We investigated the relationship between urinary 8-hydroxydeoxyguanosine (8-OH-dG), a marker of oxidative DNA damage, and various lifestyle-related diseases. The subjects were 361 local government employees in Japan. We used a self-reported questionnaire and analyzed data from 280 subjects, concerning gender, body mass index, drinking and cigarette smoking status, and exercise frequency along with the data of physical examinations such as biochemical blood and urine tests accompanied by medical check-up results. Urine specimens were collected to measure 8-OH-dG and creatinine levels. The creatinine-adjusted urinary 8-OH-dG level was used as the indicator of 8-OH-dG excretion. The urinary 8-OH-dG levels were significantly higher in cigarette smokers than in non-smokers, and were significantly higher in subjects in their 50’s than those in their 30’s. No significant relationships were observed between urinary 8-OH-dG level and each lifestyle-related disease, such as obesity, hypertension, dyslipidemia, impaired glucose tolerance, impaired liver function, and hyperuricemia. This study suggested that the urinary 8-OH-dG level was increased in high-age group or by the cigarette smoking, but these lifestyle-related diseases might not affect urinary 8-OH-dG excretion.

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The objective was to assess the mental health of the participants using psychological and biological indicators in a health promotion program. We conducted the individual program without any face-to-face communications among instructors and participants. The program offered Physical Activity (PA) data and exercise guidance to subjects, using digital devices. We quantified the amount and intensity of daily PA with a uniaxial accelerometer. Activities are categorized into eleven activity levels (0, 0.5, 1.0–9.0). Two batteries of psychosocial questionnaires and measurements of free-3-methoxy-4-hydroxyphenylglycol (MHPG) in saliva were completed before and after the program. The program showed no significant changes of mean values of all subjects in the Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ) scores, and the amounts of MHPG, either. A positive correlation was observed between the increases in the PA and the reductions in the BDI score. Furthermore, the BDI reductions correlated positively with the increased time spent in the PA at light and moderate activity levels. The MHPG increases demonstrated a significant relationship with the decreases of time spent in the PA at the activity level of sleep or non-activity. The different properties of MHPG as an index of mental health were compared with psychological questionnaires. This pilot study suggested that monitoring not only the total amounts of PA but also the intensity and duration of activities might be important to offer adequate guidance of mental health to individuals. Further research is needed to evaluate the impact of PA on mental health.

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As the Japanese health services are provided under the different scheme, it is relatively difficult to analyze the data by an integrated way. In order to ameliorate this situation, we have developed a model system for integrated analysis of health insurance claim, the long term care insurance claim and the disease management data. We used the National Health Insurance claim data (medical services and pharmaceuticals), the LTCI claim data and the lab-data of disease management program of a local town of Fukuoka prefecture. The data is one month’s data September 2009. We have developed a SQL program to combine above mentioned data by the individual client basis. Using a set of combined data, we have examined total expenditures stratified by age category, diagnosis, and existence of obesity. There are several interesting results obtained. Female dominantly used the LTCI services after 70 yr old but male always used health insurance covered services compared with those covered by the LTCI scheme. For the health insurance expenditures, neurological disorders were important for female and the respiratory disorders and the disorder of digestive system, hepato-billiary system and pancreas were dominant for male. The present study clarified the usefulness of integrated evaluating system of claim data. However there are some problems to be solved; creation of unique ID, coding of multiple diagnosis, and enrolment of nationally defined format of each claim.

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Japan faces to the rapid ageing. This ageing process accompanies with the increase of patients with chronic diseases. Under the highly aged society where most of the aged patients have multiple health and social problems, an integrated service delivery system is required. Primary care has long been regarded as indispensable in order to realize such an appropriate health service delivery system. The new Japanese health promotion program that has been implemented since 2008, offers an important opportunity for the development of primary care based chronic disease management (CDM) scheme, as this program requires for different service providers to work together. The electronic health record (EHR) that is used for the new health promotion program can be developed for the regional common EHR in future. Unfortunately, the new health promotion program has not been expanded as expected at the moment. The market seems to be rapidly shrinking. Considering the importance of establishing the primary care system for future highly aged society, the local medical association that is the key organization of primary care, is expected to actively participate the implementation of new health promotion program and then to establish a primary care based CDM system.

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