Long-Term Follow-up Study of Hospitalizations for Acute Coronary Syndrome in Kobe-City and Other Districts Under the Hyogo Smoking Ban Legislation　- A Nationwide Database Study.

BACKGROUND: Hyogo Prefecture has managed smoking ban legislation with partial restrictions in public places (Hyogo-L) since 2013. Previous studies have reported a significant decrease in admissions for acute coronary syndrome (ACS) in Kobe-city, but not in other districts of Hyogo Prefecture in the 2 years after Hyogo-L. The aim of the present study was to define the long-term effect of Hyogo-L.Methods and Results: The JROAD-DPC dataset was used to collect information on the number of hospitalizations for ACS in Hyogo Prefecture, and in Osaka-city without smoking ban legislation, from April 2013 to March 2020. Poisson regression analysis was performed to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). ACS records of 3,101 in Kobe-city, 11,375 in areas of Hyogo Prefecture other than Kobe-city and 11,079 in Osaka-city were collected for admissions. The incidence of ACS reduced significantly over time in Kobe-city [IRR (95% CI); 0.96 (0.94-0.97)], but did not reduce in the others. The decrease in Kobe-city was observed in ACS patients without smoking, hypertension, and hyperlipidemia, but not in those with such risk factors. CONCLUSIONS: The long-term ACS reduction or non-reduction under Hyogo-L was determined at the initial period and the same scenario continued, supporting the importance of legislation and compliance with the smoking ban. The lowering effect was remarkable in ACS patients without risk factors such as non-smoking.

Effectiveness of a smoking cessation educational program for Japanese nurses on subsequent changes of behavior in delivering smoking cessation counseling.

INTRODUCTION: Despite the effectiveness of smoking cessation counseling, participation of nurses in delivering smoking cessation advice has been far from satisfactory in practice. Training nurses is considered to be important for increasing self-efficacy and skills for routine delivery of smoking cessation counseling. The aim of the present study was to evaluate the effectiveness of a smoking cessation educational program for Japanese nurses on subsequent changes of their behavior in delivering smoking cessation counseling, three months later. METHODS: We ran a 6-hour smoking cessation educational program for nurses recruited from the Nursing Associations of 13 prefectures in Japan between May 2019 and February 2020. Surveys were conducted by questionnaire before the start of the program and 3 months thereafter. The successful implementation of smoking cessation counseling behavior was evaluated according to the 5As of the Clinical Practice Guidelines for Treating Tobacco Use and Dependence (Ask, Advise, Assess, Assist, Arrange). RESULTS: We received 289 responses 3 months after the program finished (response rate 46.0%). At that time, 43% of participants had increased the frequency of 'Ask' and 42.1%, 50%, 39.3%, and 28.6%, respectively, had also increased their frequency of 'Advise', 'Assess', 'Assist', and 'Arrange'. We found that smoking cessation counseling was significantly more frequently delivered after the educational program for those participants who had routinely delivered 'Advise' before the program as measured by increased delivery of 'Assess' and 'Assist' afterwards (OR=2.39; 95% CI: 1.00-5.69, OR=2.54; 95% CI: 1.16-5.60 and OR=3.68; 95% CI: 1.40-9.65, OR=2.77; 95% CI: 1.10-7.01, respectively). CONCLUSIONS: The program successfully increased the frequency of nurses providing smoking cessation advice to patients. Readiness to deliver smoking cessation counseling before the program and continuing self-efficacy after the program are important for changing the behavior of nurses in delivering smoking cessation counseling.

How Self-Efficacy toward, Perceived Importance of, and Beliefs about Smoking Cessation Support Impact-Related Behaviors in Japanese Nursing Professionals.

This study investigated the relationships among Japanese nursing professionals' percetions of the importance of smoking cessation support (SCS), attitude toward SCS, SCS self-efficacy, and SCS behaviors. An anonymous, self-administered questionnaire was administered to 613 nursing professionals (valid response rate: 89.9%) who participated in SCS workshops in Japan between May 2019 and February 2020. The survey measured factors such as SCS behaviors (the 5 As) and attitude toward SCS. Participants responded that they "always" or "usually" performed the 5 As at the following rates: Ask, 65.6%; Advise, 46.7%; Assess, 34.4%; Assist, 19.7%; and Arrange, 20.9%. Significant differences in implementation rates between "non-engagers" and "engagers" were found for all steps except Ask. Those who engaged daily in SCS had significantly higher scores for SCS behaviors and SCS perceived importance, attitude, and self-efficacy than those who did not. Structural equation modeling yielded a model with 61% explanatory power, which demonstrated that beliefs about and perceived importance of SCS had a greater impact on SCS behaviors than self-efficacy. Promotion of SCS behaviors among nursing professionals in Japan requires the beliefs about and recognition of the importance of SCS to be improved. The importance of engaging in SCS daily is also recommended.

