Perforating collagenosis.

We show a case of a 69-year-old man with perforating collagenosis, which is a rare dermatosis commonly associated with diabetes mellitus. Papules and plaques with keratotic plugs are distinctive clinical characteristic of perforating collagenosis. Representative clinical images in our article can enhance the understanding of key concepts of perforating collagenous.

Association of Hours of Paid Work with Dietary Intake and Quality in Japanese Married Women: A Cross-Sectional Study.

This study investigated the association of hours of paid work with dietary intake and diet quality among Japanese married women. This cross-sectional study was a secondary analysis of a nationwide population survey in 2013. The analytic sample included 644 married women aged 20-59 years. The participants were categorized into five groups according to hours of paid work per week: 0 (housewives), 1-14, 15-34, 35-42, and ≥43 h. Dietary intake was assessed by a self-administered diet history questionnaire. The Nutrient-Rich Food Index 9.3 (NRF9.3) was used to measure the dietary quality. The association of hours of paid work with dietary intake and NRF9.3 score was assessed using a multivariable general linear regression analysis with adjustments for confounders. Hours of paid work were associated with a higher intake of rice and lower intake of vegetables, potatoes, soy products, and seaweeds and nutrients including protein, dietary fiber, and most vitamins and minerals. Hours of paid work were negatively associated with the NRF9.3 score. This study showed that Japanese married women engaging in paid work, especially those who work long hours, have less healthy diets. Efforts to improve the dietary intake of married women with paid work might be needed.

Consumption of meals prepared away from home is associated with inadequacy of dietary fiber, vitamin C and mineral intake among Japanese adults: analysis from the 2015 National Health and Nutrition Survey.

BACKGROUND: Consumption of home-prepared meals may lead to better nutritional intake. Few studies have examined the association between the frequency of consuming meals prepared away from home and the inadequacy of nutritional intake based on nutritional standards and food group intake. We therefore aimed to investigate this issue among Japanese adults. METHODS: This study was a secondary analysis of the 2015 National Health and Nutrition Survey in Japan, involving 921 men and 1300 women aged 18-64 years, conducted as a cross-sectional survey. The frequency of consuming meals prepared away from home was defined using two questions inquiring about the frequency of eating out and take-away meals. Data on dietary intake were collected using a one-day semi-weighed household dietary record. Participants were stratified into three groups based on the frequency of consuming meals prepared away from home (High, Moderate, Low). The inadequacy of each nutrient intake was assessed by comparing estimated average requirement (EAR) level for 14 nutrients and the range of the dietary goal (DG) for seven nutrients according to the 2015 version of the Dietary Reference Intakes for Japanese. Group differences in nutrients adequacy were assessed using the covariate and logistic regression analysis. Food intake was also compared across the groups by classifying each food item into 17 groups based on Standard Tables of Food Composition. RESULTS: The proportion of participants who consumed home-prepared meals almost every day were 34.9% among men and 46.8% among women, and the proportion of those consuming a higher frequency of meals prepared away from home were 14.7 and 6.3%, respectively. A higher frequency of consuming meals prepared away from home was associated with inadequacy of dietary fiber, vitamin C and minerals (iron, magnesium and potassium) intake, and with lower intake of vegetables and higher intake of fat and oils. CONCLUSIONS: High frequency of consuming meals prepared away from home was associated with insufficient intake of dietary fiber, vitamin C and multiple minerals among Japanese adults. These nutrients may be the potential target of interventions aimed at improving nutrient intake in individuals who predominantly eat food prepared away from home.

Analysis of risk factors for multidrug-resistant pathogens and appropriate treatment indications for pneumonia in children with neurologic impairment.

