Hainanmurpanin

30828034

Background
The Japanese Ministry of Health, Labour and Welfare introduced Specific Health Checkups (SHC) to identify individuals at risk of metabolic syndrome (MS). This study aimed to describe the SHC database developed by the Japan Medical Data Center Co., Ltd. (JMDC) as a means of exploring lifestyle behaviors and lifestyle diseases among working generations.

Methods
We conducted a retrospective, cross-sectional study of employees and their families using the JMDC-SHC database to describe the prevalence of lifestyle behaviors (smoking, exercise, dietary habits, drinking habits, and sleeping) and lifestyle diseases (MS, hypertension, dyslipidemia, and diabetes mellitus). Results were compared with data from the 2015 National Health and Nutrition Survey (NHNS) in Japan as a benchmark.

Results
All 646,869 enrollees in the JMDC-SHC database were included, of whom 66.5% were men. Age ranged from 40-74 years. Compared with the results of the NHNS, the JMDC-SHC subjects were younger and had fewer MS components and a lower prevalence of diabetes and hypertension. Subjects in their 40s were most likely to have unhealthy lifestyle behaviors in all age groups (eg, smoking: 41.0% in men and 10.2% in women). The SHC group had more favorable behaviors overall, but underweight was more prevalent in the SHC females.

Conclusions
The JMDC-SHC population showed different lifestyle and lifestyle disease profiles to the NHNS population, probably due to its different age, gender, and employment distributions. Development of healthcare policies and plans for working generations would benefit from the selection of an age- and employment-appropriate database.

health checkup, lifestyle behavior, lifestyle disease, national survey, Japan

Utility of a Specific Health Checkup Database Containing Lifestyle Behaviors and Lifestyle Diseases for Employee Health Insurance in Japan

Toshiki Fukasawa,1 Nanae Tanemura,1 Shinya Kimura,2 and Hisashi Urushihara1

2020;

30550643

Background
Therapist‐delivered trauma‐focused psychological therapies are an effective treatment for post‐traumatic stress disorder (PTSD). These have become the accepted first‐line treatments for the disorder. Despite the established evidence‐base for these therapies, they are not always widely available or accessible. Many barriers limit treatment uptake, such as the limited number of qualified therapists to deliver the interventions, cost, and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments. Delivering cognitive behavioural therapy (CBT) on the Internet is an effective and acceptable alternative to therapist‐delivered treatments for anxiety and depression. However, fewer Internet‐based therapies have been developed and evaluated for PTSD, and uncertainty surrounds the efficacy of Internet‐based cognitive and behavioural therapy (I‐C/BT) for PTSD.

Objectives
To assess the effects of I‐C/BT for PTSD in adults.

Search methods
We searched the Cochrane Common Mental Disorders Group’s Specialised Register (CCMDCTR) to June 2016 and identified four studies meeting the inclusion criteria. The CCMDCTR includes relevant randomised controlled trials (RCT) from MEDLINE, Embase, and PsycINFO. We also searched online clinical trial registries and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. We ran an update search on 1 March 2018, and identified four additional completed studies, which we added to the analyses along with two that were previously awaiting classification.

Selection criteria
We searched for RCTs of I‐C/BT compared to face‐to‐face or Internet‐based psychological treatment, psychoeducation, wait list or care as usual. We included studies of adults (aged over 16 years or over), in which at least 70% of the participants met the diagnostic criteria for PTSD, according to the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD).

Data collection and analysis
We entered data into Review Manager 5 software. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data with a fixed‐effect meta‐analysis, except where heterogeneity was present, in which case we used a random‐effects model. Two review authors independently assessed the included studies for risk of bias; any conflicts were discussed with a third author, with the aim of reaching a unanimous decision.

Main results
We included 10 studies with 720 participants in the review. Eight of the studies compared I‐C/BT delivered with therapist guidance to a wait list control. Two studies compared guided I‐C/BT with I‐non‐C/BT. There was considerable heterogeneity among the included studies.

