Sex differences in the association between socioeconomic status and untreated hypertension among residents with hypertension in rural Khánh Hòa, Vietnam: a post-hoc analysis.

BACKGROUND: Several studies have examined the association between socioeconomic status (SES) and the proportion of untreated hypertension, but have produced conflicting findings. In addition, no study has been conducted to determine sex differences in the association between SES and untreated hypertension. Thus, the aim of this study was to examine whether the associations between SES and the proportion of untreated hypertension differed by sex in Vietnam. METHODS: This study was conducted using the data of 1189 individuals (558 males and 631 females) who were judged to have hypertension during the baseline survey of a prospective cohort study of 3000 residents aged 40-60 years in the Khánh Hòa Province. A multilevel Poisson regression model with a robust variance estimator was used to examine whether sex and SES indicators (household income and educational attainment) interacted in relation to untreated hypertension. RESULTS: The proportion of untreated hypertension among individuals identified as hypertensive was 69.1%. We found significant interaction between sex and SES indicators in relation to untreated hypertension (education: p < 0.001; household income: p < 0.001). Specifically, the association between SES and untreated hypertension was inverse among males while it was rather positive among females. CONCLUSIONS: Our finding suggests that the role of SES in the proportion of untreated hypertension might differ by sex.

Identifying distinct subtypes of mother-to-infant bonding using latent profile analysis in a nationwide Japanese study.

BACKGROUND: Mother-to-infant bonding (MIB) is foundational for nurturing behaviors and an infant's development. Identifying risk factors for difficulties or problems in MIB is vital. However, traditional research often dichotomizes MIB using cutoff thresholds, overlooking its underlying complexities. This research utilizes latent profile analysis (LPA) to discern MIB subtypes in a nationwide Japanese dataset. METHODS: We conducted LPA on data from the Mother-to-Infant Bonding Scale (MIBS), collected from 3,877 postpartum women within one year of childbirth. To empirically validate the derived profiles, we examined their associated risk factors, focusing on sociodemographic, health, and perinatal variables. RESULTS: Four distinct MIB profiles emerged. Profile 1 indicated minimal difficulties, while Profile 4 exhibited severe multifaceted difficulties. Profiles 2 and 3 showed moderate difficulties distinguished by lack of positive affection and presence of negative affection (especially indifference), respectively. Compared to Profile 1, women in Profiles 2-4 had a higher likelihood of postpartum depression and low family support. Each profile also presented unique risk factors: medium family support in Profile 2, maternal working status in Profile 3, and pre-pregnancy underweight status in Profile 4. Notably, both Profiles 3 and 4 were also linked to increased feelings of loneliness since the onset of the COVID-19 pandemic. CONCLUSION: This study represents the first application of LPA to MIB, revealing distinct subtypes and their respective risk profiles. These insights promise to enhance and personalize early interventions for difficulties in MIB, affirming the necessity of acknowledging MIB's heterogeneity.

Postpartum loneliness predicts future depressive symptoms: a nationwide Japanese longitudinal study.

PURPOSE: The COVID-19 pandemic has intensified feelings of loneliness, especially among postpartum women. This nationwide Japanese longitudinal study assessed the impact of such feelings on depressive symptoms and mother-to-infant bonding difficulties (MIBD), two pivotal determinants of maternal and infant well-being. METHODS: Starting with a baseline survey conducted between July and August 2021, we tracked 1254 postpartum Japanese women who initially reported minimal depressive symptoms (i.e., Edinburgh Postnatal Depression Scale < 9) and MIBD (i.e., Mother-to-Infant Bonding Scale < 5), over a follow-up period of approximately 6 months. Baseline loneliness was evaluated with the UCLA Loneliness Scale Short-Form (UCLA-LS3-SF3). RESULTS: Forty-nine percent of the sample reported the presence of baseline feelings of loneliness. After propensity score matching on sociodemographics and various pregnancy, childbirth, and COVID-19-related aspects, baseline loneliness was associated with increased risks of later depressive symptoms but not MIBD. Using restricted cubic spline logistic regression and considering loneliness as a continuous variable, we found a positive increasing quadratic relationship with depressive symptoms. As loneliness increased, so did the risk of later depressive symptoms. However, there was no significant association between loneliness and MIBD. These results were confirmed through a sensitivity analysis using inverse probability weighting to address attrition bias. CONCLUSION: Feelings of postpartum loneliness are associated with future risks of depressive symptoms. The data suggests that addressing loneliness in postpartum women early is crucial to safeguarding their well-being and that of their infants.

Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: a randomized controlled trial.

BACKGROUND: Maintaining oral health is essential for improving overall health of children living with HIV. Therefore, we evaluated the effectiveness of an oral health intervention for improving their oral and overall health. In addition, we examined their longitudinal association between changes in oral and overall health. METHODS: We conducted a 2-year randomized controlled trial involving children living with HIV in Cambodia. Children aged 3-15 years and their caregivers were randomly allocated either to the intervention (group A) or control (group B) arm. A second control arm (group C) included children without HIV. The group A children received oral health education sessions and practiced home-based daily care. RESULTS: In the baseline survey, 482 children participated (group A: n = 160, group B: n = 168, group C: n = 154), and 350 completed the endline survey. An interaction effect in teeth brushing duration was observed in children in group A relative to group B (AOR = 2.69, 95% CI: 1.37-5.31) and group C (AOR = 3.78, 95% CI: 1.70-8.40). Longitudinal associations were observed between changes in oral hygiene and overall health, as presented by alterations in dental caries in permanent teeth with viral load detection (adjusted odds ratio = 3.58, 95% CI: 1.10 - 11.73), in salivary flow quantity with the overall quality of life (ß = 0.07, 95% CI: < 0.01 - 0.13), as well as in dental caries, salivary pH, debris index with body mass index for age among group A children. CONCLUSIONS: Oral health intervention may improve oral care behaviors and potentially enhance overall health among children living with HIV in antiretroviral therapy in a resource-constrained setting. TRIAL REGISTRATION: ISRCTN 15177479.

Maternal heated tobacco product use during pregnancy and allergy in offspring.

BACKGROUND: Little is known about the association between maternal use of heated tobacco products (HTPs) during pregnancy and the onset of allergy among offspring. This study aimed to determine whether maternal HTP smoking is associated with allergy in their offspring and to evaluate the potential dose-response association. METHODS: In this web-based, cross-sectional survey conducted in July and August 2021 in Japan, we investigated 5688 pairs of postpartum women and infants (<3 years). Clinical diagnoses of infant asthma, rhinitis, conjunctivitis, or atopic dermatitis were reported. Using multilevel Poisson regression, we estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs) of allergy in infants with HTP smoking categories cross-classified by pregnancy periods, and adjusted for potential covariates including maternal cigarette smoking and partner's smoking status. Non-smokers served as the reference group. RESULTS: In total, 2.4% women smoked HTPs during pregnancy. Allergy occurred in 7.8% of the infants. The prevalence of allergy increased among the offspring of current HTP smokers during pregnancy at 15.2% (PR = 1.98, 95% CI 1.28-3.05); this association was the most pronounced during the first trimester but attenuated before pregnancy and postpartum. Dose-response associations were observed, for example a one-unit increase in daily maternal HTP use during pregnancy was associated with a 5% increase in allergy onset. Sub-group analyses excluding cigarette smokers during pregnancy and sensitivity analyses using the International Study of Asthma and Allergies in Childhood questionnaire showed a similar pattern. CONCLUSIONS: Maternal HTP smoking during pregnancy is associated with allergy in the offspring.

Surgical volume threshold to improve 3-year survival in designated cancer care hospitals in 2004-2012 in Japan.

In Japan, cancer care hospitals designated by the national government have a surgical volume requirement of 400 annually, which is not necessarily defined based on patient outcomes. This study aimed to estimate surgical volume thresholds that ensure optimal 3-year survival for three periods. In total, 186 965 patients who had undergone surgery for solid cancers in 66 designated cancer care hospitals in Osaka between 2004 and 2012 were examined using data from a population-based cancer registry. These hospitals were categorized by the annual surgical volume of each 50 surgeries (eg, 0-49, 50-99, and so on). Using multivariable Cox proportional hazard regression, we estimated the adjusted 3-year survival probability per surgical volume category for 2004-2006, 2007-2009, and 2010-2012. Using the joinpoint regression model that computes inflection points in a linear relationship, we estimated the points at which the trend of the association between surgical volume and survival probability changes, defining them as surgical volume thresholds. The adjusted 3-year survival ranges were 71.7%-90.0%, 68.2%-90.0%, and 79.2%-90.3% in 2004-2006, 2007-2009, and 2010-2012, respectively. The surgical volume thresholds were identified at 100-149 in 2004-2006 and 2007-2009 and 200-249 in 2010-2012. The extents of change in the adjusted 3-year survival probability per increase of 50 surgical volumes were +4.00%, +6.88%, and +1.79% points until the threshold and +0.41%, +0.30%, and +0.11% points after the threshold in 2004-2006, 2007-2009, and 2010-2012, respectively. The existing surgical volume requirements met our estimated thresholds. Surgical volume thresholds based on the association with patient survival may be used as a reference to validate the surgical volume requirement.

