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Isojima S, Yajima N, Yanai R, Miura Y, Fukuma S, Kaneko K, Fujio K, Oku K, Matsushita M, Miyamae T, Wada T, Tanaka Y, Kaneko Y, Nakajima A, Murashima A. Physician approval for pregnancy in patients with systemic lupus erythematosus showing only serological activity: A vignette survey study. Mod Rheumatol 2024; 34:509-514. [PMID: 37243689 DOI: 10.1093/mr/road049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/03/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The European League Against Rheumatism recommends that the disease activity of systemic lupus erythematosus should be stable before pregnancy because complications and disease flares increase if pregnancy occurs while disease activity is high. However, some patients have ongoing serological activity even after treatment. Herein, we investigated how physicians decide on the acceptability of pregnancy in patients showing only serological activity. METHODS A questionnaire was administered from December 2020 to January 2021. It included the characteristics of physicians, facilities, and the allowance for pregnancies of patients using vignette scenarios. RESULTS The questionnaire was distributed to 4946 physicians, and 9.4% responded. The median age of respondents was 46 years, and 85% were rheumatologists. Pregnancy allowance was significantly affected by the duration of the stable period and status of serological activity [duration: proportion difference 11.8 percentage points (p.p.), P < .001; mild activity: proportion difference -25.8 p.p., P < .001; high activity: proportion difference -65.6 p.p., P < .001]. For patients with high-level serological activity, 20.5% of physicians allowed pregnancy if there were no clinical symptoms for 6 months. CONCLUSIONS Serological activity had a significant effect on the acceptability of pregnancy. However, some physicians allowed patients with serological activity alone to become pregnant. Further observational studies are required to clarify such prognoses.
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Affiliation(s)
- Sakiko Isojima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Ryo Yanai
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoko Miura
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kayoko Kaneko
- Division of Maternal Medicine, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masakazu Matsushita
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takako Miyamae
- Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ayako Nakajima
- Center for Rheumatic Diseases, Mie University Hospital, Tsu, Japan
| | - Atsuko Murashima
- Division of Maternal Medicine, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Katsura M, Fukuma S, Kuriyama A, Kondo Y, Yasuda H, Matsushima K, Shiraishi A, Kusaka A, Nakabayashi Y, Yagi M, Ito F, Tanikawa A, Kushimoto S. Association of Contrast Extravasation Grade With Massive Transfusion in Pediatric Blunt Liver and Spleen Injuries: A Multicenter Retrospective Cohort Study. J Pediatr Surg 2024; 59:500-508. [PMID: 37996348 DOI: 10.1016/j.jpedsurg.2023.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND This study aimed to assess whether the grade of contrast extravasation (CE) on CT scans was associated with massive transfusion (MT) requirements in pediatric blunt liver and/or spleen injuries (BLSI). METHODS This multicenter retrospective cohort study included pediatric patients (≤16 years old) who sustained BLSI between 2008 and 2019. MT was defined as transfusion of all blood products ≥40 mL/kg within the first 24 h of admission. Associations between CE and MT requirements were assessed using multivariate logistic regression analysis with cluster-adjusted robust standard errors to calculate the adjusted odds ratio (AOR). RESULTS A total of 1407 children (median age: 9 years) from 83 institutions were included in the analysis. Overall, 199 patients (14 %) received MT. CT on admission revealed that 54 patients (3.8 %) had CE within the subcapsular hematoma, 100 patients (7.1 %) had intraparenchymal CE, and 86 patients (6.1 %) had CE into the peritoneal cavity among the overall cohort. Multivariate analysis, adjusted for age, sex, age-adjusted shock index, injury severity, and laboratory and imaging factors, showed that intraparenchymal CE and CE into the peritoneal cavity were significantly associated with the need for MT (AOR: 2.50; 95 % CI, 1.50-4.16 and AOR: 4.98; 95 % CI, 2.75-9.02, respectively both p < 0.001). The latter significant association persisted in the subgroup of patients with spleen and liver injuries. CONCLUSION Active CE into the free peritoneal cavity on admission CT was independently associated with a greater probability of receiving MT in pediatric BLSI. The CE grade may help clinicians plan blood transfusion strategies. LEVEL OF EVIDENCE Level 4; Therapeutic/Care management.
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Affiliation(s)
- Morihiro Katsura
- Department of Surgery, Okinawa Chubu Hospital, Okinawa, Japan; Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | | | - Akari Kusaka
- Critical Care Medical Center, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yosuke Nakabayashi
- Advanced Medical Emergency Department and Critical Care Center, Maebashi Red Cross Hospital, Gunma, Japan
| | - Masayuki Yagi
- Department of Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital, Chiba, Japan
| | - Fumihito Ito
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Fukushima, Japan
| | - Atsushi Tanikawa
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Mori Y, Mizuno A, Fukuma S. Low on-treatment blood pressure and cardiovascular events in patients without elevated risk: a nationwide cohort study. Hypertens Res 2024:10.1038/s41440-024-01593-y. [PMID: 38355817 DOI: 10.1038/s41440-024-01593-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
Insufficient blood pressure control among patients with hypertension without elevated risk is a global concern, suggesting the need for treatment optimization. However, the potential harm of excessive blood pressure lowering among these patients is understudied. This study addressed this evidence gap by using nationally representative public health insurer database covering 30 million working-age population. Patients who were continuously using antihypertensive drugs with 10-year cardiovascular risk <10% were identified. They were categorized by on-treatment systolic and diastolic blood pressures. The primary outcome was a composite of myocardial infarction, stroke, heart failure hospitalization, and peripheral artery disease. Of 920,533 participants (mean age, 57.3 years; female, 48.3%; mean follow-up, 2.75 years), the adjusted hazard ratios for systolic blood pressure of <110, 110-119, 120-129 (reference), 130-139, 140-149, 150-159, and ≥160 mmHg were 1.05 (95% confidence interval: 0.99-1.12), 0.97 (0.93-1.02), 1 (reference), 1.05 (1.01-1.09), 1.15 (1.11-1.20), 1.30 (1.23-1.37), and 1.76 (1.66-1.86), respectively; and for diastolic blood pressure of <60, 60-69, 70-79 (reference), 80-89, 90-99, and ≥100 mmHg were 1.25 (1.14-1.38), 0.99 (0.95-1.04), 1 (reference), 1.00 (0.96-1.03), 1.13 (1.09-1.18), and 1.66 (1.58-1.76), respectively. Among low-risk patients with hypertension, diastolic blood pressure <60 mmHg was associated with increased cardiovascular events, while systolic blood pressure <110 mmHg was not. Compared to previous investigations in high-risk patients, the potential harm of excessive blood pressure lowering was less pronounced in low-risk patients with hypertension. The association between low on-treatment blood pressure and cardiovascular events has been understudied in low-risk patients with hypertension. In our study with nationally representative working-age adults from general population with hypertension without elevated risk, increased risk of cardiovascular events was observed in diastolic blood pressure of <60 mmHg, but not in systolic blood pressure of <110 mmHg. Those results contrasted with previous investigations in high-risk patients where the risk of low on-treatment blood pressure was more pronounced.
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Affiliation(s)
- Yuichiro Mori
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Shingo Fukuma
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Sakoi N, Mori Y, Tsugawa Y, Tanaka J, Fukuma S. Early-Stage Chronic Kidney Disease and Related Health Care Spending. JAMA Netw Open 2024; 7:e2351518. [PMID: 38214933 PMCID: PMC10787321 DOI: 10.1001/jamanetworkopen.2023.51518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Importance The global burden of chronic kidney disease (CKD) is substantial and potentially leads to higher health care resource use. Objective To examine the association between early-stage CKD and health care spending and its changes over time in the general population. Design, Setting, and Participants Cohort study using nationwide health checkup and medical claims data in Japan. Participants included individuals aged 30 to 70 years with estimated glomerular filtration rates (eGFR) of 30 mL/min/1.73 m2 or greater at the baseline screening in 2014. Data analyses were conducted from April 2021 to October 2023. Exposure The CKD stages at baseline, defined by the eGFR and proteinuria, were as follows: eGFR of 60 mL/min/1.73 m2 or greater without proteinuria, eGFR of 60 mL/min/1.73 m2 or greater with proteinuria, eGFR of 30 to 59 mL/min/1.73 m2 without proteinuria, and eGFR of 30 to 59 mL/min/1.73 m2 with proteinuria. Main Outcome and Measures The primary outcome was excess health care spending, defined as the absolute difference in health care spending according to the baseline CKD stages (reference group: eGFR ≥60 mL/min/1.73 m2 without proteinuria) in the baseline year (2014) and in the following 5 years (2015 to 2019). Results Of the 79 988 participants who underwent a health checkup (mean [SD] age, 47.0 [9.4] years; 22 027 [27.5%] female), 2899 (3.6%) had an eGFR of 60 mL/min/1.73 m2 or greater with proteinuria, 1116 (1.4%) had an eGFR of 30 to 59 mL/min/1.73 m2 without proteinuria, and 253 (0.3%) had an eGFR of 30 to 59 mL/min/1.73 m2 with proteinuria. At baseline, the presence of proteinuria and an eGFR less than 60 mL/min/1.73 m2 were associated with greater excess health care spending (adjusted difference, $178; 99% CI, $6-$350 for proteinuria; $608; 99% CI, $233-$983 for an eGFR of 30-59 mL/min/1.73 m2; and $1254; 99% CI, $134-$2373 for their combination). The study consistently found excess health care spending over the following 5 examined years. Conclusions and Relevance In this cohort study of nationwide health checkup and medical claims data in Japan, early-stage CKD was associated with excess health care spending over the 5 examined years, and the association was more pronounced with a more advanced disease stage.
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Affiliation(s)
- Naomi Sakoi
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuichiro Mori
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kishi A, Fukuma S. Implementation status of prediction models for type 2 diabetes. Prim Care Diabetes 2023; 17:655-657. [PMID: 37735030 DOI: 10.1016/j.pcd.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/28/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
Although a prediction model is expected to identify individuals who are at a high risk of type 2 diabetes, the implementation status of prediction models has not been well examined. Our review indicates that the implementation of predictive models in practice remains low despite the increase in models being developed.
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Affiliation(s)
- Akio Kishi
- Department of Endocrinology, Tenri Hospital, Nara, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Omae K, Kondo T, Fukuma S, Ikenoue T, Toki D, Tachibana H, Horiuchi T, Ishiyama R, Yoshino M, Ishiyama Y, Fukuhara S, Tanabe K, Takagi T. Effects of remote ischemic preconditioning on renal protection in patients undergoing robot-assisted laparoscopic partial nephrectomy. J Robot Surg 2023; 17:2081-2087. [PMID: 37213027 DOI: 10.1007/s11701-023-01616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
We aimed to evaluate the renoprotective effects of remote ischemic preconditioning (RIPC) in patients undergoing robot-assisted laparoscopic partial nephrectomy (RAPN). Data from 59 patients with solitary renal tumors who underwent RAPN with RIPC comprising three cycles of 5-min inflation to 200 mmHg of a blood pressure cuff applied to one lower limb followed by 5-min reperfusion by cuff deflation, from 2018 to 2020 were analyzed. Patients who underwent RAPN for solitary renal tumors without RIPC between 2018 and 2020 were selected as controls. The postoperative estimated glomerular filtration rate (eGFR) at the nadir during hospitalization and the percentage change from baseline were compared using propensity score matching analysis. We performed a sensitivity analysis with imputations for missing postoperative renal function data weighted by the inverse probability of the data being observed. Of the 59 patients with RIPC and 482 patients without RIPC, 53 each were matched based on propensity scores. No significant differences in the postoperative eGFR in mL/min/1.73 m2 at nadir (mean difference 3.8; 95% confidence interval [CI] - 2.8 to 10.4) and its percentage change from baseline (mean difference 4.7; 95% CI - 1.6 to 11.1) were observed between the two groups. Sensitivity analysis also indicated no significant differences. No complications were associated with the RIPC. In conclusion, we found no significant evidence of the protective effect of RIPC against renal dysfunction after RAPN. Further research is required to determine whether specific patient subgroups benefit from RIPC.Trial registration number: UMIN000030305 (December 8, 2017).
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Affiliation(s)
- Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Data Science and AI Innovation Research Promotion Center, Shiga University, Hikone, Japan
| | - Daisuke Toki
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Urology, Saiseikai Kazo Hospital, Kazo, Japan
| | - Toshihide Horiuchi
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Ryo Ishiyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Maki Yoshino
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yudai Ishiyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Urology, Toda Chuo General Hospital, Toda, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
- Department of Health Policy Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kazunari Tanabe
- Robotic Surgery/Organ Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Fukuma S, Ikesu R, Iizuka T, Tsugawa Y. Effect of age-based left-digit bias on stroke diagnosis: Regression discontinuity design. Soc Sci Med 2023; 334:116193. [PMID: 37657159 DOI: 10.1016/j.socscimed.2023.116193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/12/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Little is known about how left-digit bias- where humans tend to discretely categorize their decisions based on the left-most digit of the continuous variables-based on patients' age affects the initial diagnosis of stroke patients. The aim of this study is to examine whether there is a discontinuous change in the ordering of imaging tests for stroke at the age threshold of 40 years old, which is indicative of left-digit bias, and whether the effect varies by patient sex. METHODS We conducted a cohort study by regression discontinuity design (RDD). We analyzed the claims database from a nationwide working-age health insurance plan in Japan. Patients who had after-hours hospital visits from January 2014 through December 2019 were included in our analysis. The exposure is patients' age, and the primary outcome was physicians' ordering imaging tests (CT or MRI) to diagnose stroke during the index visit. RESULTS Of 293,390 total visits, 48,598 visits within data-driven optimal bandwidths of 6.0 years from the cut-off of 40 years were included for the RDD analysis (mean age 40.8 years [standard deviation 3.4], female 50.5%). The baseline probability of receiving imaging tests for stroke diagnosis was 0.9%. Physicians had a higher likelihood of ordering imaging tests when patients' age was above 40 years compared with when patients' age was just below 40 years (adjusted difference, +0.51 percentage points [pp], 95%CI, +0.13 to +1.07 pp; P = 0.01). We found a significant discontinuous change in the ordering of imaging tests for stroke at 40 years for male patients (+0.84 pp, 95%CI, +0.24 to +1.69 pp; P = 0.009) but not for female patients. CONCLUSIONS Physicians have a cognitive bias in estimating stroke risk and, consistent with a left-digit bias, treat male patients aged 40 and just below differently. This pattern was observed only among male patients.