INTRODUCTION: The features of pneumonia in children with neurologic impairment (NI) resemble those of healthcare-associated pneumonia is defined as pneumonia occurring in the community associated with healthcare risk factors. There are currently no guidelines for the treatment of pneumonia in children with NI. Here, we assessed whether the guidelines applicable for treating pneumonia in adults could be applied to children with NI. METHODS: Between 2008 and 2019, we enrolled children with NI who developed pneumonia and were treated in the pediatric ward of Kawasaki Medical School Hospital. We evaluated patient characteristics, the frequency of isolation of multidrug-resistant (MDR) pathogens, and clinical outcomes. RESULTS: MDR pathogens were more frequently isolated from patients receiving tube feeding (TF) and/or with tracheostomy than from patients without these risk factors. Other risk factors, including a history of antibiotic therapy and methicillin-resistant Staphylococcus aureus isolation, recent hospitalization, residence in a nursing home or extended care facility, and low-dose, long-term macrolide therapy, did not significantly affect the frequency of MDR pathogen isolation. In patients receiving TF and/or with tracheostomy, treatment success was achieved in all cases treated with broad-spectrum antibiotics and 72.2% of cases treated with non-broad-spectrum antibiotics (P = 0.007). Conversely, among patients without these risk factors, no such difference was observed. CONCLUSIONS: Our findings indicate that the guideline to select antibiotics for treating pneumonia in children with NI should be simpler and more useful than the current guidelines for adult pneumonia, based on risk factor assessment for MDR pathogens.

Investigating interest in orthopedic surgery within an entire medical faculty: A cross-sectional study.

BACKGROUND: Discrepancies exist between the magnitude of musculoskeletal problems and the competency of physicians practicing musculoskeletal medicine, which likely stems from medical school-level educational deficiencies. Therefore, inadequate orthopedic surgery education during medical school may affect the number of students aspiring to practice orthopedic surgery. However, the motivating factors underlying medical students' selection of a career specialty are largely unknown. This study aims to use a survey to examine the motivations of medical students who consider orthopedic surgery as a potential career specialty. METHODS: A questionnaire survey was administered to medical students in our medical faculty. The results were stratified on the basis of gender, year, and experience as a patient; results were then compared between students who wished to practice orthopedic surgery and those who did not consider it a potential specialty. RESULTS: Of the 499 students who responded to the questionnaire, 47% considered orthopedic surgery as their career specialty. Being male and having experienced orthopedic surgery as a patient were significant factors influencing the aspiration to practice orthopedic surgery (p < 0.001). In addition, the motivation for choosing orthopedic surgery was academic interest for 55% of students. In the first and fifth years, more than half of the students preferred an orthopedic surgery specialty. The percentage of fifth-year students who were candidates for orthopedic surgery as their career specialty significantly exceeded that of students in other years (p = 0.03). However, the percentage of students considering orthopedic surgery decreased in the sixth year. CONCLUSION: Our findings suggest that orthopedic surgeons should provide a clearer, more informative job description to attract female medical students' attention and change their negative perception of orthopedic surgery. Furthermore, including education that incorporates experiences closer to clinical practice at the medical-school level is important for increasing the number of candidates for orthopedics.

Trends in BMI among elderly Japanese population: findings from 1973 to 2016 Japan National Health and Nutrition Survey.

OBJECTIVE: To examine 44-year trends in height, weight and BMI, and the prevalence of overweight/obesity and underweight in the elderly Japanese population because Japan, the country with the longest life expectancy, has the highest ageing population. DESIGN: Using the nationally representative cumulative data from the Japan National Health and Nutrition Survey 1973-2016, sex-specific and age-adjusted mean height, weight and BMI, and the prevalence of overweight/obesity and underweight were calculated for each year. Trend analyses were performed using the Joinpoint Regression Program. Next, changes in height, weight and BMI, and the prevalence of overweight/obesity and underweight were estimated for each age group (65-69, 70-79 and >80 years) according to the birth year groups. SETTING: Japan. PARTICIPANTS: Individuals aged ≥65 years with complete data on height and body weight measurements (N 94 508). RESULTS: Trends in average height and weight increased over the four decades in both men and women. The prevalence of overweight/obesity dramatically increased and nearly tripled in men, accompanied with significantly decreased underweight prevalence. Furthermore, the increasing trend in average BMI and overweight/obesity prevalence in women reached a peak in 2002 and showed a decreasing trend thereafter, while a downward trend in underweight prevalence showed a gradual increase in women since 2003. CONCLUSIONS: Trends in height, weight and BMI among the elderly population should continue to be closely monitored in parallel with the effects of dietary changes, energy intake and physical activity (step counts).

Associations Between Health Literacy and Underweight and Overweight Among Japanese Adults Aged 20 to 39 Years: A Cross-Sectional Study.