Secondhand Aerosol Exposure From Heated Tobacco Products and Its Socioeconomic Inequalities in Japan: The JASTIS Study 2017-2020.

INTRODUCTION: The growing use of heated tobacco products (HTPs) has raised concerns about secondhand aerosol (SHA) from HTPs, but few studies have been reported on it. This study aimed to investigate the trends in SHA exposure and their socioeconomic inequalities in Japan. METHODS: The prevalence of SHA exposure from 2017 to 2020 was estimated using longitudinal internet survey data of 5221 participants, aged 20-69 years in 2017 (baseline), with adjustments using inverse probability weighting for "being a participant in an internet survey". Multivariable modified Poisson regression models were applied to examine the association between socioeconomic status (ie, educational attainment and equivalent income) at baseline and SHA exposure in 2020 with adjustments for sex and age. RESULTS: The estimated prevalence of SHA exposure has consistently increased from 4.5% in 2017 to 10.8% in 2020. Lower educational attainment was associated with a higher risk of SHA exposure (p for trend = 0.010). The covariate-adjusted risks of SHA exposure in participants with a low-education and middle-education level were 1.57 and 1.34 times higher, respectively, than in those with a high-education level. However, significant differences in risks of SHA exposure between participants with low-, middle-, and high-income levels were not observed. Meanwhile, participants with a low-education and middle-education level also had 1.87 and 1.61 times higher risks of secondhand smoke (SHS) exposure from combustible cigarettes than those with a high-education level, respectively. CONCLUSIONS: Our study revealed a rapid increase in SHA exposure and the existence of educational inequalities in both SHA and SHS exposure. IMPLICATIONS: Using longitudinal internet cohort survey data, we found that the prevalence of exposure to secondhand aerosol (SHA) from heated tobacco products (HTPs) rapidly increased to 10.8% in 2020 in Japan. Furthermore, people with lower educational attainment were at higher risk of SHA exposure, suggesting that extensive educational interventions may be necessary to inform the public that although emissions from HTPs contain significantly lesser amounts of harmful and potentially harmful constituents and these compounds than cigarette smoke, they are not harmless and still entail risks, and its long-term effects are unknown. Therefore, future extensive monitoring of SHA exposure is needed.

The Prevalence of COVID-19 Vaccination and Vaccine Hesitancy in Pregnant Women: An Internet-based Cross-sectional Study in Japan.

BACKGROUND: Reluctance of people to receive recommended vaccines is a growing concern, as distribution of vaccines is considered critical to ending the COVID-19 pandemic. There is little information regarding pregnant women's views toward coronavirus vaccination in Japan. Therefore, we investigated the vaccination rate and reasons for vaccination and vaccine hesitancy among pregnant women in Japan. METHODS: We conducted a cross-sectional study involving 1,791 pregnant women using data from the Japan "COVID-19 and Society" Internet Survey, conducted from July to August 2021, and valid response from 1,621 respondents were analyzed. We defined participants with vaccine hesitancy as those who identified with the statement "I do not want to be vaccinated" or "I want to 'wait and see' before getting vaccinated." Multivariate Poisson regression analysis was used to investigate the factors contributing to vaccine hesitancy. RESULTS: The prevalence of vaccination and vaccine hesitancy among pregnant women was 13.4% (n = 217) and 50.9% (n = 825), respectively. The main reasons for hesitancy were concerns about adverse reactions and negative effects on the fetus and breastfeeding. Vaccine hesitancy was significantly associated with the lack of trust in the government (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.03-1.54). Other factors, such as age, educational attainment, and state of emergency declaration, were not associated with vaccine hesitancy. CONCLUSIONS: COVID-19 vaccination is not widespread among pregnant women in Japan, although many vaccines have been shown to be safe in pregnancy. Accurate information dissemination and boosting trust in the government may be important to address vaccine hesitancy among pregnant women.