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Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Ryo Ikesu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Toshiaki Iizuka
- Graduate School of Economics, The University of Tokyo, Tokyo, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
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Yamamoto S, Wells K, Morita K, Tanigaki K, Muro K, Matsumoto M, Nakai H, Arai Y, Akizuki S, Takahashi K, Minamiguchi S, Fukuma S, Yanagita M. Severe TAFRO Syndrome Mimicking Hepatorenal Syndrome Successfully Treated with a Multidisciplinary Approach: A Case Report and Literature Review. Intern Med 2023; 62:2715-2724. [PMID: 36725034 PMCID: PMC10569924 DOI: 10.2169/internalmedicine.1178-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/19/2022] [Indexed: 02/03/2023] Open
Abstract
Finding the ideal balance between efficacy and safety of immunosuppression is challenging, particularly in cases of severe TAFRO syndrome. We herein report a 60-year-old man diagnosed with grade 5 TAFRO syndrome mimicking hepatorenal syndrome that was successfully treated by glucocorticoid, tocilizumab, and cyclosporin despite virus infection. Furthermore, by examining 14 peer-reviewed remission cases, we revealed that the recovery periods among inflammation, renal dysfunction, and thrombocytopenia were quite different, with recovery from thrombocytopenia notably slow. All patients requiring dialysis were successfully withdrawn from dialysis, and the reversibility from kidney injury was good. This clinical information will help clinicians plan treatments and tailor the intensity of immunosuppression.
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Affiliation(s)
- Shinya Yamamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Ken Wells
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Keisuke Morita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Katsuya Tanigaki
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
- Department of Nephrology, Kansai Denryoku Hospital, Japan
| | - Koji Muro
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Minami Matsumoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Hirotsugu Nakai
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
- Department of Radiology, Tenri Hospital, Japan
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Shuji Akizuki
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Japan
| | - Ken Takahashi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
| | - Shingo Fukuma
- Human and Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Japan
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Iseri K, Miyakoshi C, Joki N, Onishi Y, Fukuma S, Honda H, Tsuruya K. α-Blocker Use in Hemodialysis: The Japan Dialysis Outcomes and Practice Patterns Study. Kidney Med 2023; 5:100698. [PMID: 37663953 PMCID: PMC10470217 DOI: 10.1016/j.xkme.2023.100698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Rationale & Objective Despite α-blockers' use for hypertension as add-on therapy in patients treated with hemodialysis, scant information is available on their association, particularly with safety, in these patients. Study Design Prospective cohort study. Setting & Participants patients treated with hemodialysis and receiving antihypertensive agents in the Japan Dialysis Outcomes and Practice Patterns Study, phases 4-6, were analyzed. Exposure Primary exposure was the prescription of α-blocking antihypertensive agents at baseline. Outcomes Incident fractures, falls, and all-cause mortality. Analytical Approach Multivariable Cox and modified Poisson regression analysis. Results Of 5,149 patients treated with hemodialysis (mean age, 65 years; 68% men) receiving antihypertensive drugs, 717 (14%) received α-blocking agents. During a mean follow-up period of 2.0 years, 247 fractures, 525 falls, and 498 deaths occurred. Multivariable analysis showed no significant association of α-blocker use and increased risk of fractures (hazard ratio [HR], 0.92 [95% confidence interval {CI}, 0.61-1.38]), falls (HR, 0.94 [95% CI, 0.74-1.20]), or all-cause deaths (HR, 0.87 [95% CI, 0.64-1.20]) compared with α-blocker nonuse. α-Blocker use was, however, significantly associated with a decreased risk of all-cause mortality in the subgroup analysis, for example, patients who were older (HR, 0.71 [95% CI, 0.51-0.99]), were women (HR, 0.68 [95% CI, 0.48-0.95]), or reported a history of cardiovascular disease (HR, 0.67 [95% CI, 0.48-0.95]) or a predialysis blood pressure of ≥140 mm Hg (HR, 0.69 [95% CI, 0.49-0.98]). Limitations Selection bias cannot be ruled out given the prevalent user analysis. Conclusions No significant association between α-blocker use and the risk of worse safety-related outcomes was seen, indicating that clinicians may safely prescribe α-blockers to patients receiving hemodialysis who require blood pressure lowering. Plain-Language Summary α-Blockers have been generally reserved for use as add-on therapy for resistant or refractory hypertension. However, little is known about the safety of α-blockers in patients treated by hemodialysis. We analyzed 5,149 patients receiving hemodialysis in Japan who were receiving antihypertensive drugs from the Japan Dialysis Outcomes and Practice Patterns Study. The results showed no significant increase in the risk of fractures, falls, or deaths for patients using α-blockers compared with those who did not, suggesting that α-blockers may be safely prescribed for patients receiving hemodialysis who need to lower their blood pressure.
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Affiliation(s)
- Ken Iseri
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Fukuma S, Kato H, Takaku R, Tsugawa Y. Effect of no cost sharing for paediatric care on healthcare usage by household income levels: regression discontinuity design. BMJ Open 2023; 13:e071976. [PMID: 37591654 PMCID: PMC10441085 DOI: 10.1136/bmjopen-2023-071976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES To investigate the impact of no cost sharing on paediatric care on usage and health outcomes, and whether the effect varies by household income levels. DESIGN Regression discontinuity design. SETTING Nationwide medical claims database in Japan. PARTICIPANTS Children aged younger than 20 years from April 2018 to March 2022. EXPOSURE Co-insurance rate that increases sharply from 0% to 30% at a certain age threshold (the threshold age varies between 6 and 20 years depending on region). PRIMARY OUTCOME MEASURES The outpatient care usage (outpatient visit days and healthcare spending for outpatient care) and inpatient care (experience of any hospitalisation and healthcare spending for inpatient care). RESULTS Of 244 549 children, 49 556 participants were in the bandwidth and thus included in our analyses. Results from the regression discontinuity analysis indicate that no cost sharing was associated with a significant increase in the number of outpatient visit days (+5.26 days; 95% CI, +4.89 to +5.82; p<0.01; estimated arc price elasticity, -0.45) and in outpatient healthcare spending (+US$369; 95% CI, +US$344 to +US$406; p<0.01; arc price elasticity, -0.55). We found no evidence that no cost sharing was associated with changes in inpatient care usage. Notably, the effect of no cost-sharing policy on outpatient healthcare usage was larger among children from high-income households (visit days +5.96 days; 95% CI, +4.88 to +7.64, spending +US$511; 95% CI, +US$440 to +US$627) compared with children from low-income households (visit days +2.64 days; 95% CI, +1.54 to +4.23, spending +US$154; 95% CI, +US$80 to +US$249). CONCLUSIONS No cost sharing for paediatric care was associated with a greater usage of outpatient care services, but did not affect inpatient care usage. The study found that this effect was more pronounced among children from high-income households, indicating that the no cost sharing disproportionately benefits high-income households and may contribute to larger disparities.
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Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Hirotaka Kato
- Graduate School of Health Management, Keio University, Minato-ku, Japan
| | - Reo Takaku
- Graduate School of Economics, School of International and Public Policy, Hitotsubashi University, Kunitachi, Japan
| | - Yusuke Tsugawa
- General Internal Medicine & Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Department of Health Policy and Management, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
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Ohnishi T, Mori Y, Fukuma S. Risk of cardiovascular disease associated with repeated proteinuria across annual kidney function screening among the middle-aged and older general population in Japan: a retrospective cohort study. BMJ Open 2023; 13:e071613. [PMID: 37524551 PMCID: PMC10391803 DOI: 10.1136/bmjopen-2023-071613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES We aimed to investigate the association between repetitive proteinuria and cardiovascular events among the middle-aged and older general Japanese population. DESIGN Retrospective cohort study. SETTING We used repeated health screening results and medical claim data from one of the largest health insurers in Japan. PARTICIPANTS Among the middle-aged and older participants (40-74 years, n=179 840), 90 752 were excluded for undergoing health screening fewer than two times and 344 were excluded for having a history of cardiovascular diseases; 88 744 who underwent kidney function screenings at least two times (from April 2011 to March 2015) were included in the analysis. Based on dipstick proteinuria test results, the participants were divided into 'Repetitively-positive' (positive two times or more (positive proteinuria was defined as≥1+)), 'Once-positive' and 'All-negative' groups. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome of major cardiovascular events from baseline screening to June 2021 was hospitalisation or death due to acute myocardial infarction (AMI), cerebrovascular diseases, heart failure (HF) or peripheral vascular diseases (PVDs). The association between proteinuria and major cardiovascular events was assessed using a Cox proportional hazards model. RESULTS Of the 88 744 participants, 8775 (9.9%) and 5498 (6.2%) had Once-positive and Repetitively-positive proteinuria, respectively. During the follow-up period of 402 799 person-years (median 5.25 years), 660 cardiovascular events were observed, with an incidence of 1.64 per 1000 person-years (95% CI 1.52 to 1.77). Despite adjusting for major cardiovascular risk factors, we observed a high incidence of cardiovascular events in the Repetitively-positive (HR 2.08, 95% CI 1.67 to 2.59) and Once-positive groups (HR 1.36, 95% CI 1.07 to 1.72). We found similar associations for AMI, cerebrovascular disease, HF and PVD. CONCLUSIONS Proteinuria is often repeatedly detected during annual renal screening in the general population. Repetitive proteinuria is a risk factor for major cardiovascular events.
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Affiliation(s)
- Tsuyoshi Ohnishi
- Department of Nephrology, Kasukabe Chuo General Hospital, Kasukabe, Japan
- Human Health Sciences, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Yuichiro Mori
- Human Health Sciences, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
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Takahashi S, Naganuma T, Kurita N, Omae K, Ohnishi T, Yoshioka T, Ito F, Takeshima T, Fukuma S, Hamaguchi S, Fukuhara S. Social Isolation/Loneliness and Tooth Loss in Community-Dwelling Older Adults: The Sukagawa Study. Innov Aging 2023; 7:igad065. [PMID: 37497340 PMCID: PMC10368321 DOI: 10.1093/geroni/igad065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Indexed: 07/28/2023] Open
Abstract
Background and Objectives The relationship between social isolation/loneliness and oral health is unclear. This study investigated the association between social isolation/loneliness and tooth loss in older Japanese adults. Research Design and Methods This was a cross-sectional study of a population-based cohort (the Sukagawa Study); 5,490 cohort study participants aged ≥75 years and who were independent answered a self-administered questionnaire in 2018. Social isolation was defined based on the 6-item Japanese version of the Lubben Social Network Scale. Loneliness was measured by the 3-item Japanese version of the University of California, Los Angeles (UCLA) Loneliness Scale version 3. The primary outcome was tooth loss, defined as having fewer than 20 teeth. The secondary outcomes were decreased toothbrushing frequency and diminished ability to chew food. Prevalence ratios (PRs) were estimated using a modified Poisson regression analysis in 2 models-Model 1, which adjusted for age, gender, smoking status, alcohol consumption, low annual income, and short education period, and Model 2, which added history of depression, history of diabetes mellitus, history of stroke, and cognitive impairment to Model 1. Results The primary analysis included 4,645 participants. Adjusted PRs of social isolation and loneliness for tooth loss (Model 1) were 0.97 (95% confidence interval [CI] 0.92-1.01) and 1.06 (95% CI 1.01-1.12), respectively; those for decreased toothbrushing frequency were 1.13 (95% CI 0.95-1.36) and 1.56 (95% CI 1.26-1.92), respectively; and those for chewing difficulty were 1.61 (95% CI 1.06-2.43) and 2.94 (95% CI 1.91-4.53), respectively. The adjusted PRs in Model 2 demonstrated results similar to that of Model 1. Discussion and Implications Loneliness is associated with tooth loss among older adults, whereas social isolation is not. Our findings can inform plans for policymakers, professionals, and organizations to identify lonely older adults and provide social prescriptions to improve their access to oral health care services.
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Affiliation(s)
- Sei Takahashi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
- Futaba Emergency and General Medicine Support Center, Fukushima Medical University, Fukushima, Japan
| | - Toru Naganuma
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
- Futaba Emergency and General Medicine Support Center, Fukushima Medical University, Fukushima, Japan
| | - Noriaki Kurita
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenji Omae
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Ohnishi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Kasukabe Chuo General Hospital, Saitama, Japan
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Fumihito Ito
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Taro Takeshima
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
- Center for University-wide Education, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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13
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Mori Y, Matsushita K, Inoue K, Fukuma S. Patterns and predictors of adherence to follow-up health guidance invitations in a general health check-up program in Japan: A cohort study with an employer-sponsored insurer database. PLoS One 2023; 18:e0286317. [PMID: 37228080 DOI: 10.1371/journal.pone.0286317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Japan has conducted a nationwide annual health check-up program since 2008, focusing on metabolic syndrome and subsequent health guidance in individuals at high risk for cardiovascular disease. However, the adherence rate to health guidance invitations was assumed to be low in previous reports. Therefore, this study aimed to characterize adherence patterns in the program and identify major predictors of adherence to health guidance invitations. METHODS We studied 186,316 adults (aged 40-74 years) who were included in a nationwide employer-sponsored insurer's database in Japan at the beginning of the fiscal year 2017. We first described adherence to health check-ups, the proportion of individuals with high cardiovascular risk, and adherence to health guidance invitations. Predictors of adherence to the invitation were then identified among eligible high-risk individuals. RESULTS In 2017, 71.7% of the study population (n = 133,573) underwent health check-ups, among whom 23.2% (n = 30,979) were invited for health guidance because of their high cardiovascular risk. Among those individuals, 35.2% (n = 10,614) received health guidance. Predictors of improved adherence to health guidance invitation were older age, more concerning blood pressure or laboratory data results, and self-reported motivation for a lifestyle change. CONCLUSION Though 70% of eligible adults attended Japan's annual cardiovascular risk check-ups, only 35% of individuals with high cardiovascular risk adhered to health guidance invitations. Future policy reforms to improve adherence to this program should target younger individuals and those with mild stages of hypertension, diabetes, or dyslipidemia.