Very low‐quality evidence showed that, compared with wait list, I‐C/BT may be associated with a clinically important reduction in PTSD post‐treatment (SMD -0.60, 95% CI -0.97 to -0.24; studies = 8, participants = 560). However, there was no evidence of a difference in PTSD symptoms when follow‐up was less than six months (SMD -0.43, 95% CI -1.41 to 0.56; studies = 3, participants = 146). There may be little or no difference in dropout rates between the I‐C/BT and wait list groups (RR 1.39, 95% CI 1.03 to 1.88; studies = 8, participants = 585; low‐quality evidence). I‐C/BT was no more effective than wait list at reducing the risk of a diagnosis of PTSD after treatment (RR 0.53, 95% CI 0.28 to 1.00; studies = 1, participants = 62; very low‐quality evidence). I‐C/BT may be associated with a clinically important reduction in symptoms of depression both post‐treatment (SMD -0.61, 95% CI -1.17 to -0.05; studies = 5, participants = 425; very low‐quality evidence). Very low‐quality evidence also suggested that I‐C/BT may be associated with a clinically important reduction in symptoms of anxiety post‐treatment (SMD -0.67, 95% CI -0.98 to -0.36; studies = 4, participants = 305), and at follow‐up less than six months (MD -12.59, 95% CI -20.74 to -4.44; studies = 1, participants = 42; very low‐quality evidence). The effects of I‐C/BT on quality of life were uncertain (SMD 0.60, 95% CI 0.08 to 1.12; studies = 2, participants = 221; very low‐quality evidence).

Two studies found no difference in PTSD symptoms between the I‐C/BT and I‐non‐C/BT groups when measured post‐treatment (SMD -0.08, 95% CI -0.52 to 0.35; studies = 2, participants = 82; very low‐quality evidence), or when follow‐up was less than six months (SMD 0.08, 95% CI -0.41 to 0.57; studies = 2, participants = 65; very low‐quality evidence). However, those who received I‐C/BT reported their PTSD symptoms were better at six‐ to 12‐month follow‐up (MD -8.83, 95% CI -17.32 to -0.34; studies = 1, participants = 18; very low‐quality evidence). Two studies found no difference in depressive symptoms between the I‐C/BT and I‐non‐C/BT groups when measured post‐treatment (SMD -0.12, 95% CI -0.78 to 0.54; studies = 2, participants = 84; very low‐quality evidence) or when follow‐up was less than six months (SMD 0.20, 95% CI -0.31 to 0.71; studies = 2, participants = 61; very low‐quality evidence). However, those who received I‐C/BT reported their depressive symptoms were better at six‐ to 12‐month follow‐up (MD -8.34, 95% CI -15.83 to -0.85; studies = 1, participants = 18; very low‐quality evidence). Two studies found no difference in symptoms of anxiety between the I‐C/BT and I‐non‐C/BT groups when measured post‐treatment (SMD 0.08, 95% CI -0.78 to 0.95; studies = 2, participants = 74; very low‐quality evidence) or when follow‐up was less than six months (SMD -0.16, 95% CI -0.67 to 0.35; studies = 2, participants = 60; very low‐quality evidence). However, those who received I‐C/BT reported their symptoms of anxiety were better at six‐ to 12‐month follow‐up (MD -8.05, 95% CI -15.20 to -0.90; studies = 1, participants = 18; very low‐quality evidence).

None of the included studies reported on cost‐effectiveness or adverse events.

Authors’ conclusions
While the review found some beneficial effects of I‐C/BT for PTSD, the quality of the evidence was very low due to the small number of included trials. Further work is required to: establish non‐inferiority to current first‐line interventions, explore mechanisms of change, establish optimal levels of guidance, explore cost‐effectiveness, measure adverse events, and determine predictors of efficacy and dropout

Adult, Humans, Anxiety, Anxiety/diagnosis, Anxiety/therapy, Behavior Therapy, Behavior Therapy/statistics & numerical data, Cognitive Behavioral Therapy, Depression, Depression/diagnosis, Depression/therapy, Patient Dropouts, Patient Dropouts/statistics & numerical data, Randomized Controlled Trials as Topic, Severity of Illness Index, Stress Disorders, Post‐Traumatic, Stress Disorders, Post‐Traumatic/diagnosis, Stress Disorders, Post‐Traumatic/psychology, Stress Disorders, Post‐Traumatic/therapy, Waiting Lists

Internet‐based cognitive and behavioural therapies for post‐traumatic stress disorder (PTSD) in adults

Catrin Lewis,corresponding author Neil P Roberts, Andrew Bethell, Lindsay Robertson, and Jonathan I Bisson

2018 Dec