda, Hideyasu Aoyama, Yufcinori Kume, Makoto Yamamoto, Tsuyosi Nagira

    Japanese Journal of Industrial Health   29 ( 3 )   222 - 223   1987

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  • 536. A case of chronic arsenic poisoning accompanied by Bowen's disease and lung cancer due to As_2O_3 "neighborhood exposure" at Toroku(OTHER METALS,FREE COMMUNICATION,Proceedings of the 59th Annual Meeting of Japan Association of Industrial Health(Formary Annual Meeting of Japan Society of Industrial Medicine))

    TSUDA T

    Japanese journal of industrial health   28 ( 7 )   673 - 673   1986.12

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  • 309. Measurement of diesel exhaust gas in the work of tunnel excavation(DAST AND PNEUMOCONIOSIS,FREE COMMUNICATION,Proceedings of the 59th Annual Meeting of Japan Association of Industrial Helth(Formerly Annual Meeting of Japan Society of Industrial Medicine))

    YAMAMOTO M.

    Japanese journal of industrial health   28 ( 7 )   600 - 600   1986.12

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  • A Report on the Indicators of Maternal and Child health in Okayama Prefecture

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  • A Report on Methods for the Investigation on the Causal Relationship between Air Pollution and Respiratory Diseases

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  • 精神疾患のプライマリ・ケア・サーベイ(平成4〜6年度科学研究費補助金(一般研究(A))研究成果報告書,課題番号:04404039,研究代表者:青山英康)

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  • A Report on the Indicators of Maternal and Child health in Okayama Prefecture

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  • A Report on Methods for the Investigation on the Causal Relationship between Air Pollution and Respiratory Diseases

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  • Epidemiologic Investigation on Food Poisoning - Seminar of Okayama City on Outbreak Investigation

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  • Epidemiologic Evidence of Infectious Disease and Food Poisoning - Public Health Seminar of Sakai City

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  • 岡山県母子保健指標に関する報告書

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  • 大気汚染と呼吸器疾器との関連についての調査方法検討報告書

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  • Epidemiologic Investigation on Food Poisoning - Seminar of Okayama City on Outbreak Investigation

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  • Epidemiologic Evidence of Infectious Disease and Food Poisoning - Public Health Seminar of Sakai City

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  • 岡山市食中毒疫学調査研修会 食中毒の疫学調査

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  • 堺市保健婦研修 感染症の疫学的検証

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  • 健康増進活動のための健康外来システムの開発とその評価(厚生科学研究費補助金健康科学総合研究事業研究報告書,主任研究者:馬場園明)

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  • 岡山県東南部地域に多発した肺癌に関する疫学的研究 (平成8〜10年度科学研究費補助金(基盤研究(C)(2))研究成果報告書,課題番号:08670393,研究代表者:津田敏秀)

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  • 職場のストレスのメンタルヘルスに及ぼす影響の定量的評価(平成7〜9年度科学研究費補助金(基盤研究(B))研究成果報告書,課題番号:07457095,研究代表者:三野善央)

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Awards

  • 新潟水俣 環境賞

    1999  

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    Country:Japan

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Research Projects

  • 水俣病における胎児期メチル水銀曝露の健康影響の全貌の解明

    Grant number:23K09714  2023.04 - 2026.03

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    津田 敏秀, 頼藤 貴志, 加戸 陽子, 櫻田 泰江

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    Grant amount:\4550000 ( Direct expense: \3500000 、 Indirect expense:\1050000 )

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  • Interdisciplinary Efforts to Build the Comprehensive Housing Welfare Remedy Framework for Radiation and Other Accumulative Disaster Damage in the 21st Century

    Grant number:19H01433  2019.04 - 2023.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

    吉田 邦彦, 辻内 琢也, 今野 正規, 津田 敏秀, 成 元哲, 窪田 亜矢, 淡路 剛久, 今中 哲二

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    Grant amount:\16900000 ( Direct expense: \13000000 、 Indirect expense:\3900000 )