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Affiliation(s)
- Yuichiro Mori
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shingo Fukuma
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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14
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Saito Y, Igarashi A, Nakayama T, Fukuma S. Prevalence of multimorbidity and its associations with hospitalisation or death in Japan 2014-2019: a retrospective cohort study using nationwide medical claims data in the middle-aged generation. BMJ Open 2023; 13:e063216. [PMID: 37160390 PMCID: PMC10173978 DOI: 10.1136/bmjopen-2022-063216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To describe the prevalence of multimorbidity and its associations with clinical outcomes across age groups. DESIGN Retrospective cohort study using nationwide medical claims data. SETTING Carried out in Japan between April 2014 and March 2019. PARTICIPANTS N=246 671 Japanese individuals aged 20-74 enrolled in the health insurance were included into the baseline data set for fiscal year (FY) 2014. Of those, N=181 959 individuals were included into the cohort data set spanning FY2014-FY2018. EXPOSURES Multimorbidity was defined as having ≥2 of 15 chronic conditions according to the International Classification of Diseases 10th Revision codes of the Charlson Comorbidity Index. PRIMARY AND SECONDARY OUTCOMES Primary outcome: the standardised prevalence of multimorbidity across age groups was evaluated using data from FY2014 and extrapolated to the Japanese total population. SECONDARY OUTCOME hospitalisation or death events were traced by month using medical claims data and insurer enrolment data. Associations between multimorbidity and 5-year hospitalisation and/or death events across age groups were analysed using a Cox regression model. RESULTS The standardised prevalence rate of multimorbidity in the nationwide Japanese total population was estimated to 26.1%. The prevalence rate with age was increased, approximately 5% (ages 20-29), 10% (30-39), 20% (40-49), 30% (50-59), 50% (60-69) and 60% (70-74). Compared with individuals aged 20-39 without multimorbidity, those with multimorbidity had a higher incidence of clinical events in any age group (HR=2.43 (95% CI 2.30 to 2.56) in ages 20-39, HR=2.55 (95% CI 2.47 to 2.63) in ages 40-59 and HR=3.41 (95% CI 3.23 to 3.53) in ages ≥60). The difference in the incidence of clinical events between multimorbidity and no multimorbidity was larger than that between age groups. CONCLUSIONS Multimorbidity is already prevalent in the middle-aged generation and is associated with poor clinical outcomes. These findings underscore the significance of multimorbidity and highlight the urgent need for preventive intervention at the public healthcare level.
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Affiliation(s)
- Yoshiyuki Saito
- Department of Health Economics & Outcomes Research, The University of Tokyo, Bunkyo-ku, Japan
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Ataru Igarashi
- Department of Health Economics & Outcomes Research, The University of Tokyo, Bunkyo-ku, Japan
- Unit of Public Health and Preventive Medicine, Yokohama City University, Yokohama, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Shingo Fukuma
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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15
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Inoue K, Kondo N, Sato K, Fukuma S. Trends in Cardiovascular Risk Factors by Income Among Japanese Adults Aged 30-49 Years From 2017 to 2020: A Nationwide Longitudinal Cohort Study. Endocr Pract 2023; 29:185-192. [PMID: 36627023 DOI: 10.1016/j.eprac.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Income is a major social determinant of cardiovascular health. However, individual-level evidence regarding the trends in cardiovascular risk factors by income level among young working-age adults is limited. We thus aimed to examine the trends in cardiovascular risk factors among men and women aged 30-49 years by their income levels. METHODS This nationwide longitudinal study included Japanese adults aged 30-49 years, who annually participated in the national health screening program from 2017 to 2020. Modified Poisson regression models were used to investigate trends in the prevalence of cardiovascular risk factors (obesity, hypertension, diabetes, and dyslipidemia) according to tertiles of individuals' annual income, adjusting for potential confounders. RESULTS Among 58 814 adults, 50 024 (85%) were men; the mean (SD) age was 42.1 (5.4) years. Over the study period, the low-income group consistently showed a higher prevalence of obesity, hypertension, and diabetes than the high-income group. The difference in the prevalence of these diseases, particularly hypertension, across income groups increased from 2017 to 2020 among both men (low-income vs high-income: +5.73% [95% CI, 4.72-6.73] in 2017 and +8.26% [95% CI, 7.11-9.41] in 2020) and women (low-income vs high-income: +2.53% [95% CI, 0.99-4.06] in 2017 and +3.83% [95% CI, 1.93-5.73] in 2020). CONCLUSION Among adults aged 30-49 years in Japan, a country with a universal healthcare coverage system, we found an increase in the gap of cardiovascular risk factors by income levels over the last 4 years. Careful monitoring of the increasing social disparities is needed to achieve cardiovascular health equity at this life stage.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koryu Sato
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shingo Fukuma
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Furukawa TA, Tajika A, Sakata M, Luo Y, Toyomoto R, Horikoshi M, Akechi T, Kawakami N, Nakayama T, Kondo N, Fukuma S, Noma H, Christensen H, Kessler RC, Cuijpers P, Wason JMS. Four 2×2 factorial trials of smartphone CBT to reduce subthreshold depression and to prevent new depressive episodes among adults in the community-RESiLIENT trial (Resilience Enhancement with Smartphone in LIving ENvironmenTs): a master protocol. BMJ Open 2023; 13:e067850. [PMID: 36828653 PMCID: PMC9972419 DOI: 10.1136/bmjopen-2022-067850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION The health burden due to depression is ever increasing in the world. Prevention is a key to reducing this burden. Guided internet cognitive-behavioural therapies (iCBT) appear promising but there is room for improvement because we do not yet know which of various iCBT skills are more efficacious than others, and for whom. In addition, there has been no platform for iCBT that can accommodate ongoing evolution of internet technologies. METHODS AND ANALYSIS Based on our decade-long experiences in developing smartphone CBT apps and examining them in randomised controlled trials, we have developed the Resilience Training App Version 2. This app now covers five CBT skills: cognitive restructuring, behavioural activation, problem-solving, assertion training and behaviour therapy for insomnia. The current study is designed as a master protocol including four 2×2 factorial trials using this app (1) to elucidate specific efficacies of each CBT skill, (2) to identify participants' characteristics that enable matching between skills and individuals, and (3) to allow future inclusion of new skills. We will recruit 3520 participants with subthreshold depression and ca 1700 participants without subthreshold depression, to examine the short-term efficacies of CBT skills to reduce depressive symptoms in the former and to explore the long-term efficacies in preventing depression in the total sample. The primary outcome for the short-term efficacies is the change in depressive symptoms as measured with the Patient Health Questionnaire-9 at week 6, and that for the long-term efficacies is the incidence of major depressive episodes as assessed by the computerised Composite International Diagnostic Interview by week 50. ETHICS AND DISSEMINATION The trial has been approved by the Ethics Committee of Kyoto University Graduate School of Medicine (C1556). TRIAL REGISTRATION NUMBER UMIN000047124.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Masaru Horikoshi
- National Center of Neurology and Psychiatry, Tokyo, Japan
- Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Norito Kawakami
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Nakayama
- Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Institute for Future Initiative, The University of Tokyo, Tokyo, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | | | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - James M S Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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17
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Katsura M, Fukuma S, Chida K, Saegusa Y, Kanda S, Kawasaki K, Tsuzuki Y, Ie M. Which factors influence the decision to perform Hartmann's reversal in various causative disease situations? A retrospective cohort study between 2006 and 2021. Colorectal Dis 2023; 25:305-314. [PMID: 36222174 DOI: 10.1111/codi.16364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/18/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023]
Abstract
AIM Our aim was to investigate the predictive factors for Hartmann's reversal and to describe the differences in the rates and timings of Hartmann's reversal for various causative diseases. METHOD In this multicentre retrospective cohort study patients who underwent Hartmann's procedure (HP) between 2006 and 2018 were enrolled. To describe the demographic patterns of Hartmann's reversal through to 2021, we analysed the cumulative incidence rate of Hartmann's reversal over time based on the Kaplan-Meier failure estimate. Multivariable Cox proportional hazard analysis was performed with cluster-adjusted robust standard errors to calculate hazard ratios (HRs) for the assessment of variables associated with colostomy reversal. RESULTS Of 250 patients who underwent the index HP and survived to discharge, 112 (45%) underwent subsequent Hartmann's reversal (36% for malignant and 51% for benign disease). The causative diseases with the highest probability of colostomy reversal were trauma (85%) and diverticular disease (73%). Conversely, colostomy reversal was performed in only 16% for colonic volvulus and 17% for bowel ischaemia. Home discharge after index HP (HR 5.22, 95% CI 3.31-8.23) and a higher body mass index (HR 1.03, 95% CI 1.01-1.04) were associated with a higher probability of Hartmann's reversal, whereas older age, malignant disease and a history of cardiovascular and psychoneurological diseases were independently associated with a lower probability of colostomy reversal. CONCLUSION The probability and timing of Hartmann's reversal varied considerably with the surgical indications for colostomy creation. Our results could help surgeons counsel patients and their families regarding stoma closure surgery to set realistic expectations.
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Affiliation(s)
- Morihiro Katsura
- Department of Surgery, Okinawa Chubu Hospital, Uruma, Japan.,Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Chida
- Department of Surgery, Okinawa Chubu Hospital, Uruma, Japan
| | | | - Shuhei Kanda
- Department of Surgery, Okinawa Miyako Hospital, Miyakojima, Japan
| | - Kyohei Kawasaki
- Department of Surgery, Okinawa Yaeyama Hospital, Ishigaki, Japan
| | - Yukihiro Tsuzuki
- Department of Surgery, Okinawa Nanbu Medical Center & Children's Medical Center, Haebaru, Japan
| | - Masafumi Ie
- Department of Surgery, Okinawa Chubu Hospital, Uruma, Japan
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18
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Mori Y, Duru OK, Tuttle KR, Fukuma S, Taura D, Harada N, Inagaki N, Inoue K. Sodium-Glucose Cotransporter 2 Inhibitors and New-onset Type 2 Diabetes in Adults With Prediabetes: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Clin Endocrinol Metab 2022; 108:221-231. [PMID: 36217306 DOI: 10.1210/clinem/dgac591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/16/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT The preventive effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors for new-onset diabetes was investigated in secondary analyses of several randomized controlled trials (RCTs). However, the results were inconsistent. OBJECTIVE This work aimed to synthesize available evidence and evaluate whether SGLT2 inhibitors are effective in preventing new-onset diabetes. METHODS In this systematic review and meta-analysis of RCTs, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched through February 11, 2022. Two independent authors screened the search results and extracted summary data from eligible RCTs (including original and post hoc analyses) comparing SGLT2 inhibitors and placebo for the risk of new-onset diabetes among adults with prediabetes. Meta-analysis was conducted using random-effects models to calculate risk ratios and 95% CIs. RESULTS We included 4 RCTs with 5655 participants who had prediabetes. Based on the random-effects meta-analysis, SGLT2 inhibitors were significantly associated with a lower risk of new-onset diabetes (relative risk, 0.79; 95% CI, 0.68-0.93). The relative risks of new-onset diabetes in dapagliflozin and empagliflozin were 0.68 (95% CI, 0.52-0.89) and 0.87 (95% CI, 0.72-1.04), respectively (P-for-heterogeneity = .14). The frequency of severe hypoglycemia was not elevated in the SGLT2 inhibitors group compared to the placebo group. CONCLUSION In this meta-analysis, SGLT2 inhibitors were associated with a reduced risk of new-onset type 2 diabetes among adults with prediabetes and heart failure or chronic kidney disease. These findings indicate the potential usefulness of SGLT2 inhibitors in preventing diabetes among high-risk populations with prediabetes.
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Affiliation(s)
- Yuichiro Mori
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 6068507, Japan
| | - O Kenrik Duru
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
| | - Katherine R Tuttle
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington 98104, USA
- Division of Nephrology, University of Washington, Seattle, Washington 98195, USA
- Providence Medical Research Center, Providence Health Care, Spokane, Washington 99204, USA
| | - Shingo Fukuma
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 6068507, Japan
| | - Daisuke Taura
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto 6068315, Japan
| | - Norio Harada
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto 6068315, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto 6068315, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto 6068315, Japan
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Fukuma S, Mukaigawara M, Iizuka T, Tsugawa Y. Impact of the national health guidance intervention for obesity and cardiovascular risks on healthcare utilisation and healthcare spending in working-age Japanese cohort: regression discontinuity design. BMJ Open 2022; 12:e056996. [PMID: 35906047 PMCID: PMC9345054 DOI: 10.1136/bmjopen-2021-056996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Increases in obesity and cardiovascular diseases contribute to rapidly growing healthcare expenditures in many countries. However, little is known about whether the population-level health guidance intervention for obesity and cardiovascular risk factors is associated with reduced healthcare utilisation and spending. The aim of this study was to investigate the effect of population-level health guidance intervention introduced nationally in Japan on healthcare utilisation and spending. DESIGN Retrospective cohort study, using a quasiexperimental regression discontinuity design. SETTING Japan's nationwide employment-based health insurers. PARTICIPANTS Participants in the national health screening programme (from January 2014 to December 2014) aged 40-74 years. PREDICTORS Assignment to health guidance intervention (counselling on healthy lifestyles, and referral to physicians as needed) determined primarily on whether the individual's waist circumference was above or below the cut-off value in addition to having at least one cardiovascular risk factor. PRIMARY AND SECONDARY OUTCOME MEASURES Healthcare utilisation (the number of outpatient visits days, any medication use and any hospitalisation use) and spending (total medical expenditure, outpatient medical expenditure and inpatient medical expenditure) within 3 years of the intervention. RESULTS A total of 51 213 individuals within the bandwidth (±6 cm of waist circumference from the cut-off) out of 113 302 screening participants (median age 50.0 years, 11.9% woman) were analysed. We found that the assignment to the national health guidance intervention was associated with fewer outpatient visit days (-1.3 days; 95% CI, -11.4 to -0.5 days; p=0.03). We found no evidence that the assignment to the health guidance intervention was associated with changes in medication or hospitalisation use, or healthcare spending. CONCLUSION Among working-age, male-focused Japanese from a health insurer of companies of civil engineering and construction, the national health guidance intervention might be associated with a decline in outpatient visits, with no change in medication/hospitalisation use or healthcare spending.
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Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Toshiaki Iizuka
- Graduate School of Economics, The University of Tokyo, Tokyo, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Kataoka Y, Baba T, Ikenoue T, Matsuoka Y, Matsumoto J, Kumasawa J, Tochitani K, Funakoshi H, Hosoda T, Kugimiya A, Shirano M, Hamabe F, Iwata S, Kitamura Y, Goto T, Hamaguchi S, Haraguchi T, Yamamoto S, Sumikawa H, Nishida K, Nishida H, Ariyoshi K, Sugiura H, Nakagawa H, Asaoka T, Yoshida N, Oda R, Koyama T, Iwai Y, Miyashita Y, Okazaki K, Tanizawa K, Handa T, Kido S, Fukuma S, Tomiyama N, Hirai T, Ogura T. Development and external validation of a deep learning-based computed tomography classification system for COVID-19. Ann Clin Epidemiol 2022; 4:110-119. [PMID: 38505255 PMCID: PMC10760489 DOI: 10.37737/ace.22014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/31/2022] [Indexed: 03/21/2024]
Abstract
BACKGROUND We aimed to develop and externally validate a novel machine learning model that can classify CT image findings as positive or negative for SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR). METHODS We used 2,928 images from a wide variety of case-control type data sources for the development and internal validation of the machine learning model. A total of 633 COVID-19 cases and 2,295 non-COVID-19 cases were included in the study. We randomly divided cases into training and tuning sets at a ratio of 8:2. For external validation, we used 893 images from 740 consecutive patients at 11 acute care hospitals suspected of having COVID-19 at the time of diagnosis. The dataset included 343 COVID-19 patients. The reference standard was RT-PCR. RESULTS In external validation, the sensitivity and specificity of the model were 0.869 and 0.432, at the low-level cutoff, 0.724 and 0.721, at the high-level cutoff. Area under the receiver operating characteristic was 0.76. CONCLUSIONS Our machine learning model exhibited a high sensitivity in external validation datasets and may assist physicians to rule out COVID-19 diagnosis in a timely manner at emergency departments. Further studies are warranted to improve model specificity.
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Affiliation(s)
- Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health
- Scientific Research Works Peer Support Group (SRWS-PSG)
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine
- Graduate School of Data Science, Shiga University
| | - Yoshinori Matsuoka
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health
- Department of Emergency Medicine, Kobe City Medical Center General Hospital
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine
| | - Junji Kumasawa
- Human Health Sciences, Kyoto University Graduate School of Medicine
- Department of Critical Care Medicine, Sakai City Medical Center
| | | | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine Department of Interventional Radiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital
| | - Aiko Kugimiya
- Department of Respiratory Medicine, Yamanashi Prefectural Central Hospital
| | | | - Fumiko Hamabe
- Department of Radiology, National Defense Medical College
| | - Sachiyo Iwata
- Division of Cardiovascular Medicine, Hyogo Prefectural Kakogawa Medical Center
| | | | | | - Shingo Hamaguchi
- Department of Emergency and Critical Care Medicine Department of Interventional Radiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | | | | | - Koji Nishida
- Department of Respiratory Medicine, Sakai City Medical Center
| | - Haruka Nishida
- Department of Emergency Medicine, Kobe City Medical Center General Hospital
| | - Koichi Ariyoshi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital
| | | | | | - Tomohiro Asaoka
- Department of Infectious Diseases, Osaka City General Hospital
| | - Naofumi Yoshida
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Rentaro Oda
- Department of Infectious Diseases, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Koyama
- Department of Infectious Diseases, Hyogo Prefectural Amagasaki General Medical Center
| | - Yui Iwai
- Department of Infectious Diseases, Hyogo Prefectural Amagasaki General Medical Center
| | | | - Koya Okazaki
- Department of Respiratory Medicine, Hyogo Prefectural Amgasaki General Medical Center
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University
| | - Shoji Kido
- Department of Artificial Intelligence Diagnostic Radiology, Graduate School of Medicine, Osaka University
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
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21
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Inaguma D, Hayashi H, Yanagiya R, Koseki A, Iwamori T, Kudo M, Fukuma S, Yuzawa Y. Development of a machine learning-based prediction model for extremely rapid decline in estimated glomerular filtration rate in patients with chronic kidney disease: a retrospective cohort study using a large data set from a hospital in Japan. BMJ Open 2022; 12:e058833. [PMID: 35680264 PMCID: PMC9185577 DOI: 10.1136/bmjopen-2021-058833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Trajectories of estimated glomerular filtration rate (eGFR) decline vary highly among patients with chronic kidney disease (CKD). It is clinically important to identify patients who have high risk for eGFR decline. We aimed to identify clusters of patients with extremely rapid eGFR decline and develop a prediction model using a machine learning approach. DESIGN Retrospective single-centre cohort study. SETTINGS Tertiary referral university hospital in Toyoake city, Japan. PARTICIPANTS A total of 5657 patients with CKD with baseline eGFR of 30 mL/min/1.73 m2 and eGFR decline of ≥30% within 2 years. PRIMARY OUTCOME Our main outcome was extremely rapid eGFR decline. To study-complicated eGFR behaviours, we first applied a variation of group-based trajectory model, which can find trajectory clusters according to the slope of eGFR decline. Our model identified high-level trajectory groups according to baseline eGFR values and simultaneous trajectory clusters. For each group, we developed prediction models that classified the steepest eGFR decline, defined as extremely rapid eGFR decline compared with others in the same group, where we used the random forest algorithm with clinical parameters. RESULTS Our clustering model first identified three high-level groups according to the baseline eGFR (G1, high GFR, 99.7±19.0; G2, intermediate GFR, 62.9±10.3 and G3, low GFR, 43.7±7.8); our model simultaneously found three eGFR trajectory clusters for each group, resulting in nine clusters with different slopes of eGFR decline. The areas under the curve for classifying the extremely rapid eGFR declines in the G1, G2 and G3 groups were 0.69 (95% CI, 0.63 to 0.76), 0.71 (95% CI 0.69 to 0.74) and 0.79 (95% CI 0.75 to 0.83), respectively. The random forest model identified haemoglobin, albumin and C reactive protein as important characteristics. CONCLUSIONS The random forest model could be useful in identifying patients with extremely rapid eGFR decline. TRIAL REGISTRATION UMIN 000037476; This study was registered with the UMIN Clinical Trials Registry.
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Affiliation(s)
- Daijo Inaguma
- Internal Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | | | - Ryosuke Yanagiya
- Medical Information Systems, Fujita Health University, Toyoake, Japan
| | | | | | | | - Shingo Fukuma
- Human Health Science, Kyoto University, Kyoto, Japan
| | - Yukio Yuzawa
- Nephrology, Fujita Health University, Toyoake, Japan
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22
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Isojima S, Yajima N, Yanai R, Miura Y, Fukuma S, Kaneko K, Fujio K, Oku K, Matsushita M, Miyamae T, Wada T, Kaneko Y, Tanaka Y, Nakajima A, Murashima A. POS0734 THE CLINICAL JUDGMENT FOR THE ACCEPTABILITY OF PREGNANCY IN PATIENTS WITH SEROLOGICALLY ACTIVE SLE IN JAPAN: A NATIONWIDE ONLINE SURVEY FROM THE VIGNETTE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe risk of pregnancy complications, such as gestational hypertension is high in pregnancies with SLE. In addition, the risk of flare is elevated if pregnancy occurs during the high disease activity. The EULAR recommendation provides a checklist for preconception counseling, in which patients with SLE desiring pregnancy were required the condition that the disease activity prior to pregnancy should be stable for 6-12 months in terms of serological activity (1). However, it does not provide specific criteria for serological activity so that physicians should evaluate the risk of pregnancy in each case by their clinical intuitions.ObjectivesIn order to uncover the present clinical situation for the acceptability of pregnancy in patients with SLE, we performed questionnaire survey to physicians regarding to the degree of serological activity.MethodsThis cross-sectional study was performed to physicians registered with the Japanese College of Rheumatology from December 2020 to January 2021 using the online survey. The questionnaire asked about the characteristics of physicians, facilities and the permission of pregnancies with SLE using vignette scenarios. In this study, data from vignettes of women visiting a regular outpatient clinic were used. The vignettes varied in age (28 or 35 years), duration of stable disease and serological activity. Analysis methods were descriptive statistics, chi-square test. generalized estimating equations (GEE) was performed to investigate the relationship between the determining permission for pregnancy and the scenario patient’s characteristics (age, period of stable disease, titer of anti ds-DNA antibody)ResultsThe questionnaire was distributed to 4946 physicians, and 463 responded. Completion rate (ratio agreed to participate/finished survey) of survey was 91.1%. The median age of physicians was 46 (interquartile range (IQR) 2-10). The specialty was rheumatology (84.9%), other internal medicine (8%), and pediatrics (5.6%). There were no significant differences in patient’s age about the acceptability of pregnancy (coeffficianet -0.02, 95% CI -0.17 -0.01, p=0.42). Case who had been stable for 6 months were more tolerant of pregnancy than case who had been stable for 3 months (coeffficianet 0.12, 95% CI 0.09-0.15, P<0.001) Pregnancy was not allowed in case with mild or high serological activity (mild: coefficient -0.49, 95% CI -0.29- -0.22, p <0.001, high: -0.64, 95% CI -0.65 - -0.61, p <0.001). In contrast, as many as 92 (19.2%) physicians tolerated pregnancy even in the presence of residual high anti ds-DNA antibody titers. Female physicians are significantly more cautious about pregnancy than male when patients have a serologically high activity (12% vs 37.5%, p<0.001). There were no significant differences in specialty status or clinical experience.ConclusionWe found that even mild serological activity alone had a significant negative effect on the physician’s decision to allow pregnancy. We conclude that current physicians make cautious decisions about pregnancies of patients with SLE following the recommendation. On the other hand, an additional investigation should be performed about the results of pregnancies in patients with serological abnormalities, since there are some physicians who thought that pregnancy may be acceptable for patients with only serological abnormalities if the clinical symptoms are stable.References[1]Ann Rheum Dis.2017 Mar;76(3):476-485AcknowledgementsI would like to express my gratitude to the members of Japan College of Rheumatology who cooperated in filling out the questionnaire.Disclosure of InterestsSakiko Isojima: None declared, Nobuyuki Yajima: None declared, Ryo Yanai: None declared, Yoko Miura: None declared, Shingo Fukuma: None declared, Kayoko Kaneko: None declared, Keishi Fujio: None declared, Kenji Oku: None declared, Masakazu Matsushita: None declared, Takako Miyamae: None declared, Takashi Wada: None declared, Yuko Kaneko: None declared, Yoshiya Tanaka Speakers bureau: Y. Tanaka has received speaking fees and/or honoraria from Gilead, Abbvie, Behringer-Ingelheim, Eli Lilly, Mitsubishi-Tanabe, Chugai, Amgen, YL Biologics, Eisai, Astellas, Bristol-Myers, Astra-Zeneca, Grant/research support from: Y. Tanaka has received research grants from Asahi-Kasei, Abbvie, Chugai, Mitsubishi-Tanabe, Eisai, Takeda, Corrona, Daiichi-Sankyo, Kowa, Behringer-Ingelheim, and consultant fee from Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, Abbvie., Ayako Nakajima: None declared, ATSUKO MURASHIMA: None declared
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23
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Katsuragawa S, Goto A, Tsurutani Y, Fukuma S, Inoue K. No Healthcare Utilization and Death. J Gen Intern Med 2022; 37:1648-1657. [PMID: 34590212 PMCID: PMC9130427 DOI: 10.1007/s11606-021-07138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND An inappropriately low frequency of healthcare utilization has been reported to be associated with poor control of chronic diseases, accelerating healthcare disparities. However, the evidence is limited regarding the association between no healthcare utilization and mortality. OBJECTIVES To examine whether individuals without healthcare utilization have the increased risks of mortality among the US general population. DESIGN Prospective cohort study PARTICIPANTS: Adults aged ≥ 20 years (n = 39,067) in the National Health and Nutrition Examination Survey (NHANES)1999-2014 linked to national mortality data through December 2015. MAIN MEASURES The exposure was the number of visits to healthcare providers during the past year (healthcare utilization): none, 1-3 times (referent), 4-9 times, or ≥ 10 times. Cox hazard regression models were employed to estimate the adjusted hazard ratios (aHR) of all-cause, cardiovascular, and cancer mortality adjusting for socio-demographic characteristics and comorbidities. KEY RESULTS During a median follow-up of 7.4 years, participants without visit over the past year showed higher risks of all-cause mortality (aHR [95% CI] = 1.16 [1.04-1.30]) and cardiovascular mortality (aHR [95% CI] = 1.62 [1.28-2.05]) than those who visited the office 1-3 times. We found no evidence of the association between no visit and cancer mortality. The association between no providers' office visit and all-cause mortality was stronger among males (aHR [95% CI] = 1.22 [1.06-1.40]) than females (aHR [95% CI] = 0.97 [0.79-1.19]; p-for-interaction = 0.01) and among uninsured individuals (aHR [95% CI] = 1.22 [0.98-1.51]) than insured individuals (aHR [95% CI] = 1.09 [0.95-1.25]; p-for-interaction = 0.04). CONCLUSION No providers' office visit over a year was associated with increased risks of all-cause and cardiovascular mortality. Further investigations are warranted to identify the underlying reasons for the elevated mortality risks due to no healthcare utilization.
