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Article ; Online: Gender difference of geographic distribution of physicians in Japan

Kazuki Kimura / Kazuo Inoue / Takahito Ando / Masanori Ito

BMC Health Services Research, Vol 23, Iss 1, Pp 1-

three-point analysis of 1994, 2004 and 2014

2023 Volume 10

Abstract: Abstract Background Japan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of ... ...

Abstract	Abstract Background Japan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of physicians in rural areas. This study examined this issue, focusing on gender and considering years of physician experience, demographic and geographic factors. Methods We analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians’ gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience. Results The number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4% to 20.4%. We found that 87.7% of physicians were concentrated in the top 1/3 municipalities in terms of population. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficient for all physicians was 0.315–0.298–0.298 (male physicians: 0.311–0.289–0.283, female physicians: 0.394–0.385–0.395) The Gini coefficients for female compared to male physicians were higher in all age groups, showing that The distribution of female physicians is skewed toward urban areas. Conclusion Female physicians are less distributed in rural areas than male physicians. In addition, despite the fact that the number of female physicians has increased more than male physicians over the past 20 years, the ...
Keywords	Physician ; Gender difference ; Geographic distribution ; Year of experience ; Japan ; Public aspects of medicine ; RA1-1270
Subject code	303
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Association of the past epidemic of Mycobacterium tuberculosis with mortality and incidence of COVID-19.

Kazuo Inoue / Saori Kashima

PLoS ONE, Vol 16, Iss 6, p e

2021 Volume 0253169

Abstract: The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a remarkable and varying impact in every country, inciting calls for broad attention. Recently, the Bacillus ... ...

Abstract	The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a remarkable and varying impact in every country, inciting calls for broad attention. Recently, the Bacillus Calmette-Guérin (BCG) vaccination has been regarded as a potential candidate to explain this difference. Herein, we hypothesised that the past epidemic of Mycobacterium tuberculosis (M. tuberculosis) may act as a latent explanatory factor for the worldwide differences seen in COVID-19 impact on mortality and incidence. We compared two indicators of past epidemic of M. tuberculosis, specifically, incidence (90 countries in 1990) and mortality (28 countries in 1950), with the mortality and incidence of COVID-19. We determined that an inverse relationship existed between the past epidemic indicators of M. tuberculosis and current COVID-19 impact. The rate ratio of the cumulative COVID-19 mortality per 1 million was 2.70 (95% confidence interval [CI]: 1.09-6.68) per 1 unit decrease in the incidence rate of tuberculosis (per 100,000 people). The rate ratio of the cumulative COVID-19 incidence per 1 million was 2.07 (95% CI: 1.30-3.30). This association existed even after adjusting for potential confounders (rate of people aged 65 over, diabetes prevalence, the mortality rate from cardiovascular disease, and gross domestic product per capita), leading to an adjusted rate ratio of COVID-19 mortality of 2.44, (95% CI: 1.32-4.52) and a COVID-19 incidence of 1.31 (95% CI: 0.97-1.78). After latent infection, Mycobacterium survives in the human body and may continue to stimulate trained immunity. This study suggests a possible mechanism underlying the region-based variation in the COVID-19 impact.
Keywords	Medicine ; R ; Science ; Q
Subject code	306
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Low creatinine levels in diabetes mellitus among older individuals

Saori Kashima / Kazuo Inoue / Masatoshi Matsumoto

Scientific Reports, Vol 11, Iss 1, Pp 1-

the Yuport Medical Checkup Center Study

2021 Volume 8

Abstract: Abstract ORIC ID: 0000-0002-3401-8191. It is unknown whether the interrelationship between diabetes and muscle loss is affected by ageing. Therefore, the serum creatinine levels, an indicator of muscle mass, were compared between older people with ... ...

Abstract	Abstract ORIC ID: 0000-0002-3401-8191. It is unknown whether the interrelationship between diabetes and muscle loss is affected by ageing. Therefore, the serum creatinine levels, an indicator of muscle mass, were compared between older people with diabetes and those without diabetes, using a cross-sectional dataset from the Yuport Medical Checkup Center Study. We classified 6133 participants without kidney dysfunction into three age-groups: early-elderly (65–69 years), middle-elderly (70–74 years), and late-elderly (≥ 75 years). The association between diabetes and the lowest creatinine level, defined as less than or equal to the 25 percentile of serum creatinine, was evaluated in each age group, by calculating the odds ratio (OR) using logistic regression. Serum creatinine levels increased with ageing in the participants, and these trends were markedly observed in the non-diabetic group. Late-elderly people with diabetes were significantly more likely to have low creatinine levels than those without diabetes, with adjusted ORs 2.50 (95% CI 1.99–4.50) in men and 2.88 (95% CI 1.47–5.64) in women. Ageing modified the effect of their diabetes status towards a lower creatinine level (p for interactions between the diabetic status and age-groups were 0.01 in men and 0.05 in women, respectively). Ageing may thus accelerate the loss of muscle mass in people with diabetes.
Keywords	Medicine ; R ; Science ; Q
Subject code	571
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Methylglyoxal attenuates isoproterenol-induced increase in uncoupling protein 1 expression through activation of JNK signaling pathway in beige adipocytes

