Sex- and age-specific impacts of smoking, overweight/obesity, hypertension, and diabetes mellitus in the development of disabling dementia in a Japanese population

BACKGROUND@#Sex- and age-specific impacts of cardiovascular risk factors on the development of dementia have not been well evaluated. We investigated these impacts of smoking, overweight/obesity, hypertension, and diabetes mellitus on the risk of disabling dementia.@*METHODS@#The study participants were 25,029 (10,134 men and 14,895 women) Japanese aged 40-74 years without disabling dementia at baseline (2008-2013). They were assessed on smoking status (non-current or current), overweight/obesity (body mass index ≥25 kg/m2 and ≥30 kg/m2, respectively), hypertension (systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or any antihypertensive medication use), and diabetes mellitus (a fasting serum glucose ≥126 mg/dL, non-fasting glucose ≥200 mg/dL, hemoglobin A1c ≥6.5% by the National Glycohemoglobin Standardization Program or glucose-lowering medication use) at baseline. Disabling dementia was identified as the level of care required ≥1 and cognitive disability grade ≥IIa according to the National Long-term Care Insurance Database. We used a Cox proportional regression model to estimate hazard ratios and 95% confidence intervals (95% CIs) of disabling dementia according to the cardiovascular risk factors and calculated the population attributable fractions (PAFs).@*RESULTS@#During a median follow-up of 9.1 years, 1,322 (606 men and 716 women) developed disabling dementia. Current smoking and hypertension were associated with a higher risk of disabling dementia in both sexes, whereas overweight or obesity was not associated with the risk in either sex. Diabetes mellitus was associated with a higher risk only in women (p for sex interaction = 0.04). The significant PAFs were 13% for smoking and 14% for hypertension in men and 3% for smoking, 12% for hypertension, and 5% for diabetes mellitus in women. The total PAFs of the significant risk factors were 28% in men and 20% in women. When stratified by age, hypertension in midlife (40-64 years) was associated with the increased risk in men, while diabetes mellitus in later-life (65-74 years) was so in women.@*CONCLUSIONS@#A substantial burden of disabling dementia was attributable to smoking, and hypertension in both sexes and diabetes mellitus in women, which may require the management of these cardiovascular risk factors to prevent dementia.

Problems for uninsured traveler in availing medical treatment: Case study of a person who suffered cerebral infarction / 国際保健医療

Background  The number of foreign tourists visiting Japan has increased to about 30 million people per year. 1.5% of them were injured or became sick during their travelin Japan and had to undergo medical treatment. Among the foreign tourists, 27% were not covered by travel health insurance.Case  A 40-year-old man from Southeast Asia who was visiting his relative in Japan experienced sudden hemiparesis and was diagnosed with cerebral infarction. During the initial treatment, it was found that the patient did not have health insurance and the relatives could not afford to pay the treatment costs. No other source of financial support was available to him During our consultations with the patient and his relatives about the medical treatment including medical expenses, he continued to be treated as an outpatient and it was aimed at an early return to his home country.Discussion  Foreigners, who are not covered under travel health insurance, could fall ill or sustain an injury during their stay in Japan. Appropriate medical care should be provided regardless of their ability to pay. However, a situation that could lead them to incur huge medical expenses from availing medical care should be avoided. For medical consultations of non-insured foreigners, it is better to consult the available systems and pay attention about feasible medical expenses. There is a need for a long-term vision of medical care to make a smooth transition from medical treatment in Japan to treatment in their home country.Conclusion  Although medical institutions can offer only a limited response, it is necessary to accumulate case examples from across the nation and prepare specific countermeasures and counselors.

Candidemia in a Regional Hospital without Infectious Diseases Department / 日本農村医学会雑誌

  In Japan, there are many hospitals which do not have departments specializing in infectious diseases. Treatment of critical nosocomial infections such as candidemia is not sufficient and varies greatly from one institution to another. We reviewed the cases of candidemia in Saku Central Hospital from 2004 to 2008, and examined fungal species, clinical background, therapy, prognosis and the rate of treatment in accordance with the Infectious Diseases Society of America (IDSA) guidelines for candida infection. Blood culture revealed 43 cases diagnosed as candidemia. <i>Candida albicans</i> was the most common fungus. Antibiotics were administered to 84% of the patients and 79% had central venous catheters (CVC). The empirical antifungal administration included fosfluconazole and micafungin, but 23% of the patients did not receive any appropriate antifungal therapy. CVCs were removed from 23 of 34 patients, and 42% of the patients underwent ophthalmologic examination. Some of the patients (42%) were treated according to the IDSA guidelines, but most were not. The 28-day mortality rate was 33%. This study demonstrated that the strategy for treating candidemia in our hospital was insufficient, and also suggested that critical nosocomial infections cases were treated in adequately in many other regional hospitals in Japan. In conclusion, a well-organized and guideline-based therapeutic system is necessary in hospitals without the infectious diseases department.