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Affiliation(s)
- Sho Katsuragawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosuke Inoue
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Kaneko K, Sato Y, Uchino E, Toriu N, Shigeta M, Kiyonari H, Endo S, Fukuma S, Yanagita M. Lineage tracing analysis defines erythropoietin-producing cells as a distinct subpopulation of resident fibroblasts with unique behaviors. Kidney Int 2022; 102:280-292. [DOI: 10.1016/j.kint.2022.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 12/17/2022]
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Suzuki R, Takada T, Takeshima T, Hayashi M, Miyashita J, Azuma T, Usui M, Hamaguchi S, Fukuma S, Maehara K, Fukuhara S. Usefulness of a mobile phone application for respiratory rate measurement in adult patients. Jpn J Nurs Sci 2022; 19:e12481. [PMID: 35289085 DOI: 10.1111/jjns.12481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
AIMS Respiratory rate measurement is one of the core nursing skills for early detection of deterioration of a patient's condition. Nevertheless, it is sometimes bothersome to visually measure respiratory rate over 1 min. Respiratory rate measurement using a mobile phone application "RRate" has been reported to be accurate and completed in a short time. However, it has only been investigated in children. The aim of this study was to validate the "RRate" compared with the 1-min method in adult patients. METHODS This was a cross-sectional study in the setting of a nursing school. Videos of the movement of the thorax during respiration of adult patients were made. Nursing students watched these videos and measured respiratory rate with each method. Bland-Altman analysis was used to calculate bias and limits of agreement. The times taken for the measurements were compared using a t test. RESULTS A total of 59 nursing students participated. When compared to the reference measurement, the one measured using "RRate" and the one measured over 1 min showed a bias of 0.40 breaths per minute and 0.65 breaths per minute, limits of agreement of -2.86 to 3.67 breaths per minute and -2.11 to 3.41 breaths per minute, respectively. The mean measurement time for "RRate" was 22.8 s (95% CI 13.9-36.6), which was significantly shorter than the 65.8 s (95% CI 61.0-73.2) for the measurement over 1 min (p < .001). CONCLUSIONS Respiratory rate can be measured accurately in a shorter time using a mobile phone application in adult patients.
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Affiliation(s)
- Ryuji Suzuki
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Michiko Usui
- Shirakawa Kosei General Hospital Affiliated Nursing School, Fukushima, Japan
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shingo Fukuma
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhira Maehara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kataoka Y, Kimura Y, Ikenoue T, Matsuoka Y, Matsumoto J, Kumasawa J, Tochitatni K, Funakoshi H, Hosoda T, Kugimiya A, Shirano M, Hamabe F, Iwata S, Fukuma S. Integrated model for COVID-19 diagnosis based on computed tomography artificial intelligence, and clinical features: a multicenter cohort study. Ann Transl Med 2022; 10:130. [PMID: 35284557 PMCID: PMC8904977 DOI: 10.21037/atm-21-5571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
Background We developed and validated a machine learning diagnostic model for the novel coronavirus (COVID-19) disease, integrating artificial-intelligence-based computed tomography (CT) imaging and clinical features. Methods We conducted a retrospective cohort study in 11 Japanese tertiary care facilities that treated COVID-19 patients. Participants were tested using both real-time reverse transcription polymerase chain reaction (RT-PCR) and chest CTs between January 1 and May 30, 2020. We chronologically split the dataset in each hospital into training and test sets, containing patients in a 7:3 ratio. A Light Gradient Boosting Machine model was used for the analysis. Results A total of 703 patients were included, and two models—the full model and the A-blood model—were developed for their diagnosis. The A-blood model included eight variables (the Ali-M3 confidence, along with seven clinical features of blood counts and biochemistry markers). The areas under the receiver-operator curve of both models [0.91, 95% confidence interval (CI): 0.86 to 0.95 for the full model and 0.90, 95% CI: 0.86 to 0.94 for the A-blood model] were better than that of the Ali-M3 confidence (0.78, 95% CI: 0.71 to 0.83) in the test set. Conclusions The A-blood model, a COVID-19 diagnostic model developed in this study, combines machine-learning and CT evaluation with blood test data and performs better than the Ali-M3 framework existing for this purpose. This would significantly aid physicians in making a quicker diagnosis of COVID-19.
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Affiliation(s)
- Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-cho, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Sakyo-ku, Kyoto, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yuya Kimura
- Clinical Research Center, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, Kiyose-shi, Tokyo, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
- Graduate School of Data Science, Shiga University, Otsu, Shiga, Japan
| | - Yoshinori Matsuoka
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Sakyo-ku, Kyoto, Japan
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe City, Hyogo, Japan
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Junji Kumasawa
- Human Health Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
- Department of Critical Care Medicine, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Kentaro Tochitatni
- Department of Infectious Diseases, Kyoto City Hospital, Nakagyo-ku, Kyoto, Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Aiko Kugimiya
- Department of Emergency and Critical Care Medicine, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan
| | - Fumiko Hamabe
- Department of Radiology, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Sachiyo Iwata
- Division of Cardiovascular Medicine, Hyogo Prefectural Kakogawa Medical Center, Kanno-cho, Kakogawa, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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Shimizu S, Onishi Y, Kabaya K, Wang J, Fukuma S, Morinaga J, Hatakeyama S, Kobayashi S, Maeno K, Yamazaki H, Fukuhara S. Cohort profile: Alliance for Quality Assessment in Healthcare-Dialysis (AQuAH-D) prospective cohort study of patients on haemodialysis in Japan. BMJ Open 2022; 12:e054427. [PMID: 35078844 PMCID: PMC8796223 DOI: 10.1136/bmjopen-2021-054427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The global burden of kidney failure is increasing, but the treatment of kidney failure varies widely between patients, between dialysis facilities and over time. The Alliance for Quality Assessment in Healthcare-Dialysis (AQuAH-D) aims to conduct efficient and timely cohort studies on associations between those variations and clinical and patient-reported outcomes. PARTICIPANTS Included are outpatients aged 20 years old or older who are undergoing haemodialysis and have consented to participate. A total of 2895 patients were enrolled from 25 facilities in Japan between August 2018 and July 2020 and are to be followed until 31 December 2026. Chart review and annual questionnaires are used to collect data on patient characteristics and on outcomes including quality of life. Data on medications, haemodialysis prescriptions and blood tests are obtained from existing electronic records. Data are collected retrospectively from 1 January 2017 to patient enrolment, and prospectively from patient enrolment until the end of December 2026. FINDINGS TO DATE To date, the mean age is 68.3 (SD 12.2) years and 35.2% are female. The most common cause of kidney failure is diabetic nephropathy (37.4%). In January 2020, the facilities' median weekly doses of erythropoietin stimulating agent (ESA) and of intravenous vitamin D ranged from 1846 to 9692 IU (epoetin alfa equivalent) and 0.78 to 2.25 µg (calcitriol equivalent), respectively. The facilities' percentages of patients to whom calcimimetics are prescribed varied from 19% to 79%. During the retrospective period (averaging 1.85 years per participant), the incidence rates of any hospitalisation and of hospitalisation due to cardiovascular disease were 67.2 and 12.0 per 100 person-years, respectively. FUTURE PLANS AQuAH-D data will be updated every 6 months and will be available for studies addressing a wide range of research questions, using the advantages of granular data and quality-of-life measurement of ageing patients on haemodialysis.
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Affiliation(s)
- Sayaka Shimizu
- Department of Research, Institute for Health Outcomes & Process Evaluation Research, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihiro Onishi
- Department of Research, Institute for Health Outcomes & Process Evaluation Research, Kyoto, Japan
| | - Koji Kabaya
- Department of Research, Institute for Health Outcomes & Process Evaluation Research, Kyoto, Japan
| | - Jui Wang
- Department of Research, Institute for Health Outcomes & Process Evaluation Research, Kyoto, Japan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shingo Fukuma
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Morinaga
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
| | | | | | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
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Fukuma S, Sasaki S, Taguri M, Goto R, Misumi T, Saigusa Y, Tsugawa Y. Effect of Nudge-Based Intervention on Adherence to Physician Visit Recommendations and Early Health Outcomes among Individuals Identified with Chronic Kidney Disease in Screens. J Am Soc Nephrol 2022; 33:175-185. [PMID: 34903568 PMCID: PMC8763194 DOI: 10.1681/asn.2021050664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/10/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although CKD screening programs have been provided in many settings, little is known as to how we can effectively translate those screening programs into improved health. METHODS We conducted a randomized clinical trial on national health screening for CKD in Japan between April 2018 and March 2019. A total of 4011 participants in CKD screening programs aged 40-63 years were randomly assigned to two interventions or the control, with a ratio of 2:2:1, respectively: (1) the nudge-based letter that contained a message on the basis of behavioral economics, (2) the clinical letter including general information about CKD risks, and (3) the control (informed only of the screening results). The main outcome was adherence to a recommended physician visit within 6 months of the intervention. The secondary outcomes were eGFR, proteinuria, and BP 1 year after the intervention. RESULTS Compared with the control group, the probability of undergoing a recommended physician visit was higher among participants who received the nudge-based letter (19.7% for the intervention group versus 15.8% for the control; difference, +3.9 percentage points [pp]; 95% CI, +0.8 to +7.0; P=0.02) and the clinical letter (19.7% versus 15.8%; difference, +3.9 pp; 95% CI, +0.8 to +7.0; P=0.02). We found no evidence that interventions were associated with improved early health outcomes. CONCLUSIONS The behavioral economics intervention tested in this large RCT had limited effect on changing behavior or improving health outcomes. Although the approach has promise, this study demonstrates the challenge of developing behavioral interventions that improve the effectiveness of CKD screening programs.Clinical Trial registry name and registration number: University Hospital Medical Information Network Clinical Trial Registry, UMIN000035230.
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Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shusaku Sasaki
- Faculty of Economics, Tohoku Gakuin University, Miyagi, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University School of Data Science, Yokohama, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California,Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
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29
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Lee YH, Sato Y, Saito M, Fukuma S, Saito M, Yamamoto S, Komatsuda A, Fujiyama N, Satoh S, Lee SH, Boor P, Habuchi T, Floege J, Yanagita M. Advanced Tertiary Lymphoid Tissues in Protocol Biopsies are Associated with Progressive Graft Dysfunction in Kidney Transplant Recipients. J Am Soc Nephrol 2022; 33:186-200. [PMID: 34725107 PMCID: PMC8763171 DOI: 10.1681/asn.2021050715] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/13/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Tertiary lymphoid tissues (TLTs) are ectopic lymphoid tissues found in chronically inflamed organs. Although studies have documented TLT formation in transplanted kidneys, the clinical relevance of these TLTs remains controversial. We examined the effects of TLTs on future graft function using our histologic TLT maturity stages and the association between TLTs and Banff pathologic scores. We also analyzed the risk factors for the development of TLTs. METHODS Serial protocol biopsy samples (0 hour, 1, 6, and 12 months) without rejection were retrospectively analyzed from 214 patients who underwent living donor kidney transplantation. TLTs were defined as lymphocyte aggregates with signs of proliferation and their stages were determined by the absence (stage I) or presence (stage II) of follicular dendritic cells. RESULTS Only 4% of patients exhibited TLTs at the 0-hour biopsy. Prevalence increased to almost 50% at the 1-month biopsy, and then slightly further for 12 months. The proportion of advanced stage II TLTs increased gradually, reaching 19% at the 12-month biopsy. Presence of stage II TLTs was associated with higher risk of renal function decline after transplantation compared with patients with no TLT or stage I TLTs. Stage II TLTs were associated with more severe tubulitis and interstitial fibrosis/tubular atrophy at 12 months and predicted poorer graft function independently from the degree of interstitial inflammation. Pretransplantation rituximab treatment dramatically attenuated the development of stage II TLTs. CONCLUSIONS TLTs are commonly found in clinically stable transplanted kidneys. Advanced stage II TLTs are associated with progressive graft dysfunction, independent of interstitial inflammation.
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Affiliation(s)
- Yu Ho Lee
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yuki Sato
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Medical Innovation Center TMK Project, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuru Saito
- Department of Urology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaya Saito
- Department of Hematology, Nephrology, and Rheumatology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Shigenori Yamamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Medical Innovation Center TMK Project, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Komatsuda
- Department of Hematology, Nephrology, and Rheumatology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Nobuhiro Fujiyama
- Center for Kidney Disease and Transplantation, Akita University Hospital, Akita, Japan
| | - Shigeru Satoh
- Center for Kidney Disease and Transplantation, Akita University Hospital, Akita, Japan
| | - Sang-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Peter Boor
- Institute of Pathology, RWTH University of Aachen, Germany, Aachen, Germany,Division of Nephrology, RWTH University of Aachen, Germany, Aachen, Germany,Electron Microscopy Facility, RWTH University of Aachen, Aachen, Germany
| | - Tomonori Habuchi
- Department of Urology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Jürgen Floege
- Division of Nephrology, RWTH University of Aachen, Germany, Aachen, Germany
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
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Kimachi M, Omae K, Kamitani T, Fukuma S. Primary care physicians' perceptions concerning engagement in cancer survivor care. J Gen Fam Med 2021; 23:149-157. [PMID: 35509332 PMCID: PMC9062547 DOI: 10.1002/jgf2.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/19/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Given the growing diversity among cancer survivors and the fact that oncologists typically do not perform long‐term care, the expected role of primary care physicians (PCPs) in survivor care is expanding. However, communication and collaboration between oncologists and PCPs are lacking. Therefore, we assessed the perception of cancer survivor care among PCPs. Methods We sent a questionnaire to 767 Japanese Board–certified PCPs, regardless of facility type (clinics and hospitals), inquiring about PCPs' perceptions of their role in survivor care. Additionally, we included vignette‐based scenarios focused on colorectal and prostate cancer survivors to explore factors associated with their clinical decisions. Results We obtained 91 replies (response rate: 11.9%). A total of 75% of PCPs had encountered at least 1 cancer patient in actual practice. Even for patients actively receiving cancer treatment, >70% of PCPs reported that they were willing to engage in comprehensive survivor care, except for the administration of anticancer drugs. Further, 49% of PCPs considered that both PCPs and oncologists were suited to performing regular screening for cancer recurrence in high‐risk patients. Multivariable logistic regression analyses revealed that clinic PCPs were less inclined to conduct screening for recurrence than hospital PCPs in both colorectal (odds ratio, 3.85 [95% confidence interval 1.40–10.6]) and prostate (4.36 [95% confidence interval 1.51–12.6]) cancer scenarios. Conclusions Our findings suggest that Japanese PCPs are willing to engage in survivor care and encourage closer collaboration between oncologists and PCPs. However, oncologists might need to request cooperation, considering the facility type with which PCPs are affiliated. The present study revealed that Japanese primary care physicians (PCPs) were willing to engage in comprehensive survivor care, except for the administration of anticancer drugs. Further, most PCPs were willing to engage in psychosocial support to relieve survivors' anxiety and manage work‐related issues, but they have few opportunities to collaborate with oncologists. Oncologists and PCPs need to engage in more communication and conduct cancer survivor care while capitalizing on PCPs' willingness and capability.![]()
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Affiliation(s)
- Miho Kimachi
- Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
| | - Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT) Fukushima Medical University Fukushima Japan
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Shingo Fukuma
- Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
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31
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Katsura M, Kuriyama A, Tada M, Tsujimoto Y, Luo Y, Yamamoto K, So R, Aga M, Matsushima K, Fukuma S, Furukawa TA. High variability in results and methodological quality among overlapping systematic reviews on the same topics in surgery: a meta-epidemiological study. Br J Surg 2021; 108:1521-1529. [PMID: 34791075 DOI: 10.1093/bjs/znab328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Redundant publication of systematic reviews and meta-analyses (SRs/MAs) on the same topic presents an increasing burden for clinicians. The aim of this study was to describe variabilities in effect size and methodological quality of overlapping surgery-related SRs/MAs and to investigate factors associated with their postpublication citations. METHODS PubMed/MEDLINE was searched to identify SRs/MAs of RCTs on thoracoabdominal surgeries published in 2015. Previous SRs/MAs on the same topics published within the preceding 5 years (2011-2015) were identified and 5-year citation counts (through to 2020) were evaluated. Discrepancies in pooled effect sizes and their methodological quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) among overlapping SRs/MAs were assessed. The SR/MA-level factors associated with 5-year citation counts were explored, using a mixed-effects regression model with a random intercept for surgical topics. RESULTS A total of 57 surgery-related SRs/MAs (48 topics) published in 2015 were identified, and 146 SRs/MAs had overlapping publications on 29 topics (60.4 per cent of all topics) in the preceding 5 years. There was considerable variability in methodological quality of SRs/MAs and coverage probability for relevant RCTs, resulting in discrepant effect size estimates for the same topic. High quality (AMSTAR score 8-11) was independently associated with higher 5-year citation counts (coefficient = 32.82; 95 per cent c.i. 15.63 to 50.02; P < 0.001). CONCLUSION Overlapping SRs/MAs with high variability in results and methodological quality were common in surgery. A high-quality SR/MA score was an independent predictor of more frequent citations. Researchers and journal editors should concentrate their efforts on limiting publications to higher-quality reviews.