Background. Both underweight and overweight are public health concerns in Japan. Several studies examined the association between health literacy (HL) and obesity status in the general population; however, there is limited information on young adults. In addition, the association between HL and underweight status has not been extensively investigated. Aim. To examine the association between HL and underweight/overweight status among young Japanese adults aged 20 to 39 years. Method. This study was based on a cross-sectional survey of population-representative adults. HL was assessed using a questionnaire validated in Japanese adults. Body mass index (BMI) was calculated using self-reported weight and height. Participants were divided into two groups by HL score using the median score (lower vs. higher HL). The association between HL and underweight (BMI <18.5) or overweight (BMI ≥25.0) was examined using multinomial logistic regression analyses after adjusting for potential confounders. Results. In total, 476 women and 454 men were included in the analyses. Prevalence of underweight and overweight was 20.8% and 10.3% in women and 8.8% and 20.3% in men, respectively. In women, 45.1% of normal weight, 47.5% of underweight, and 30.6% of overweight had higher HL. Among men, 50.3% of normal weight, 35.0% of underweight, and 44.6% of overweight had higher HL. Bivariate analyses showed no statistically significant association between HL level and underweight/overweight status. Even after adjusting for potential confounders, these associations did not change. Discussion and Conclusion. This study suggests that HL scores may not be associated with underweight or overweight status in Japanese adults.

Associations between nutritional adequacy and insomnia symptoms in Japanese men and women aged 18-69 years: a cross-sectional study.

OBJECTIVES: Sleep and diet are important lifestyle factors for maintaining health. Although previous studies have suggested that sleep quality may be associated with specific nutrient and food intakes, the relationship between nutritional adequacy and sleep quality remains unclear. The purpose of this study was to examine the relationship between sleep quality (insomnia symptoms) and adequate nutrient intake among Japanese adults. DESIGN: Cross-sectional. SETTING: Nationwide population survey conducted in 2013. PARTICIPANTS: 1,997 participants (940 men and 1,057 women) aged 18-69 years. MEASUREMENTS: Insomnia symptoms were assessed using the Athens Insomnia Scale (AIS) and participants were classified into three groups (absent, minor, and moderate-severe) based on the total AIS score. Dietary intake was estimated using a questionnaire and nutrient intake adequacy was evaluated by comparing the self-reported intake with two indices of the Dietary Reference Intakes for Japanese (2015): an estimated average requirement (EAR) and tentative dietary goal for preventing lifestyle-related disease (DG). RESULTS: A total of 205 men (21.8%) and 266 women (25.2%) were categorized as having moderate-severe insomnia symptoms. Among men, moderate-severe symptoms were associated with higher prevalences of inadequate intakes of total dietary fiber, vitamin C, and zinc. However, there was little association between inadequate nutrient intake and insomnia symptoms among women. The number of inadequate nutrients was significantly associated with insomnia symptoms in men (DG, P=0.004; EAR, P=0.003) but not in women. CONCLUSIONS: This study suggested that insomnia symptoms may be associated with nutritional inadequacy in Japanese adults, especially among men.

The Association between Milk and Dairy Products Consumption and Nutrient Intake Adequacy among Japanese Adults: Analysis of the 2016 National Health and Nutrition Survey.

Consumption of dairy products in the usual diet may be important for improving the overall quality of dietary intake. This study aimed to assess the difference in nutrient intake adequacy according to the intake of dairy products based on a 1-day weighed dietary record of Japanese adults from the 2016 National Health and Nutrition Survey. Nutritional adequacy was determined based on the Dietary Reference Intakes for Japanese 2015, with 2 goals: Tentative dietary goals (DG) for preventing lifestyle-related diseases, and the estimated average requirement (EAR). According to the dairy products consumption, participants were categorized into three groups (milk, other dairy product, or non-dairy), and the total number of those not meeting DG and EAR was compared. Non-dairy consumers were less likely to meet both DG and EAR compared to dairy consumers. Dairy consumers were more likely to exceed the DG for saturated fat than non-dairy consumers. Japanese adult dairy consumers were more likely to have adequate nutritional intake than non-dairy consumers, especially for calcium. We also observed a higher saturated fat intake in dairy consumers, which might be due to a certain dietary pattern in this group. Further investigation is needed to determine dairy intake and its influence on dietary quality among the Japanese population.