    福島の原発事故による放射能被害を皮切りに、蓄積的損害に関わる被害者救済の学際的考察を幅広く行うことを目指してリセットをかけた本研究だが、原発事故の被害者救済について、定期的な実務家との研究会にもかかわらず、関連の裁判例は芳しくなく(とくに放射能被害の知見が問われる『自主被害者(区域外被害者)』の問題)、非力を感じ、更なる学際的研究の詰めを求めたい。
    <BR>
    災害復興との関係で、否応なく地球温暖化問題(水害、森林火災、熱帯雨林の破壊)に直面することとなり、その関連場所の訪問や会議報告を行った。東南アジア、南アメリカ(とくにブラジル)などにおける自然環境破壊は、先住民族問題も関係し、自然災害難民も生んでいて、グローバルな経済、資本主義権力とも深く関わり、21世紀の難問で打開策は急務なのだが緒はつかみがたく、因果関係の立証も難しく、不法行為救済を超える枠組み作りに苦慮している。さらに世界はコロナウィルスウイルス災害に席巻されるようになり、感染防止の点から身動きがとれなくなり、現場主義的研究・実証的(経験的)研究をモットーとしている本研究の手法は、同様に求められるだろう。
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    これらの課題との関係で、本年度は、別素材で視野拡大を試みた。例えば、沖縄ないし琉球弧の島々における米軍基地・軍事基地の環境悪化の調査に努め、これに関して、フランス・マルセイユのIUCN世界会議の場で、世界自然遺産(沖縄北部のやんばるの森など)との関係での環境問題を指摘し、地元紙でも注目された。軍事基地が急激に増強される宮古島における環境悪化の問題についても、「国防と居住福祉」の問題提起をした。そうこうするうちに、ウクライナ戦争が始まり、究極の環境破壊である戦争問題、核汚染危機も考察対象になりつつある。不実情報や補償・平和問題(関係修復)に真っ向から背を向ける行動様式にどう対処するかという難題に対峙することになっている。

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  • Epidemiologic study on risk perceptions, risk behaviors and health among Japanese overseas travelers

    Grant number:17K02111  2017.04 - 2023.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    山川 路代, 田中 優子, 津田 敏秀, 小野 真由美, 中瀬 克己

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    Grant amount:\4290000 ( Direct expense: \3300000 、 Indirect expense:\990000 )

    日本人旅行者における感染症罹患にかかわる行動のメカニズムを解明することは、旅行者を行動変容に導くリスク情報の提示方法を知る上で不可欠と考えられる。そこで、本研究は、①個人特性とリスク認知・リスク行動との関連性、②リスク認知とリスク行動との関連性、③リスク行動と疾病発症との関連性、という3つの観点から検討を進めている。2016年から2018年に大学主催の語学研修に参加した日本人学生825名を対象に、渡航前と渡航後に質問紙調査を実施した。渡航前に、渡航歴やリスク認知、既往歴などについて情報収集した。渡航後に、リスク行動や疾病発症、渡航時に携帯した医薬品類などについて情報収集した。渡航先でのリスク行動(衛生、食事・生活習慣、アクティビティなど)は、本人の心理的な要因の関与が示唆されている。今年度は、②について、渡航先での手指衛生の実施状況をアウトカムとし、リスク認知・不安が渡航先での手指衛生の実施状況にどのような影響を及ぼしているか検討した。結果として、性別や年齢、渡航歴、渡航年を調整しても、衛生に対する不安が少ないほど、渡航先で手指衛生を実施しない傾向が見られた。一方で、リスク認知については、有意な関連性は見られなかった。得られた結果は、国内学会で発表するとともに、国際誌に投稿した。また、渡航先や旅行目的によってリスク行動にどのような違いが生じるか、リスク行動に関連する要因にどのような違いがあるか知ることを目的とし、感染リスクの高い地域(インド)を個人旅行する日本人を対象に、2020年度にWebアンケートによる横断調査を実施した。得られたデータをもとに、今年度はリスク行動と関連する要因について分析を進めた。

