Regional differences in the prevalence of generalized pustular psoriasis in Japan

Generalized pustular psoriasis (GPP), a rare form of psoriasis, is characterized by neutrophil-rich, sterile pustules. In Japan, GPP has intractable and rare disease designation, which allows patients to access support from national and local governments for medical expenses. Previously, similar numbers of patients in Tokyo and Hokkaido have been shown to have GPP designation, despite different population sizes. Here, we determine whether there are regional differences in the proportion of patients receiving GPP designation status in Japan and aim to identify causal factors. In this descriptive, retrospective cohort study, publicly available data were collected on the number of patients with intractable and rare disease designation for GPP in each prefecture and age classification (April 2018-March 2021). Three other designated intractable and rare disease cohorts were included: pemphigus, rare skin diseases, and all diseases. The primary outcome was the standardized morbidity ratio (SMR) of patients at prefecture level (observed numbers divided by expected). Regional differences were compared with the statistical expectation for the total population and age distribution of each prefecture. Regional differences were observed in all cohorts. Overall, 1910 patients had GPP as a designated intractable and rare disease in 2020. Regional differences in SMRs for GPP were observed with high SMRs (≥1.5) in Hokkaido, Tottori, Kagawa, and Miyazaki, and low SMRs (<0.6) in Gunma and Kanagawa. Regional differences in SMRs for GPP did not correlate with the number of medical doctors or dermatologists or internal migration. The number of medical doctors or dermatologists correlated with SMRs in the rare skin diseases and total cohorts. Regional differences in Japan exist in the number of patients with GPP who have an intractable and rare disease designation. Managing rare diseases is an important public health issue, and further research is required to elucidate the factors contributing to these differences.

Heterogeneous trends of premature mortalities in Japan: joinpoint regression analysis of years of life lost from 2011 to 2019

Purpose

To assess long-term premature mortalities in Japan for providing evidence of strategies for sustainable development in population health.

Methods

Descriptive study for observing the trends of premature mortalities due to 10 major causes and all-cause in Japan was conducted using governmental statistics taken between 2011 and 2019. Years of life lost (YLL) was calculated for each cause, and the trends of these were examined by joinpoint regression analysis.

Results

The means of YLL for all-cause through 2011 to 2019 were 8,121,565.1 in males and 6,743,198.4 in females. For each cause, the trends of age-standardized YLL were downward except for malignant neoplasm of pancreas and heart failure in males, and malignant neoplasm of pancreas, malignant neoplasm of breast, and age-related physical debility in females. One significant joinpoint for heart failure was found in males, and one significant joinpoint for each of malignant neoplasm of pancreas and age-related physical debility were found in females.

Conclusions

Premature mortalities due to malignant neoplasm of pancreas in both sexes, heart failure in males and malignant neoplasm of breast in females were issues to be prioritized for promoting population health in Japan.

Analysis of the linear oscillation dynamics of Fluidyne engines

A Fluidyne engine is a liquid piston Stirling engine that uses thermally induced self-sustained oscillations of water and air that are filled in a looped tube and tuning column. It presents high potential for use as a low-temperature-difference Stirling engine with a simple structure. This study analyzes the linear oscillation dynamics of the Fluidyne from a thermoacoustic point of view, with particular emphasis on the local specific acoustic impedance of the working gas, which is given by the ratio of the complex amplitudes of the pressure and velocity oscillations in the regenerator of the Fluidyne. The frequency dependence of the specific acoustic impedance indicates that the gas in the regenerator region undergoes a thermodynamic cycle equivalent to the Stirling cycle when the oscillation frequency is equal to the natural oscillation frequency of the U-shaped liquid column in the Fluidyne. The analysis of the natural oscillation modes determined two key parameters for the desired specific acoustic impedance: the tuning column length and the connecting position to the loop. Experimental verification was achieved via measurements of the onset temperature ratio and acoustic field of a prototype Fluidyne engine.