The frequency of cooking dinner at home and its association with nutrient intake adequacy among married young-to-middle-aged Japanese women: the POTATO Study.

Home cooking has been suggested as a key to healthy dietary intakes. However, little is known about the association between cooking behaviour and nutrient intake among young-to-middle-aged women. We aimed to investigate the association between home cooking frequency and nutrient intake adequacy among married Japanese women. Self-administered questionnaires were used to assess the weekly frequency of cooking dinner at home and habitual nutrient intake during the preceding month. We evaluated nutrient intake adequacy by comparing the self-reported intake with two indices of the dietary reference intakes for Japanese (2015): the estimated average requirement (EAR) of fourteen nutrients, and the 'tentative dietary goal for preventing lifestyle-related diseases' (DG) of seven nutrients. A total of 143 participants (25-44 years old) completed the questionnaires, with 32·9 % of participants reporting a weekly home cooking frequency of seven times/week. Women with a higher home cooking frequency (seven times/week) were more likely to have children (P = 0·001) than those with a lower home cooking frequency (0-6 times/week). Of the nutrients evaluated, there was no significant difference between the two groups in meeting EAR and DG. Our findings suggest that daily home cooking may not be necessary to achieve adequate nutrient intake, specifically among married, young-to-middle-aged Japanese women.

Comparing Antimicrobial Susceptibilities among Mycoplasma pneumoniae Isolates from Pediatric Patients in Japan between Two Recent Epidemic Periods.

We compared the antimicrobial susceptibility of Mycoplasma pneumoniae isolates from pediatric patients in Japan in 2011-2012 and 2015-2016, when epidemics occurred. The antimicrobial activity of macrolides and tetracyclines against M. pneumoniae infection tended to be restored in 2015-2016. There was no change in the antimicrobial activity of quinolones against M. pneumoniae infection.

No association between fruits or vegetables and non-alcoholic fatty liver disease in middle-aged men and women.

OBJECTIVE: It has been hypothesized that fruit and vegetable intake is inversely associated with non-alcoholic fatty liver (NAFLD). However, some studies have speculated that fruit intake might be positively associated with NAFLD owing to the fructose content of the fruit. This might cause consumers to hesitate consuming fruit. The aim of this study was to assess the association between fruit and vegetable consumption and NAFLD. METHODS: This was a cross-sectional study of 977 men and 1467 women, 40 to 69 y of age without current liver disease other than NAFLD and who did not report excess alcohol intake (i.e., ≥30 g/d in men and ≥20 g/d in women). Dietary intake was assessed using a validated diet history questionnaire. NAFLD was diagnosed from abdominal ultrasonography results. The association between quartiles of fruit or vegetable consumption and NAFLD prevalence was assessed using logistic regression analysis, with lowest category as reference. RESULTS: The prevalence of NAFLD was 34.9% in men and 11.7% in women. Adjusted for age and lifestyle factors, fruit intake was inversely associated with NAFLD in both sexes. However, these associations disappeared after further adjustment for body mass index. Consumption of total vegetables was not associated with NAFLD. In women, a linear inverse association was demonstrated between green and yellow vegetable intake and NAFLD in the final model (Ptrend = 0.04), but odds ratios for any intake category did not reach significance. CONCLUSIONS: No obesity-independent association was found between fruit or vegetable intake and NAFLD. According to the findings of this study, Japanese do not need to restrict fruit consumption to limit fructose intake as a means of preventing NAFLD.

Epstein-Barr Virus (EBV)-induced B-cell Lymphoproliferative Disorder Mimicking the Recurrence of EBV-associated Hemophagocytic Lymphohistiocytosis.

We describe the case of a 23-month-old male infant with Epstein-Barr virus (EBV)-associated lymphoproliferative disorder, which mimicked the recurrence of EBV-associated hemophagocytic lymphohistiocytosis. Chemotherapy with dexamethasone, etoposide, and cyclosporine resolved fever, hepatosplenomegaly, and pancytopenia. However, on day 81 of illness, the patient developed similar symptoms. Plasma EBV-DNA levels markedly increased again, but no T-cell clonality was observed. B cells were identified to be infected with EBV. He was successfully treated with rituximab, dexamethasone and etoposide. When recurrence of EBV-associated hemophagocytic lymphohistiocytosis is suspected, performing tests to identify the infected cells will enable accurate understanding of the clinical condition, resulting in proper treatments.

