Seiyo Municipal Nomura Hospital

Ehime, Japan

Seiyo Municipal Nomura Hospital

Ehime, Japan

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Kawamoto R.,Ehime University | Kawamoto R.,Seiyo Municipal Nomura Hospital | Kohara K.,Ehime University | Katoh T.,Seiyo Municipal Nomura Hospital | And 7 more authors.
Hypertension Research | Year: 2014

Central blood pressure (BP) has been shown to strongly associate with cardiovascular disease and outcome. Recent studies have demonstrated a relationship between changes in body size by exercise training and peripheral BP; however, the effect on changes in central BP is unknown. The aim of this study was to assess whether changes in body size are independently related to changes in central BP in the elderly. The subjects were 11 men (mean age, 68±6 years) and 84 women (68±7 years) from a rural village. Before and at the end of the 12-week training program, metabolic variables, and first peak radial systolic BP (SBP1) and second peak radial SBP (SBP2) as estimates of central SBP, were obtained. Radial augmentation index (AI) was calculated as follows: ((SBP2-diastolic BP (DBP))/(SBP1-DBP)) × 100 (%) and we used AI corrected at heart rate 75 per min (AI@75). After the 12-week training program, weight loss correlated strongly with reduction in brachial mean arterial pressure (MAP), radial SBP1, SBP2 and AI@75. After adjusting for confounding factors, weight loss was significantly and independently associated with each reduction in brachial MAP (β=0.34, P=0.001), radial SBP1 (β=0.31, P=0.002), SBP2 (β=0.37, P<0.001) and AI@75 (β=0.36, P=0.001). These findings suggest that weight loss by a 12-week training program may be an effective strategy to improve central BP parameters among Japanese elderly persons. © 2014 The Japanese Society of Hypertension All rights reserved.


Takayama S.,Ehime University | Kawamoto R.,Ehime University | Kawamoto R.,Seiyo Municipal Nomura Hospital | Kusunoki T.,Ehime University | And 3 more authors.
Cardiovascular Diabetology | Year: 2012

Background: Carotid intima-media thickness (IMT) is an useful surrogate marker of cardiovascular disease. Associations between uric acid (UA), metabolic syndrome (MetS) and carotid IMT have been reported, but findings regarding the relationship have been inconsistent.Methods: A total of 1,579 Japanese elderly subjects aged ≥65 years {663 men aged, 78 ± 8 (mean ± standard deviation) years and 916 women aged 79 ± 8 years} were divided into 4 groups according to UA quartiles. We first investigated the association between UA concentrations and confounding factors including MetS; then, we assessed whether there is an independent association of UA with carotid IMT and atherosclerosis in participants subdivided according to gender and MetS status.Results: Carotid IMT was significantly increased according to the quartiles of UA in both genders without MetS and women with MetS. Multivariate logistic regression analysis showed that odds ratio (OR) {95% confidence interval (CI)} in men for carotid atherosclerosis was significantly increased in the third (OR, 1.75; 95% CI, 1.02-3.02), and fourth quartiles (OR, 2.01; 95% CI, 1.12-3.60) of UA compared with that in the first quartile of UA, and the OR in women was significantly increased in the fourth quartile (OR, 2.10; 95% CI, 1.30-3.39). Similarly, the ORs were significantly associated with increasing quartiles of UA in both genders without MetS, but not necessarily increased in those with MetS.Conclusions: UA was found to be an independent risk factor for incidence of carotid atherosclerosis in both genders without MetS. © 2012 Takayama et al; licensee BioMed Central Ltd.


