Comparison of Physical Activity and Sedentary Behavior between Work in Office and Work From Home: A Self-controlled Study.

OBJECTIVE: To compare physical activity levels and sedentary behavior between individuals working in the office and those working from home, with the aim of elucidating the potential implications on employees' health. METHODS: We used triaxial accelerometers to assess the physical activity levels of 94 white-collar employees from a large-scale manufacturing company in Japan. They were instructed to wear the accelerometers during their working hours, which included the commuting time on work-in-office days. RESULTS: The mean energy expenditure on work in office was 426 kcal for individuals, while it was 228 kcal on work from home (P < 0.01). In addition, not including commuting, the time spent sedentary on work-from-home days was higher than that on work-in-office days by 20 minutes. CONCLUSIONS: Work from home decreases physical activity and increases sedentary time compared with work in office.

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.

Perineurioma Diagnosed After Endoscopic Treatment of Suspected Gastric Adenocarcinoma of the Fundic Gland.

Perineurioma is a relatively rare tumor with an occasionally difficult differential diagnosis. A 63-year-old woman underwent esophagogastroduodenoscopy, which revealed a 15 mm, slightly faded, flat, and elevated lesion in the gastric body. Biopsy revealed a bundle-like proliferation of spindle-shaped cells; however, the diagnosis was unconfirmed. Endoscopic submucosal dissection was performed for diagnosis and treatment. Histopathological examination of the lesion revealed cell proliferation with short spindle-shaped and oval nuclei and little atypia in the lamina propria. Immunohistochemical examination indicated a perineurioma. Thus, when spindle-shaped cells are found on biopsy, it is necessary to consider the possibility of perineurioma.

Comparison of pancreatic enzyme abnormalities and protease-activated receptor-2-positive eosinophils in the duodenum of patients with functional dyspepsia-irritable bowel syndrome overlap with functional dyspepsia alone in Asian populations.

BACKGROUND AND AIM: Some patients with functional gastrointestinal disorders exhibit pancreatic dysfunctions and pancreatic enzyme abnormalities. Thus, we aimed to clarify whether significant differences in clinical characteristics, prevalence of pancreatic enzyme abnormalities, duodenal inflammation, and protease-activated receptor 2 (PAR2) expression levels related to hypersensitivity exist between functional dyspepsia (FD) alone and FD-irritable bowel syndrome (IBS) overlap group. METHODS: Ninety-three patients based on the Rome IV criteria, FD alone (n = 44) and FD overlapped with IBS (n = 49) group were enrolled. The patients scored their own clinical symptoms after consuming high-fat meals. Serum trypsin, PLA2, lipase, p-amylase, and elastase-1 levels were measured. PAR2, eotaxin-3, and TRPV4 mRNA levels in duodenum were determined using real-time polymerase chain reaction methods. PRG2- and PAR2 in the duodenum were evaluated using immunostaining. RESULTS: FD score and global GSRS in patients with FD-IBS overlap were significantly higher than FD alone. Although the prevalence of pancreatic enzyme abnormalities in patients with FD alone was significantly (P < 0.01) higher than that in FD-IBS overlap, the ratio of aggravation of clinical symptoms following high-fat intake in patients with FD-IBS overlap was significantly higher (P = 0.007) than that in patients with FD alone. PAR2- and PRG2-double positive cells were localized in the degranulated eosinophils in the duodenum of patients with FD-IBS overlap. The number of PAR2- and PRG2-double positive cells in FD-IBS overlap was significantly (P < 0.01) higher than FD alone. CONCLUSIONS: Pancreatic enzyme abnormalities and PAR2 expression on degranulated eosinophils infiltrations in the duodenum may be associated with the pathophysiology of patients with FD-IBS overlap in Asian populations.

Assessment of exposure and DNA damage from second-hand smoke using potential biomarker in urine: cigarettes and heated tobacco products.

Second-hand smoke exposure is an established cause of several adverse health effects. Tobacco smoke exposure in the environment has been improved by the WHO Framework Convention on Tobacco Control. However, concerns have been raised regarding the health effects of heated tobacco products. Analysis of tobacco smoke biomarkers is critical for assessing the health effects of second-hand tobacco smoke exposure. In this study, nicotine metabolites (nicotine, cotinine, trans-3'-hydroxycotinine) and carcinogenic 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol were analysed in the urine of non-smokers with or without passive exposure to cigarettes and heated tobacco products. In addition, 7-methylguanine and 8-hydroxy-2'-deoxyguanosine were simultaneously measured as DNA damage markers. The results revealed higher levels of urinary nicotine metabolites and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol in participants exposed to second-hand tobacco smoke (both cigarettes and heated tobacco products) at home. In addition, the urinary levels of 7-methylguanine and 8-hydroxy-2'-deoxyguanosine tended to be higher in the second-hand tobacco smoke-exposed group. The urinary levels of nicotine metabolites and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol were high in workplaces with no protection against passive smoking. These biomarkers will be useful for evaluating passive exposure to tobacco products.

Pre-operative Physical Performance Is Associated With Early Return to Work in Peri-operative Lung Cancer Patients.

Little is known about the factors related to return to work (RTW) in patients with peri-operative lung cancer (LC). This study aimed to investigate whether pre-operative physical performance is associated with early RTW in patients with peri-operative LC. A total of 59 patients who wished to resume work after lung resection surgery were included and were divided into three groups: early RTW (within 14 days after discharge), delayed RTW (within 15-90 days), and non-RTW (failure of RTW within 90 days). The early RTW group had significantly lower scores on the modified Medical Research Council dyspnea scale (mMRC) and significantly higher scores on the Euro Quality of Life 5-Dimension 3-Level (EQ-5D-3L) than the non-RTW group. Multivariate logistic regression analysis showed that EQ-5D-3L scores were significantly associated with early RTW, and mMRC scores and knee extensor strength tended to be associated with early RTW. Better pre-operative quality of life, mild dyspnea, and greater lower limb muscle strength tended to be associated with early RTW in patients with peri-operative LC.

Capability of Relative Odor Level Monitors to Measure the Odor of Thirdhand Smoke.

We investigated the probability of measuring the odor of thirdhand smoke using four odor-measuring monitors and three gas detector tubes. We measured the changes in tobacco odor on paper towels and cloth products over time. The results of the measurements were plotted against time to obtain an exponential approximation curve. The coefficient of x and the R2 values were calculated from this curve. The odor indicated by four types of odor-measuring monitors and three types of gas detector tubes decreased exponentially over time. The curves obtained from all measuring devices had coefficients of ex between -0.001 and -0.021, and R2 values of >0.8. The reproducibility of measuring relative odor levels through all measuring devices was high, suggesting a good capability of measuring thirdhand smoke odor. Two different odor-level standard gases can be used for the calibration of the regression curve for each monitor.

Comparison of clinical characteristics, eating behaviors, and clinical symptoms following fat intake in functional dyspepsia with functional dyspepsia with pancreatic enzyme abnormalities between Singapore and Japan.

BACKGROUND AND AIM: To clarify whether there were any significant differences in clinical symptoms and eating patterns between functional dyspepsia (FD) patients and FD with pancreatic enzyme abnormalities (FD-P) patients as refractory FD, we compared these factors in multicenter studies in Singapore and Japan. METHODS: One hundred ninety-eight consecutive patients presenting with FD (n = 88), FD-P patients (n = 81) based on Rome III classification and controlled group (n = 39) recruited from six institutions in Singapore and Japan. Clinical characteristics, clinical symptoms for dietary fat intake, and eating behaviors were estimated using questionnaires. Anxiety and health-related quality of life were determined by STAI-state/-trait and SF-8, respectively. RESULTS: There were no significant differences in age, sex, BMI, smoking, alcohol intake, past medical history, and history of allergy in FD and FD-P patients between Singapore and Japan. There were no significant differences in FD subtypes, gastrointestinal symptom rating scale score, severity of FD symptoms, and eating pattern in Singapore and Japan. Moreover, there were significant differences in certain eating behaviors between FD and FD-P patients in Singapore and Japan. Interestingly, epigastric pain and early satiety following fat meals in FD-P patients were significantly (P = 0.003 and P = 0.008, respectively) higher compared with those in FD patients in Japan. Physical component score in FD-P patients was significantly (P = 0.019) disturbed compared with those in FD patients in Japan. CONCLUSIONS: Epigastric pain and early satiety following fat meals in FD-P patients may be useful tools to differentiate FD-P patients from FD patients in Japan.

Measurement of particulate matter 2.5 in surgical smoke and its health hazards.

PURPOSE: Surgical smoke is generated during the cauterization, coagulation, and incision of biological tissues by electrocautery, ultrasonic coagulation, incising devices, and lasers. Surgical smoke comprises water, water vapor, steam, and some particulate matter, including bacteria, viruses, cell fragments, and volatile organic compounds, which can pose health risks to the operating room personnel. In this study, we measured the concentration of particulate matter 2.5 (particles with a diameter of ≤ 2.5 µm) in surgical smoke. METHODS: We used digital dust counters for real-time monitoring of particulate matter 2.5 generated intraoperatively in breast and gastrointestinal surgeries performed at our hospitals between 2019 and 2020. RESULTS: Concentrations of particulate matter 2.5 were measured in surgical smoke generated when performing 14 different surgeries. Immediately after electrocautery, the concentration of particulate matter 2.5 increased to 2258 µg/m3 and then, when we stopped using the devices, it decreased rapidly to the initial levels. Interestingly, the concentrations increased after each intermittent electrocautery procedure. Higher concentrations of particulate matter 2.5 were observed during breast surgeries than during laparoscopic procedures. CONCLUSION: Surgical smoke poses potential health risks to operating room personnel by contaminating their breathing zone with high concentrations of particulate matter 2.5. A local exhaust ventilation system is needed to reduce exposure.

Excessive Workload Beyond Measured Exercise Tolerance Affects Post-Discharge Mental Health in Workers With Heart Disease: A Case-Based Observational Study.

OBJECTIVE: We evaluated work intensity, exercise tolerance, and mental health among workers with heart disease and assessed the relationship between return to work (RTW) status and changes in mental health 3 months post-discharge. METHODS: Patients were enrolled from 2014 to 2019. Data were collected on admission and 3 months post-discharge. Mental health was assessed using the Hospital Anxiety and Depression Scale. Jobs were defined as "reasonable workload (RW)" or "over workload (OW)" based on metabolic equivalents. RESULTS: Twenty-six patients responded (81.3%). RTW after 3 months was higher in the RW group (100%) than in the OW group (63.6%). Mental health in the OW group significantly deteriorated compared with baseline and was higher than that in the RW group. CONCLUSIONS: Patients whose work intensity was higher than their exercise tolerance had worsened mental health 3 months post-discharge.

[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.

Secondhand Smoke from a Veranda Spreading to Neighboring Households.

Secondhand smoke (SHS) caused by smoking on apartment verandas is a severe social problem in Japan. If someone smokes on a veranda, SHS drifts into other residents' rooms through their windows. Most non-smoking residents are annoyed by this, but they do not confront the person responsible. To study this situation, we burned cigarettes and measured the spread of SHS in terms of fine particle (PM2.5) concentrations. Cigarette smoke generated on a lower veranda spread to upper and horizontal neighboring verandas and into rooms through windows, reaching a maximum concentration of 139 µg/m3. The Health Promotion Act that was revised in 2018 and enacted in 2019-2020 requires all smokers to avoid producing SHS, even outdoors and at home. It is expected that combining the measurement of SHS from verandas to other verandas and rooms with the revised Health Promotion Act could create a national consensus on "no smoking on apartment verandas."

Clinical factors associated with safety and efficacy in patients receiving direct oral anticoagulants for non-valvular atrial fibrillation.

Although patients suffering from atrial fibrillation have increased worldwide, detailed information about factors associated with bleeding during direct oral anticoagulant therapy remains insufficient. We studied 1086 patients for whom direct oral anticoagulants were initiated for non-valvular atrial fibrillation between April 2011 and June 2017. Endpoints were clinically relevant bleeding or major adverse cardiac and cerebrovascular events until the end of December 2018. Incidences of bleeding and thrombosis were 4.5 per 100 person-years and 4.7 per 100 person-years, respectively. Most bleeding events represented gastrointestinal bleeding. Multivariate analysis revealed initiation of anticoagulants at ≥ 85 years old as significantly associated with bleeding, particularly gastrointestinal bleeding, but not major cardiac and cerebrovascular events. Other significant factors included chronic kidney disease, low-dose aspirin and nonsteroidal anti-inflammatory drugs. For gastrointestinal bleeding alone, histories of gastrointestinal bleeding and malignancy also showed positive correlations, in addition to the above-mentioned factors. Clinicians should pay greater attention to the risk of gastrointestinal bleeding when considering prescription of anticoagulants to patients ≥ 85 years old with atrial fibrillation.