Nutrition knowledge related to breakfast skipping among Japanese adults aged 18-64 years: a cross-sectional study.

OBJECTIVE: Breakfast skipping is regarded as a public health issue among adults worldwide. Nutrition knowledge has been reported to be one of predictors of dietary behaviour. Therefore, the aim of the present study was to examine the association between nutrition knowledge and breakfast skipping. DESIGN: Data regarding nutrition knowledge were obtained by using a validated, self-administered general nutrition knowledge questionnaire for Japanese adults (JGNKQ). Participants were classified into three nutrition knowledge level groups according to total JGNKQ score: Low, Middle and High. In addition, participants reported the frequency of meal consumption per week and rated the difficulty in finding time to eat breakfast, lunch and dinner in the lifestyle questionnaire. The differences in frequency of breakfast, lunch and dinner consumption among Low, Middle and High nutrition knowledge groups were determined by using ANCOVA adjusted for potential confounding factors. SETTING: Kanto region, Japan.ParticipantsJapanese adults aged 18-64 years (n 1165, 57·3% women). RESULTS: Mean age of the participants was 43·8 (sd 8·9) years. There were no significant differences found in the proportion of respondents reporting difficulty in finding time to eat each meal among the three groups. However, the frequency of breakfast consumption was significantly different among Low, Middle and High groups, while lunch and dinner frequency did not differ among the three groups. CONCLUSIONS: The present study suggests that nutrition knowledge level is related to breakfast skipping among Japanese adults.

Association between the Portion Sizes of Traditional Japanese Seasonings-Soy Sauce and Miso-and Blood Pressure: Cross-Sectional Study Using National Health and Nutrition Survey, 2012⁻2016 Data.

While previous studies have reported the association between food portion size and health outcomes, the association between food seasonings and blood pressure (BP) has not been clarified. This study aimed to investigate the association between the portion sizes of traditional Japanese seasonings and BP. Data on 25,738 Japanese participants (10,154 men and 15,584 women) aged ≥20 years registered in the 2012⁻2016 National Health and Nutrition Survey (NHNS) were used for this cross-sectional study. The portion sizes of soy sauce or miso were calculated from the reported weight of soy sauce or miso, and the number of dishes. Regression models were used to estimate BP and prevalence of hypertension, and their 95% confidence intervals according to the portion size of soy sauce or miso. We did not observe an association between the portion sizes of soy sauce or miso and BP. A larger portion size of soy sauce or miso was associated with a higher prevalence of hypertension in the crude model among women, but no significant associations were observed in the multivariate model in both sexes. Our findings suggest that the portion sizes of soy sauce or miso are not associated with BP among Japanese adults.

Incidence of Viremia With DNA Viruses in Oncology Patients With Febrile Neutropenia.

BACKGROUND: Although febrile neutropenia (FN) is one of the most common adverse events produced by chemotherapy, its microbiological etiology is determined for only 15% to 30% of cases. OBJECTIVES: We investigated the rate of viremia with common DNA viruses in patients with FN. STUDY DESIGN: From June 2012 to April 2014, 72 blood samples from 24 patients receiving chemotherapy, who experienced FN episodes, were examined for the presence of herpes viruses and other DNA viruses. We used real-time polymerase chain reaction assays to detect herpes simplex virus type 1 and 2, varicella zoster virus, Epstein-Barr virus, cytomegalovirus, human herpes virus types 6 and 7, BK virus and human parvovirus B19 (B19). RESULTS: Viruses were identified in 14 of 72 samples (19.4%). The detected etiological agents were BK virus (5 episodes), human herpes virus type 6 (4 episodes), B19 (4 episodes), Epstein-Barr virus (2 episodes), and cytomegalovirus (1 episode). CONCLUSIONS: Our results indicate that viral infections are common causes in patients with FN. Therefore, viruses may be responsible for FN in a large proportion of patients in whom a causative microorganism could not be identified, and this viral etiology may explain their poor response to antibiotic therapy.