Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis.

BACKGROUND: Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its member states have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers to determine risk groups for targeted control measures. METHODS AND FINDINGS: Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdm patients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1 January 2010 from 19 countries or administrative regions--Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong SAR, Japan, Madagascar, Mexico, The Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom--to characterize and compare the distribution of risk factors among H1N1pdm patients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased with severity of disease. The highest per capita risk of hospitalization was among patients <5 y and 5-14 y (relative risk [RR] = 3.3 and 3.2, respectively, compared to the general population), whereas the highest risk of death per capita was in the age groups 50-64 y and ≥65 y (RR = 1.5 and 1.6, respectively, compared to the general population). Similarly, the ratio of H1N1pdm deaths to hospitalizations increased with age and was the highest in the ≥65-y-old age group, indicating that while infection rates have been observed to be very low in the oldest age group, risk of death in those over the age of 64 y who became infected was higher than in younger groups. The proportion of H1N1pdm patients with one or more reported chronic conditions increased with severity (median = 31.1%, 52.3%, and 61.8% of hospitalized, ICU-admitted, and fatal H1N1pdm cases, respectively). With the exception of the risk factors asthma, pregnancy, and obesity, the proportion of patients with each risk factor increased with severity level. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. Our findings suggest that morbid obesity might be a risk factor for ICU admission and fatal outcome (RR = 36.3). CONCLUSIONS: Our results demonstrate that risk factors for severe H1N1pdm infection are similar to those for seasonal influenza, with some notable differences, such as younger age groups and obesity, and reinforce the need to identify and protect groups at highest risk of severe outcomes. Please see later in the article for the Editors' Summary.

History of nutrition policy in Japan.

Why has Japan become the longest-lived country in the world? The longevity is often attributed to Japan's economic growth, but Japan experienced an extended life expectancy prior to achieving such economic growth. During and after the Second World War when the General Headquarters of the Supreme Commander for the Allied Powers was occupying Japan, the welfare administration system was drastically reformed, resulting in dramatic improvements in the hygiene status, which led to an increase in the average life expectancy in Japan. Here, this background is reviewed, along with an explanation of how Japan has become the world's longest-lived country.

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.

Trends in Policy on the Prevention and Control of Non-Communicable Diseases in Japan.

Abstract-For the past decades Japan has remained number one in a range of population health metrics including the world's longest healthy life expectancy. While this was achieved through various socioeconomic factors besides public health interventions, health promotion policies to prevent and control non-communicable diseases (NCDs) played a major role. Japan introduced its first comprehensive national plan to prevent and control NCDs in 1978 and has revised the plan every decade since. These 10-year policy packages were instrumental in galvanizing stakeholders, while adapting to changing social, behavioral, and epidemiological trends. In this article, we provide an overview of trends in policy on the prevention and control of NCDs in Japan with a focus on successes and challenges especially due to a rapidly aging population. Through this review we aim to share the lessons learned in Japan for other countries tackling or expecting to be challenged by NCDs. These lessons include the role of multisectoral approaches, clear goals and targets with effective monitoring and evaluation mechanisms, addressing social aspects, adjustment to the local context, and foreseeing future demographic transition. Japan is committed to contributing to the world as a forerunner of the health challenges posed by unprecedented demographic change, by sharing its lessons in the global quest to create a world where all people can live longer and healthier lives.

[Analysis of factors determining transfusion albumin usage in different prefectures].

OBJECTIVE: According to recent changes in the prevalence of diseases and innovations in medical technology, the requirement for blood products and blood plasma fractions has increased dramatically in Japan. The difficulty in meeting demands is making resort to importation of blood products from other countries necessary. Hokkaido, the prefecture with the highest consumption of blood products, uses 10 times more albumin than that of the lowest blood consumer, Kouchi, This study analyzed the factors, underlying these differences in albumin consumption between prefectures, to provide pointers to meet most appropriately blood products utilization. METHOD: The questionnaire regarding management of blood products, total amount of consumption of blood products, sex, age and diagnosis of patients, examinations of albumin concentrations in the blood before and after the use of albumin product, operations etc. was distributed to 8,334 medical institutes, collected and analyzed. We divided all 47 prefectures into 4 groups, according to albumin consumption amount, and compared factors for 45-84 year old patients. RESULTS: The results showed the proportion of patients with the top 20 diseases to be significantly higher in the highest albumin consumer group than in the others. In addition, the percentage of non-examinations of albumin concentrations in the serum before and after the use of albumin products was significantly higher in the highest albumin consumer group. Furthermore, the concentrations of albumin in the serum both before and after their application were significantly higher in the highest albumin consumer group than in the others. There was no significant difference in bed usage among the groups. Comparison of the results for the 4 groups indicated that the use of albumin in cases of liver fibrosis, cirrhosis, hepatoma and gastric cancer may have a special impact on the total consumption of albumin per person. Albumin may be used in the highest albumin consumer group without sufficient consideration for the shortage of albumin products. CONCLUSIONS: There are some factors causing difference in albumin consumption among prefectures, such as whether or not albumin concentrations in the blood are examined before and after the usage, The importance of adopting measures to assure appropriate consumption of albumin clearly needs to be emphasized.