Nicotine dependence of cigarette and heated tobacco users in Japan, 2019: a cross-sectional analysis of the JASTIS Study.

OBJECTIVES: Japan is currently the biggest market of heated tobacco products (HTPs) in the world. Little is known about nicotine dependence among HTP users. Thus, the objective was to assess the association of type of tobacco use and time-to-first-use, a marker of nicotine dependence. METHODS: A cross-sectional analysis of the 2019 data from an internet cohort study was conducted. The analytical sample consisted of 2147 current (≥1 day use in the past 30 days) HTP and/or conventional cigarette users, aged 25+ years. Marginal structural binomial regression was used to estimate nicotine dependence prevalence ratios (PRs) for each category of tobacco use (exclusive daily cigarette, exclusive HTP (≥1 day), dual HTP+daily cigarette, dual HTP+non-daily cigarette), relative to exclusive, non-daily cigarette smoking. RESULTS: Using a 5 min cut-off for time-to-first-use, the prevalence of nicotine dependence was higher among dual users of HTP and daily cigarettes (PR=1.38; 95% CI: 1.05 to 1.82) and exclusive, daily cigarette users (PR=1.48; 95% CI: 1.15 to 1.91), relative to exclusive, non-daily cigarette users. However, nicotine dependence among exclusive HTP users, and dual HTP+non-daily cigarette users, did not differ from that of exclusive, non-daily cigarette users. When using 15 and 30 min cut-offs, all types of users, including exclusive HTP, had higher levels of nicotine dependence relative to exclusive, non-daily cigarette users. CONCLUSIONS: Regardless of HTP use, daily cigarette users had higher prevalence of nicotine dependence compared with non-daily cigarette users. Exclusive HTP users had similar (or potentially higher) dependence compared with exclusive, non-daily cigarette users. Longitudinal studies are needed to interrogate the public health implications of growing HTP use worldwide.

Threatened abortion, threatened premature labor, and preterm birth during the first state of emergency for COVID-19 in 2020 in Japan.

AIM: This study examined the maternal experience of threatened abortion, threatened premature labor, or preterm birth before, during, and after the first state of emergency for COVID-19 in 2020 in Japan. METHODS: This was a cross-sectional, internet-based questionnaire survey. We recruited 600 postpartum women and divided them into three groups by date of delivery: before (October 2019-March 2020), during (April-May 2020), and after (June-October 2020) the first state of emergency. The outcome was the presence of at least one of the following complications: threatened abortion, threatened premature labor, and/or preterm birth. The prevalence ratios (PRs) of the outcome were calculated and compared among the three groups using a multivariable Poisson regression model with adjustment for potential confounders. RESULTS: Of the 553 women eligible for analysis, those who delivered during (PR 0.69, 95% confidence interval [CI] 0.47-0.99) and after (PR 0.62, 95% CI 0.42-0.90) the state of emergency were less likely to have experienced either threatened abortion, threatened premature labor, or preterm birth than those who delivered before the state of emergency. Among the adjustment variables, smoking at the time of survey (PR 1.68, 95% CI 1.01-2.80) and living in the prefectures with a population of >5 million (PR 0.71, 95% CI 0.51-0.97) were associated with the study outcome. CONCLUSION: Threatened abortion, threatened premature labor, or preterm birth appeared to decrease during and after the first state of emergency in 2020. The longitudinal effects of coronavirus disease on maternal and newborn health should be monitored continuously.

Evaluation of a package of continuum of care interventions for improved maternal, newborn, and child health outcomes and service coverage in Ghana: A cluster-randomized trial.