Risk of hospital insolvency and its relationship with income and borrowings from banks: a case-control study with large-scale financial data in Japan

Considering the variety of stakeholders surrounding hospitals, hospital financial distress should be understood as a social issue, rather than just a matter involving the hospital owners. The present study aimed to assess Japanese hospital insolvency and related factors based on a nationwide financial dataset, and to identify indicators of the risk of insolvency. The legal financial reports used included a balance sheet and a profit-and-loss statement of hospitals owned by healthcare corporations, representing about 70% of all Japanese hospitals. This case-control study with descriptive analyses was conducted to clarify the financial status of healthcare corporations and to assess associations between specific factors and insolvency. Insolvency was found in 5.9% of healthcare corporations in 2016. Insolvency was significantly associated with operational income per sales (odds ratio, 0.16), and both short- and long-term borrowings per sales (odds ratios: 1.46 and 1.22 in this order). The present study found that 5.9% of Japanese healthcare corporations were insolvent, and hospital profitability and borrowing (both short- and long-term) could be key factors related to preventing hospital insolvency in Japan. To maintain sustainable healthcare services by hospitals, decision makers should consider the risk of insolvency, and balance the amount of borrowings against sales.

SAT0083 PREVALENCE OF DYSPHAGIA AND ASSOCIATED RISK FACTORS IN ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Dysphagia (swallowing disorder) is an important health concern among the elderly that is associated with a poor prognosis [1]. Rheumatic diseases such as dermatomyositis are thought to represent an important risk factor for dysphagia, but few studies have described the association between dysphagia and rheumatoid arthritis (RA), and details on the prevalence of dysphagia in RA patients is not known [2] [3].

Objectives:

The present study aimed to determine the prevalence of dysphagia and associated risk factors among elderly patients with rheumatoid arthritis.

Methods:

We conducted a cross-sectional study including 93 patients with RA and osteoarthritis (OA) over 65 years of age. OA patients were included in the study as healthy controls. Patients with a history of stroke, neuromuscular disease, or head and neck tumors were excluded from the study. From July to November 2019, the water swallowing test (WST) and repetitive saliva swallowing test (RSST) were performed to evaluate the presence or absence of dysphagia in the patients. We also checked oral conditions, hoarseness, temporomandibular joint symptoms, cervical range of motion limitations, and grip strength. In addition, interviews were conducted to investigate swallowing ability and aspiration history. We compared the prevalence of dysphagia between RA and OA patients and explored potential risk factors for dysphagia in RA patients using logistic regression models.

Results:

Our study subjects comprised 63 RA patients (mean age, 73.8 years; 86.5% female) and 30 OA patients (mean age, 75.8 years; 82.3% female). The WST and RSST revealed that RA patients had a significantly higher prevalence of dysphagia than OA patients (23.8% vs 6.7%, p<0.05). While RA patients with dysphagia (n=15) were significantly older and had a longer disease duration than the OA patients, we observed no difference in disease activity or administrated drugs. Of the RA patients with dysphagia, 60% reported no previous episodes of aspiration. Increasing age (odds ratio (OR) 3.21, 95% confidence interval (CI) 1.06-4.56), cervical range of motion limitations (OR 3.14, 95% CI 1.02-7.24), opening disorder of the jaw (OR 2.26, 95% CI 1.12-4.86), and decreased grip strength (OR 1.96, 95% CI 1.01-4.15) were identified as factors related to the presence of dysphagia. Coexistence of Sjogren’s syndrome did not significantly affect the prevalence of dysphagia.

Conclusion:

Dysphagia was more prevalent among RA patients than in OA patients, suggesting an association with temporomandibular involvement, cervical disorder, and muscle weakness. Subclinical dysphagia should be assessed and monitored carefully in the clinical course of elderly patients with RA.

References:

[1] KW Altman et al. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010 Aug; 136 (8):784-9.

[2] Gilheaney Ó et al. The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with Temporomandibular Disorders Associated with Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Dysphagia. 2017 Oct; 32 (5):587-600.

[3] Mugii N et al. Oropharyngeal Dysphagia in Dermatomyositis: Associations with Clinical and Laboratory Features Including Autoantibodies. PLoS One. 2016 May 11;11 (5):e0154746.

Disclosure of Interests:

None declared

AB0106 THE SERUM N-ACETYLGLUCOSAMINE CONCENTRATIONS IN RHEUMATOID ARTHRITIS PATIENTS ARE ASSOCIATED WITH JOINT DESTRUCTION AND RELATED METABOLISM MORE THAN INFLAMMATORY CONDITION

Background:

In rheumatoid arthritis (RA) patients, synovitis causes severe articular cartilage damage. N-acetylglucosamine (NAc-Glc) is a component of gluglucosaminoglycans (GAG) such as hyaluronic acid (HA) and keratan sulfate (KS), heparan sulfate (HS). NAc-Glc concentration in plasma is thought to reflect the balance between biosynthesis and destruction of articular cartilage, however, few studies had examined the relationship between plasma NAc-Glc conncentration and RA activity.