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  • Evaluation of the effects to morbidity, mortality, and new born outcome by air pollution

    Grant number:26460746  2014.04 - 2017.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    Tsuda Toshihide

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    Grant amount:\4680000 ( Direct expense: \3600000 、 Indirect expense:\1080000 )

    Epidemiological evidence on air pollution is still limited in Japan. We thus evaluated the following hypotheses: 1. To evaluate the association between acute exposure to air pollution and morbidity using the ambulance data. 2. To evaluate the association between acute exposure to air pollution and mortality in Yokkaichi. 3. To evaluate the effect of air pollution on perinatal outcomes based on a clinic. 4. To evaluate the effect of air pollution on child morbidity using a large population-based cohort data. We then found the following results. 1. Acute exposure to air pollution increased risk of emergency visits due to cardiovascular disease, respiratory disease, and cardiac arrest. 2. Daily level of SO2 was associated with cause-specify mortality (in particular owing to cardiovascular disease). 3. We have evaluated the exposure model and now are collecting the further data. 4. Prenatal exposure to air pollution could affect term low birth weight and subsequent development.

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  • The comprehensive study on the health effects of air pollution in Japan and other Asian countries

    Grant number:24510033  2012.04 - 2015.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    DOI HIROYUKI, TSUDA Toshihide, KASHIMA Saori, YORIFUJI Takashi

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    Grant amount:\5460000 ( Direct expense: \4200000 、 Indirect expense:\1260000 )

    Air pollution has large impacts on public health, in particular in Asian regions. We therefore conducted several studies in Japan as well as in other South-East Asian countries. As collaborative studies in Asian countries, we conducted health impact assessment due to air pollution exposure, evaluated effects of acute exposure to air pollution on mortality, and examined health effects of Asian dust. In Japan, we evaluated the effects of acute exposure to air pollution on incidences of stroke, respiratory disease, and cardiac arrest as well as the effects of chronic exposure to air pollution on mortality due to cardiovascular disease and lung cancer. We further conducted air pollution epidemiological studies on perinatal health and air pollution intervention.

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  • Development of Public Health Nursing Skills to Show the Necessity/Results of Healthcare-activities toward Population and Decision Maker

    Grant number:23390517  2011.04 - 2015.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

    REIKO Okamoto, HATONO Yoko, IWAMOTO Saori, KOIDE Keiko, KUSANO Emiko, TSUDA Toshihide, HAMADA Jun, KITAWAKI Tomomi, HAGA Chiyori, GOUDA Kayoko, YAMAKAWA Michiyo, OKAMOTO Rika, FUKUKAWA Kyoko, NAGANO Fusami

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    Grant amount:\18330000 ( Direct expense: \14100000 、 Indirect expense:\4230000 )

    The purpose of this study was to build the public health nursing skills to show the necessity and the results of healthcare-activities toward population and decision makers, and to develop the learning programs to acquire that.
    "Public health nursing skills for showing" was defined in fiscal year 2011 and the contents were systematized about the skills which were to show “necessity of healthcare-activities”, “results of healthcare-activities” and “existence value of public health nurses”. We wrote the text in fiscal year 2012, and it was published in May 2013 (Okayama University publishing Association). Learning programs using the text were considered and made some trials in fiscal year 2013, and WEB teaching materials for the results dissemination were created and opened to the public in fiscal year 2014 (http://wwwmiseru.fhs.okayama-u.ac.jp).