Su-Ping Ng / Wataru Nomura / Haruya Takahashi / Kazuo Inoue / Teruo Kawada / Tsuyoshi Goto

Biochemistry and Biophysics Reports, Vol 28, Iss , Pp 101127- (2021)

2021

Abstract: Methylglyoxal (MG) is a metabolite derived from glycolysis whose levels in the blood and tissues of patients with diabetes are higher than those of healthy individuals, suggesting that MG is associated with the development of diabetic complications. ... ...

Abstract	Methylglyoxal (MG) is a metabolite derived from glycolysis whose levels in the blood and tissues of patients with diabetes are higher than those of healthy individuals, suggesting that MG is associated with the development of diabetic complications. However, it remains unknown whether high levels of MG are a cause or consequence of diabetes. Here, we show that MG negatively affects the expression of uncoupling protein 1 (UCP1), which is involved in thermogenesis and the regulation of systemic metabolism. Decreased Ucp1 expression is associated with obesity and type 2 diabetes. We found that MG attenuated the increase in Ucp1 expression following treatment with isoproterenol in beige adipocytes. However, MG did not affect protein kinase A signaling, the core coordinator of isoproterenol-induced Ucp1 expression. Instead, MG activated c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinases. We found that JNK inhibition, but not p38, recovered isoproterenol-stimulated Ucp1 expression under MG treatment. Altogether, these results suggest an inhibitory role of MG on the thermogenic function of beige adipocytes through the JNK signaling pathway.
Keywords	Methylglyoxal ; Beige adipocytes ; Ucp1 ; JNK ; Biology (General) ; QH301-705.5 ; Biochemistry ; QD415-436
Subject code	500 ; 616
Language	English
Publishing date	2021-12-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Low-fat diet, and medium-fat diets containing coconut oil and soybean oil exert different metabolic effects in untrained and treadmill-trained mice

Mark Christian Manio / Shigenobu Matsumura / Kazuo Inoue

Journal of the International Society of Sports Nutrition, Vol 15, Iss 1, Pp 1-

2018 Volume 16

Abstract: Abstract Background Diets containing fats of different proportions and types have been demonstrated to influence metabolism. These fats differ in long chain fatty acids (LCFAs) or medium chain fatty acids (MCFAs) content. In our laboratory using swimming ...

Abstract	Abstract Background Diets containing fats of different proportions and types have been demonstrated to influence metabolism. These fats differ in long chain fatty acids (LCFAs) or medium chain fatty acids (MCFAs) content. In our laboratory using swimming as the training modality, MCFAs increased endurance attributed to increased activities of oxidative enzymes. How it affects whole-body metabolism remains unexplored. The present study investigated the metabolic, biochemical and genetic adaptations with treadmill running as the training modality. Methods C57BL/6N mice were divided into untrained and trained groups and provided with low-fat (10% kcal from soybean oil), coconut oil (10% kcal from soybean oil, 20% kcal from coconut oil) or soybean oil (30% kcal from soybean oil) diet. Training was performed on a treadmill for 30 days. After recovery, whole-body metabolism at rest and during exercise, endurance, substrate metabolism, mitochondrial enzyme activities, and gene expression of training-adaptive genes in the muscle and liver were measured. Results At rest, medium-fat diets decreased respiratory exchange ratio (RER) (p < 0.05). Training increased RER in all diet groups without affecting oxygen consumption (p < 0.05). During exercise, diets had no overt effects on metabolism while training decreased oxygen consumption indicating decreased energy expenditure (p < 0.05). Coconut oil without training improved endurance based on work (p < 0.05). Training improved all endurance parameters without overt effects of diet (p < 0.05). Moreover, training increased the activities of mitochondrial enzymes likely related to the increased expression of estrogen related receptor (ERR) α and ERRβ (p < 0.05). Coconut oil inhibited peroxisome proliferator-activated receptor (PPAR) β/δ activation and glycogen accumulation in the muscle but activated PPARα in the liver in the trained state (p < 0.05). Substrate utilization data suggested that coconut oil and/or resulting ketone bodies spared glycogen ...
Keywords	Low-fat diet ; Soybean oil ; Coconut oil ; Treadmill exercise ; Endurance ; Glycogen ; Nutrition. Foods and food supply ; TX341-641 ; Sports medicine ; RC1200-1245
Subject code	796
Language	English
Publishing date	2018-06-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Disruption of CRTC1 and CRTC2 in Sim1 cells strongly increases high-fat diet intake in female mice but has a modest impact on male mice