[Secondhand smoke exposure in a car].

OBJECTIVE: The Health Promotion Act was revised in 2018 and prohibits smoking inside taxis and buses. However, there is no regulation for smoking in the business vehicles of companies or private cars. This paper examined exposure to secondhand smoke in vehicles with digital dust monitors. MATERIAL AND METHODS: A cigarette was smoked inside of a five-seat car, and particulate matter 2.5 (PM2.5) concentrations were measured at front and rear seats. RESULTS: The concentration of PM2.5 reached 3,400 µg/m3 with all windows closed and decreased to approximately 3,000 µg/m3 when driver's window and passengers' windows were opened by 10 cm. However, the PM2.5 concentration did not decrease to levels below 1,500 µg/m3 with all windows fully opened. DISCUSSION AND CONCLUSION: To prevent exposure to secondhand smoke, smoking should not be allowed inside any vehicle when non-smokers are present.

Estimating the Carcinogenic Potency of Second-Hand Smoke and Aerosol from Cigarettes and Heated Tobacco Products.

The revised Promotion Act, enforced in April 2020, allows the establishment of dedicated smoking rooms for heated tobacco products (HTPs). Since carcinogenicity assessment is unable to determine the safe level of secondhand smoke, we estimated excess lifetime cancer risk using previously reported risk factors. Assuming that nicotine inhalation is proportional to cancer potency, the lifetime cancer risk for HTP IQOS is expected to be below 10-5 (1/100,000), which is three orders of magnitude lower than that for cigarettes.

Exposure Assessment of Environmental Tobacco Aerosol from Heated Tobacco Products: Nicotine and PM Exposures under Two Limited Conditions.

It is too early to provide a clear answer on the impact of exposure to the second-hand aerosol of heated tobacco products (HTPs) in the planning of policy for smoke-free indoors legislation. Here, we conducted a preliminary study to evaluate indoor air quality with the use of HTPs. We first measured the concentration of nicotine and particulate matter (PM2.5) in the air following 50 puffs in the use of HTPs or cigarettes in a small shower cubicle. We then measured these concentrations in comparison with the use equivalent of smoking 5.4 cigarettes per hour in a 25 m3 room, as a typical indoor environment test condition. In the shower cubicle test, nicotine concentrations in indoor air using three types of HTP, namely IQOS, glo, and ploomTECH, were 25.9-257 µg/m3. These values all exceed the upper bound of the range of tolerable concentration without health concerns, namely 3 µg/m3. In particular, the indoor PM2.5 concentration of about 300 to 500 µg/m3 using IQOS or glo in the shower cubicle is hazardous. In the 25 m3 room test, in contrast, nicotine concentrations in indoor air with the three types of HTP did not exceed 3 µg/m3. PM2.5 concentrations were below the standard value of 15 µg/m3 per year for IQOS and ploomTECH, but were slightly high for glo, with some measurements exceeding 100 µg/m3. These results do not negate the inclusion of HTPs within a regulatory framework for indoor tolerable use from exposure to HTP aerosol, unlike cigarette smoke.

Characteristics of Abdominal Aortic Aneurysm in Japanese Patients Aged 50 Years or Younger.