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Affiliation(s)
- Morihiro Katsura
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Surgery, Okinawa Chubu Hospital, Okinawa, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Centre, Kurashiki Central Hospital, Okayama, Japan
| | - Masafumi Tada
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.,Department of Neurology, Emergency Medicine, Nagoya City University East Medical Centre, Nagoya, Japan
| | - Yasushi Tsujimoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Hyogo, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Kazumichi Yamamoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.,Institute for Airway Disease, Hyogo, Japan
| | - Ryuhei So
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.,Okayama Psychiatric Medical Centre, Okayama, Japan
| | - Masaharu Aga
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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Ikenoue T, Kataoka Y, Matsuoka Y, Matsumoto J, Kumasawa J, Tochitatni K, Funakoshi H, Hosoda T, Kugimiya A, Shirano M, Hamabe F, Iwata S, Fukuma S. Accuracy of deep learning-based computed tomography diagnostic system for COVID-19: A consecutive sampling external validation cohort study. PLoS One 2021; 16:e0258760. [PMID: 34735458 PMCID: PMC8568139 DOI: 10.1371/journal.pone.0258760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022] Open
Abstract
Ali-M3, an artificial intelligence program, analyzes chest computed tomography (CT) and detects the likelihood of coronavirus disease (COVID-19) based on scores ranging from 0 to 1. However, Ali-M3 has not been externally validated. Our aim was to evaluate the accuracy of Ali-M3 for detecting COVID-19 and discuss its clinical value. We evaluated the external validity of Ali-M3 using sequential Japanese sampling data. In this retrospective cohort study, COVID-19 infection probabilities for 617 symptomatic patients were determined using Ali-M3. In 11 Japanese tertiary care facilities, these patients underwent reverse transcription-polymerase chain reaction (RT-PCR) testing. They also underwent chest CT to confirm a diagnosis of COVID-19. Of the 617 patients, 289 (46.8%) were RT-PCR-positive. The area under the curve (AUC) of Ali-M3 for predicting a COVID-19 diagnosis was 0.797 (95% confidence interval: 0.762‒0.833) and the goodness-of-fit was P = 0.156. With a cut-off probability of a diagnosis of COVID-19 by Ali-M3 set at 0.5, the sensitivity and specificity were 80.6% and 68.3%, respectively. A cut-off of 0.2 yielded a sensitivity and specificity of 89.2% and 43.2%, respectively. Among the 223 patients who required oxygen, the AUC was 0.825. Sensitivity at a cut-off of 0.5% and 0.2% was 88.7% and 97.9%, respectively. Although the sensitivity was lower when the days from symptom onset were fewer, the sensitivity increased for both cut-off values after 5 days. We evaluated Ali-M3 using external validation with symptomatic patient data from Japanese tertiary care facilities. As Ali-M3 showed sufficient sensitivity performance, despite a lower specificity performance, Ali-M3 could be useful in excluding a diagnosis of COVID-19.
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Affiliation(s)
- Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe City, Hyogo, Japan
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Junji Kumasawa
- Department of Critical Care Medicine, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Kentaro Tochitatni
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto-city, Kyoto, Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, Kawasaki-ku, Kawasaki Kanagawa, Japan
| | - Aiko Kugimiya
- Department of Emergency and Critical Care Medicine, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Fumiko Hamabe
- Department of Radiology, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Sachiyo Iwata
- Division of Cardiovascular Medicine, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Naganuma T, Takahashi S, Takeshima T, Kurita N, Omae K, Yoshioka T, Ohnishi T, Ito F, Fukuma S, Hamaguchi S, Fukuhara S. Cohort profile: A super-elderly population-based cohort in Japan (the Sukagawa Study). Int J Epidemiol 2021; 50:727-727h. [PMID: 33544828 DOI: 10.1093/ije/dyaa285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 12/24/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Toru Naganuma
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Health care Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sei Takahashi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Health care Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taro Takeshima
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Noriaki Kurita
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.,Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenji Omae
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Health care Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Health care Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Ohnishi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Nephrology, Kasukabe Central General Hospital, Kusagabe, Saitama, Japan
| | - Fumihito Ito
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Emergency Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
| | - Shingo Fukuma
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sugihiro Hamaguchi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Health care Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Fukuma S, Ikenoue T, Yamada Y, Saito Y, Green J, Nakayama T, Fukuhara S. Changes in Drug Utilization After Publication of Clinical Trials and Drug-Related Scandals in Japan: An Interrupted Time Series Analysis, 2005-2017. J Epidemiol 2021; 31:410-416. [PMID: 32624520 PMCID: PMC8187611 DOI: 10.2188/jea.je20200181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/21/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Breaches of ethics undermine the practice of medicine. In Japan, two major scandals involving clinical research and drug marketing occurred after the publication of clinical trials. To study the effects of those scandals, we evaluated changes in the use of first-generation angiotensin II receptor blockers (ARBs) after publication of relevant clinical trials and also after the subsequent scandals. METHODS We conducted a quasi-experimental design of an interrupted time series analysis (ITSA) on nationwide monthly drug-market data covering 12 years (2005 to 2017) in Japan. The main outcome was the use of first-generation ARBs (valsartan, candesartan, and losartan). The two exposures were the publication of ARB-related clinical-trial results (October 2006) and subsequent ARB-related scandals involving research and marketing (February 2013). A generalized estimating equation model was fitted for ITSA with a log link, Poisson distribution, robust variance estimators, and seasonality adjustment. RESULTS The publication of clinical trials was associated with 12% increase in the use of first-generation ARBs in Japan, and the subsequent ARB-related scandals was associated with 19% decrease. The decrease in the use of first-generation ARBs after the scandals was greater than the increase in their use after the publication of clinical-trial results. The net effect of the two exposures was a 9% decrease in the use of first-generation ARBs. CONCLUSIONS The scandals were associated with decrease in the use of first-generation ARBs, and that decrease was greater than the increase associated with the publication of "successful" clinical trials, making the net effect not zero but negative.
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Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukari Yamada
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiyuki Saito
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Joseph Green
- Research Division, Institute for Health Outcomes and Process Evaluation Research (iHope International), Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
- Shirakawa STAR for General Medicine, Fukushima Medical University, Fukushima, Japan
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Wakamatsu T, Iwasaki Y, Yamamoto S, Matsuo K, Goto S, Narita I, Kazama JJ, Tanaka K, Ito A, Ozasa R, Nakano T, Miyakoshi C, Onishi Y, Fukuma S, Fukuhara S, Yamato H, Fukagawa M, Akizawa T. Type I Angiotensin II Receptor Blockade Reduces Uremia-Induced Deterioration of Bone Material Properties. J Bone Miner Res 2021; 36:67-79. [PMID: 32786093 PMCID: PMC9328427 DOI: 10.1002/jbmr.4159] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
Chronic kidney disease (CKD) is associated with a high incidence of fractures. However, the pathophysiology of this disease is not fully understood, and limited therapeutic interventions are available. This study aimed to determine the impact of type 1 angiotensin II receptor blockade (AT-1RB) on preventing CKD-related fragility fractures and elucidate its pharmacological mechanisms. AT-1RB use was associated with a lower risk of hospitalization due to fractures in 3276 patients undergoing maintenance hemodialysis. In nephrectomized rats, administration of olmesartan suppressed osteocyte apoptosis, skeletal pentosidine accumulation, and apatite disorientation, and partially inhibited the progression of the bone elastic mechanical properties, while the bone mass was unchanged. Olmesartan suppressed angiotensin II-dependent oxidation stress and apoptosis in primary cultured osteocytes in vitro. In conclusion, angiotensin II-dependent intraskeletal oxidation stress deteriorated the bone elastic mechanical properties by promoting osteocyte apoptosis and pentosidine accumulation. Thus, AT-1RB contributes to the underlying pathogenesis of abnormal bone quality in the setting of CKD, possibly by oxidative stress. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Takuya Wakamatsu
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshiko Iwasaki
- Department of Health Sciences, Oita University of Nursing and Health Sciences, Oita, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koji Matsuo
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shin Goto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Junichiro J Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Kennichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Akemi Ito
- Ito Bone Histomorphometry Institute, Niigata, Japan
| | - Ryosuke Ozasa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Suita, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Suita, Japan
| | - Chisato Miyakoshi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Yoshihiro Onishi
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Hideyuki Yamato
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Soeno S, Takada T, Takeshima T, Kaneyama M, Sagawa M, Hayashi M, Miyashita J, Azuma T, Fukuma S, Fukuhara S. Association between the use of physical restraint and functional decline among older inpatients admitted with pneumonia in an acute care hospital: A retrospective cohort study. Arch Gerontol Geriatr 2020; 94:104330. [PMID: 33493952 DOI: 10.1016/j.archger.2020.104330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
AIM This study was conducted to investigate the association between the use of physical restraint and functional decline in older inpatients admitted with pneumonia in an acute care setting. Although several adverse effects related to restraint use have been reported, few researchers have examined this subject in acute care settings. METHODS This retrospective cohort study was conducted at a 471-bed, acute care hospital in Japan. Patients 65 years old and older who were admitted with pneumonia between April 2015 and September 2017 were included. The use of restraints (belts and/or mittens) was recorded for every 8-hour shift. The number of shifts during which each patient was restrained was used as an explanatory variable. The primary outcome was the Katz ADL score at discharge. We used multiple linear regression analysis to adjust for confounding factors. RESULTS Of 403 patients, 94 required physical restraints. The mean age was 84.5 years (standard deviation [SD] 8.2); 44.4% were women. The mean Katz score on admission was 2.7 (SD 2.4). For multiple linear regression analysis, the coefficient of the number of restraints used was -0.024 (95% confidence interval: -0.044, -0.003, p = .022). Consequently, the restraint use for 13.9 days was associated with the decrease in the Katz score by 1.0. CONCLUSIONS Results suggest that physical restraint use is associated with functional decline among older inpatients admitted with pneumonia in acute care settings.
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Affiliation(s)
- Shoko Soeno
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan.
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Mirei Kaneyama
- Nursing Service Department, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Manami Sagawa
- Nursing Service Department, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Shingo Fukuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Human Health Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Fukuma S, Iizuka T, Ikenoue T, Tsugawa Y. Association of the National Health Guidance Intervention for Obesity and Cardiovascular Risks With Health Outcomes Among Japanese Men. JAMA Intern Med 2020; 180:1630-1637. [PMID: 33031512 PMCID: PMC7536624 DOI: 10.1001/jamainternmed.2020.4334] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Obesity and cardiovascular risks have become major public health problems. However, evidence is limited as to whether population-level lifestyle interventions for obesity and cardiovascular risk factors are associated with improved population health outcomes. OBJECTIVE To investigate the association of the national health guidance intervention in Japan with population health outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a regression discontinuity design that included men aged 40 to 74 years who participated in the national health screening program in Japan from April 2013 to March 2018. EXPOSURES Assignment to the national health guidance intervention (counseling on healthy lifestyle and appropriate clinical follow-up for individuals found to have waist circumference of 85 cm or greater with 1 or more cardiovascular risk factors during annual national health screening program). MAIN OUTCOMES AND MEASURES Changes in obesity status (body weight, body mass index, waist circumference), and cardiovascular risk factors (blood pressure, hemoglobin A1c level, and low-density lipoprotein cholesterol level) 1 to 4 years after screening. RESULTS Of 74 693 men (mean [SD] age, 52.1 [7.8] years; mean [SD] baseline waist circumference, 86.3 [9.0] cm), the assignment to the health guidance intervention was associated with lower weight (adjusted difference, -0.29 kg; 95% CI, -0.50 to -0.08; P = .005), body mass index (-0.10; 95% CI, -0.17 to -0.03; P = .008), and waist circumference (-0.34 cm; 95% CI, -0.59 to -0.04; P = .02) 1 year after screening. The observed association of the guidance assignment attenuated over time and was no longer significant by years 3 to 4. No evidence was found that the health guidance intervention was associated with changes in participants' systolic blood pressure, diastolic blood pressure, hemoglobin A1c level, or low-density lipoprotein cholesterol level in years 1 to 4. CONCLUSIONS AND RELEVANCE Among working-age men in Japan, the national health guidance intervention was not associated with clinically meaningful weight loss or other cardiovascular risk factor reduction. Further research is warranted to understand the specific design of lifestyle interventions that are effective in improving obesity and cardiovascular risk factors.