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  • Long term clinical consequences of developmental arsenic exposure from contaminated milk powder – Pilot study

    Grant number:23790662  2011 - 2012

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Young Scientists (B)

    YORIFUJI Takashi, TSUDA Toshihide

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    Grant amount:\4290000 ( Direct expense: \3300000 、 Indirect expense:\990000 )

    During the summer of 1955, mass arsenic poisoning of bottle-fed infants occurred in the western part of Japan due to contaminated milk powder. However, few epidemiological and toxicological studies have focused on developmental or programming effects of arsenic exposure until now. We therefore conducted a pilot study to evaluate the associations of arsenic intake with a series of clinical tests that reflect neurological, neurophysiological, neurobehavioral functions and indicators of possible cancer development. We included 27 exposed subjects and 23 controls and conducted the study during the period from April 24, 2012, to February 26, 2013. After we compared the findings between the exposed and the controls, the exposed subjects tended to manifest some symptoms more frequently. The exposed subjects also tended to show some deficits in neurobehavioral tests except finger tapping. The exposed subjects had shorter height and had higher ALP compared to the controls.

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  • Identification of vulnerable population to climate changes and establishment of effective preventive strategies

    Grant number:22390124  2010 - 2012

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

    TSUDA Toshihide, YAMAMOTO Eiji, DOI Hiroyuki, YORIFUJI Takashi, KASHIMA Saori, SUZUKI Etsuji

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    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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  • Proposal of suicide prevention strategy and implementation of an epidemiological study based on case reports of all suicides in Okayama prefecture

    Grant number:21590695  2009 - 2011

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    HAMADA Jun, TSUDA Toshihide, YORIFUJI Takashi, MIYAISHI Satoru

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    Grant amount:\3380000 ( Direct expense: \2600000 、 Indirect expense:\780000 )

    By analyzing all the suicide cases in Okayama prefecture, we showed that suffocation suicides(rentan jisatsu) tend to occur during a certain season among men in their 30s to 40s. By creating a data set from the Vital Statistics, which has been compiled by the Ministry of Health, Labour and Welfare, we sought to identify vulnerable population to economic contraction in order to implement preventive interventions among them to reduce suicide. In addition, by analyzing suicide prevention strategies in advanced regions(e. g., Akita prefecture, Iwate prefecture, and Adachi-ku), we also demonstrated a significance of implementing their health promotion approaches in urban areas.

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  • Epidemiologic study of the association between job stress and cancer incidence and its mechanisms

    Grant number:16390170  2004 - 2007

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

    KAWAKAMI Norito, TSUTSUMI Akizumi, SHIMAZU Akihito

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    Grant amount:\15130000 ( Direct expense: \14500000 、 Indirect expense:\630000 )

    The present study project investigated the association between job stressors and cancer incidence, as well as its mechanisms, by conducting two prospective cohort studies (old and new cohort studies) and smaller prospective and cross-sectional epidemiologic studies on the mediators between job stressors and cancer incidence (physiological parameters, such as immune functions, oxidative DNA damage, and health-related behaviors such as diet).
    The project tested the following associations: (1) the association of job stressors based on the two major theories of job stress, i.e., "demand-control-support model" and "effort-reward imbalance model", with all cancer incidence (as well as site-specific cancer incidences), (2) the association of other psychosocial factors at work with all cancer incidence, and (3) the association of the job stressors with physiological parameters (immune functions, oxidative DNA damage) and health-related behaviors (smoking, drug, and diet).
    As the results of the present research project, it is suggested that the job stressors increase the all-cancer incidence. Part of the association seems to be explained by oxidative DNA damage caused by the job stressors. Diet and other health-related behaviors may not play a major role in connecting the job stressors and cancer incidence.