Objectives:

NAc-Glc concentrations in RA patients were measured, and association with clinical indicators was assessed.

Methods:

A cross-sectional study was carried out including 60 RA cases. Using N-acetylglucosamine-d3 as standard, the serum of subjects were deproteinized by protein precipitation method with acetonitrile, then concentration of NAc-Glc was measured with high-speed liquid chromatography mass spectrometer (LC-MS / MS). Clinical evaluation items: basic metabolism, presence or absence of exercise habit, Larsen score of knee and wrist joint, therapeutic agents (csDMARDs, biologics and PSL), DAS28, CRP, MMP-3, modified HAQ score (mHAQ). Statically analyzed by Spearman non parametric test.

Results:

The age of 60 RA cases was 59.7±16.4 years, and the duration of the disease was 10.4±8.7 years. Biologics were used in 29 cases (TNF inhibitors in 16 cases, IL-6 inhibitors in 4 cases, Abatacept in 9 cases), MTX in 32 cases, and prednisolone in 15 cases.

Plasma NAc-Glc concentration was 113±41 (ng/dl), DAS28CRP was 3.04±1.2, and mHAQ was 0.863±891. Plasma NAc-Glc concentration showed positive correlation with age (correlation coefficient 0.644), knee joint destruction (0.425), HAQ score (0.340), BUN (0.412), and RF (0.287). Plasma NAc-Glc concentrations also negatively correlated with eGFR (-0.597), MTX use (-0.389), basal metabolism (-0.313), and sex difference (-0.272). There was no correlation between plasma NAc-Glc concentration and body weight, BMI, DAS28, CRP, MMP-3, NTX, serum creatinine, hand joint disease, and transaminase.In this study, plasma NAc-Glc concentration had increased with age, and had have a negative correlation with basal metabolism. Considering these results, it is unlikely that NAc-Glc is released into plasma as a metabolite of synthesis promotion. Further, since NAc-Glc had a negative correlation (-0.389) with MTX as a folic acid inhibitor, it was supposed to be affected by protein synthesis reduction. Because no correlation between NAc-Glc and inflammation or bone metabolism markers was observed, NAc-Glc may represent removal of GAG from the cell membrane (shedding).

In previous GAGs studies, in RA patients, HA, KS, CRP, DAS28, was very associated with arthritis, such as MMP-3.The concentration of NAc-Glc in plasma was more relevant to dysfunctions such as destruction and HAQ due to arthritis such as HAQ than inflammatory indicators such as DAS28, MMP-3 and CRP. It is appearing in the plasma by destruction by shedding, as an index to see the joint destruction, it was presumed to be a better indicator than the GAGs. It was also thought that there is a possibility that MTX affects cartilage substrate metabolism.

Conclusion:

Serum NAc-Glc concentration in rheumatoid arthritis patients may represent cartilage metabolism and joint destruction.

References:

[1]Y.Matsuura. et al.Ann.Rheum.Dis. 2018;77: 1219-1225

[2]T D Spector.et al. Ann.Rheum.Dis. 1992;51: 1134-1137

Disclosure of Interests:

None declared

P1745Clinical characteristics and long-term outcome in patients with helicopter-transported acute coronary syndrome after primary percutaneous coronary intervention

Background

Reducing delay to percutaneous coronary intervention improves functional outcome and reduces long-term mortality. Transportation by helicopter is often quicker than ground transport and thus may improve overall prognosis through reduced ischemic injury and infarction size. Our hospital is located on the medically-depopulated peninsula surrounded by mountain. The journey from the southern tip of the peninsula to the critical care medical center of our hospital take 1.5 hour by a ground ambulance but only 15 minutes by helicopter.

We compared the clinical characteristics and long-term mortality between air and ground transport of ACS patients for primary PCI.

Methods

We conducted an observational cohort study evaluating 2324 patients (mean age 68.5±12.0, male 75.2%) with ACS underwent primary PCI between April 2004 and December 2017 at our hospital.

We divided into three groups according to transportation system type (air, ground, walk-in).

