Enteral nutrition for maintaining remission in patients with quiescent Crohn's disease: current status and future perspectives.

PURPOSE: The value of enteral nutrition (EN) as maintenance therapy in patients with quiescent Crohn's disease (CD) has not been fully evaluated. The purpose of this study was to review the efficacy of EN for the maintenance of remission in patients with quiescent CD. METHODS: Seven prospective cohort studies evaluating the efficacy of EN for the maintenance of remission in quiescent CD were included. Three of the seven studies were randomized-controlled trials (RCTs). In all studies, patients used EN as a supplement or as a nocturnal tube feeding in addition to their normal food. RESULTS: One study compared the efficacy of elemental diet and polymeric diet. Elemental and polymeric diets were equally effective for the maintenance of clinical remission and for allowing tapering and cessation of steroid therapy. The other six studies compared the outcomes between patients treated with and without EN. The maintained clinical remission rate at 1 year was significantly higher in patients treated with EN in four of the six studies. Quantitative pooling of the studies was not feasible due to a small number of RCTs and a narrative account of the study characteristics. CONCLUSIONS: Our review suggests that EN is useful for the maintenance of remission in patients with quiescent CD. However, there are several limitations in the reviewed studies. There are few RCTs. Further, the sample size is small, and the duration of intervention and follow-up is short. Large and well-designed RCTs should be conducted to rigorously evaluate the efficacy of EN for maintaining remission.

Preconceptional exposure to oral contraceptive pills and the risk of wheeze, asthma and rhinitis in children.

BACKGROUND: The prevalence of maternal oral contraceptive pills (OCP) use and that of childhood asthma are high in western countries. The aim of this study is to examine the association of OCP use with childhood wheeze and allergic diseases in Japan. METHODS: Relevant data were extracted from a hospital based birth cohort study named as Tokyo-Children's Health, Illness and Development Study (T-CHILD) of which questionnaire conducted during pregnancy included maternal history and duration of OCP use. To identify wheeze and allergic diseases in the children, the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) was used. Logistic regression models were applied to estimate those association and adjustments were made for maternal history of allergy, maternal education level, maternal age at pregnancy, maternal BMI, maternal smoking during pregnancy, mode of delivery, gestational age at delivery, daycare attendance, number of previous live births, and gender of child. RESULTS: OCP use was associated with ever wheeze (adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 1.10-2.40), current wheeze (aOR, 1.59; 95% CI, 1.01-2.50), ever asthma (aOR, 1.65; 95% CI, 1.02-2.65), and ever rhinitis (aOR, 1.90; 95% CI, 1.30-2.80). Compared with no prior OCP use, using OCP for more than three months statistically increased the odds of ever wheeze (P = 0.012), current wheeze (P = 0.035), and ever rhinitis (P = 0.002). CONCLUSIONS: Our findings suggest that maternal OCP use has a role in the development of wheeze, asthma and rhinitis in children. Extended use of OCP is likely to increase the risk of wheeze and rhinitis.

Caregivers of children with no food allergy--their experiences and perception of food allergy.

BACKGROUND: Food allergy (FA) is one of the most important health issues in schoolchildren. Although one of the most common places where pediatric anaphylaxis occurs is the home of a peer, the perception and experiences of caregivers who do not have a child with FA are unclear. METHODS: An anonymous paper-based questionnaire was distributed to caregivers of FA children (FA caregivers) in the National Center for Child Health and Development and caregivers of non-FA children (non-FA caregivers) in public school in Tokyo. We examined the perception and experiences of FA among three groups: Group 1, non-FA caregiver who had not witnessed adverse reactions and near-miss events related to FA; Group 2, non-FA caregivers who had witnessed adverse reactions and near-miss events related to FA; and Group 3, caregivers who had a child with FA. RESULTS: Epinephrine auto-injector was recognized by 43.6% non-FA caregivers. Only 2.8% of non-FA caregivers had experienced a child being bullied, harassed, or refused by a school because of FA. There were more caregivers in Group 2 who thought they could take the appropriate action if they witnessed a child with adverse response to causal food than in Group 1 (p < 0.05). All groups felt anxious over adverse events related to FA. CONCLUSION: The experiences and perception of FA were lacking among non-FA caregivers. Therefore, it is also important to provide FA education for non-FA caregivers to improve the quality of life of FA children.