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  • The effect of mental health on occurrence of diseases in a workplace

    Grant number:14570340  2002 - 2004

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    BABAZONO Akira, MINO Yoshio, TSUDA Toshihide, NAGANO Jun

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    Grant amount:\3900000 ( Direct expense: \3900000 )

    We have performed health management in a manufacturing enterprise in H prefecture and carried out a survey of workplace stress and mental health at 2-year intervals. In the survey in fiscal 1997,of all 1,363 workers, 1,246(84.6%) responded to the questionnaire. Of the respondents, 1,036(83.1%) could be followed up by the survey after 2 years (fiscal 1999). The questionnaire on subjective workplace stress consists of 14 items based on Uehata's. For each item, one of "always", "sometimes", and "do not feel" is selected. As for an occurrence of stress related diseases, medical visits were asked within a year before the survey. Peptic ulcer, lower back pain, neck-shoulder-arm syndrome, insomnia were selected as stress related diseases because their prevalence was high in the survey. Multiple logistic regression analysis was performed using the occurrence of the diseases in fiscal 1999 as a dependent variable and subjective workplace stress, sex, age, alcohol usage, smoking and a kind of work in fiscal 1997 as explanatory variables. P<0.05 was regarded as significant. As a result of multiple logistic regression analysis for peptic ulcer, the odds ratios (95% CI) of female to male, and age per a year, work in the factory to research & development/ofiice work, and "always" and "sometimes" to "do not feel" for too little work were 0.28(0.10-0.81),1.05(1.02-1.09),2.38(1.21-4.69), 2.00(1.02-3.94), respectively. For lower back pain, the odds ratios (95% CI) of work in the factory to research & development/office work, and "always" and "sometimes" to "do not feel" for too little work were 3.94(1.69-9.15), 2.29(1.12-4.68), respectively. For neck-shoulder-arm syndrome, the odds ratios (95% CI) of work in the factory to research & development/office work, and "always" and "sometimes" to "do not feel" for feel pressed for time were 2.18(1.08-4.39) and 2.47(0.94-6.50), respectively. For insomnia, the odds ratio (95% CI) of "always" and "sometimes" to "do not feel" for work hours too long was 2.56(1.00-6.51).

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  • A Sociopsychological, physiological and genetic epidemiologic study of mental health among community residents

    Grant number:13470082  2001 - 2003

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

    KAWAKAMI Norito, OHTSU Tadahiro, TSUDA Toshihide, TSUTSUMI Akizumi, OZAKI Norio, TAKAO Soshi

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    Grant amount:\13500000 ( Direct expense: \13500000 )

    We prepared a survey questionnaire, translating and back translating the questions, developing a software which ran the CAPI (Computer Assisted Personal Interview), and then trained interviewers and conducted a production survey in 2001-2002. A letter was sent to a random sample (n=1607) from community residents in Okayama city and 27 interviewers completed interviews for 925 subjects (response rate, 66%, after excluding non-eligible subjects). Major depression, specific phobia, alcohol abuse were relatively common in this city. The lifetime prevalence of major depression was 7-8%, and the 12-month prevalence was 2.5-2.6%. We reported a preliminary finding at an international meeting in France, July 3-10, 2003 to obtain a further advice on the analysis. In 2003, a sample was drawn from the respondents who experienced mental disorders and did not, and we conducted a follow-up survey including blood sampling and psychophysiological examinations. Several genetic markers were measured. These surveys were reviewed and approved by the research ethics committees of the Okayama University Graduate School of Medicine & Dentistry. We analyzed associations among mental disorders, suicide behaviors, social functioning, QOL, occupational variables, genetic factors.

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  • Effects of an Increase in Patient Co-payments on Medical Service Demands of the Insured in Japan

    Grant number:11670373  1999 - 2001

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    BABAZONO Akira, TSUDA Toshihide

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    Grant amount:\3000000 ( Direct expense: \3000000 )

    We examine the effects of additional patient co-payments on the insured in Japan. This provision, involving an increase in co-payments to 20%, was introduced when the Employee Health Insurance in Japan was revised in September 1997. Co-payments for the insured had been 10% since October 1984, and nearly zero before that. Here, we examine the effect of the additional 10% co-payments introduced in 1997. This study includes all employees insured by the 1,797 health insurance societies belonging to the National Federation of Health Insurance Societies in 1996 and 1998. We again evaluate indicators of inpatient, outpatient, and dental service demand, including not only case rates and the number of service days per case, as in the previous study, but also the medical cost per day and the medical cost per insured. We estimate the effects of the additional 10% co-payments, controlling for average age, average monthly salary, and total number of the insured, gender (male-to-female) ratio, and dependent ratio (the number of dependents/ the number of insured). Insurers saved substantial medical costs in 1997 from the additional cost shifting to the insured. We also observed an income effect from the additional 10% co-payments, where we had not in the earlier study of the initial 10% co-payments. The impact of co-payments on quality of care remains unknown.