BACKGROUND: In low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal, newborn, and child health (MNCH) is not always complete. This study aimed to evaluate the effectiveness of an integrated package of CoC interventions on the CoC completion, morbidity, and mortality outcomes of woman-child pairs in Ghana. METHODS AND FINDINGS: This cluster-randomized controlled trial (ISRCTN: 90618993) was conducted at 3 Health and Demographic Surveillance System (HDSS) sites in Ghana. The primary outcome was CoC completion by a woman-child pair, defined as receiving antenatal care (ANC) 4 times or more, delivery assistance from a skilled birth attendant (SBA), and postnatal care (PNC) 3 times or more. Other outcomes were the morbidity and mortality of women and children. Women received a package of interventions and routine services at health facilities (October 2014 to December 2015). The package comprised providing a CoC card for women, CoC orientation for health workers, and offering women with 24-hour stay at a health facility or a home visit within 48 hours after delivery. In the control arm, women received routine services only. Eligibility criteria were as follows: women who gave birth or had a stillbirth from September 1, 2012 to September 30, 2014 (before the trial period), from October 1, 2014 to December 31, 2015 (during the trial period), or from January 1, 2016 to December 31, 2016 (after the trial period). Health service and morbidity outcomes were assessed before and during the trial periods through face-to-face interviews. Mortality was assessed using demographic surveillance data for the 3 periods above. Mixed-effects logistic regression models were used to evaluate the effectiveness as difference in differences (DiD). For health service and morbidity outcomes, 2,970 woman-child pairs were assessed: 1,480 from the baseline survey and 1,490 from the follow-up survey. Additionally, 33,819 cases were assessed for perinatal mortality, 33,322 for neonatal mortality, and 39,205 for maternal mortality. The intervention arm had higher proportions of completed CoC (410/870 [47.1%]) than the control arm (246/620 [39.7%]; adjusted odds ratio [AOR] for DiD = 1.77; 95% confidence interval [CI]: 1.08 to 2.92; p = 0.024). Maternal complications that required hospitalization during pregnancy were lower in the intervention (95/870 [10.9%]) than in the control arm (83/620 [13.4%]) (AOR for DiD = 0.49; 95% CI: 0.29 to 0.83; p = 0.008). Maternal mortality was 8/6,163 live births (intervention arm) and 4/4,068 live births during the trial period (AOR for DiD = 1.60; 95% CI: 0.40 to 6.34; p = 0.507) and 1/4,626 (intervention arm) and 9/3,937 (control arm) after the trial period (AOR for DiD = 0.11; 95% CI: 0.11 to 1.00; p = 0.050). Perinatal and neonatal mortality was not significantly reduced. As this study was conducted in a real-world setting, possible limitations included differences in the type and scale of health facilities and the size of subdistricts, contamination for intervention effectiveness due to the geographic proximity of the arms, and insufficient number of cases for the mortality assessment. CONCLUSIONS: This study found that an integrated package of CoC interventions increased CoC completion and decreased maternal complications requiring hospitalization during pregnancy and maternal mortality after the trial period. It did not find evidence of reduced perinatal and neonatal mortality. TRIAL REGISTRATION: The study protocol was registered in the International Standard Randomised Controlled Trial Number Registry (90618993).

Three-year survival from diagnosis in surgically treated patients in designated and nondesignated cancer care hospitals in Japan.

The Japanese national and prefectural governments have accredited high-capacity, high-experience cancer care hospitals as "designated cancer care hospitals" to standardize cancer care, centralize patients, and improve clinical outcomes, but the performance of these designated hospitals has not been evaluated. We retrospectively compared 3-year patient survival in national, prefectural, and nondesignated cancer care hospitals in 2010-2012 in Osaka using registry-based data of 86 456 surgically treated cancer patients aged 15 years or older. Hazard ratios and 3-year survival probabilities were compared among national, prefectural, and nondesignated hospitals using a Cox proportional hazard regression model. Subgroup analyses for six cancers (stomach, colorectum, lung, breast, uterus, and prostate) and other cancers were carried out. In 2010-2012, 36 634 (42.4%), 38 048 (44.0%), and 11 774 (13.6%) patients were treated at national, prefectural, and nondesignated hospitals, respectively. The mortality hazard for all-site cancer was significantly lower in national and prefectural designated hospitals (adjusted hazard ratio 0.60 [95% confidence interval, 0.53-0.68] and 0.72 [0.66-0.80], respectively) than in nondesignated hospitals. The adjusted 3-year survival probabilities for all-site cancer were 86.6%, 84.2%, and 78.8% in national, prefectural, and nondesignated hospitals, respectively. Site-specific subgroup analyses revealed significantly lower hazard ratios in national and prefectural hospitals than in nondesignated hospitals for stomach, colorectal, lung, breast, and other cancers. To conclude, the majority of cancer patients underwent surgeries at designated hospitals and had higher 3-year survival probabilities than those treated at nondesignated hospitals. Further centralization of patients from nondesignated to designated hospitals could improve population-level survival.