Kawamoto R.,Ehime University | Kawamoto R.,Seiyo Municipal Nomura Hospital | Tabara Y.,Ehime University | Kohara K.,Ehime University | And 4 more authors.
Endocrine | Year: 2013

Hematological parameters including red blood cell (RBC) count, hematocrit (Hct), and hemoglobin (Hgb) are independently associated with insulin resistance. The aim of this study was to determine whether hematological parameters are associated with metabolic syndrome (MetS), and its components, independent of gender, body mass index (BMI) and other confounders of cardiovascular disease. A total of 692 men [60 ± 14 (mean ± standard deviation); 20-89 (range) years] and 1,004 women (63 ± 12; 21-88 years) participants without diabetes were recruited from a single community at the time of their annual health examination. We examined the relationship between hematological parameters and insulin resistance assessed by Homeostasis model assessment of insulin resistance (HOMA-IR), MetS, and its components. RBC count, Hct, and Hgb were all significantly associated with measures of HOMA-IR. Multiple linear regression analyses for HOMA-IR showed that RBC count, Hct, and Hgb were all shown to be independently and significantly associated with HOMA-IR as well as gender, BMI, alcohol consumption, current smoking status, γ-glutamyltransferase, high molecular weight adiponectin, and uric acid. Inclusion of hematological parameters into the model further increased the coefficient of determination (R 2). Compared to participants with the lowest quartile of Hct, multivariate-adjusted odds ratio for insulin resistance (HOMA-IR ≥ 1.74) was 2.27 [95 % confidence interval (CI), 1.55-3.31] for the third quartile, and 3.78 (95 % CI, 2.38-5.99) for the highest quartile. Hct was significantly and strongly associated with increased HOMA-IR levels. Hematological parameters were positively associated with insulin resistance and prevalence of MetS in Japanese dwelling-community persons. © 2013 Springer Science+Business Media, LLC.


Kawamoto R.,Ehime University | Kawamoto R.,Seiyo Municipal Nomura Hospital | Kohara K.,Ehime University | Kusunoki T.,Ehime University | And 3 more authors.
Cardiovascular Diabetology | Year: 2012

Background: The aim of the present study was to examine how liver markers are associated with insulin resistance in Japanese community-dwelling adults.Methods: This cross-sectional study included 587 men aged 58 ± 14 (mean ± standard deviation; range, 20-89) years and 755 women aged 60 ± 12 (range, 21-88) years. The study sample consisted of 998 (74.4%) non-obese [body mass index (BMI) <25.0 kg/m2] and 344 (25.6%) overweight (BMI ≥25 kg/m2) subjects. Insulin resistance was defined by homeostasis model assessment of insulin resistance (HOMA-IR) of at least 2.5, and HOMA-IR and potential confounders were compared between the groups. Areas under the curve (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum markers.Results: In non-obese subjects, the best marker of insulin resistance was alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio of 0.70 (95% confidence interval (CI), 0.63-0.77). In overweight subjects, AUC values for the ALT/AST ratio and ALT were 0.66 (0.59-0.72) and 0.66 (0.59-0.72), respectively. Multiple linear regression analyses for HOMA-IR showed that ALT/AST ratios were independently and significantly associated with HOMA-IR as well as other confounding factors in both non-obese and overweight subjects. The optimal cut-off point to identifying insulin resistance for these markers yielded the following values: ALT/AST ratio of ≥0.82 in non-obese subjects and ≥1.02 in overweight subjects. In non-obese subjects, the positive likelihood ratio was greatest for ALT/AST ratio.Conclusions: In non-obese Japanese adults, ALT/AST ratio may be the best reliable marker of insulin resistance. © 2012 Kawamoto et al.; licensee BioMed Central Ltd.


PubMed | Ehime University and Seiyo Municipal Nomura Hospital
Type: Journal Article | Journal: PloS one | Year: 2016