Relieving pain and distress during venipuncture: Pilot study of the Japan Environment and Children's Study (JECS).

Pain management for needle-related procedures is poor in Japan. In many countries the use of lidocaine/prilocaine cream for the relief of pain associated with venipuncture has been approved. In children, a psychological approach has also been shown to be effective in reducing pain with venipuncture. We developed a multidisciplinary procedure that combines a cream (2.5% lidocaine and 2.5% prilocaine) and pharmacological approaches such as preparation, education, positioning and distraction. We evaluated the feasibility and acceptability of the procedure for young children. Among 132 pediatric participants, 58.3% did not cry during venipuncture. According to caregiver questionnaire, 71.9% felt that the multidisciplinary procedure eliminated the fear of needle-related procedures in the children; 90.9% were satisfied with it and 75.8% thought it should be applied to all children undergoing venipuncture. The present results suggest that the multidisciplinary procedure is feasible, acceptable and suitable for use in children undergoing venipuncture.

Inverse association of des-acyl ghrelin with worksite blood pressure in overweight/obese male workers.

BACKGROUND: Job strain, defined as a combination of high job demands and low job control, has been reported to elevate blood pressure (BP) during work. Meanwhile, a recent experimental study showed that ghrelin blunted the BP response to such mental stress. In the present study, we examined the hypothesis that des-acyl ghrelin may have some beneficial effects on worksite BP through modulating the BP response to work-related mental stress, i.e., job strain. METHODS: Subjects were 34 overweight/obese male day-shift workers (mean age 41.7 ± 6.7 years). No subjects had received any anti-hypertensive medication. A 24-h ambulatory BP monitoring was recorded every 30 min on a regular working day. The average BP was calculated for Work BP, Morning BP, and Home BP. Job strain was assessed using the short version of the Japanese Job Content Questionnaire. RESULTS: Des-acyl ghrelin showed significant inverse correlations with almost all BPs except Morning SBP, Morning DBP, and Home DBP. In multiple regression analysis, des-acyl ghrelin inversely correlated with Work SBP after adjusting for confounding factors. Des-acyl ghrelin was also negatively associated with BP changes from Sleep to Morning, Sleep to Work, and Sleep to Home. CONCLUSIONS: Des-acyl ghrelin was inversely associated with Worksite BP, suggesting a unique beneficial effect of des-acyl ghrelin on Worksite BP in overweight/obese male day-shift workers.

Effect of the Administration of Cordyceps militaris Mycelium Extract on Blood Markers for Anemia in Long-Distance Runners.

In the present study, we conducted a placebo-controlled, double-blind, parallel-group comparison trial in which an extract of Cordyceps militaris (CM) mycelium was administered to long-distance runners for 16 weeks during the pre-season training period and blood test markers for anemia were investigated. The results indicated that the change rates of serum ferritin levels were moderately increased in the CM group (n = 11) but decreased in the placebo group (n = 11) during the study period, and the levels were significantly increased in the CM group compared with those in the placebo group at 4 weeks and 8 weeks after the test food intake (p < 0.05). Moreover, the change rates of hemoglobin and hematocrit were significantly increased in the CM group compared with those in the placebo group at 8 weeks after the test food intake (p < 0.05). These observations suggest that the intake of test food containing Cordyceps militaris mycelium extract is expected to effectively maintain the hemoglobin and hematocrit levels in long-distance runners, possibly via the suppression of the decrease in iron storage, which is reflected by serum ferritin, during pre-season training. Furthermore, the levels of creatine kinase were increased above the normal range in both the placebo and CM groups at registration. Interestingly, the creatine kinase levels were significantly decreased in the CM group compared with those in the placebo group at 16 weeks after the test food intake (p < 0.05). These results suggest that Cordyceps militaris mycelium extract exhibits a protective action on the muscle damage observed in long-distance runners and may suppress muscle injury. Together, these observations suggest that Cordyceps militaris mycelium extract exhibits an improving effect on the markers for not only anemia, but also muscle injury in long-distance runners during pre-season training.

Association between pupillometric sleepiness measures and sleep latency derived by MSLT in clinically sleepy patients.

OBJECTIVES: The multiple sleep latency test (MSLT) has been employed extensively in clinical and research settings as a gold standard for objectively measuring sleepiness. In a general population or in a variety of work settings, however, a more convenient, rapidly administered measuring method is preferable. We examined the potential utility of pupillometry by comparing its objective measures, pupillary unrest index (PUI) and relative pupillary unrest index (RPUI), with MSLT-derived sleep latency (SL). METHODS: The study cohort comprised 45 patients (39 males, 6 females, mean age 38.9 ± 11.3 years) referred to the Sleep Disorders Center for the two-nap SL test. SL was measured twice before noon, and pupillometric measurement was performed immediately before each SL test. Subjective sleepiness was measured by using the Epworth Sleepiness Scale (ESS). RESULTS: The association between PUI and SL was significant and far closer than that between RPUI and SL. A significant difference was observed between the two groups, based on each subject's experience of drowsy driving accidents over the past 3 years in the PUI and RPUI, as well as in SL. The subjective sleepiness measure, ESS, did not relate to any other physiological sleepiness measures. CONCLUSIONS: In our study cohort, the pupillometric sleepiness measure, PUI, was significantly correlated with, and behaved in a manner equivalent to, MSLT-derived SL in clinically sleepy patients. However, several points remain to be carefully examined before applying pupillometry for screening sleepiness in a general population, or in occupational settings.

Nationwide cross-sectional population-based study on the prevalences of asthma and asthma symptoms among Japanese adults.

BACKGROUND: Asthma is a common respiratory disease worldwide. However, few reports are available on the prevalences of asthma and asthma symptoms among Asian subjects. METHODS: To determine the prevalences of asthma and asthma symptoms among Japanese subjects, we performed a nationwide cross-sectional, population-based study on Japanese adults aged 20-79 years. Ten areas spread throughout the country were randomly selected. Door-to-door or postal surveys were performed using a translated version of the European Community Respiratory Health Survey questionnaire. RESULTS: The survey was completed by 23,483 participants. The overall response rate was 70.6%. The prevalences of wheeze and current asthma among all participants aged 20-79 years were 10.1% (95% CI: 9.7-10.5%) and 4.2% (95% CI: 4.0-4.5%), respectively. The prevalences among young adults aged 20-44 years were 9.3% (95% CI: 8.7-9.9%) and 5.3% (95% CI: 4.8-5.8%), respectively. The prevalence of current asthma was highest in females aged 30-39 years in comparison with the other gender and age groups. CONCLUSIONS: This nationwide study determined the prevalences of asthma and asthma symptoms among Japanese adults. The results provide fundamental information on the respiratory health of Japanese adults.

Exercise-induced asthma is associated with impaired quality of life among children with asthma in Japan.

BACKGROUND: Asthma is the most common chronic diseases in school-aged children in Japan. It is important to consider health-related quality of life (QoL) among children with chronic diseases when treatment decisions are made. METHODS: A school-based survey was conducted in randomly selected public schools in Tokyo by using a KINDL questionnaire for evaluating QoL and the international study of asthma and allergy on childhood (ISAAC) questionnaire, which is designed for comparing the asthma prevalence in various countries, from May to June in 2005. We recruited approximately 10% of the total children 6-7-years-old and 13-14-years-old living in Tokyo for sampling. RESULTS: Response rate of this questionnaire was 86% (22,645 children) in the 6-7-year-old group and 64% (12,879 children) in the 13-14-year-old group. Comparing asthmatics with non-asthmatics in the same age, QoL of children with asthma was significantly impaired. The severity of QoL of children with asthma was significantly impaired. QoL of children with exercise-induced asthma (EIA) were more significantly impaired than ones without EIA and showed lower scores in the categories of physical functioning, emotional and school activities than those without EIA. Of note, QoL was more impaired in the EIA-positive group among severe asthmatics, suggesting that QoL of children with even severe asthma could be improved when EIA is appropriately controlled. CONCLUSIONS: Existence of EIA among asthmatic children most strongly impairs their QoL. We should be more cautious about the management of EIA.

The first instance of a cat excreting Echinococcus multilocularis eggs in Japan.

A cat excreting Echinococcus multilocularis eggs was recently identified in Hokkaido, representing the first such observation in Japan. The cat was raised free-range and frequently ate rodents. Fecal egg examination revealed eggs of taeniids (EPG: 440) and Spirometra spp. (EPG: >1000). PCR targeting part of the mitochondrial cytochrome c oxidase subunit I gene of E. multilocularis was positive with DNA from 3 single isolated taeniid eggs, and sequence analysis of one amplicon confirmed E. multilocularis. The results indicated that the eggs of E. multilocularis distributed in Hokkaido can be excreted in cat feces, and suggested the necessity of further studies to clarify whether the eggs excreted in cat feces are infective and thus whether cats can serve as infectious source to humans in Japan.

Job strain and smoking cessation among Japanese male employees: a two-year follow-up study.

The purpose of the present study was to assess the association between job strain and smoking cessation among Japanese male employees. In 1997, a baseline questionnaire was given to 2,625 (2,113 males and 512 females) employees of an electronics firm in Gifu Prefecture, Japan. The self-administered questionnaire was a set of questions on smoking habits and consisted of items on socio-demographic variables and smoking habits, including the Japanese version of the Job Content Questionnaire (JCQ). The JCQ consists of scales of job control, job demand, supervisory support, coworker support, job insecurity, physical demands, and isometric load. A total of 733 male smokers were then followed for 2 years, with 446 completing a follow-up questionnaire in 1999 (follow-up rate, 61%). Logistic regression analyses were performed to examine associations between job strain and smoking cessation. Among the 446 participants, 38 had quit smoking. After adjusting for age ((odds ratio: OR) = 0.38, 95% (contidence interval: CI) = 0.15-0.94), men with a high level of physical demands at baseline showed a lower smoking cessation rate at follow-up than did those with a low level. However, when adjustments were made for age and other socio-demographic variables, the odds ratio of smoking cessation showed marginal significance (OR = 0.45, 95% CI = 0.16-1.29). There was no significant association between other job strain variables and smoking cessation at the 2-year follow-up. No significant association was found between job strain and change in the number of smoked cigarettes per day. The present study did not support the hypothesis that higher levels of job stressors are associated with a lower rate of smoking cessation among men.

Five-hour sleep restriction for 7 days increases subjective sleepiness.

We investigated the effects of a 5-h sleep restriction for 7 d on subjective sleepiness in an ambulatory condition by comparing them with baseline conditions consisting of an 8-h sleep for 7 consecutive days. Subjects were 13 healthy male students (mean age 21.1 yr). Each subject was required to get 8 h of sleep (baseline, from 2300 to 0700) for 7 d, and 5 h of sleep (sleep restriction, from 0100 to 0600) for 7 d in an ambulatory condition. The order of the two sleep schedules was randomly assigned. Subjective sleepiness was assessed by a Visual Analog Scale (VAS) every 3 h at 0900, 1200, 1500, 1800, and 2100 for 7 successive days during each sleep schedule. The VAS score during sleep restriction gradually increased up to the 5th day and then reached a plateau. The patterns of time-course changes in the VAS score were similar to those at baseline. The VAS scores showed a peak at 0900, taking a dip at 1200, and then gradually increasing toward 2100. The mean VAS score of the last three days of the 5-h sleep restriction was significantly higher than that at baseline (p<0.001). A 5-h sleep restriction for 7 d in an ambulatory condition increased subjective sleepiness up to the 5th day and then reached a plateau. The patterns of the time-course changes in sleepiness of 5-h sleep restriction per day did not differ from that at baseline.

Neural and Genetic Correlates of the Social Sharing of Happiness.

Happiness is regarded as one of the most fundamental human goals. Given recent reports that positive feelings are contagious (e.g., the presence of a happy person enhances others' happiness) because of the human ability to empathize (i.e., sharing emotions), empathic ability may be a key factor in increasing one's own subjective level of happiness. Based on previous studies indicating that a single nucleotide polymorphism in the serotonin 2A receptor gene [HTR2A rs6311 guanine (G) vs. adenine (A)] is associated with sensitivity to emotional stimuli and several mental disorders such as depression, we predicted that the polymorphism might be associated with the effect of sharing happiness. To elucidate the neural and genetic correlates of the effect of sharing happiness, we first performed functional magnetic resonance imaging (fMRI) during a "happy feelings" evocation task (emotional event imagination task), during which we manipulated the valence of the imagined event (positive, neutral, or negative), as well as the presence of a friend experiencing a positive-valence event (presence or absence). We recruited young adult women for this fMRI study because empathic ability may be higher in women than in men. Participants felt happier (p < 0.01) and the mentalizing/theory-of-mind network, which spans the medial prefrontal cortex, temporoparietal junction, temporal poles, and precuneus, was significantly more active (p < 0.05) in the presence condition than in the absence condition regardless of event valence. Moreover, participants with the GG (p < 0.01) and AG (p < 0.05) genotypes of HTR2A experienced happier feelings as well as greater activation of a part of the mentalizing/theory-of-mind network (p < 0.05) during empathy for happiness (neutral/presence condition) than those with the AA genotype. In a follow-up study with a vignette-based questionnaire conducted in a relatively large sample, male and female participants were presented with the same imagined events wherein their valence and the presence of a friend were manipulated. Results showed genetic differences in happiness-related empathy regardless of sex (p < 0.05). Findings suggest that HTR2A polymorphisms are associated with the effect of sharing happiness by modulating the activity of the mentalizing/theory-of-mind network.

Possible connections among job stress, depressive symptoms, lipid modulation and antioxidants.

BACKGROUND: Oxidative/antioxidative status may be related to psychological stress or pathogenesis of depression. SUBJECTS AND METHODS: Participants were selected from 381 female nurses working in a university hospital, and the Brief Job Stress Questionnaire was utilized to assess them. Nurses with high job stress (JS) (n = 18) and with low JS (n = 15) consented to participate in this study. Depressive symptoms were assessed by the Centre for Epidemiologic Studies Depression scale (CES-D). Cholesterols, lipid peroxidation (malondialdehyde, MDA) and antioxidants in the plasma were measured. RESULTS: High JS participants exhibited significantly higher CES-D scores (t = 3.34, p < 0.005), and significantly lower concentrations of total cholesterol (TC), low density+very low density lipoprotein cholesterols (LDL+VLDL), alpha-tocopherol, and beta-carotene compared with low JS participants (t = 2.69, p < 0.05; t = 3.46, p < 0.005; t = 2.96, p < 0.05; t = 2.98, p < 0.05, respectively). However, the reductions in plasma indicators were substantially weakened after controlling for lifestyle factors with the exception of LDL+VLDL and alpha-tocopherol. In addition, the significance of alpha-tocopherol concentrations appeared to depend on cholesterol levels. CES-D scores correlated positively with plasma MDA levels, the MDA/TC ratio and the MDA/LDL+VLDL ratio among the low JS group (r = 0.69, p < 0.001; r = 0.79, p < 0.001; r = 0.75, p < 0.005, respectively), whereas there were no correlations among the high JS group. After controlling for lifestyle covariates, the relationship between CES-D scores and the MDA/LDL+VLDL ratio remained significant (beta = 0.95, p < 0.05) using a multiple linear regression model (F = 3.61, p < 0.05). LIMITATIONS: Sample numbers in each JS group were relatively small. CONCLUSIONS: Psychological stress may reduce the plasma levels of LDL+VLDL accompanying an alpha-tocopherol decrease. There appeared to be a correlation between elevated MDA and depressive symptoms in low JS participants.

Trajectory of prehospital delay in patients with acute myocardial infarction in the Japanese health care system.

OBJECTIVE: The purpose of this study was to understand the trajectory of prehospital delay in patients with acute myocardial infarction (AMI) in the Japanese health care system, which offers patients a choice between seeking treatment in a neighborhood clinic/small hospital (clinic group) or a large hospital with comprehensive cardiac services, including a cardiac catheterization laboratory (hospital group). METHODS: In this cross sectional study, 155 consecutive patients admitted with AMI to one of 5 urban hospitals in Japan were interviewed within 7 days after admission. RESULTS: The median total prehospital delay time in the clinic group (n=84) was significantly longer than the hospital group (n=71) (6 h and 48 min vs 2 h and 9 min, p<.001). Patients with severe chest pain were significantly less likely to seek treatment at a clinic/small hospital than at a large hospital compared to patients with mild or moderate symptoms (OR 0.85, 95% CI: 0.75, 0.97). Patients who did not interpret their symptoms as cardiac in origin were significantly more likely to seek treatment at a clinic/small hospital than at a large hospital compared to patients who interpreted their symptoms as cardiac in origin (OR 3.32, 95% CI: 1.56, 7.10). After controlling for demographic and medical history, patients in the clinic group were 3.69 times (95% CI: 1.28, 10.66) less likely to receive any reperfusion therapy compared to patients in the hospital group. CONCLUSIONS: Findings support the need for public education in Japan that focuses on the appropriate response to AMI symptoms. Moreover, regional AMI networks need to be instituted to provide for early transfer for PCI from clinic/small hospitals to tertiary centers.