The primary outcome was defined as all-cause death during the long-term follow-up.

Results

Among the entire cohort, 577 patients (24.8%) were transported by air. 1326 (57.1%) patients by ambulance, 421 (18.1%) patients by walk. Baseline characteristics were comparable, but patients by air had a higher prevalence of ST-elevation myocardial infarction.

The rate of long-term mortality was comparable during the median follow up of 6 years (air, 21.1% vs. ground, 21.4% vs. walk-in, 21.1%, respectively, log-rank p=0.72). Multivariate Cox regression analysis showed no significant association between air transportation and long-term mortality (Adjusted HR [vs ground] 1.05, 95% CI 0.60–1.78, p=0.85 and [vs walk-in] 0.94, 95% CI 0.62–1.43, respectively, p=0.77).

Kaplan-Meier curve

Conclusions

The rate of long-term mortality in patients with ACS transported by air was comparable with those transported by ground.

Are cold extremities an issue in women's health? Epidemiological evaluation of cold extremities among Japanese women

Background

Unlike traditional East Asian medicine, the necessity of health care services for cold extremities is yet to be acknowledged in Western medicine. In this study, we aimed to conduct an epidemiological evaluation of this unremarkable symptom among women in Japan.

Materials and methods

A cross-sectional study was conducted from February 2016 to April 2017, and data of 238 women throughout Japan were analyzed. Questionnaires were used to examine participants’ demographics, health-related behaviors, health status, and frequency of subjective symptoms over the past 1 year. The association between cold extremities and other subjective symptoms was examined by the multiple logistic regression analysis.

Results

The prevalences of mild and severe cold extremities were 49.6% and 35.3%, respectively. Temperature and utilization of health care services were not significantly different by the severity of cold extremities. The accompanying symptoms that were significantly associated with the cold extremities were shoulder stiffness, fatigue, low back pain, headache, nasal congestion, itching, injury, and difficulty hearing. After multiple logistic regression analysis, low back pain (OR: 4.91) and difficulty hearing (OR: 4.84) kept the significance. Factors related to cold extremities including mental quality of life, sleep quality, and habitual drinking were significantly associated with other accompanying symptoms.

Conclusion

Women with cold extremities have various accompanying symptoms and health-risk behaviors. Symptomatic treatment for cold extremities may not be sufficient, and comprehensive care would be required.

Long-term clinical impact of serum albumin in coronary artery disease patients with preserved renal function

BACKGROUND AND AIMS

Low serum albumin level is reportedly associated with worse clinical outcomes in patients with chronic kidney disease (CKD). However, associations between decreased serum albumin level and outcomes in non-CKD patients with coronary artery disease (CAD) remain unclear. Therefore, we aimed to evaluate the prognostic value of serum albumin concentrations in stable CAD patients with preserved renal function.

METHODS AND RESULTS

We studied 1316 patients with CAD and preserved renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m²) who underwent their first PCI between 2000 and 2011 and had data available for pre-procedural serum albumin. Patients were assigned to quartiles based on pre-procedural albumin concentrations. The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, was evaluated. Mean albumin concentration was 4.1 ± 0.4 g/dL. During the median follow-up of 7.5 years, 181 events occurred (13.8%). Kaplan-Meier curves revealed that patients with decreased serum albumin concentrations showed a higher event rate for MACE (log-rank, p < 0.0001). Using the highest tertiles (>4.3 g/dL) as reference, adjusted hazard ratios were 1.97 (95% CI, 1.12-3.55), 1.77 (95% CI, 0.99-3.25), and 1.19 (95% CI, 0.68-2.15) for serum albumin concentrations of <3.9, 3.9-4.0, and 4.1-4.3 g/dL, respectively. Decreased serum albumin concentration was associated with MACE even after adjusting for other independent variables (HR, 2.21 per 1-g/dL decrease; 95% CI, 1.37-3.56, p = 0.001).

CONCLUSION

Decreased serum albumin concentration independently predicted worse long-term prognosis in non-CKD patients after PCI. Pre-procedural serum albumin concentration could offer a useful predictor for patients with CAD and preserved renal function.

Prevalence and Risk Factors of Internet Addiction Among Employed Adults in Japan

Background

The prevalence of Internet addiction (IA) among employed adults has not been reported using a large sample. To clarify the actual status of addictive Internet use among employed adults, this study aimed to evaluate the prevalence and the risk factors of IA and at-risk IA among employed adults in Japan.

Methods

This cross-sectional study surveyed all junior and senior high school personnel in Shimane Prefecture, a rural area in Japan. Eligible participants included 3,211 junior and senior high school personnel (1,259 men and 1,952 women). Participants completed a questionnaire on their activities and factors related to Internet use.

Results

The prevalence of IA and at-risk IA was 0.03% and 4.82%, respectively. Furthermore, game playing was shown to be the Internet activity most closely associated with at-risk IA.

Conclusions

This study showed that around 5% of school personnel in a rural area in Japan are at risk for developing addiction to the Internet and that using the Internet for game playing is related to at-risk IA. Our results suggest that employed adults should be instructed to use the Internet properly.

Successful Treatment of Sudden Hepatitis Induced by Long-Term Nivolumab Administration

Immune checkpoint inhibitors have drastically changed in the treatment of many kinds of malignancies, especially malignant melanoma. The focus of the recent experiments has not only been on their efficacy but also immune-related adverse events (irAEs). We report a case of fulminant hepatitis due to nivolumab. In this case, the patient had undergone long-term nivolumab therapy. He did not complain of any symptoms but his liver enzyme levels were extremely elevated (grade 4). We promptly decided to start oral corticosteroids in the patient. His liver function rapidly improved. The dose of corticosteroids was gradually reduced. Our case demonstrates that sudden onset fulminant hepatitis can occur despite the safe use of long-term nivolumab therapy. The irAE can improve rapidly with proper corticosteroid treatment. This report will be useful for the physicians who always use immune checkpoint inhibitors.

Sudden Onset of Brain Metastasis despite the Use of Vemurafenib for Another Metastatic Lesion in Malignant Melanoma Patients

Vemurafenib is an inhibitor of the BRAF mutation and has been approved by the Food and Drug Administration as a treatment option for patients with unresectable melanoma without brain metastasis. In the literature, vemurafenib has been reported to be also effective against brain metastasis. We encountered 3 cases with brain metastasis on vemurafenib therapy. In these cases, vemurafenib was clinically effective against metastatic lesions other than those in the brain. The brain lesions developed after the metastatic lesion had occurred. Therefore, we assume that the melanomas of the patients acquired resistance against vemurafenib. The brain metastases were treated with the cyberknife. Patients 1 and 2 without LDH elevation are still alive, but patient 3 with abnormal LDH elevation died despite the treatment. We need to carefully follow patients on vemurafenib therapy because brain metastasis can suddenly occur even if the metastatic lesion has decreased clinically. The therapeutic effect of vemurafenib against brain metastasis is poor in cases with LDH elevation.

Two Cases of Nivolumab Re-Administration after Pneumonitis as Immune-Related Adverse Events

Nivolumab is a recently approved medication for the treatment of unresectable malignant melanoma. Many immune-related adverse events (irAEs) associated with nivolumab have been reported, such as pneumonitis, hepatitis, dermatitis, and thyroiditis. Prednisolone can effectively treat irAEs. However, it is unclear how or if nivolumab should be administered to patients after they have experienced an irAE. Herein, we show 2 patients who underwent pneumonitis as irAE. Case 1 demonstrated a cryptogenic organizing pneumonia pattern in the CT scan and case 2 had a diffuse alveolar damage (DAD) pattern. Oral corticosteroids improved chest shadow of CT scan in both cases. However, when nivolumab was re-administrated, case 1 demonstrated no symptoms, but case 2 demonstrated pneumonia again. From our cases, it is difficult to re-administrate nivolumab for the patients with pneumonitis which shows a DAD pattern in CT, even if oral corticosteroids improve their symptoms.

Differentials in variables associated with past history of artificial abortion and current contraception by age: Results of a randomized national survey in Japan

AIM

This study analyzes differentials in the variables associated with the experience of artificial abortion (abortion) and use of contraception by age among women in Japan.

METHODS

The 2010 National Lifestyle and Attitudes Towards Sexual Behavior Survey was distributed to 2693 men and women aged 16-49 selected from the Japanese population using a two-stage random sampling procedure. From the 1540 respondents, we selected 700 women who reported having had sexual intercourse at least once. We used logistic regression to analyze how social and demographic factors were associated with the experience of abortion and contraceptive use.