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  • Mood disorders and expressed emotion (EE) of families

    Grant number:10470108  1998 - 2000

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B).

    MINO Yoshio, SHIMODERA Shinji, AOKI Syozo, INOUE Shimpei, OHTSU Tadahiro, TSUDA Toshihide

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    Grant amount:\6600000 ( Direct expense: \6600000 )

    The reliability of expressed emotion (EE) ratings by Camberwell Family Interview (CFI) and characteristics of EE were evaluated in families of patients with mood disorders in Japan. The subjects were 27 patients with mood disorders and 31 members of their families. Concerning critical comments (CC), hostility (H), and emotional overinvolvement (EOI), which are important for EE rating, Spearman's correlation coefficient and the kappa value were 0.4 - 0.8, and the reliability of EE ratings in mood disorders was not high. The proportion of positive agreement was particularly low in H and EOI.CCs were fewer in families of Japanese patients with mood disorders than in those with schizophrenia or families of American or European patients with mood disorders. Re-evaluation of the infer-rater reliability of EE ratings in mood disorders is needed. Expressed emotion was more suppressed in families of patients with mood disorders than in those of patients with schizophrenia.
    The subjects were 32 patients diagnosed to have mood disorders on the basis of DSM-IV and ICD-10 and 36 principal members of their families. The families of the patients were interviewed by CFI within 2 weeks after admission of the patients, and EE was evaluated. A cohort study was conducted by following up the subjects for 9 months after discharge of the patients. The patients were divided into a high-EE group and a low-EE group using a few cut-off points concerning the number of CCs and EOI, the risk of relapse during the 9 month was compared, and the relapse risk ratio and its 95% confidence interval were calculated. Also, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and the optimal cut-off point was evaluated. Multiple logistic regression analysis was performed to control the effects of potential confounding factors. When the subjects with 3 or more CCs and an EOI score of 3 or higher were regarded as a high-EE group, and the others as a low-EE group, the risk of relapse during the 9 months was 83.3% (5/6) and 19.2% (5/26), respectively, and the relapse risk ratio (95% confidence interval) was 4.3 (1.8 - 12.2). The values of the validity parameters were the highest with these cut-off points. The effect of EE was significant also on multiple logistic regression analysis. EE based on CFI correlated with relapse also in Japan.

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  • An Epidemiologic Study on an Excess Risk of Lung Cancer in the Southeast Area of Okayama Prefecture, Japan

    Grant number:08670393  1996 - 1998

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    TSUDA Toshihide, MINO Yoshio

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    Grant amount:\2400000 ( Direct expense: \2400000 )