Objective: We investigated the characteristics and surgical outcomes of abdominal aortic aneurysm (AAA), which typically occurs in elderly persons, in Japanese patients aged 50 years or younger. Materials and Methods: Clinical records of 999 patients who underwent open or endovascular repair for AAA at our hospital between 2007 and 2015 were reviewed to identify the clinical characteristics and surgical outcomes of young patients with AAA. The cohort included 14 patients aged 50 years or younger (mean, 40.4 years; young group) and 985 patients aged older than 50 years (mean, 72.8 years; old group). Results: Marfan syndrome, prior aortic dissection, and a history of aortic surgery were more prevalent in the young group, and 50% of the patients in the young group had dissecting aneurysms. All patients in the young group underwent open repair. Overall in-hospital mortality rates were 7.1% (1/14) and 1.9% (19/985) in the young and old groups, respectively (P=0.67). Seven-year survival and aortic event-free survival rates in the young group were 82.5%±11.5%, and 71.2±14.5%, respectively. Conclusion: AAA in patients aged 50 years or younger tended to be associated with Marfan syndrome, a history of aortic surgery, and prior aortic dissection. Early outcomes of AAA among young patients are acceptable, but close postoperative monitoring is important.

Electronic Cigarette Use and Smoking Abstinence in Japan: A Cross-Sectional Study of Quitting Methods.

The benefit of electronic cigarettes (e-cigarettes) in smoking cessation remains controversial. Recently, e-cigarettes have been gaining popularity in Japan, without evidence of efficacy on quitting cigarettes. We conducted an online survey to collect information on tobacco use, difficulties in smoking cessation, socio-demographic factors, and health-related factors in Japan. Among the total participants (n = 9055), 798 eligible persons aged 20-69 years who smoked within the previous five years were analyzed to assess the relationship between the outcome of smoking cessation and quitting methods used, including e-cigarettes, smoking cessation therapy, and unassisted. E-cigarette use was negatively associated with smoking cessation (odds ratio (OR) = 0.632; 95% confidence interval (CI) = 0.414-0.964) after adjusting for gender, age, health-related factors, and other quitting methods. Conversely, smoking cessation therapy (i.e., varenicline) was significantly associated with smoking cessation (OR = 1.885; 95% CI = 1.018-3.492) in the same model. For effective smoking cessation, e-cigarette use appears to have low efficacy among smokers in Japan. Allowing for the fact that this study is limited by its cross-sectional design, follow-up studies are needed to assess the prospective association between e-cigarette use and smoking cessation.

Acute Aortic Dissection Occurring "Behind The Wheel", Report of 11 Cases.

We investigated the clinical picture of non-traumatic acute aortic dissection (AAD) occurring behind the wheel. Between 1990 and 2014, AAD had occurred in 11 patients while driving (nine men, mean age; 58.3 years, seven commercial drivers). The symptoms included chest and/or back pain (n = 9) and syncope (n = 2). One patient with syncope caused a traffic accident. Ten patients had type A dissection (DeBakey type I) and 1 type B dissection. In-hospital mortality was 9.9% (1/11). Our data showed if affected drivers are transported to a hospital in a timely fashion, a good surgical outcome can be expected.

Biodegradation of chlordane and hexachlorobenzenes in river sediment.

Contamination of river sediments by persistent organic pollutants (POPs) is a worldwide concern, and microbial degradation is regarded as an important process for removal of POPs from river sediments. To date, there is still a lack of systematic study on chlordane biodegradation in river sediments, and the information on hexachlorobenzene (HCB) biodegradation in river sediments is very limited in Japan. We investigated the anaerobic biodegradation potential of trans-chlordane (TC), cis-chlordane (CC), and HCB in sediment samples collected at three sites along the Kamogawa River in Saitama Prefecture, Japan. Lag period and biodegradation rates of TC and CC in the three sediments varied greatly with their properties and contamination by TC and CC. In contrast, biodegradation of HCB in all three sediments started immediately with the start of the experiment without lag period, and major differences in biodegradation rates among the sediments were not observed. At the end of 20-week anaerobic incubation in the dark at 30 degrees C temperature, degradation rates ranged from 0.0% to 33.0% for TC, 0.0% to 12.0% for CC, and 47.6% to 59.4% for HCB. Results showed that the high-to-low order of biodegradation in the river sediments was HCB>TC>CC. Although the sediments were collected in the same river, their biodegradation potential varied with properties. Sediment with rich organic content and contamination by TC and CC or HCB was observed to have high biodegradation rates for these pollutants. In addition, biodegradation of TC, CC and HCB was companied by obvious methane generation and drop of oxidation-reduction potential (ORP).

Epicardial radiofrequency ablation for chronic atrial fibrillation undergoing simultaneous on-pump beating coronary artery bypass grafting.

Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocardial revascularization because of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass.