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1.
BMJ ; 368: m34, 2020 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996350

RESUMEN

OBJECTIVE: To investigate the association between several types of soy products and all cause and cause specific mortality. DESIGN: Population based cohort study. SETTING: Japan Public Health Centre-based Prospective Study, which includes 11 public health centre areas in Japan. PARTICIPANTS: 92 915 participants (42 750 men and 50 165 women) aged 45 to 74 years. EXPOSURES: Intake of total soy products, fermented soy products (natto and miso), non-fermented soy products, and tofu from a five year survey questionnaire. MAIN OUTCOME MEASURES: All cause and cause specific mortality (cancer, total cardiovascular disease, heart disease, cerebrovascular disease, respiratory disease, and injury) obtained from residential registries and death certificates. RESULTS: During 14.8 years of follow-up, 13 303 deaths were identified. In the multivariable adjusted models, intake of total soy products was not significantly associated with total mortality. Compared with the lowest fifth of total soy product intake, the hazard ratios in the highest fifth were 0.98 (95% confidence interval 0.91 to 1.06, Ptrend=0.43) in men and 0.98 (0.89 to 1.08, Ptrend=0.46) in women. Intake of fermented soy products was inversely associated with all cause mortality in both sexes (highest versus lowest fifth: 0.90 (0.83 to 0.97), Ptrend=0.05 in men, and 0.89 (0.80 to 0.98), Ptrend=0.01 in women). Natto showed significant and inverse associations with total cardiovascular disease related mortality in both sexes. CONCLUSIONS: In this study a higher intake of fermented soy was associated with a lower risk of mortality. A significant association between intake of total soy products and all cause mortality was not, however, observed. The findings should be interpreted with caution because the significant association of fermented soy products might be attenuated by unadjusted residual confounding.


Asunto(s)
Dieta , Conducta Alimentaria/etnología , Mortalidad , Alimentos de Soja/estadística & datos numéricos , Anciano , Causas de Muerte , Estudios de Cohortes , Dieta/mortalidad , Dieta/estadística & datos numéricos , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Medición de Riesgo , Encuestas y Cuestionarios
2.
Medicine (Baltimore) ; 99(1): e18486, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895781

RESUMEN

We have been examining the Comprehensive Health Check of the Fukushima Health Management Survey of residents of 13 municipalities who were forced by the government to evacuate due to the 2011 Great East Japan Earthquake (GEJE). Our findings showed that evacuation is a risk factor for polycythemia and suggested that experiencing an unprecedented disaster and exposure to chronic stress due to evacuation might be a cause of polycythemia.We analyzed the relationship between the prevalence of polycythemia and the following factors observed in the Mental Health and Lifestyle Survey in an observational study with a cross-sectional design: traumatic symptoms, depression status, socioeconomic factors such as residential environment, and working situation after the GEJE. Target population of the survey included men and women who were at least 15 years of age and who lived in the evacuation zones specified by the government. Participants analyzed consisted of 29,474 persons (12,379 men and 16,888 women) who had participated in both the 2011 Comprehensive Health Check and Mental Health and Lifestyle Survey from June 2011 through March 2012.The prevalence of polycythemia was not associated with mental states associated with traumatic symptoms (Post-Traumatic Stress Disorder Checklist Scale ≥ 44) and depression status (Kessler 6-item Scale ≥ 13). Furthermore, multivariate analysis showed that there was a tendency for males to develop polycythemia, with characteristics such as being aged 65 years and older, highly educated, obese (body mass index ≥ 25), hypertensive, diabetic, having liver dysfunction, and a smoker being significantly related to the prevalence of polycythemia.Our findings conclusively demonstrated that polycythemia was not significantly related to psychological factors, but was significantly related to the onset of lifestyle-related disease after the GEJE.


Asunto(s)
Accidente Nuclear de Fukushima , Policitemia/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Causalidad , Comorbilidad , Terremotos , Femenino , Humanos , Japón/epidemiología , Estilo de Vida , Masculino , Persona de Mediana Edad , Policitemia/etiología , Policitemia/psicología , Prevalencia , Tsunamis , Adulto Joven
3.
BJOG ; 127(3): 335-342, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31654606

RESUMEN

OBJECTIVE: Asian dust is a natural phenomenon in which dust particles are transported from desert areas in China and Mongolia to East Asia. Short-term exposure to Asian dust has been associated with cardiovascular disease through mechanisms such as systemic inflammation. Because inflammation is a potential trigger of placental abruption, exposure may also lead to abruption. We examined whether exposure to Asian dust was associated with abruption. DESIGN: A bi-directional, time-stratified case-crossover design. SETTING AND POPULATION: From the Japan Perinatal Registry Network database, we identified 3014 patients who delivered singleton births in hospitals in nine Japanese prefectures from 2009 to 2014 with a diagnosis of placental abruption. METHODS: Asian dust levels were measured at Light Detection and Ranging monitoring stations, and these measurements were used to define the Asian dust days. As there was no information on the onset day of abruption, we assumed this day was the day before delivery (lag1). MAIN OUTCOME MEASURES: Placental abruption. RESULTS: During the study period, the Asian dust days ranged from 15 to 71 days, depending on the prefecture. The adjusted odds ratio of placental abruption associated with exposure to Asian dust was 1.4 (95% confidence interval = 1.0, 2.0) for cumulative lags of 1-2 days. Even after adjustment for co-pollutant exposures, this association did not change substantially. CONCLUSIONS: In this Japanese multi-area study, exposure to Asian dust was associated with an increased risk of placental abruption. TWEETABLE ABSTRACT: Exposure to environmental factors such as Asian dust may be a trigger of placental abruption.


Asunto(s)
Desprendimiento Prematuro de la Placenta , Polvo , Monitoreo del Ambiente , Exposición por Inhalación/efectos adversos , Desprendimiento Prematuro de la Placenta/diagnóstico , Desprendimiento Prematuro de la Placenta/epidemiología , Adulto , Estudios Cruzados , Monitoreo del Ambiente/métodos , Monitoreo del Ambiente/estadística & datos numéricos , Femenino , Humanos , Sistemas de Información/estadística & datos numéricos , Japón/epidemiología , Embarazo , Medición de Riesgo , Factores de Riesgo
4.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 64-68, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31092676

RESUMEN

OBJECTIVE: Apgar scores of zero at 10 min strongly predict mortality and morbidity in infants. However, recent data reported improved outcomes among infants with Apgar scores of zero at 10 min. We aimed to review the mortality rate and neurodevelopmental outcomes of infants with Apgar scores of zero at 10 min in Japan. DESIGN: Observational study. PATIENTS: Twenty-eight of 768 infants registered in the Baby Cooling Registry of Japan between 2012 and 2016, at >34 weeks' gestation, with Apgar scores of zero at 10 min who were treated with therapeutic hypothermia. INTERVENTIONS: We investigated the time of first heartbeat detection in infants with favourable outcomes and who had neurodevelopmental impairments or died. MAIN OUTCOME MEASURES: Clinical characteristics, mortality rate and neurodevelopmental outcomes at 18-22 months of age were evaluated. RESULTS: Nine (32%) of the 28 infants died before 18 months of age; 16 (57%) survived, but with severe disabilities and 3 (11%) survived without moderate-to-severe disabilities. At 20 min after birth, 14 of 27 infants (52%) did not have a first heartbeat, 13 of them died or had severe disabilities and one infant, who had the first heartbeat at 20 min, survived without disability. CONCLUSION: Our study adds to the recent evidence that neurodevelopmental outcomes among infants with Apgar scores of zero at 10 min may not be uniformly poor. However, in our study, all infants with their first heartbeat after 20 min of age died or had severe disabilities.


Asunto(s)
Puntaje de Apgar , Asfixia Neonatal/mortalidad , Hipotermia Inducida , Hipoxia-Isquemia Encefálica/mortalidad , Trastornos del Neurodesarrollo/epidemiología , Asfixia Neonatal/terapia , Reanimación Cardiopulmonar , Estudios de Seguimiento , Gastrostomía/estadística & datos numéricos , Humanos , Hipoxia-Isquemia Encefálica/terapia , Lactante , Recién Nacido , Intubación Intratraqueal , Japón/epidemiología , Pruebas Neuropsicológicas , Sistema de Registros , Respiración Artificial/estadística & datos numéricos , Traqueostomía/estadística & datos numéricos , Escala de Memoria de Wechsler
5.
Int J Cancer ; 146(3): 635-645, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30873589

RESUMEN

Radiation effects on colorectal cancer rates, adjusted for smoking, alcohol intake and frequency of meat consumption and body mass index (BMI) by anatomical subsite (proximal colon, distal colon and rectum) were examined in a cohort of 105,444 atomic bomb survivors. Poisson regression methods were used to describe radiation-associated excess relative risks (ERR) and excess absolute rates (EAR) for the 1958-2009 period. There were 2,960 first primary colorectal cancers including 894 proximal, 871 distal and 1,046 rectal cancers. Smoking, alcohol intake and BMI were associated with subsite-specific cancer background rates. Significant linear dose-responses were found for total colon (sex-averaged ERR/Gy for 70 years old exposed at age 30 = 0.63, 95% confidence interval [CI]: 0.34; 0.98), proximal [ERR = 0.80, 95% CI: 0.32; 1.44] and distal colon cancers [ERR = 0.50, 95% CI: 0.04; 0.97], but not for rectal cancer [ERR = 0.023, 95% CI: -0.081; 0.13]. The ERRs for proximal and distal colon cancers were not significantly different (p = 0.41). The ERR decreased with attained age for total colon, but not for proximal colon cancer, and with calendar year for distal colon cancer. The ERRs and EARs did not vary by age at exposure, except for decreasing trend in EAR for proximal colon cancer. In conclusion, ionizing radiation is associated with increased risk of proximal and distal colon cancers. The ERR for proximal cancer persists over time, but that for distal colon cancer decreases. There continues to be no indication of radiation effects on rectal cancer incidence in this population.


Asunto(s)
/estadística & datos numéricos , Neoplasias del Colon/epidemiología , Neoplasias Inducidas por Radiación/epidemiología , Neoplasias del Recto/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Índice de Masa Corporal , Niño , Preescolar , Colon/efectos de la radiación , Neoplasias del Colon/etiología , Relación Dosis-Respuesta en la Radiación , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Recién Nacido , Mucosa Intestinal/efectos de la radiación , Japón/epidemiología , Masculino , Carne/efectos adversos , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/etiología , Neoplasias del Recto/etiología , Recto/efectos de la radiación , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Adulto Joven
6.
Int J Cancer ; 146(3): 712-719, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30927373

RESUMEN

Earlier cohort studies using conventional regression models have consistently shown an increased cancer risk among individuals with type 2 diabetes. However, reverse causality and residual confounding due to common risk factors could exist, and it remains unclear whether diabetes per se contributes to cancer development. Mendelian randomization analyses might clarify the true association between diabetes and cancer risk. We conducted a case-cohort study with 10,536 subcohort subjects and 3,541 newly diagnosed cancer cases derived from 32,949 eligible participants aged 40-69 years within the Japan Public Health Center-based Prospective Study. With 29 known type 2 diabetes susceptibility variants, we used an inverse variance-weighted method to estimate hazard ratios for the associations of diabetes with risks of total and site-specific cancers. The hazard ratios of cancer per doubling of the probability of diabetes were 1.03 (95% confidence interval [CI], 0.92-1.15) overall, 1.08 (95% CI: 0.73-1.59) for the pancreas, 0.80 (95% CI: 0.57-1.14) for the liver and 0.90 (95% CI: 0.74-1.10) for the colorectum. Additional analyses, using publicly available large-scale genome-wide association study data on colorectal cancer in Japan, resulted in a narrower CI (hazard ratio: 1.00; 95% CI: 0.93-1.07). In this prospective Mendelian randomization study with a large number of incident cancer cases, we found no strong evidence to support associations between diabetes and overall and site-specific cancer risks. Our findings suggest that there is little evidence to support the genetic role of type 2 diabetes in cancer development in the Japanese population.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Análisis de la Aleatorización Mendeliana , Neoplasias/epidemiología , Adulto , Anciano , Índice de Masa Corporal , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/genética , Estudios de Seguimiento , Estudio de Asociación del Genoma Completo , Humanos , Incidencia , Japón/epidemiología , Persona de Mediana Edad , Neoplasias/genética , Polimorfismo de Nucleótido Simple , Estudios Prospectivos , Medición de Riesgo/métodos , Factores de Riesgo
7.
Lancet ; 394(10216): 2255-2262, 2020 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-31862250

RESUMEN

BACKGROUND: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. METHODS: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. FINDINGS: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24-1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13-1·52], p<0·0001). INTERPRETATION: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. FUNDING: None.


Asunto(s)
Reanimación Cardiopulmonar/instrumentación , Cardioversión Eléctrica/instrumentación , Enfermedades del Sistema Nervioso/etiología , Paro Cardíaco Extrahospitalario/terapia , Adulto , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar/métodos , Desfibriladores , Cardioversión Eléctrica/métodos , Servicios Médicos de Urgencia , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Oportunidad Relativa , Paro Cardíaco Extrahospitalario/complicaciones , Paro Cardíaco Extrahospitalario/mortalidad , Puntaje de Propensión , Estudios Prospectivos , Instalaciones Públicas , Recuperación de la Función , Sistema de Registros , Estudios Retrospectivos
8.
Environ Health Prev Med ; 24(1): 69, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31785607

RESUMEN

BACKGROUND: Even though there is bidirectional association between hypertension and atherosclerosis, atherosclerosis itself is involved in the process of endothelial repair. To clarify the association of endothelial repair with hypertension, a cross-sectional study was conducted. METHODS: We conducted a cross-sectional study of 562 elderly Japanese men aged 60-69. As gamma-glutamyl transpeptidase (γ-GTP) could act as a marker of oxidative stress that injures endothelial cell and higher levels of CD34-positive cell indicate a higher activity of endothelial repair, we therefore performed a CD34-positive level specific analysis of γ-GTP on atherosclerosis and hypertension. RESULTS: In the present study population, hypertension was independently and positively associated with atherosclerosis (multivariable odds ratio (OR) = 2.09 (1.30, 3.35)). Among participants with high CD34-positive cells, γ-GTP showed significant and positive association with atherosclerosis (OR of the log-transformed value of γ-GTP (OR) = 2.26 (1.32, 3.86)) but not with hypertension (OR = 0.77 (0.51, 1.17)). Among participants with low CD34-positive cells, even γ-GTP showed no significant association with atherosclerosis (OR = 0.92 (0.51, 1.68)), but was significantly and positively associated with hypertension (OR = 1.99 (1.27, 3.12)). CONCLUSIONS: γ-GTP revealed to have ambivalent association with hypertension and atherosclerosis. Active endothelial repair that is associated with atherosclerosis might have beneficial association with hypertension.


Asunto(s)
Aterosclerosis/enzimología , Hipertensión/enzimología , gamma-Glutamiltransferasa/sangre , Anciano , Antígenos CD34/análisis , Aterosclerosis/sangre , Aterosclerosis/epidemiología , Aterosclerosis/patología , Biomarcadores/sangre , Estudios Transversales , Células Endoteliales/química , Células Endoteliales/patología , Humanos , Hipertensión/sangre , Hipertensión/epidemiología , Hipertensión/patología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa
9.
Environ Health Prev Med ; 24(1): 74, 2019 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-31812162

RESUMEN

BACKGROUND: There have been inconsistent findings reported on maternal passive smoking during pregnancy and child risk of ADHD. In this study, ADHD symptoms at pre-school age children in association with prenatal passive and active tobacco smoke exposure determined by maternal plasma cotinine levels in the third trimester were investigated. METHODS: This was a follow-up study of the birth cohort: the Hokkaido Study on Environment and Children's Health. Children whose parents answered Strengths and Difficulties Questionnaire (SDQ) to identify child ADHD symptoms (hyperactivity/inattention and conduct problems) and total difficulties at age 5 years with available maternal plasma cotinine level at the third trimester were included (n = 3216). Cotinine levels were categorized into 4 groups; ≦ 0.21 ng/ml (non-smoker), 0.22-0.51 ng/ml (low-passive smoker), 0.52-11.48 ng/ml (high-passive smoker), and ≧ 11.49 ng/ml (active smoker). RESULTS: Maternal cotinine levels of active smokers were significantly associated with an increased risk of total difficulties (OR = 1.67) and maternal low- and high-passive smoking also increased the risk (OR = 1.11, 1.25, respectively) without statistical significance. Similarly, maternal cotinine levels of active smokers were associated with an increased risk of hyperactivity/inattention (OR = 1.49). Maternal low- and high-passive smoking and active smoking increased the risk of hyperactivity/inattention (OR = 1.45, 1.43, and OR = 1.59, respectively) only in boys. CONCLUSION: Our findings suggested that maternal active smoking during pregnancy may contribute to the increased risk of child total difficulties and hyperactivity/inattention at pre-school age. Pregnant women should be encouraged to quit smoking and avoid exposure to tobacco smoke.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/etiología , Exposición Materna/efectos adversos , Efectos Tardíos de la Exposición Prenatal/etiología , Fumar Tabaco/efectos adversos , Adulto , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Preescolar , Cotinina/sangre , Femenino , Estudios de Seguimiento , Humanos , Japón/epidemiología , Masculino , Madres , Embarazo , Tercer Trimestre del Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Riesgo , Factores Sexuales , Fumar Tabaco/epidemiología
10.
Medicine (Baltimore) ; 98(51): e18315, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860982

RESUMEN

The incidence of breast cancer among Japanese women is substantially increasing. This study evaluated the effects of reproductive and lifestyle factors with respect to breast cancer overall and separately among pre- and postmenopausal women using data from the Three-Prefecture Cohort Study of Japan.A total of 33,410 women aged 40 to 79 years completed a self-administered questionnaire, which included items about menstrual and reproductive history and other lifestyle factors. The follow-up period was from 1984 to 1992 in Miyagi and 1985 to 2000 in Aichi Prefectures. We used Cox proportional hazards regression models to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) after adjusting for confounding factors.After 9.8 mean years of follow-up, 287 cases of breast cancer were recorded. In the overall analysis, later menarche (≥16 years) and parity were significantly associated with a decreased risk of breast cancer, with HRs of 0.69 (95% CI 0.48-0.99) and 0.72 (95% CI 0.52-0.99), respectively. Further, there was a significant decline in the risk of breast cancer with increasing number of birth among parous women (P for trend = .010). On the contrary, a family history of breast cancer in the mother was significantly associated with an increased risk of breast cancer (HR 3.22, 95% CI 1.52-6.84). Analyses based on menopausal status at baseline indicated that height (≥160 cm) and weight (≥65 kg) were significantly associated with an increased risk of postmenopausal breast cancer, with HRs of 1.34 (95% CI 0.72-2.50) and 3.13 (95% CI 1.75-5.60), respectively. Risk associated with BMI significantly differs by menopausal status.Our findings suggest the important role of reproductive factors in the development of breast cancer in Japanese women; however, body mass index (BMI) may have different effects on breast cancer in Japanese women compared with western women.


Asunto(s)
Neoplasias de la Mama/etiología , Adulto , Anciano , Índice de Masa Corporal , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/genética , Estudios de Cohortes , Femenino , Humanos , Japón/epidemiología , Estilo de Vida , Anamnesis , Menarquia , Persona de Mediana Edad , Paridad , Factores de Riesgo , Encuestas y Cuestionarios
12.
Ther Adv Cardiovasc Dis ; 13: 1753944719894509, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31854243

RESUMEN

BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. METHODS: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). RESULTS: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) (p = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group (n = 8, 67%) was significantly lower than that in the conventional treatment group (n = 19, 100%) (p = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day (p = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group (n = 11, 58%) than in the SGLT2 inhibitor group (n = 2, 16%) (p = 0.031). CONCLUSIONS: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.


Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/administración & dosificación , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Enfermedad Aguda , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/prevención & control , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Glucemia/metabolismo , Comorbilidad , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hemoglobina A Glucada/metabolismo , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente , Supervivencia sin Progresión , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/efectos adversos , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Factores de Tiempo
13.
Environ Health Prev Med ; 24(1): 64, 2019 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-31775617

RESUMEN

BACKGROUND: Flourishing, defined as the coexistence of hedonic and eudaimonic well-being, is the most favorable end of the mental health spectrum. A growing body of evidence has demonstrated the association between flourishing mental health and favorable work-related outcomes. However, epidemiology of flourishing mental health is scarce in Japan. Moreover, the relationship between flourishing mental health and occupational stress has not been elaborated. Therefore, the aim of this study was to elucidate (1) the prevalence of flourishing mental health and (2) the association between flourishing mental health and occupational stress among Japanese workers. METHODS: The present survey was conducted in from February to March 2017 via an anonymous, self-administered, and web-based questionnaire among workers in Tsukuba Science City, Japan. Mental Health Continuum Short Form was used to assess flourishing mental health. We performed binomial logistic regression analyses to calculate the adjusted odds ratios (AOR) and 95% confidence intervals (CI) of occupational stress for flourishing mental health, controlling for sociodemographic factors. RESULTS: A total of 7012 respondents (4402 men, 2610 women) were analyzed. The overall prevalence of flourishing mental health among the respondents was 12.4%. Full-time (permanent) workers were less likely to be flourishing. Reward from work (AOR = 2.34, 95% CI = 2.04-2.68), support from colleagues and superiors (AOR = 1.67, 95% CI = 1.44-1.94), and workload (AOR = 1.19, 95% CI = 1.05-1.36) were positively associated with flourishing mental health, whereas mental workload (AOR = 0.65, 95% CI = 0.57-0.75) was inversely associated with flourishing mental health. CONCLUSIONS: The findings of the present study shed light on the association between flourishing mental health and occupational stress.


Asunto(s)
Salud Mental , Salud Laboral , Estrés Laboral/psicología , Lugar de Trabajo/psicología , Adulto , Estudios Transversales , Empleo/psicología , Femenino , Encuestas Epidemiológicas , Humanos , Japón/epidemiología , Masculino , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Estrés Laboral/epidemiología , Oportunidad Relativa , Prevalencia , Carga de Trabajo/psicología , Adulto Joven
14.
Environ Health Perspect ; 127(11): 117007, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31769300

RESUMEN

BACKGROUND: Previous literature suggests that higher ambient temperature may play a role in increasing the risk of suicide. However, no multi-country study has explored the shape of the association and the role of moderate and extreme heat across different locations. OBJECTIVES: We examined the short-term temperature-suicide relationship using daily time-series data collected for 341 locations in 12 countries for periods ranging from 4 to 40 y. METHODS: We conducted a two-stage meta-analysis. First, we performed location-specific time-stratified case-crossover analyses to examine the temperature-suicide association for each location. Then, we used a multivariate meta-regression to combine the location-specific lag-cumulative nonlinear associations across all locations and by country. RESULTS: A total of 1,320,148 suicides were included in this study. Higher ambient temperature was associated with an increased risk of suicide in general, and we observed a nonlinear association (inverted J-shaped curve) with the highest risk at 27°C. The relative risk (RR) for the highest risk was 1.33 (95% CI: 1.30, 1.36) compared with the risk at the first percentile. Country-specific results showed that the nonlinear associations were more obvious in northeast Asia (Japan, South Korea, and Taiwan). The temperature with the highest risk of suicide ranged from the 87th to 88th percentiles in the northeast Asian countries, whereas this value was the 99th percentile in Western countries (Canada, Spain, Switzerland, the UK, and the United States) and South Africa, where nearly linear associations were estimated. The country-specific RRs ranged from 1.31 (95% CI: 1.19, 1.44) in the United States to 1.65 (95% CI: 1.40, 1.93) in Taiwan, excluding countries where the results were substantially uncertain. DISCUSSION: Our findings showed that the risk of suicide increased with increasing ambient temperature in many countries, but to varying extents and not necessarily linearly. This temperature-suicide association should be interpreted cautiously, and further evidence of the relationship and modifying factors is needed. https://doi.org/10.1289/EHP4898.


Asunto(s)
Calor/efectos adversos , Suicidio/estadística & datos numéricos , Brasil/epidemiología , Canadá/epidemiología , Ciudades , Humanos , Japón/epidemiología , Filipinas/epidemiología , República de Corea/epidemiología , Riesgo , Sudáfrica/epidemiología , España/epidemiología , Suiza/epidemiología , Taiwán/epidemiología , Reino Unido/epidemiología , Estados Unidos/epidemiología , Vietnam/epidemiología
15.
Int Heart J ; 60(6): 1253-1258, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666454

RESUMEN

On March 11, 2011, a great earthquake, known as the Great East Japan Earthquake, hit northeastern Japan, resulting in a tsunami that caused a nuclear disaster, the Fukushima Daiichi Nuclear Power Plant accident, forcing about 160,000 people to evacuate. We, therefore, sought to examine the effects of this evacuation on the onset of cardiovascular diseases and sudden death (SD) in Fukushima Prefecture, three years after the earthquake. We divided the evacuation zone into two areas, whole evacuation zone (Area 1) and partial evacuation zone (Area 2), and we defined the north district of the prefecture as the control area (Area 3). We cross-referenced the death certificate data with data from the Fukushima Prefecture acute myocardial infarction registration survey. For each area, we tallied the number of people who fell into the SD, myocardial infarction (MI), and MI suspected groups. We calculated the age-adjusted incidence rates and analyzed the differences in the adjusted incidence rates across three years using a Poisson regression model. The age-adjusted death rate of the SD group was significantly higher in 2011 in all areas than in 2012 or 2013 (P < 0.05). The total death rate was higher in Area 1 in March 2011, just after the disaster, than in the other two areas. The rate of SD was also higher in Area 1 than in the other areas in March 2011. The incidence of sudden cardiac death might have increased just after the Great East Japan Earthquake in the evacuation area, but not in other areas in Fukushima Prefecture.


Asunto(s)
Muerte Súbita/epidemiología , Terremotos , Accidente Nuclear de Fukushima , Cardiopatías/epidemiología , Tsunamis , Adulto , Anciano , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Distribución de Poisson
16.
Nihon Shokakibyo Gakkai Zasshi ; 116(11): 913-926, 2019.
Artículo en Japonés | MEDLINE | ID: mdl-31708504

RESUMEN

Although chronic constipation is highly prevalent, its definition remains unclear. Therefore, the prevalence varies depending on reports, and the understanding of actual situations is unclear. Hence, we performed an internet survey on constipation among the Japanese general population to study the background factors and actual situations. Preliminary study on the awareness of constipation was conducted among 10000 people in which 9523 of them was asked if they had constipation at the time of the survey. In this population, 51.5% realized that they had constipation. Multivariate analysis showed the significant association of constipation to age, sex, and past histories or complications of diabetes, hemorrhoids, and cerebrovascular diseases. In a main research composed of 3000 general Japanese population, approximately 30.9% of the subjects reported the use of laxatives to treat constipation, and 43.8% of them were found to use irritant laxatives. Moreover, 67.5% of the subjects purchased laxatives at a pharmacy. The frequency of bowel movement less than 3 times per week was manifested in 36.3% of the subjects, and more than once per week in 21.4%. The percentage of hard (Bristol Stool Form Scale [BSFS] Type 1-2), normal (BSFS Type 3-5), and diarrhea stools (BSFS Type 6-7) was 33.1%, 60.0%, and 6.9%, respectively. The quality of life (QOL) of the subjects with hard and diarrhea stools evaluated by SF-8 was significantly lower than that of those with normal stools. Furthermore, the actual monthly cost for the therapeutic drugs used for treating constipation was less than 1000 yen in 75% of the subjects. Analysis of the IBS-QOL-J indicated that the ≥5000 yen payable group had the lowest satisfaction of defecation among the study groups. At present, many Japanese patients with constipation have not been receiving enough treatment for constipation. Therefore, appropriate medication by physicians as well as instruction to patients is required.


Asunto(s)
Estreñimiento/epidemiología , Calidad de Vida , Humanos , Internet , Japón/epidemiología , Encuestas y Cuestionarios
17.
Brain Nerve ; 71(11): 1236-1244, 2019 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-31722309

RESUMEN

Recent papers of amyotrophic lateral sclerosis/parkinsonism-dementia complex in the Kii peninsula, Japan (Kii ALS/PDC), published since 2015, were reviewed The studies included transition element of scalp hair analysis, dopaminergic PET study, review of life style changes in the high incident area, neurotoxic BMAA analysis, a clinical report of a migration case, comprehensive neuropathological study, cerebellar tau pathology, nitrative stress in the central nervous system study, optinurin pathology in the spinal cord, and tau PET study. Tau PET was advocated to be a new useful tool for diagnosis, even in the early stage of ALS/PDC with tauopathy. The etiology of Kii ALS/PDC remainds unknown. There are patients and healthy residents within the same environment in the high incidence foci, therefore it is difficult to explain this result by exposure to environmental factors alone. From the genetic viewpoint, rare-disease and rare-variant model may be applied to Kii ALS/PDC. Because there was an immigrant who was diagnosed neuropathologically, and a drastic decrease of the prevalence in the past several decades in the high incident area, it is feasible that Kii ALS/PDC is a multifactorial disease caused by both risk genes and environmental factors. Identifying risk genes and environmental factors for Kii ALS/PDC may contribute to the prevention of neurodegenerative diseases.


Asunto(s)
Esclerosis Amiotrófica Lateral/epidemiología , Demencia/epidemiología , Trastornos Parkinsonianos/epidemiología , Humanos , Japón/epidemiología
19.
Ann Hematol ; 98(12): 2815-2823, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31713653

RESUMEN

Allogeneic hematopoietic stem cell transplantation (allo-SCT) has been considered as a potentially curative treatment option for refractory or relapsed diffuse large B cell lymphoma (DLBCL) patients. However, there is little information available, especially for Japanese patients and in cord blood transplantation (CBT). We aimed to determine treatment outcomes of allo-SCT for DLBCL in the Kyoto Stem Cell Transplantation Group, a multi-institutional joint research group. Sixty-eight DLBCL patients who underwent their first allo-SCT between 2003 and 2016 were included. The median time from diagnosis to transplantation was 13.5 months. Thirty-one patients were in CR/PR at transplantation. Twenty-seven patients underwent CBT. The median follow-up for survivors was 44.2 months. Four-year overall survival (OS) and relapse-free survival (RFS) rates were 23% (95% CI, 13-35%) and 20% (95% CI, 11-31%), respectively. Cumulative incidences of non-relapse mortality and relapse were 23% and 57%, respectively. Patients in CR/PR at allo-SCT had better OS (4-year, 46% vs 4%, P < 0.001) and RFS (4-year, 36% vs 7%, P = 0.005). The source of the stem cell did not significantly affect OS (4-year, bone marrow vs cord blood vs peripheral blood, 28.6% vs 27.2% vs 6.5%, P = 0.193). In multivariate analysis, non-remission status at SCT associated with inferior OS and RFS. Duration from diagnosis to transplantation of less than 1 year associated with inferior RFS. Allo-SCT, including CBT, may be a promising therapeutic modality for DLBCL patients who have good disease control at transplantation.


Asunto(s)
Trasplante de Células Madre de Sangre del Cordón Umbilical , Linfoma de Células B Grandes Difuso , Adulto , Anciano , Aloinjertos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Japón/epidemiología , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia
20.
Medicine (Baltimore) ; 98(48): e18218, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31770283

RESUMEN

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by joint destructions and human leukocyte antigen (HLA)-DRB1 is an important genetic risk factor for RA and influences the phenotype of RA. The clinical features of elder age onset RA (EORA) were known to be different from those of younger age onset RA (YORA). Previous studies reported the different association pattern of DRB1 alleles with YORA or EORA. The associations of DRB1 genotype with these RA subsets remained almost unknown. We investigated the genotype association of DRB1 with YORA or EORA in Japanese populations.HLA genotyping was performed in Japanese RA patients and the association of allele or genotype carrier frequencies were analyzed.The genotype frequency of DRB104:05/DRB104:06 (P = .0204, OR 7.69, 95%CI 1.39-42.72), DRB104:05/DRB112:01 (P = .0050, OR 5.53, 95%CI 1.71-17.88), and DRB104:05/DRB115:01 (P = .0124, OR 3.34, 95%CI 1.39-8.02) in YORA was higher than EORA. However, the frequencies of DRB101:01/DRB104:05 in YORA was tended to be lower than EORA (P = .0784, OR 0.14, 95%CI 0.01-2.42). The gene dosage effect of the shared epitope alleles was detected in EORA, but not in YORA. Trans-complementing DQ heterodimer molecules, formed by DQA1 and DQB1 of the haplotypes with and without shared epitope alleles, might explain the higher genotype frequencies of "shared epitope /not shared epitope". Linear regression analyses showed the primary role of DQB104:01 allele for the age at onset of RA.This is the first report for the associations of DRB1 genotype with YORA or EORA in the Japanese population and the differential distribution of the genotypes was noted between these RA subsets. The involvement of DQ molecules for the age at onset of RA was suggested.


Asunto(s)
Edad de Inicio , Artritis Reumatoide , Cadenas HLA-DRB1/genética , Adulto , Anciano , Alelos , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/epidemiología , Artritis Reumatoide/genética , Correlación de Datos , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Humanos , Pruebas Inmunológicas/métodos , Japón/epidemiología , Masculino , Persona de Mediana Edad
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