Trends in survival of leukemia among children, adolescents, and young adults: A population-based study in Osaka, Japan.

This study focused on children as well as adolescents and young adults (AYAs) and aimed to examine trends in survival of leukemia over time using population-based cancer registry data from Osaka, Japan. The study subjects comprised 2254 children (0-14 years) and 2,905 AYAs (15-39 years) who were diagnosed with leukemia during 1975-2011. Leukemia was divided into four types: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and other leukemias. We analyzed 5-year overall survival probability (5y-OS), using the Kaplan-Meier method and expressed time trends using the joinpoint regression model. For recently diagnosed (2006-2011) patients, a Cox proportional hazards model was applied to determine predictors of 5y-OS, using age group, gender, and treatment hospital as covariates. Over the 37-year period, 5y-OS greatly improved among both children and AYAs, for each leukemia type. Among AYAs, 5y-OS of ALL improved, especially after 2000 (65% in 2006-2011), when the pediatric regimen was introduced but was still lower than that among children (87% in 2006-2011, P < .001). Survival improvement was most remarkable in CML, and its 5y-OS was over 90% among both children and AYAs after the introduction of molecularly targeted therapy with tyrosine kinase inhibitors. Among patients with recently diagnosed AML, the risk of death was significantly higher for patients treated at nondesignated hospitals than those treated at designated cancer care hospitals. The changes in survival improvement coincided with the introduction of treatment regimens or molecularly targeted therapies. Patient centralization might be one option which would improve survival.

Prognostic Effect of Incidental Pulmonary Embolism on Long-Term Mortality in Cancer Patients.

BACKGROUND: The effect of incidental pulmonary embolism (PE) on long-term prognosis in cancer patients is unclear. This study assessed the characteristics of cancer and venous thromboembolism (VTE) and the effect of incidental PE identified by oncologists on long-term survival of patients with cancer.Methods and Results:This single-center, retrospective, cohort study used hospital-based cancer registry data from the Osaka International Cancer Institute linked with electronic medical records and administrative data from Japan's Diagnosis Procedure Combination Per-diem Payment System. Overall, 15,689 cancer patients underwent contrast-enhanced thoracic computed tomography during 2010-2018. After excluding patients with missing data, symptomatic patients, or patients with suspected PE, 174 with incidental PE (PE+ group) and 13,197 with no PE (PE- group) were identified. The total incidence of incidental PE was 1.3%. No deaths from thrombotic events were identified in the PE+ group. Both groups were adjusted for cancer- and VTE-related characteristics using inverse probability weighting. After adjusting for immortal time bias in the PE+ group, Kaplan-Meier analysis revealed that all-cause mortality was higher in the PE+ group (hazard ratio, 2.26; 95% confidence interval, 1.53-3.33). A Cox proportional hazard model revealed that metastatic cancer and a history of curative treatment were significant prognostic factors, whereas central PE and residual proximal deep vein thrombosis were not. CONCLUSIONS: Incidental PE in cancer patients indicates poorer prognosis. Cancer-related but not thrombosis-related factors determine prognosis.

Multicentre cohort study of the impact of percutaneous coronary intervention on patients with concurrent cancer and ischaemic heart disease.