Serum uric acid (UA) has strong anti-oxidant properties. Muscle strength and mass decrease with age, and recently, this decrease has been defined as sarcopenia. Sarcopenia may be triggered by oxidative stress. We investigated whether serum UA is associated with handgrip strength (HGS), which is a useful indicator of sarcopenia, among Japanese community-dwelling elderly persons. The present study included 602 men aged 72 7 years and 847 women aged 71 6 years from a rural village. We examined the cross-sectional relationship between serum UA and HGS. In both genders, HGS increased significantly with increased serum UA levels. A multiple linear regression analysis using HGS as an objective variable and various confounding factors as explanatory variables showed that in men age, drinking status, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and estimated glomerular filtration ratio (eGFRCKDEPI) were independently and significantly associated with HGS, and in women, serum UA as well as age, body mass index, drinking status, diastolic blood pressure, and eGFRCKDEPI were independently and significantly associated with HGS. In women, age and multivariate-adjusted HGS were significantly higher in the Quartile-3 (4.8-5.4 mg/dL) and Quartile-4 groups (5.5-9.3 mg/dL) of serum UA than in the lower groups (0.7-4.7 mg/dL). These results suggest that serum UA may have a protective role in aging-associated decline in muscle strength in community-dwelling elderly women.


PubMed | Ehime University and Seiyo Municipal Nomura Hospital
Type: | Journal: Medical education online | Year: 2016

In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career.The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbachs alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables.Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: Admission from hometown (=0.189, P=0.001), Student preparing for the entrance exam (=0.172; P=0.001), Intent for rural practice (=0.123, P=0.016), and Work-life balance (=0.126, P=0.013). While significant variables that were negatively associated with choosing GM/FM were Presence of medical relatives (=-0.107, P=0.037) and Scientific orientation (=-0.125, P=0.013).Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career, we may be able to increase enthusiasm for this specialty.


PubMed | Ehime University and Seiyo Municipal Nomura Hospital
Type: Journal Article | Journal: Clinical and experimental hypertension (New York, N.Y. : 1993) | Year: 2016

The association of low muscle strength with cardio-metabolic risks remains controversial. The present study included 742 men aged 709 years and 937 women aged 708 years from a rural village. We examined the cross-sectional relationship between relative muscle strength defined by handgrip strength (HGS)/body weight (BW) ratio, and metabolic syndrome (MetS) based on the modified criteria of the National Cholesterol Education Programs Adult Treatment Panel (NCEP-ATP) III report and its components. Of these, 203 men (27.4%) and 448 women (47.8%) had MetS. In men, increasing quartile of HGS/BW ratio was significantly and independently associated with high waist circumference {odds ratio, 0.31; 95% confidence interval (CI), 0.24-0.41} and elevated triglyceridemia (0.71, 0.59-0.86). In women, it was also significantly and independently associated with high waist circumference (0.41; 0.36-0.48), high blood pressure (0.78; 0.66-0.92), Low HDL-cholesterolemia (0.84; 0.73-0.98) and elevated triglyceridemia (0.65; 0.53-0.79). In both genders, the prevalence of MetS significantly decreased in relation to increasing HGS/BW ratio. After adjustment for age, smoking status, drinking status, LDL-C, estimated glomerular filtration ratio (eGFR), and medication, the respective odds ratio (95% CI) for the quartile of HGS/BW ratio for MetS was 1.00, 0.54 (0.34-0.85), 0.32 (0.19-0.53), and 0.16 (0.09-0.29) in men, and 1.00, 0.76 (0.50-1.16), 0.33 (0.22-0.51), and 0.16 (0.10-0.25) in women. These results suggest that HGS/BW ratio was significantly and negatively associated with an increased risk of cardio-metabolic disorders in Japanese-community dwelling persons.


PubMed | Ehime University and Seiyo Municipal Nomura Hospital
Type: Journal Article | Journal: BMC medical education | Year: 2016