RESULTS

The abortion rate according to the survey was 19.3%. Of the 700 women in the sample, 6.9% had experienced two or more abortions. Logistic regression revealed that, although significant variables depended on age, a high level of education and discussions about contraceptive use with partners were negatively associated with the experience of abortion. Self-injury, approval of abortion and first sexual intercourse between the age of 10 and 19 were positively associated with the experience of abortion. Marriage, smoking and first sexual intercourse between the age of 10 and 19 were negatively associated with contraceptive use. Higher education and discussion of contraception with partners were positively associated with contraceptive use.

CONCLUSIONS

To prevent unwanted pregnancy and abortion, social support and sexual education should be age-appropriate. It is vital to educate young people of the importance of discussing contraceptive use with their partners.

Disseminated nocardiosis after unrelated bone marrow transplantation

Nocardiosis is a rare bacterial infection occurring mainly in patients with deficient cell-mediated immunity. Although disseminated nocardiosis after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a rare complication, it is associated with high mortality. Moreover, after allo-HSCT, nocardiosis may be mistaken for other bacterial or fungal infections because clinical and radiographic findings of pulmonary, cerebral, and cutaneous nocardiosis lesions are non-specific. Here, we report a case of disseminated nocardiosis (caused by Nocardia abscessus) with skin, pulmonary, liver, lymph node, and multiple brain abscesses in a patient after allo-HSCT. The patient initially responded clinically and radiographically to imipenem/cilastin and trimethoprim-sulfamethoxazole therapy. Clinicians should be aware of the possibility of nocardiosis in allo-HSCT recipients who are treated with multiple immunosuppressive agents to control chronic graft-versus-host disease. Accurate diagnosis and identification of disseminated nocardiosis is important to ensure administration of the correct antibiotic regimen.

Contraception in Japan: Current trends

OBJECTIVES

High proportion of Japanese uses condoms; lower proportion uses oral contraceptive pills (OCPs). We examined the longitudinal patterns for contraceptive usage in Japan and evaluated differences before and after OCP government approval.

STUDY DESIGN

We accessed nationally representative survey data for women aged 16-49years from 1950 to 2014.

RESULTS

Usage of condoms and OCP was 83.4% and 3.0%, respectively in 2014. OCP use before (1.21%) and after (1.97%) government approval did not differ significantly (p=.58).

CONCLUSIONS

The prevalence of OCP usage remains low in Japan. A wide gap in use between Japan and other developed countries exists.

IMPLICATIONS

Through a wide gap in OCP use between Japan and other countries, we revealed how choices of contraceptive methods and their benefits could be openly available for women of reproductive age, and how health care professionals disseminate appropriate knowledge about contraception for women in need.

A cohort study of chronic diseases for Mongolian people: Outline with baseline data of the Moncohort study

Many Mongolian people suffer from non-communicable chronic diseases. In order to plan preventive strategies against such diseases, we designed a community-based prospective cohort study of chronic diseases, called the Moncohort study, in Mongolia. This is the first nationwide large-scale cohort study of chronic diseases. This paper describes the study’s rationale, design and methods with baseline data.

Mongolian residents aged ⩾40 years were selected nationwide from many geographic regions in 2009. Data were collected on demographics, socioeconomic status, lifestyle, and anthropometric and biochemical measurements.

In total, 2280 Mongolian residents were registered in the survey. Socioeconomic, lifestyle, anthropometric and biochemical characteristics were differentiated by gender and geographical area in descriptive data. Aging, low social class, physical inactivity and infrequent fruits intake were positively associated with histories of chronic disease in men, while aging was positively associated with histories of chronic disease in women.

Factors associated with chronic diseases reveal gender-oriented strategies might be needed for their prevention. Detailed prospective analyses will illustrate the impact of risk factors on chronic diseases and lead to evidence for designing programs aimed at preventing chronic diseases and related disorders in Mongolia.

Caregiver daily impression could reflect illness latency and severity in frail elderly residents in long-term care facilities: A pilot study

AIMS

To propose a caregiver daily impression (CDI) rating instrument for personal caregivers of residents living in long-term care facilities (LTCF) to comprehensively evaluate residents' daily health condition, and to investigate whether the CDI reflects illness latency and severity in residents transferred emergently.