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Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshiaki Iizuka
- Graduate School of Economics, the University of Tokyo, Tokyo, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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Yamamoto S, Yamamoto M, Nakamura J, Mii A, Yamamoto S, Takahashi M, Kaneko K, Uchino E, Sato Y, Fukuma S, Imamura H, Matsuda M, Yanagita M. Spatiotemporal ATP Dynamics during AKI Predict Renal Prognosis. J Am Soc Nephrol 2020; 31:2855-2869. [PMID: 33046532 DOI: 10.1681/asn.2020050580] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Depletion of ATP in renal tubular cells plays the central role in the pathogenesis of kidney diseases. Nevertheless, inability to visualize spatiotemporal in vivo ATP distribution and dynamics has hindered further analysis. METHODS A novel mouse line systemically expressing an ATP biosensor (an ATP synthase subunit and two fluorophores) revealed spatiotemporal ATP dynamics at single-cell resolution during warm and cold ischemic reperfusion (IR) with two-photon microscopy. This experimental system enabled quantification of fibrosis 2 weeks after IR and assessment of the relationship between the ATP recovery in acute phase and fibrosis in chronic phase. RESULTS Upon ischemia induction, the ATP levels of proximal tubule (PT) cells decreased to the nadir within a few minutes, whereas those of distal tubule (DT) cells decreased gradually up to 1 hour. Upon reperfusion, the recovery rate of ATP in PTs was slower with longer ischemia. In stark contrast, ATP in DTs was quickly rebounded irrespective of ischemia duration. Morphologic changes of mitochondria in the acute phase support the observation of different ATP dynamics in the two segments. Furthermore, slow and incomplete ATP recovery of PTs in the acute phase inversely correlated with fibrosis in the chronic phase. Ischemia under conditions of hypothermia resulted in more rapid and complete ATP recovery with less fibrosis, providing a proof of concept for use of hypothermia to protect kidney tissues. CONCLUSIONS Visualizing spatiotemporal ATP dynamics during IR injury revealed higher sensitivity of PT cells to ischemia compared with DT cells in terms of energy metabolism. The ATP dynamics of PTs in AKI might provide prognostic information.
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Affiliation(s)
- Shinya Yamamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masamichi Yamamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Advanced Scientific Research Leaders Development Unit, Gunma University Graduate School of Medicine, Maebashi, Japan.,Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Saitama, Japan
| | - Jin Nakamura
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akiko Mii
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigenori Yamamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Takahashi
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiichi Kaneko
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eiichiro Uchino
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Sato
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Medical Innovation Center TMK Project, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shingo Fukuma
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromi Imamura
- Graduate School of Biostudies, Kyoto University, Kyoto, Japan
| | - Michiyuki Matsuda
- Department of Pathology and Biology of Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan .,Institute for the Advanced Study of Human Biology, Kyoto University, Kyoto, Japan
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Kato C, Fujii N, Miyakoshi C, Asada S, Onishi Y, Fukuma S, Nomura T, Wada M, Fukagawa M, Fukuhara S, Akizawa T. Changes in 3-month mineral and bone disorder patterns were associated with all-cause mortality in prevalent hemodialysis patients with secondary hyperparathyroidism. BMC Nephrol 2020; 21:432. [PMID: 33045994 PMCID: PMC7552558 DOI: 10.1186/s12882-020-02088-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 10/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence on the association between short-term changes in mineral and bone disorder parameters and survival in maintenance hemodialysis patients. METHODS We investigated the association between changing patterns of phosphorus, calcium and intact parathyroid hormone levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism. Each parameter was divided into three categories (low [L], middle [M] and high [H]), and the changing patterns between two consecutive visits at 3-month intervals were categorized into nine groups (e.g., L-L and M-H). The middle category was defined as 4.0-7.0 mg/dL for phosphorous, 8.5-9.5 mg/dL for calcium and 200-500 pg/mL for intact parathyroid hormone. Adjusted incidence rates and rate ratios were analyzed by weighted Poisson regression models accounting for time-dependent exposures. RESULTS For phosphorus, shifts from low/high to middle category (L-M/H-M) were associated with a lower mortality compared with the L-L and H-H groups, whereas shifts from middle to low/high category (M-L/M-H) were associated with a higher mortality compared with the M-M group. For calcium, shifts from low/middle to high category (L-H/M-H) were associated with a higher mortality compared with the L-L and M-M groups, whereas shifts from high to middle category (H-M) were associated with a lower mortality compared with the H-H group. For intact parathyroid hormone, shifts from low to middle category (L-M) were associated with a lower mortality compared with the L-L group. CONCLUSIONS Changes in the 3-month patterns of phosphorus and calcium toward the middle category were associated with lower mortality. Our study also suggests the importance of avoiding hypercalcemia.
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Affiliation(s)
- Chihiro Kato
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Naohiko Fujii
- Department of Internal Medicine (Nephrology Unit), Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Chisato Miyakoshi
- Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shinji Asada
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan.
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | - Takanobu Nomura
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Michihito Wada
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Fukuma S, Ikenoue T, Saito Y, Yamada Y, Saigusa Y, Misumi T, Taguri M. Lack of a bridge between screening and medical management for hypertension: health screening cohort in Japan. BMC Public Health 2020; 20:1419. [PMID: 32943038 PMCID: PMC7499996 DOI: 10.1186/s12889-020-09532-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
Background Patient journeys for hypertensive individuals after detection at screening have not been well examined in a general population. Thus, we aimed to assess the medical treatment status and subsequent longitudinal changes in blood pressure in a middle-aged Japanese population. Methods We conducted a cohort study using a nationwide Japanese health screening cohort, from April 2014 to March 2019. Among health screening participants aged 40–74 years who had not previously received treatment for hypertension, hypertensive patients were newly identified based on screening results, and their medical treatment status for hypertension during the year following their initial screening was assessed. The main outcomes were longitudinal changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) over 4 years after initial screening. Results Of the 153,523 screening participants (mean age = 49.7 years), 16,720 (10.9%) and 4150 (2.7%) were newly detected as having hypertension, with baseline SBP of 140–159 mmHg (grade 1) and ≥ 160 mmHg (grade 2–3), respectively. Among them, 15.9% of the grade 1 hypertensive participants and 36.3% of the grade 2–3 hypertensive participants started receiving medical treatment during the year following initial screening. A linear generalised estimating equation with propensity score matching showed that receiving medical treatment was associated with 5.77 mmHg lower SBP (95% CI − 6.64 to − 4.90) and 3.82 mmHg lower DBP (95% CI − 4.47 to − 3.16) in the grade 1 hypertensive group, and 14.69 mmHg lower SBP (95% CI − 16.35 to − 13.04) and 8.42 mmHg lower DBP (95% CI − 9.49 to − 7.34) in the grade 2–3 hypertensive group. Conclusions Health screenings detected hypertension in a substantial percentage of the middle-aged population in this study. However, detection was often followed by insufficient medical treatment and inappropriate blood pressure management. These findings indicate an inadequate link between health screenings and medical treatments in patients with hypertension.
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Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Shogoin-Kawahara, Sakyo, Kyoto, 606-8507, Japan.
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Shogoin-Kawahara, Sakyo, Kyoto, 606-8507, Japan
| | - Yoshiyuki Saito
- Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Shogoin-Kawahara, Sakyo, Kyoto, 606-8507, Japan
| | - Yukari Yamada
- Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Shogoin-Kawahara, Sakyo, Kyoto, 606-8507, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University School of Data Science, Yokohama, Japan
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Fukuma S, Ikenoue T, Bragg-Gresham J, Norton E, Yamada Y, Kohmoto D, Saran R. Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan. BMJ Open 2020; 10:e037247. [PMID: 32895282 PMCID: PMC7476489 DOI: 10.1136/bmjopen-2020-037247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obesity is a growing public health problem worldwide. We evaluated the mediators and association between changes in obesity metrics and renal outcomes in the general population. METHODS Using the Japanese nationwide health check-based cohort from April 2011 to March 2019, we selected individuals aged 40-74 years, with a baseline estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m2, whose body mass index (BMI) change was assessed. The primary outcome was combined 30% decline in eGFR, eGFR <15 mL/min/1.73 m2 and end-stage renal disease. RESULTS During 245 147 person-years' follow-up among 50 604 participants (mean eGFR, 83.7 mL/min/1.73 m2; mean BMI, 24.1 kg/m2), 645 demonstrated eGFR decline (incidence rate 2.6/1000 person-years, 95% CI: 2.4 to 2.8). We observed continued initial changes in BMI for over 6 years and a U-shaped association between BMI change and eGFR decline. Compared with 0% change in BMI, adjusted HRs for changes of -10%, -4%, 4% and 10% were 1.53 (95% CI: 1.15 to 2.04), 1.14 (95% CI: 1.01 to 1.30), 1.16 (95% CI: 1.02 to 1.32) and 1.87 (95% CI: 1.25 to 2.80), respectively. The percentage of excess risk of BMI increase (>4%) mediated by three risk factors (blood pressure, haemoglobin A1c and total cholesterol), was 13.3%. CONCLUSION In the middle-aged Japanese population, both, increase and decrease in BMI were associated with subsequent eGFR decline. Changes in risk factors mediated a small proportion of the association between BMI increase and eGFR decline. Our findings support the clinical significance of monitoring BMI as a renal risk factor.
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Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Jennifer Bragg-Gresham
- Internal Medicine and Molecular and Integrative Physiology, Division of Nephrology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Edward Norton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Daichi Kohmoto
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rajiv Saran
- Internal Medicine and Molecular and Integrative Physiology, Division of Nephrology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Yamada Y, Uchida T, Ogino M, Ikenoue T, Shiose T, Fukuma S. Changes in Older People's Activities During the Coronavirus Disease 2019 Pandemic in Japan. J Am Med Dir Assoc 2020; 21:1387-1388.e1. [PMID: 32981665 PMCID: PMC7396974 DOI: 10.1016/j.jamda.2020.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yukari Yamada
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoe Uchida
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mari Ogino
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Shingo Fukuma
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Ishiwatari A, Yamamoto S, Fukuma S, Hasegawa T, Wakai S, Nangaku M. Changes in Quality of Life in Older Hemodialysis Patients: A Cohort Study on Dialysis Outcomes and Practice Patterns. Am J Nephrol 2020; 51:650-658. [PMID: 32739911 DOI: 10.1159/000509309] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite improvements in dialysis treatment, mortality rates remain high, especially among older hemodialysis patients. Quality of life (QOL) among hemodialysis patients is strongly associated with higher risk of death. This study aimed to describe the health-related QOL and its change in older maintenance hemodialysis patients and to demonstrate characteristics associated with health-related QOL. METHODS Data on 892 maintenance hemodialysis patients aged 60 years or older who were surveyed using the Kidney Disease Quality of Life Short Form at baseline and 2 years after study enrollment in phases 4 (2009-2011) and 5 (2012-2014) of the Japanese Dialysis Outcomes and Practice Patterns Study were analyzed. We categorized participants into 3 age groups (60-69, 70-79, and ≥80 years) and described baseline physical component summary (PCS) and mental component summary (MCS) scores, as well as their distribution of changes after 2 years across each category. RESULTS Hemodialysis patients aged 70-79 years and ≥80 years had lower PCS scores than those aged 60-69 years (median: 70-79 years = 43.1; interquartile range [IQR], 35.2-49.4; ≥80 years = 38.8; IQR, 31.6-43.8; 60-69 years = 45.4; IQR, 37.5-51.4; p < 0.001). In contrast, MCS scores did not significantly differ by age category (70-79 years = 45.6; IQR, 38.4-53.7; ≥80 years = 45.4; IQR, 36.9-55.1; 60-69 years = 46.8; IQR, 39.5-55.7; p = 0.1). As dialysis vintage lengthened, the PCS score significantly became lower, whereas no association was found with change in the MCS score. The MCS score declined over time in older patients, especially among those aged 80 years and older after 2 years' follow-up. CONCLUSIONS Physical QOL became worse as dialysis vintage lengthened. In contrast, mental QOL declined over time within a relatively short period among older maintenance hemodialysis patients.
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Affiliation(s)
| | - Shungo Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Hasegawa
- Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
- Department of Hygiene, Public Health, and Preventive Medicine, Graduate School of Medicine, Showa University, Tokyo, Japan
- Division of Nephrology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Sachiko Wakai
- Division of Nephrology, Okubo Hospital, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Hashimoto S, Nagai M, Ohira T, Fukuma S, Hosoya M, Yasumura S, Satoh H, Suzuki H, Sakai A, Ohtsuru A, Kawasaki Y, Takahashi A, Okazaki K, Kobashi G, Kamiya K, Yamashita S, Fukuhara SI, Ohto H. Influence of post-disaster evacuation on incidence of hyperuricemia in residents of Fukushima Prefecture: the Fukushima Health Management Survey. Clin Exp Nephrol 2020; 24:1025-1032. [PMID: 32715354 PMCID: PMC7524849 DOI: 10.1007/s10157-020-01924-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/25/2020] [Indexed: 11/13/2022]
Abstract
Aim After the Great East Japan Earthquake, over 160,000 residents in Fukushima Prefecture were forced to evacuate the area around the Fukushima Daiichi power plant following nuclear accident there. Health problems in these evacuees have since become a major issue. We have examined the association between evacuation and incidence of hyperuricemia among residents in Fukushima. Methods We conducted a cohort study of residents aged 40–90 years without hyperuricemia at the time of the Fukushima disaster. Among 8173 residents who met the inclusion criteria before the disaster, 4789 residents (men: 1971, women: 2818; follow-up duration: 1.38 years; and follow-up rate: 58.6%) remained available for follow-up examinations at the end of March 2013. The main endpoint was incidence of hyperuricemia, defined by the Japanese committee guidelines, using local health data from before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of hyperuricemia, adjusting for potential confounders, age, gender, waist circumference, physical activity, and alcohol consumption. Results Incidence of hyperuricemia was higher in evacuees (men 10.1%; women 1.1%) than in non-evacuees (men 7.4%, women 1.0%). Evacuees had higher body mass index, waist circumference, triglycerides, LDL-cholesterol, fasting plasma glucose, HbA1c, and lower HDL-cholesterol after the disaster than non-evacuees. We found that evacuation was associated with incidence of hyperuricemia (adjusted odds ratio: 1.38; 95% confidence interval: 1.03–1.86). Conclusion This is the first study to demonstrate an association between evacuation after a disaster and increased incidence of hyperuricemia.
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Affiliation(s)
- Shigeatsu Hashimoto
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan. .,Departmnt of Endocrinology, Metabolism, Diabetology and Nephrology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan.
| | - Masato Nagai
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, Kyoto University School of Public Health, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Mitsuaki Hosoya
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroaki Satoh
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hitoshi Suzuki
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Cardiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Sakai
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Ohtsuru
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yukihiko Kawasaki
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Takahashi
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kanako Okazaki
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Shunichi Yamashita
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.,Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Shun-Ichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center, Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
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Asada S, Yokoyama K, Miyakoshi C, Fukuma S, Endo Y, Wada M, Nomura T, Onishi Y, Fukagawa M, Fukuhara S, Akizawa T. Relationship between serum calcium or phosphate levels and mortality stratified by parathyroid hormone level: an analysis from the MBD-5D study. Clin Exp Nephrol 2020; 24:630-637. [PMID: 32236781 PMCID: PMC7271007 DOI: 10.1007/s10157-020-01879-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 03/14/2020] [Indexed: 10/31/2022]
Abstract
INTRODUCTION There is limited evidence about the association between calcium and phosphate levels and mortality stratified by intact parathyroid hormone (iPTH) level. METHODS We investigated whether differences in iPTH level affect the relationship between calcium and phosphate levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism (SHPT). Calcium and phosphate levels were categorized as low (< 8.5 mg/dL, < 4.0 mg/dL), medium (≥ 8.5-< 9.5 mg/dL, ≥ 4.0-< 7.0 mg/dL), and high (≥ 9.5 mg/dL, ≥ 7.0 mg/dL), respectively. iPTH levels were grouped into < 300 or ≥ 300 pg/mL. Adjusted incidence rate ratios (aIRRs) were analyzed by weighted Poisson regression. RESULTS For calcium, patients with higher iPTH (≥ 300 pg/mL) had significantly higher all-cause mortality rates in the high than in the medium category (aIRR 1.99, 95% confidence interval [CI] 1.16-3.42), and tended to have a higher mortality rate in the low category (aIRR 2.04, 95% CI 0.94-4.42). Patients with lower iPTH (< 300 pg/mL) had higher mortality rates in the high than in the medium category (aIRR 1.65, 95% CI 1.39-1.96). For phosphate, the mortality rate was significantly higher in the high than in the medium category in patients with higher and lower iPTH (aIRR 3.23, 95% CI 1.63-6.39 for iPTH ≥ 300 pg/mL; aIRR 1.58, 95% CI 1.06-2.36 for iPTH < 300 pg/mL). CONCLUSION High calcium and phosphate levels were associated with increased risk of mortality irrespective of iPTH level.
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Affiliation(s)
- Shinji Asada
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan.
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- Jikei University Harumi Triton Clinic, Jikei University School of Medicine, Tokyo, Japan
| | - Chisato Miyakoshi
- Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | - Yuichi Endo
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Michihito Wada
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Takanobu Nomura
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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46
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Fukuma S. Learning Health System In A Senior Retirement Community: A Platform To Promote Implementation Research. Gerontol Geriatr Med 2020. [DOI: 10.24966/ggm-8662/100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sato Y, Boor P, Fukuma S, Klinkhammer BM, Haga H, Ogawa O, Floege J, Yanagita M. Developmental stages of tertiary lymphoid tissue reflect local injury and inflammation in mouse and human kidneys. Kidney Int 2020; 98:448-463. [PMID: 32473779 DOI: 10.1016/j.kint.2020.02.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Tertiary lymphoid tissues (TLTs) are inducible ectopic lymphoid tissues in chronic inflammatory states and function as sites of priming local immune responses. We previously demonstrated that aged but not young mice exhibited multiple TLTs after acute kidney injury and that TLTs were also detected in human aged and diseased kidneys. However, the forms of progression and the implication for kidney injury remain unclear. To clarify this we analyzed surgically resected kidneys from aged patients with or without chronic kidney disease as well as kidneys resected for pyelonephritis, and classified TLTs into three distinct developmental stages based on the presence of follicular dendritic cells and germinal centers. In injury-induced murine TLT models, the stages advanced with the extent of kidney injury, and decreased with dexamethasone accompanied with improvement of renal function, fibrosis and inflammation. Kidneys from aged patients with chronic kidney disease consistently exhibited more frequent and advanced stages of TLTs than those without chronic kidney disease. Kidneys of patients with pyelonephritis exhibited more frequent TLTs with more advanced stages than aged kidneys. Additionally, TLTs in both cohorts shared similar locations and components, suggesting that TLT formation may not be a disease-specific phenomenon but rather a common pathological process. Thus, our findings provide the insights into biological features of TLT in the kidney and implicate TLT stage as a potential marker reflecting local injury and inflammation.
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Affiliation(s)
- Yuki Sato
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Medical Innovation Center TMK Project, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Peter Boor
- Institute of Pathology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany; Department of Nephrology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Barbara M Klinkhammer
- Institute of Pathology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany; Department of Nephrology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jürgen Floege
- Department of Nephrology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan.
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Sasaki S, Takada T, Fukuma S, Imamoto M, Hasegawa T, Nishiwaki H, Iida H, Fukuhara S. Screening tool for identifying adults with excessive salt intake among community-dwelling adults: a population-based cohort study. Am J Clin Nutr 2020; 111:814-820. [PMID: 32020161 DOI: 10.1093/ajcn/nqaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Excessive salt intake is widely known to be a cause of hypertension, cardiovascular events, and so on. However, simple tools for screening excessive salt intake are lacking. OBJECTIVE We aimed to develop a simple screening tool to identify community-dwelling adults with excessive salt intake. METHODS The present study involved participants who received health check-ups in Fukushima, Japan, in 2016 and 2017. We defined data from the 2016 check-up as the derivation set, and data from those who received check-ups in 2017 but not 2016 as the validation set. The outcome measure was excessive salt intake, defined as the estimated daily salt intake of 1 SD or more. Candidate predictors associated with the outcome were extracted using the Delphi method by an expert panel and narrowed down with clinical expertise and stepwise backward selection. The screening tool was developed using a coefficient-based multivariable scoring method and externally validated. RESULTS A total of 1101 participants were included in the derivation set and 249 in the validation set. At the conclusion of the deviation process, 8 predictors were selected and scored. The areas under the receiver operating characteristic curve for derivation and external validation were 0.70 (95% CI: 0.67, 0.74) and 0.71 (95% CI: 0.62, 0.80), respectively. The calibration slope and intercept for external validation were 1.16 and -0.03, respectively. CONCLUSION We developed a screening tool to identify adults with excessive salt intake. By extracting groups with excessive salt intake, target populations needing intervention for salt reduction can be highlighted efficiently.
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Affiliation(s)
- Sho Sasaki
- Department of Nephrology/Clinical Research Support Office, Iizuka Hospital, Fukuoka, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
| | - Toshihiko Takada
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan.,Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Miyuki Imamoto
- Department of Foods and Human Nutrition, Faculty of Human Life Sciences, Notre Dame Seishin University, Kurashiki, Japan
| | - Takeshi Hasegawa
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan.,Office for Promoting Medical Research, Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan.,Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroki Nishiwaki
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hidekazu Iida
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,You Home Clinic Ishinomaki, Isinomaki, Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
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Katsura M, Fukuma S, Kuriyama A, Takada T, Ueda Y, Asano S, Kondo Y, Ie M, Matsushima K, Murakami T, Fukuzato Y, Osaki N, Mototake H, Fukuhara S. Association between contrast extravasation on computed tomography scans and pseudoaneurysm formation in pediatric blunt splenic and hepatic injury: A multi-institutional observational study. J Pediatr Surg 2020; 55:681-687. [PMID: 31350043 DOI: 10.1016/j.jpedsurg.2019.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/29/2019] [Accepted: 07/06/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to examine the association between contrast extravasation (CE) on initial computed tomography (CT) scan and pseudoaneurysm (PSA) development in pediatric blunt splenic and/or liver injury. METHODS We conducted a multi-institutional retrospective study in cases of blunt splenic and/or hepatic injury who underwent an initial attempt of nonoperative management. A logistic regression model was used to compare PSA formation and CE on initial CT scan, and the area under the receiver operating characteristic curve (AUC) with and without CE was used to assess the predictive performance of CE for PSA formation. RESULTS Of 236 cases enrolled from 10 institutions, PSA formation was observed in 17 (7.2%). Multivariate analysis showed a significant association between CE on initial CT scan and increased incidence of PSA formation (odds ratio, 4.96; 95% confidence interval, 1.37-18.0). There was no statistically significant association between the grade of injury and PSA formation. The AUC improved from 0.75 (0.64-0.87) to 0.80 (0.70-0.91) with CE. CONCLUSION Active CE on initial CT scan was an independent predictor of PSA formation. Selective use of follow-up CT in children who showed CE on initial CT may provide early identification of PSA formation, regardless of injury grade. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- Morihiro Katsura
- Department of General Surgery, Okinawa, Chubu Hospital, Okinawa, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.
| | - Tadaaki Takada
- Department of Emergency and Critical Care Medicine, Tokushima, Red Cross Hospital, Tokushima, Japan.
| | - Yasuhiro Ueda
- Tajima Emergency and Critical Care Medical Center, Toyooka, Public Hospital, Hyogo, Japan.
| | - Shima Asano
- Department of Surgery, Okinawa, Miyako Hospital, Okinawa, Japan.
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan.
| | - Masafumi Ie
- Department of General Surgery, Okinawa, Chubu Hospital, Okinawa, Japan.
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA.
| | - Takahiro Murakami
- Department of General Surgery, Okinawa, Chubu Hospital, Okinawa, Japan.
| | - Yoshimitsu Fukuzato
- Department of Pediatric Surgery, Okinawa, Nanbu Medical Center & Children's Medical Center, Okinawa, Japan.
| | - Nobuhiro Osaki
- Department of Surgery, Okinawa, Yaeyama Hospital, Okinawa, Japan.
| | | | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Omae K, Kurita N, Takahashi S, Fukuma S, Yamamoto Y, Fukuhara S. Association of advanced glycation end-product accumulation with overactive bladder in community-dwelling elderly: A cross-sectional Sukagawa study. Asian J Urol 2020; 8:189-196. [PMID: 33996475 PMCID: PMC8099641 DOI: 10.1016/j.ajur.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to evaluate the influence of advanced glycation end-product (AGE) accumulation on the prevalence and severity of overactive bladder (OAB) in community-dwelling elderly adults. Methods We conducted a cross-sectional study involving 269 Japanese community dwellers aged ≥75 years in 2015. AGE accumulation was non-invasively measured via skin autofluorescence (SAF) values using AGE Reader. The primary and secondary outcomes were the presence and severity of OAB evaluated using the Overactive Bladder Symptom Score (OABSS). Individuals with an urgency score of ≥2 and sum score of ≥3 were considered to have OAB. The associations of SAF with the prevalence and severity of OAB were assessed using logistic and linear regression models, respectively, adjusted for clinically important confounders. Results The median age of participants was 78 years. Of 269 participants, 110 (40.9%) were men and 75 (27.9%) had OAB. The median SAF was 2.2 arbitrary units (AUs). Increasing median SAF was observed with increasing age. Multivariable analysis revealed that SAF was not associated with either the likelihood of having OAB (odds ratio per AU=0.77, 95% confidence interval: 0.37–1.62) or the natural log-transformed OABSS (β per AU=−0.07, 95% confidence interval: −0.26–0.12). Conclusions In this study, AGE accumulation, as assessed by SAF, was not associated with the prevalence and severity of OAB in Japanese community-dwelling elderly people aged ≥75 years.
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Affiliation(s)
- Kenji Omae
- Kyoto University, School of Public Health in the Graduate School of Medicine, Department of Healthcare Epidemiology, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.,Fukushima Medical University, Center for Innovative Research for Communities and Clinical Excellence, 1 Hikarigaoka, Fukushima City, Fukushima, Japan.,Fukushima Medical University Hospital, Department of Innovative Research and Education for Clinicians and Trainees, 1 Hikarigaoka, Fukushima City, Fukushima, Japan.,Tokyo Women's Medical University, Department of Urology, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Noriaki Kurita
- Fukushima Medical University, Center for Innovative Research for Communities and Clinical Excellence, 1 Hikarigaoka, Fukushima City, Fukushima, Japan.,Fukushima Medical University Hospital, Department of Innovative Research and Education for Clinicians and Trainees, 1 Hikarigaoka, Fukushima City, Fukushima, Japan.,Fukushima Medical University, Graduate School of Medicine, Department of Clinical Epidemiology, 1 Hikarigaoka, Fukushima City, Fukushima, Japan
| | - Sei Takahashi
- Kyoto University, School of Public Health in the Graduate School of Medicine, Department of Healthcare Epidemiology, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.,Fukushima Medical University, Center for Innovative Research for Communities and Clinical Excellence, 1 Hikarigaoka, Fukushima City, Fukushima, Japan
| | - Shingo Fukuma
- Fukushima Medical University, Center for Innovative Research for Communities and Clinical Excellence, 1 Hikarigaoka, Fukushima City, Fukushima, Japan.,Kyoto University, Graduate School of Medicine, Human Health Sciences, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Yosuke Yamamoto
- Kyoto University, School of Public Health in the Graduate School of Medicine, Department of Healthcare Epidemiology, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Shunichi Fukuhara
- Kyoto University, School of Public Health in the Graduate School of Medicine, Department of Healthcare Epidemiology, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.,Fukushima Medical University, Center for Innovative Research for Communities and Clinical Excellence, 1 Hikarigaoka, Fukushima City, Fukushima, Japan
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