Jin Tanaka / Fuka Ishikawa / Tomoki Jinno / Motoki Miyakita / Haruka Miyamori / Tsutomu Sasaki / Takumi Yokokawa / Tsuyoshi Goto / Kazuo Inoue / Shigenobu Matsumura

PLoS ONE, Vol 17, Iss

2022 Volume 1

Abstract: cAMP responsive element binding protein (CREB)-regulated transcription coactivators (CRTCs) regulate gene transcription in response to an increase in intracellular cAMP or Ca2+ levels. To date, three isoforms of CRTC have been identified in mammals. All ... ...

Abstract	cAMP responsive element binding protein (CREB)-regulated transcription coactivators (CRTCs) regulate gene transcription in response to an increase in intracellular cAMP or Ca2+ levels. To date, three isoforms of CRTC have been identified in mammals. All CRTCs are widely expressed in various regions of the brain. Numerous studies have shown the importance of CREB and CRTC in energy homeostasis. In the brain, the paraventricular nucleus of the hypothalamus (PVH) plays a critical role in energy metabolism, and CRTC1 and CRTC2 are highly expressed in PVH neuronal cells. The single-minded homolog 1 gene (Sim1) is densely expressed in PVH neurons and in some areas of the amygdala neurons. To determine the role of CRTCs in PVH on energy metabolism, we generated mice that lacked CRTC1 and CRTC2 in Sim1 cells using Sim-1 cre mice. We found that Sim1 cell-specific CRTC1 and CRTC2 double-knockout mice were sensitive to high-fat diet (HFD)-induced obesity. Sim1 cell-specific CRTC1 and CRTC2 double knockout mice showed hyperphagia specifically for the HFD, but not for the normal chow diet, increased fat mass, and no change in energy expenditure. Interestingly, these phenotypes were stronger in female mice than in male mice, and a weak phenotype was observed in the normal chow diet. The lack of CRTC1 and CRTC2 in Sim1 cells changed the mRNA levels of some neuropeptides that regulate energy metabolism in female mice fed an HFD. Taken together, our findings suggest that CRTCs in Sim1 cells regulate gene expression and suppress excessive fat intake, especially in female mice.
Keywords	Medicine ; R ; Science ; Q
Subject code	570
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Disruption of CRTC1 and CRTC2 in Sim1 cells strongly increases high-fat diet intake in female mice but has a modest impact on male mice.

Jin Tanaka / Fuka Ishikawa / Tomoki Jinno / Motoki Miyakita / Haruka Miyamori / Tsutomu Sasaki / Takumi Yokokawa / Tsuyoshi Goto / Kazuo Inoue / Shigenobu Matsumura

PLoS ONE, Vol 17, Iss 1, p e

2022 Volume 0262577

Abstract	cAMP responsive element binding protein (CREB)-regulated transcription coactivators (CRTCs) regulate gene transcription in response to an increase in intracellular cAMP or Ca2+ levels. To date, three isoforms of CRTC have been identified in mammals. All CRTCs are widely expressed in various regions of the brain. Numerous studies have shown the importance of CREB and CRTC in energy homeostasis. In the brain, the paraventricular nucleus of the hypothalamus (PVH) plays a critical role in energy metabolism, and CRTC1 and CRTC2 are highly expressed in PVH neuronal cells. The single-minded homolog 1 gene (Sim1) is densely expressed in PVH neurons and in some areas of the amygdala neurons. To determine the role of CRTCs in PVH on energy metabolism, we generated mice that lacked CRTC1 and CRTC2 in Sim1 cells using Sim-1 cre mice. We found that Sim1 cell-specific CRTC1 and CRTC2 double-knockout mice were sensitive to high-fat diet (HFD)-induced obesity. Sim1 cell-specific CRTC1 and CRTC2 double knockout mice showed hyperphagia specifically for the HFD, but not for the normal chow diet, increased fat mass, and no change in energy expenditure. Interestingly, these phenotypes were stronger in female mice than in male mice, and a weak phenotype was observed in the normal chow diet. The lack of CRTC1 and CRTC2 in Sim1 cells changed the mRNA levels of some neuropeptides that regulate energy metabolism in female mice fed an HFD. Taken together, our findings suggest that CRTCs in Sim1 cells regulate gene expression and suppress excessive fat intake, especially in female mice.
Keywords	Medicine ; R ; Science ; Q
Subject code	570
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characteristics of Physician Outflow from Disaster Areas following the Great East Japan Earthquake.