BACKGROUND: The incidence of concurrent cancer and ischaemic heart disease (IHD) is increasing; however, the long-term patient prognoses remain unclear. METHODS: Five-year all-cause mortality data pertaining to patients in the Osaka Cancer Registry, who were diagnosed with colorectal, lung, prostate, and gastric cancers between 2010 and 2015, were retrieved and analysed together with linked patient administrative data. Patient characteristics (cancer type, stage, and treatment; coronary risk factors; medications; and time from cancer diagnosis to index admission for percutaneous coronary intervention [PCI] or IHD diagnosis) were adjusted for propensity score matching. Three groups were identified: patients who underwent PCI within 3 years of cancer diagnosis (n = 564, PCI + group), patients diagnosed with IHD within 3 years of cancer diagnosis who did not undergo PCI (n = 3058, PCI-/IHD + group), and patients without IHD (n = 27,392, PCI-/IHD- group). Kaplan-Meier analysis was used for comparisons. RESULTS: After propensity score matching, the PCI + group had better prognosis (n = 489 in both groups, hazard ratio 0.64, 95% confidence interval 0.51-0.81, P < 0.001) than the PCI-/IHD + group. PCI + patients (n = 282) had significantly higher mortality than those without IHD (n = 280 in each group, hazard ratio 2.88, 95% confidence interval 1.90-4.38, P < 0.001). CONCLUSIONS: PCI might improve the long-term prognosis in cancer patients with IHD. However, these patients could have significantly worse long-term prognosis than cancer patients without IHD. Since the present study has some limitations, further research will be needed on this important topic in cardio-oncology.

Hospital volume and 5-year survival in head and neck cancer patients in Osaka, Japan.

BACKGROUND: Few previous studies have examined the relationship between hospital volume and hazard of death for head and neck cancer patients. The purpose of this study was to examine the association between hospital volume and 5-year survival from diagnosis among head and neck cancer patients. METHODS: Using data from the population-based Osaka Cancer Registry, hospital volume was divided into three volume groups according to the number of head and neck cancer treatments identified between 2009 and 2011. We analysed the association between hospital volume and 5-year survival among 3069 patients aged 0-79 using Cox proportional hazard models, adjusting for characteristics of patients. RESULTS: Compared with head and neck cancer patients in high-hospital volume, patients treated in middle- and low-hospital volume were found to have a higher risk of death (middle-hospital volume: hazard ratio = 1.26; 95% confidence interval, 1.09-1.46, low-hospital volume: hazard ratio = 1.24; 95% confidence interval, 1.06-1.46). CONCLUSIONS: We found a significantly higher risk of hazard of death in middle- and low-hospital volume than in high-hospital volume for head and neck cancer.

Changes in Smoking Behavior Since the Declaration of the COVID-19 State of Emergency in Japan: A Cross-sectional Study From the Osaka Health App.

BACKGROUND: In April 2020, the Japanese government declared a state of emergency due to the COVID-19 pandemic, and infection control measures, including requests to work from home and stay-at-home restrictions, were introduced. This study examined changes in smoking behavior during the COVID-19 state of emergency. METHODS: An online cross-sectional survey was conducted in Osaka, Japan. To assess differences in smoking behavior among 5,120 current smokers before and after the declaration of a state of emergency, prevalence ratios (PRs) for two outcomes, increased smoking and quitting smoking, were calculated using multivariable Poisson regression, adjusting for potential covariates. RESULTS: We found 32.1% increased the number of cigarettes smoked and 11.9% quit smoking. After adjustment for all variables, we found risk factors for COVID-19 (men and older age group) had both significantly higher PR for quitting smoking (men: PR 1.38; 95% confidence interval [CI], 1.17-1.62) and participants aged ≥65 years: PR 2.45; 95% CI, 1.92-3.12) and significantly lower PR of increased smoking (men: PR 0.85; 95% CI, 0.78-0.93 and participants ≥65 years: PR 0.38; 95% CI, 0.29-0.49). Additionally, respondents working from home or living alone had significantly higher PR for increased smoking (working from home: PR 1.29; 95% CI, 1.17-1.41 and living alone: PR 1.23; 95% CI, 1.10-1.38) and respondents who changed from cigarettes to heated tobacco products (HTPs) had significantly lower PR for quitting smoking (PR 0.150; 95% CI, 0.039-0.582). CONCLUSIONS: We suggest people who have high-risk factors for COVID-19 might change their smoking behavior for the better, while people who work from home or live alone might change their smoking behavior for the worse, during the COVID-19 state of emergency. Additionally, changing from smoking cigarettes to using HTPs makes smokers less likely to quit.

Hospital Surgical Volume and 3-Year Mortality in Severe Prognosis Cancers: A Population-Based Study Using Cancer Registry Data.