Cohabiting with Smokers Is an Independent Factor for Worsening Arterial Stiffness Even in Smoking Workers.

Preventing cardiovascular disease (CVD) is an urgent public health challenge. Although brachial-ankle pulse wave velocity (baPWV) can indicate the risk of arterial stiffness and CVD, findings regarding whether baPWV is associated with smoking are inconsistent. This study considered the influence of smoking on arteriosclerosis, specifically focusing on secondhand smoke (SHS), and aimed to construct a strategy for preventing the worsening of arteriosclerosis. We recruited 295 male employees from five companies who had smoking habits such as being smokers, living with smokers, and exposure to SHS outside the home. We measured body composition and hemodynamics, including blood pressure and baPWV, and found that baPWV had significant positive correlations with age, smoking index, alcohol consumption, body-fat percentage, blood pressure, and heart rate, and significant negative correlations with height, fat-free mass, and lower-limb muscle mass. Moreover, baPWV showed a significant adverse effect on participants who had metabolic syndrome (MetS) risk factors such as hypertension, dyslipidemia, and diabetes. Multiple regression analysis showed that baPWV had significant positive relationships with age, height, MetS risk factors, cohabitation with smokers, blood pressure, and heart rate, and a significant negative relationship with lower-limb muscle mass. The same results were obtained when adjusting for current smoking status, smoking index, cohabitation with smokers at birth, and frequency of exposure to SHS outside the home. Exposure to tobacco smoke due to cohabitation with smokers increased baPWV regardless of the person's smoking habits. Thus, to prevent an increase in baPWV in housemates and smokers, it is necessary for smokers to quit smoking.

Effects of smoking cessation on biological monitoring markers in urine.

INTRODUCTION: Urinary nicotine and cotinine levels are often measured as biomarkers for tobacco smoke exposure. However, these biomarkers are not appropriate to evaluate the effects of quitting smoking for several days, because of their short half-lives. In this study, we focused on the changes in the urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels of 55 patients in a smoking cessation program, because of the long half-life. At the same time, urinary 7-methylguanine (m7Gua) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), as DNA damage markers of cigarette smoking, were also measured. RESULTS: In the subjects who completed the quit-smoking program (18 subjects out of 55), the urinary nicotine and cotinine levels decreased to 1.7 and 0.2% at 8 weeks after the first visit to the clinic. By contrast, the NNAL levels decreased to 12.3% at 8 weeks after quitting smoking. During the same period, the urinary m7Gua levels significantly decreased, from 27.32 µg/mg creatinine to 14.17 µg/mg creatinine by the elimination of subjects who showed increased levels of NNAL during the smoking cessation program. The 8-OHdG levels were also reduced within the same period, but were not significantly different. From the all data analysis, the urinary levels of cotinine and NNAL positively correlated with the level of m7Gua. CONCLUSIONS: NNAL may be an appropriate exposure marker for evaluating the smoking status of patients in a smoking cessation program. The urinary cotinine and NNAL levels positively correlated with the m7Gua levels.

[Policy recommendation for the regulation of heated tobacco products based on evidence review of their health effects and influence on tobacco control].

Objective This report aimed to present policy recommendations on the regulation of heated tobacco products based on a review of the literature on the use of heated tobacco products, component analysis of harmful chemical substances, and product characteristics as nicotine delivery device, and on an examination of the influence of the product's increasing usage to the main measures of tobacco control.Methods The literature search was performed using Japan Centra Revuo Medicina and PubMED database. The search yielded 11 articles that examined the use of heated tobacco products, component analysis of harmful chemical substances, and product characteristics as nicotine delivery device. Eight articles were additionally collected from reports of public health research in Japan and public reports in foreign countries. The six main policies advocated by World Health Organization as MPOWER (Monitor, Protect, Offer, Warn, Enforce, Raise) were adopted in considering the expected influence of this product's increasing usage this product epidemic on tobacco control. In addition to the abovementioned 19 articles, 26 documents and materials related to the status of tobacco control were collected and used to examine the influence of the product's increasing usage to the main measures of tobacco control.Results In Japan, heated tobacco products have been available since December 2013, and the spread of use has risen remarkably since 2016. As of October 2016, Japan consumed more than 90% of the heated tobacco products sold internationally. Compared with cigarettes, heated tobacco products can reduce exposure to harmful substances except nicotine. However, their use does not lead to reduced risk of illness. The reduction of exposure to harmful substances cannot be expected when used in combination with cigarettes. Heated tobacco products and cigarettes have similar nicotine exposure levels and pharmacokinetics; thus, use of the former results in nicotine dependence and exacerbates the difficulty in discontinuing tobacco consumption. The popularity of heated tobacco products could adversely affect any of the six main measures of tobacco control.Conclusion Although public health concerns have been identified for the popularity of heated tobacco products, evidence remains insubstantial for the formulation of regulatory implications. Additional research is needed on the health effects to users and bystanders, effects on cigarettes use, and influence on tobacco control policy. From the perspective of the precautionary principle of public health, the same regulation as for cigarettes should be implemented as regards heated tobacco products until their health effects are fully elucidated.

Frequency of Exposure to Secondhand Smoke Outside the Home Is Associated with a Lower FEV1/FVC in Male Workers Regardless of Smoking Status.

Decreased respiratory function associated with aging leads to the onset of chronic obstructive pulmonary disease (COPD) and increased risk of death in the elderly. Prevention of a decline in respiratory function from a young age is important. This study aimed to clarify the factors that affect decreased forced expiratory volume in one second (FEV1)/forced vital capacity (FVC), an index of obstructive respiratory disorder caused by airway obstruction, by considering the influence of body composition and lifestyle. We recruited 262 employed adult men and determined their lifestyle-related factors, including smoking status, past or current secondhand smoke (SHS) exposure, exposure to SHS outside the home, and physical activity (PA). Body composition and respiratory function were also measured. The data were then compared with those of non-smokers using logistic regression analysis, adjusting for age. We also investigated factors influencing FEV1/FVC using multiple regression analysis, adjusting for age, height, smoking status, and lifestyle. Current smokers and heavy smokers exhibited significantly lower amounts of PA and had a higher body fat%, visceral fat area, prevalence of cohabitation with smokers, and frequency of SHS exposure outside the home, and FEV1/FVC was significantly lower in heavy smokers. A multiple regression analysis revealed that FEV1/FVC was associated only with the frequency of SHS exposure outside the home. It is important for occupational health personnel of a company to advise both non-smokers and smokers to avoid SHS to prevent chronic obstructive pulmonary disease onset. This needs to be coupled with encouragement to quit smoking, especially for heavy smokers.

An exaggerated blood pressure response to exercise is associated with the dietary sodium, potassium, and antioxidant vitamin intake in normotensive subjects.

AIM: This study was designed to examine the associations between an exaggerated systolic blood pressure (SBP) response to exercise and the nutrient intake in normotensive subjects. METHODS: The subjects consisted of 302 normotensive subjects (64 males and 238 females; age, 48.4 ± 11.3 years) without a history of cardiovascular disease or stroke who were not taking any medications. Each subject performed a multistage graded submaximal exercise stress test using an electric bicycle ergometer, and their blood pressure was measured at rest and during the last minute of each stage. The nutrient intake was assessed using a self-administered food frequency questionnaire. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP ≥210 mmHg in males, or ≥190 mmHg in females). RESULTS: An exaggerated SBP response to exercise was observed in 85 subjects. A multiple logistic regression analysis revealed that the dietary sodium-to-potassium (Na/K) ratio (odds ratio [OR]: 5.75, 95% confidence interval [CI]: 2.37-13.75, p = 0.001) and vitamin E intake (OR: 0.67, 95% CI: 0.51-0.93, p = 0.012) were significantly associated with an exaggerated SBP response to exercise. Furthermore, the percent change in SBP during exercise was found to be significantly associated with an increase in the dietary Na/K ratio (p for trend = 0.0005) and a decrease in the vitamin E intake (p for trend = 0.018). CONCLUSIONS: These results suggest that an exaggerated SBP response to exercise was associated with the dietary sodium, potassium, and antioxidant vitamin intake in normotensive subjects.