    In the south east of Okayama Prefecture, Japan, there have been reports on high prevalence of silicosis among refractory brick production workers, and excess risk of lung cancer among the residents. Therefore, a population based case-control study was conducted on the relationship between silica, silicosis, and lung cancer.
    Cases and controls were restricted to male subjects and obtained from death certificates from 1986 to 1993 in the area. Four kinds of deceased control groups were selected ; the series of deaths from liver cancer, colon cancer, and cancers of the other organs, which assumed not to be related to silica exposure. Age and smoking habits were adjusted by stratified analysis using the Mantel-Haenszel odds ratio estimates. Unconditional logistic regression analysis was also conducted for controlling potential confounding factors ; such as age and smoking habits.
    The age-, smoking-adjusted odds ratios were 1.59 (0.87-3.03) for liver cancer control, 1.94 (0.94-4.43) for colon cancer control, and 2.13 (1.19-3.85) for the other cancer control on silica exposure, and 2.45 (1.22-5.34), 2.94 (1.30-8.90), and 2.69 (1.43-5.37) on silicosis, respectively. Histologic or cytologic types of lung cancer cases were obtained from 64.1% (118/184). On histologic types of lung cancer, small cell carcinoma may related to silica exposure after comparing with unexposed lung cancer cases and the data from the general Japanese population. On the findings of chest X-ray, elevated lung cancer mortality compared with other cancers than lung was demonstrated among the patients without large opacities.
    Silica exposure increased the lung cancer mortality in the area. The results support the causal relationship between silica exposure and lung cancer, designated by IARC in 1997. From now, the relationship between silica exposure and esophagus cancer, gastric cancer, liver cancer. and hematopoietic malignancy which has been reported the association to silica exposure should be investigated and examined.

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  • A cohort study of the relationship between perceived job stress and mental health

    Grant number:07457095  1995 - 1997

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

    MINO Yoshio, MATSUOKA Hiroaki, TSUDA Toshihide

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    Grant amount:\6800000 ( Direct expense: \6800000 )

    To determine whether perceived job stress affects mental health in occupational setting, a 2-year cohort study was conducted. Of 462 workers who initially sowed a General Health Questionnaire (GHQ) score of 7 or less, 310 were successfully followed for 2 years. The two-year risks of developing mental ill health (a GHQ score of 8 or more) were assessed in relation to perceived job stress. The overall two-year risk for developing mental ill health was very high at 57.7%. Workers who reported aspects of perceived job stress showed a greater 2-year risk than those without stress. Multiple logistic regression analyzes showed that some components of perceived job stress were associated with a higher 2-year risk, among which "not allow to make mistakes" showed the largest adjusted odds ratio (95% confidence interval) of 2.37 (1.32-4.29). "Poor relationship with superior" had a significant effect on mental health only in females. Certain items of perceived job stress to be associated with mental ill health in workers.
    To clarify the degree of recovery from mentally ill states in occupational settings and the nature of perceived job stress associated with recovery, a 1-year cohort study was carried out in 287 of 763 workers who showed a GHQ score of 8 or more. Recovery from mentally ill states was observed in 48.7% after the first 6 months and in 68.0% after 1 year. During the first 6-month period, no job stress item associated with recovery was identified. During the second 6-month period, the odds ratio (95% CI) between recovery and perceived job stress was 4.16 (1.32-13.1) for "Too much responsibility" even after control of potential confounders. To promote recovery inmentally ill workers in the workplace, reduction in their responsibility may be effective.

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  • 塵肺症及び粉塵暴露と肺癌の多発に関する研究

    Grant number:06770260  1994

    日本学術振興会  科学研究費助成事業  奨励研究(A)

    津田 敏秀

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    Grant amount:\900000 ( Direct expense: \900000 )

    近年、岡山県の東南部、東備地域では、肺癌の過剰死亡が報告されている(昭和61年から平成2年までの5年間の市町村別標準化死亡比で、備前市・1.22、日生町・1.80)。そこで岡山県保健福祉部、厚生省統計情報部、岡山県東備保健所の協力を得て、この地域(備前市・日生町・佐伯町・和気町・吉永町)の死亡小票を調査し、肺癌発生に及ぼすじん肺症の影響の程度の推定を症例対照研究の手法で試みた。
    死亡小票は上記5市町の昭和63年から平成5年までのものを利用した。症例対照研究は、肺癌死亡症例を症例群とし、対照群に胃癌とその他の癌による死亡症例を選んだ。暴露の指標はじん肺所見の記載を採用した。分析対象は、40才以上の男性に限った。死亡時の年齢で層別し、各々の層をマンテル・ヘンツェル法で統合し、調製オッズ比を求めた。
    胃癌を対照疾患としたときの年齢調整オッズ比は1.41(95%信頼区間0.57-3.52)、胃癌と肺癌以外の癌を対照疾患としたときには2.22(同1.63-4.65)、肺癌以外の全癌を対照疾患としたときには1.97(同0.99-3.89)であった。いずれも、じん肺患者における肺癌の過剰死亡を示唆し、これまでの日本でのコホート研究の結果に一致している。しかし、今回は暴露の指標を、死亡小票のじん肺所見の記載に頼っているため、Nondifferential misclassificationなどのバイアスが考えられ、今後より良い推定値を得るためにさらに研究が必要であると考える。また、今回は年齢以外の交絡要因の情報、例えば喫煙歴に関する情報などは得られていないので、この点に関しても、今後更に検討が必要である。

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  • Mental Health Survey in Primary Care

    Grant number:04404038  1992 - 1994

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for General Scientific Research (A)

    AOYAMA Hideyasu, TUDA Toshihide, AOKI Shozo, MINO Yoshio

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    Grant amount:\12000000 ( Direct expense: \12000000 )

    Mental health survey in primary care
    A questionnaire survey was conducted for depression in primary care. Subjects were 302 patients who visited primary care clinics during three days. A questionnaire consisted of Inventory to Diagnose Depression (IDD) and Dartmouth COOP Functional Health Assessment Charts. In 275 patients who responded satisfactorily, prevalence of major depression was 6 % according to Diagnostic and Satistical Manual of Mental Disorders, Third edition revised (DSM-III-R), and 13% for both major and minor depression. During 6-month follow-up, 54 % of patients with major depression recovered from the state. In the international comparison study, prevalence of major depression was 13 % in USA and 3 % in Israel. These suggests that mental health care in primary care should receive more attention among not only family physicians but also psychiatrists.
    A cohort study was carried out in order to determine whether Expressed Emotion (EE) of families was related to the course of schizophrenia. Subjects were 52 schizophrenic patients diagnosed according to the DSM-III-R.Families' EE was evaluated through Camberwell Family Interview by a certified rater. Nine-month relapse risk of patients who lived in high EE households was 58 %, significantly larger than in low EE households. The finding was true when controlling confounding factors, such as psychiatric symptoms in Brief Psychiatric Rating Scale (BPRS), drug compliance, and duration of the illness. In the two-year follow-up study, the finding was also observed. EE study is promising in developing community care for the mentally ill in Japan.
    A effective family psychosocial intervention for schizophrenia is required.

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  • Anevaluation on Activities of Health Promotion Facilities in Health Insurance Association

    Grant number:01440036  1989 - 1991

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for General Scientific Research (A)

    AOYAMA Hideyasu, UCHIDA Hayato, TSUDA Toshihide, BABAZONO Akira, KODA Shigeki, ITANI Toru

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    Grant amount:\19600000 ( Direct expense: \19600000 )

    In Japan, national medical expenditures have steadily grown with increasing number of elderly people. Rising medical expenditures force people to bear an excessive burden, which could lead to a deterioration in socioeconomic activities.
    In order to persuade "the highest attachable standard of health as a fundamental right of human being", which was confirmed by World Health Organization, various kinds of policies have planned all over the world. In Japan, the National Health Insurance Scheme has covered the entire population since 1961 and it has assured high-quality medical services.
    Health insurance societies depend on fees paid by the insured and the government recommended that health insurance societies should provide the insured persons and their family not only with medical expenditure but also with health by more than 5% of total income to the societies.
    Financial situation of health insurance societies in 1985 was compared with that in 1990 in order to evaluate the governmental recommendation. Results were as follows : 1) a proportion of expenditure for physical activities in a total income had increased during these 5 years. 2) a proportion of expenditure for physical fitness in the expenditure had not increased.
    A manual for physical fitness in industries was published, considering the financial situation of the health insurance societies.

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  • 医学裁判での証言(水俣病)

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