BACKGROUND: The impact of hospital surgical volume on long-term mortality has not been well assessed in Japan, especially for esophageal, biliary tract, and pancreatic cancer, although these three cancers need a high level of medical-technical skill. The purpose of this study was to examine associations between hospital surgical volume and 3-year mortality for these severe-prognosis cancer patients. METHODS: Patients who received curative surgery for esophageal, biliary tract, and pancreatic cancers were analyzed using the Osaka Cancer Registry data from 2006-2013. Hospital surgical volume was categorized into tertiles (high/middle/low) according to the average annual number of curative surgeries per hospital for each cancer. Three-year survivals were calculated using the Kaplan-Meier method. Hazard ratios (HRs) of 3-year mortality were calculated using Cox proportional hazard models, adjusting for patient characteristics. RESULTS: Three-year survival was higher with increased hospital surgical volume for all three cancers, but the relative importance of volume varied across sites. After adjustment for all confounding factors, HRs in middle- and low-volume hospitals were 1.34 (95% confidence interval [CI], 1.14-1.58) and 1.57 (95% CI, 1.33-1.86) for esophageal cancer; 1.39 (95% CI, 1.15-1.67) and 1.57 (95% CI, 1.30-1.89) for biliary tract cancer; 1.38 (95% CI, 1.16-1.63) and 1.90 (95% CI, 1.60-2.25) for pancreatic cancer, respectively. In particular for localized pancreatic cancer, the impact of hospital surgical volume on 3-year mortality was strong (HR 2.66; 95% CI, 1.61-4.38). CONCLUSION: We suggest that patients who require curative surgery for esophageal, biliary tract, and pancreatic cancer may benefit from referral to high-volume hospitals.

Workplace smoke-free policies that allow heated tobacco products and electronic cigarettes use are associated with use of both these products and conventional tobacco smoking: the 2018 JASTIS study.

OBJECTIVES: Heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) are rapidly gaining popularity, especially in Japan. However, at the time of the survey (2018), there was no national legislation banning HTPs or e-cigarette use in the workplace. The objective is to examine the current situation for workplace smoke-free policies which ban the use of HTPs/e-cigarettes and the associations of such rules with the use of HTP and e-cigarette as well as conventional cigarette smoking. METHODS: An internet-based self-reported questionnaire survey was conducted in 2018 as a part of the Japan Society and New Tobacco Internet Survey study. 5646 eligible employees aged 15-72 years were analysed. Proportions and adjusted rate ratios for HTP and e-cigarette use were calculated according to covariates, using Poisson regression models. Those who reported HTP or e-cigarette use within 30 days were defined as current user of the products. RESULTS: In workplaces which prohibited smoking indoors but permitted the use of HTPs/e-cigarettes, the rate ratios of HTP use was 2.19 (95% CI 1.57 to 3.06), e-cigarette use was 3.86 (95% CI 1.97 to 7.57) and combustible cigarette use was 1.67 (95% CI 1.19 to 2.34) when using workplaces which also prohibited HTPs/e-cigarettes as a reference category. CONCLUSIONS: Workplaces that allow HTP/e-cigarette use indoors were associated with higher rate for HTP and e-cigarette users, and for combustible cigarette smokers. National legislation banning tobacco should be enforced and also cover HTPs and e-cigarettes in order to avoid renormalisation of smoking and nicotine addiction.

Hospital volume and postoperative survival for three urological cancers: Prostate, kidney, and bladder.

OBJECTIVE: To examine the association between hospital volume and postoperative 5-year survival for patients with prostate, kidney, and bladder cancer. METHOD: Using Osaka Cancer Registry data, we identified 9285 patients who were diagnosed as having prostate, kidney, or bladder cancer and who underwent surgery between 2007 and 2011 in Osaka, Japan. The surgical hospital volume of each hospital was calculated and then divided into quartiles (high, medium, low, very low). We estimated the hazard ratios of hospital volume (quartiles) for 5-year survival using Cox proportional hazard models. RESULTS: For all three cancer sites, the mortality hazard of hospitals with the lowest hospital volume was significantly higher than that of hospitals with the highest volume. The difference in adjusted 5-year survival rates between hospitals with the highest and lowest hospital volume was 3.6% for prostate cancer, 6.6% for kidney cancer, and 13.3% for bladder cancer. CONCLUSION: Hospital surgical volume seems to affect 5-year survival for patients with urological cancers, especially kidney and bladder cancer.