Predictors of in-hospital delay to reperfusion in patients with acute myocardial infarction in Japan.

The purpose of this study was to identify factors associated with in-hospital delay in patients with acute myocardial infarction (AMI) in Japan. In this observational study, 155 consecutive patients admitted with AMI to one of five urban hospitals were studied. The median door-to-needle time and door-to-catheterization-laboratory time was 19 min and 60 min, respectively. Three variables predicted door-to-catheterization-laboratory times >/= 60 min: failing to call an ambulance, direct admission to the hospital, and absence of diaphoresis (p < 0.05). These findings support the need for public education emphasizing the importance of calling an ambulance for AMI symptoms. Moreover, Japanese physicians should be aware that admitting patients directly to the hospital and bypassing the Emergency Department might increase delay to treatment.

The association among ferruginous body, uncoated fibers, asbestos and non-asbestos fibers in lung tissue in terms of length.

To demonstrate the correlations between the concentrations of ferruginous body as well as uncoated fiber both of which can be observed with phase-contrast microscope and the concentration of various inorganic fibers including asbestos which requires the observation with TEM or SEM, we measured those indices among Japanese and Korean cases. Though the concentration of ferruginous body in lung tissue is an important index of asbestos exposure, uncoated fibers observed with phase-contrast microscope might be another index especially in such cases with relatively low exposure due to their history of living in a general environment. However, to establish the reliability of uncoated fibers as an index of asbestos exposure, analysis with more cases and from various backgrounds must be carried out.

Prehospital delay and independent/interdependent construal of self among Japanese patients with acute myocardial infarction.

Reducing the time from symptom onset to reperfusion therapy is an important approach to minimizing myocardial damage and to preventing death from acute myocardial infarction (AMI). Previous studies suggest that certain ethnic or national groups, such as the Japanese, are more likely to delay in accessing care than other groups. The aims of this paper were the following; (1) to examine whether culture (defined as independent and interdependent construal of self) is associated with delay in accessing medical care in Japanese patients experiencing symptoms of AMI; (2) to determine if the relationship between independent and interdependent construal of self and prehospital delay time is mediated by cognitive responses and/or emotional responses; and (3) to determine if independent and interdependent construal of self independently predicts choice of treatment site (clinic vs. hospital). A cross-sectional study was conducted at hospitals in urban areas in Japan. One hundred and forty-five consecutive patients who were admitted with AMI within 72 h of the onset of symptoms were interviewed using the modified response to symptoms questionnaire and the independent and interdependent construal of self scale. The interdependent construal of self scores were significantly associated with prehospital delay time, controlling for demographics, medical history, and symptoms (p<.001). However, the relationship between independent and interdependent self and prehospital delay times was not mediated by cognitive or emotional responses. In multiple logistic regression analysis, patients with high independent construal of self were more likely to seek care at a hospital rather than a clinic compared to those with lower independent construal of self. In conclusion, cultural variation within this Japanese group was observed and was associated with prehospital delay time.

Association between perceived social support and Th1 dominance.

Social support is supposed to have a positive health effect via alteration of immunity. In this study, associations between perceived social support and immune systems were examined. Immunological assessments, e.g. T cell count, Natural Killer cell count, Interferon-gamma, Interleukin-4, and psychological assessments, e.g. Generic Job Stress Questionnaire were conducted on male employees. Two-way (social support x job stressor) analyses of covariance controlling for age, smoking, alcohol consumption, and exercise revealed that there were main effects of perceived social support on NK cell counts, IL-4, and Th1/Th2 balance. On the other hand, interaction effects were observed on T cell counts and INF-gamma production in vitro. Social support affects immune function in a way that is consistent with both the direct and buffering hypotheses depending on the sources of support and the immune parameter.