Saori Kashima / Kazuo Inoue / Masatoshi Matsumoto

PLoS ONE, Vol 12, Iss 1, p e

2017 Volume 0169220

Abstract: The shortage of physicians after a major disaster is a crucial issue. We aimed to evaluate the characteristics of physicians who left affected areas following the accident at Fukushima Daiichi Nuclear Power Plant caused by the Great East Japan Earthquake ...

Abstract	The shortage of physicians after a major disaster is a crucial issue. We aimed to evaluate the characteristics of physicians who left affected areas following the accident at Fukushima Daiichi Nuclear Power Plant caused by the Great East Japan Earthquake on March 11, 2011.Using data from a physician census conducted in 2010 (pre-disaster) and 2012 (post-disaster), we evaluated changes in the number of physicians in affected areas. We then calculated the odds ratios and 95% confidence intervals using a logistic regression model to evaluate the association between physician characteristics and outflow. We also conducted stratified analyses based on physician characteristics.The number of physicians decreased in Fukushima Prefecture (-5.3%) and increased in Miyagi Prefecture (2.8%). The decrease in Fukushima and increase in Miyagi were evident even after taking the prefecture's population change into account (change in physician to population ratios: -1.9% and 3.2%, respectively). Compared with physicians who lived in areas >100 km from the nuclear power plant, physicians living 20-50 km and 50-100 km were, respectively, 3.9 times (95% confidence interval, 2.6-5.7) and 2.6 times (95% confidence interval, 1.7-3.8) more likely to migrate to distant areas. In the stratified analysis, younger physicians and those earlier in their careers had higher odds ratios for outflow than other physicians (P for interaction = 0.02 and <0.01, respectively).The risk of outflow was greater among younger and early-career physicians in areas around the power plant. Political support may be necessary to recruit and retain such physicians, who will be responsible for future community health in the disaster area.
Keywords	Medicine ; R ; Science ; Q
Subject code	310
Language	English
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Have the tsunami and nuclear accident following the Great East Japan Earthquake affected the local distribution of hospital physicians?

Saori Kashima / Kazuo Inoue / Masatoshi Matsumoto

PLoS ONE, Vol 12, Iss 5, p e

2017 Volume 0178020

Abstract: The Great East Japan Earthquake occurred on 11 March 2011 near the northeast coast of the main island, 'Honshu', of Japan. It wreaked enormous damage in two main ways: a giant tsunami and an accident at the Fukushima Daiichi Nuclear Power Plant (FDNPP). ... ...

Abstract	The Great East Japan Earthquake occurred on 11 March 2011 near the northeast coast of the main island, 'Honshu', of Japan. It wreaked enormous damage in two main ways: a giant tsunami and an accident at the Fukushima Daiichi Nuclear Power Plant (FDNPP). This disaster may have affected the distribution of physicians in the region. Here, we evaluate the effect of the disaster on the distribution of hospital physicians in the three most severely affected prefectures (Iwate, Miyagi, and Fukushima).We obtained individual information about physicians from the Physician Census in 2010 (pre-disaster) and 2012 (post-disaster). We examined geographical distributions of physicians in two ways: (1) municipality-based analysis for demographic evaluation; and (2) hospital-based analysis for geographic evaluation. In each analysis, we calculated the rate of change in physician distributions between pre- and post-disaster years at various distances from the tsunami-affected coast, and from the restricted area due to the FDNPP accident.The change in all, hospital, and clinic physicians were 0.2%, 0.7%, and -0.7%, respectively. In the municipality-based analysis, after taking account of the decreased population, physician numbers only decreased within the restricted area. In the hospital-based analysis, hospital physician numbers did not decrease at any distance from the tsunami-affected coast. In contrast, there was a 3.3% and 2.3% decrease in hospital physicians 0-25 km and 25-50 km from the restricted area surrounding the FDNPP, respectively. Additionally, decreases were larger and increases were smaller in areas close to the FDNPP than in areas further away.Our results suggest that the tsunami did not affect the distribution of physicians in the affected regions. However, the FDNPP accident changed physician distribution in areas close to the power plant.
Keywords	Medicine ; R ; Science ; Q
Subject code	900
Language	English
Publishing date	2017-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Highly Pathogenic Avian Flu, Japan

Kazuo Inoue

Emerging Infectious Diseases, Vol 10, Iss 7, Pp 1327-

2004 Volume 1328

Keywords	Japan ; Medicine ; R ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2004-07-01T00:00:00Z
Publisher	Centers for Disease Control and Prevention
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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