METHODS

We carried out a retrospective review of facility care records from 20 LTCF in Hyogo, Japan. The participants were 169 LTCF residents with episodes of transfer to emergency hospitalization facilities during a 3-month period. We determined specific CDI variables by interviewing experienced LTCF caregivers, and then carried out a principal component analysis to determine the major parameter set. The generated components were incorporated into a regression model to investigate the association with hospitalization.

RESULTS

The mean age was 87.9 ± 6.5 years, 68% were women and 28% of transfers resulted in hospitalization. The interview procedure identified 12 specific CDI variables, and the principal component analysis generated five distinct components: "change in feeding," "change in emotion," "disengaged or listless gaze," "decrease in eye reactivity" and "change in movement." By multivariate logistic regression, hospitalization was associated with "decrease in eye reactivity" (adjusted OR 1.78, 95% CI 1.07-2.97) and poor vital signs (adjusted OR 2.84, 95% CI 1.15-6.98), but not with body temperature (adjusted OR 1.29, 95% CI 0.52-3.21).

CONCLUSIONS

The CDI might reflect underlying illness severity beyond quantitative physical findings. Once the CDI can be appropriately validated, quantified and linked to physical findings, it could be used by caregivers for daily resident assessments and as a practical triage tool in emergency situations. Geriatr Gerontol Int 2016; 16: 612-617.

Epidemiologic features of metabolic syndrome in a general Mongolian population

BACKGROUND

Although cardiovascular health is a crucial problem for Mongolian people, little information about metabolic syndrome, which is well known to be associated with the development of cardiovascular disease, is available in Mongolia. The aim of this study was to observe the epidemiological features of metabolic syndrome in a general Mongolian population.

METHODS

This cross-sectional study was performed in 1911 general Mongolian subjects (717 men, 1194 women), who were ≥40 years old and free of ischemic heart disease, by using a dataset from a nationwide population-based cohort study in Mongolia. The prevalence of metabolic syndrome, as defined by International Diabetes Federation criteria, was determined. Alcohol consumption, smoking habits, and physical activity were evaluated. Education, marital status, income, and occupation were also examined as factors of socioeconomic status (SES). Their association with metabolic syndrome was determined by logistic regression models.

RESULTS

The prevalence of metabolic syndrome was significantly higher in women (n=488, 40.6%) than in men (n=138, 19.4%). The prevalence of metabolic syndrome was high, especially in the Khangai region, in women. Moderate-to-high alcohol consumption was a significantly positively associated factor of metabolic syndrome in men [odds ratio (OR)=2.01; 95% confidence interval (CI) 1.15-3.51; adjusted odds ratio (AOR)=2.41; 95% CI 1.31-4.44] and widowed status was a significantly positively associated factor of metabolic syndrome in women (OR=1.61, 95% CI 1.18-2.18; AOR=1.49, 95% CI 1.07-2.08).

CONCLUSIONS

Metabolic syndrome was prevalent in women compared with men among Mongolian adults. Preventive strategies aimed at men with a higher alcohol consumption and women with widowed status may help reduce metabolic syndrome, thereby improving cardiovascular health conditions in Mongolia.

Descriptive epidemiology of Kawasaki disease in Japan, 2011-2012: from the results of the 22nd nationwide survey

BACKGROUND

The number of patients and incidence rate of Kawasaki disease (KD) are increasing in Japan. We have therefore characterized the latest epidemiological information on KD.

METHODS

The 22nd nationwide survey of KD, which targeted patients diagnosed with KD in 2011 and 2012, was conducted in 2013 and included a total of 1983 departments and hospitals. In order to report on all patients with KD during the 2 survey years, we targeted hospitals of 100 beds or more with pediatric departments, or specialized pediatric hospitals.

RESULTS

From a total of 1420 hospitals and departments (71.6% response rate), 26,691 KD patients were reported (12,774 in 2011 and 13,917 in 2012; 15,442 males and 11,249 females). The annual incidence rates were 243.1 per 100,000 population aged 0 to 4 years in 2011 and 264.8 in 2012. The number of cases of KD recorded in 2012 was the highest ever reported in Japan. The incidence rate of complete cases was also the highest ever reported in Japan and contributed to the increase in the rate of total cases in recent years. The number of patients diagnosed per month peaked in January, and additional peaks were noted during summer months, although these peaks were lower than those seen in winter. Age-specific incidence rate showed a monomodal distribution with a peak in the latter half of the year in which patients were born.