In Japan, the absolute deficiency of doctors and maldistribution of doctors by specialty is a significant problem in the Japanese health care system. The purpose of this study was to investigate the factors contributing to specialty preference in career choice among Japanese medical students.A total of 368 medical students completed the survey giving an 88.2% response rate. The subjects comprised 141 women aged 213 (range, 18-34) years and 227 men aged 224 (range, 18-44) years. Binary Logistic regression analysis was performed using specialty preferences as the criterion variable and the factors in brackets as six motivational variables (e.g., Factor 1: educational experience; Factor 2: job security; Factor 3: advice from others; Factor 4: work-life balance; Factor 5: technical and research specialty; and Factor 6: personal reasons).Women significantly preferred pediatrics, obstetrics & gynecology, and psychology than the men. Men significantly preferred surgery and orthopedics than the women. For both genders, a high odds ratio (OR) of technical & research specialty and a low OR for personal reasons were associated with preference for surgery. Technical & research specialty was positively associated with preference for special internal medicine and negatively for pediatrics. Work-life balance was positively associated with preference for psychology and negatively for emergency medicine. Among the women only, technical & research specialty was negatively associated with preference for general medicine/family medicine and obstetrics & gynecology, and job security was positively associated for general medicine/family medicine and negatively for psychology. Among men only, educational experience and personal reasons were positively, and job security was negatively associated with preference for pediatrics. For both genders, work-life balance was positively associated with preference for controllable lifestyle specialties.We must acknowledge that Japanese medical students have dichotomized some motivations for their specialty preference based on gender. Systematic improvements in the working environment are necessary to solve these issues.


PubMed | Seiyo Municipal Nomura Hospital
Type: Journal Article | Journal: Journal of medical ultrasonics (2001) | Year: 2016

To determine optimal cutoff values for preperitoneal fat thickness measured by ultrasonography as indicators for obesity-related disorders.We studied 276 men aged 60 13 years and 307 women aged 64 11 years. Participants were consecutively enrolled from inpatients aged 75 years. Demographic data were collected and maximal preperitoneal fat thickness (PFTmax) and carotid intima-media thickness were evaluated on B-mode ultrasonography. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cutoff values for PFTmax.Multiple regression analysis using one or more obesity-related disorders as an objective variable showed that the tertile on the basis of PFTmax was a significant independent contributing factor in both men and women. Receiver operating characteristic curve analysis identified the cutoff points of 6.1mm for PFTmax in men (sensitivity, 66.7%; specificity, 62.5%) and 8.7mm for PFTmax in women (sensitivity, 56.6%; specificity, 63.6%) as discriminator values corresponding to the presence of one or more obesity-related disorders. Using the new criteria to diagnose visceral obesity, we found that adjusted carotid intima-media thickness was significantly higher in men and women with visceral obesity and two or more obesity-related disorders than in those without them.These findings suggested that PFTmax measured on ultrasonography was useful in screening for indicators of cardiovascular risk factors.


PubMed | Ehime University and Seiyo Municipal Nomura Hospital
Type: Journal Article | Journal: Clinical and experimental hypertension (New York, N.Y. : 1993) | Year: 2016

Diabetes is strongly associated with several mechanisms of tissue damage such as oxidative stress. Serum bilirubin may have a beneficial role in preventing oxidative changes in cardiovascular disease (CVD). Limited information is available on whether serum bilirubin is an independent confounding factor for carotid atherosclerosis among elderly persons with type 2 diabetes. The study subjects were 169 men aged 798 (meanSD) years and 205 women aged 818 years that were enrolled consecutively from patients in the medical department. Carotid intima-media thickness (IMT) and plaque were derived via B-mode ultrasonography. Multiple linear regression analysis showed that serum total bilirubin (=-0.160) was significantly associated with carotid IMT. Compared to subjects with a serum total bilirubin of tertile-1 (0.13-0.58mg/dL), the multivariate-adjusted odds ratio (95% confidence interval) of carotid IMT 1.0mm including plaque and carotid plaque was 0.46 (0.23-0.93) and 0.32 (0.17-0.60) in the Tertile-3 group (0.87-1.93mg/dL), respectively. Next, data were further stratified by gender, age, smoking status, medication and prevalence of CVD. There were no significant differences in serum total bilirubin levels between selected subgroups. Our data demonstrated a negative association between serum total bilirubin and carotid atherosclerosis among elderly persons with type 2 diabetes.

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