CONCLUSIONS

The number of patients and the incidence rate of KD in Japan continue to increase. A similar trend has also been seen for patients with complete KD.

Cardiac lesions and initial laboratory data in Kawasaki disease: a nationwide survey in Japan

BACKGROUND

Cardiac lesions, such as coronary dilatation, aneurysms, narrowing, myocardial infarction, and valvular lesions, sometimes occur in Kawasaki disease, but most studies have only evaluated cardiac lesions in the later phase of the disease. This study was undertaken to clarify the related factors between cardiac lesions and laboratory data in the initial phase of Kawasaki disease.

METHODS

We conducted a cross-sectional study using data for 26 691 patients from the 22nd nationwide survey of Kawasaki disease in Japan, the observation period of which was from January 2011 through December 2012. We excluded patients with recurrent Kawasaki disease and who were more than seven days from the start of symptoms at admission. We analyzed 23 155 cases (13 353 boys; mean age: 923 ± 734 days) with available laboratory data for white blood cell count, platelet count, serum albumin, and C-reactive protein (CRP).

RESULTS

Cardiac lesions were detected in 984 cases (656 boys and 328 girls); lesions were classified as coronary dilatation (764 cases), coronary aneurysm (40), giant coronary aneurysm (6), coronary narrowing (3), and valvular lesions (204). The significant related factors of initial coronary dilatation were male sex (odds ratio [OR] 1.73), older age (OR per 100 days increase 1.03), higher platelet count (OR per 10 000 cells/µL increase 1.006), lower albumin (OR per 1 g/dL increase 0.66), and higher CRP (OR per 1 mg/dL increase 1.02). The factors related to coronary aneurysm were higher platelet count (OR 1.01) and lower albumin (OR 0.34). No factors were significantly related to giant coronary aneurysm. The related factors of valvular lesions were age (OR 0.98), and higher CRP (OR 1.05).

CONCLUSIONS

Clinicians should consider male sex, older age, higher platelet count, lower albumin levels, and higher CRP levels when assessing risk of cardiac lesions in the initial phase of Kawasaki disease.

Exercise counseling of primary care physicians in metabolic syndrome and cardiovascular diseases is associated with their specialty and exercise habits

Background

We investigated the practice of exercise counseling of primary care physicians in metabolic syndromes and cardiovascular diseases and its association with their age class, specialty, work place, and their own exercise habits.

Subjects and methods

The subjects were 3,310 medical doctors who had graduated from Jichi Medical University in Japan. The study instrument was a self-administered questionnaire to investigate their age class, specialty, workplace, exercise habits, and exercise counseling for their patients.

Results

Overall, 839 completed responses were analyzed from a total of 933 that were received (28.2%). The primary care physicians whose specialties were internal medicine and general medicine significantly more often recommended exercise in diabetes mellitus, hyperlipidemia, heart failure, and hypertension cases than those whose specialties were surgery and pediatrics. The primary care physicians whose specialty was pediatrics recommended exercise less often in apoplexia cases than those whose specialties were internal medicine, general medicine, and surgery. Their exercise habits were positively associated with their recommendation of exercise in hyperlipidemia, heart failure, and hypertension cases; however, these associations were not observed in diabetes mellitus and apoplexia. The primary care physicians’ age class and work place showed no association with their exercise recommendations in metabolic syndrome and cardiovascular diseases.

Conclusion

The primary care physicians whose specialties were internal medicine and general medicine significantly more often recommended exercise in diabetes mellitus, hyperlipidemia, heart failure, and hypertension cases. In addition, their own exercise habits were positively associated with their recommendation of exercise in hyperlipidemia, heart failure, and hypertension cases.

[Satisfaction with hospital care among diabetic outpatients and its associated factors. Secondary use of official statistics]

OBJECTIVES

Generalizable data on current satisfaction levels are required to establish a scientific basis for the political advancement of measures to improve satisfaction with hospital care among patients with diabetes. The present study made secondary use of existing official statistics in order to demonstrate the range of satisfaction levels with hospital care among diabetic outpatients and to closely examine related factors.

METHODS

Data sets that consolidated the Patient Survey, the Survey of Medical Care Institutions, and the Patient Behavior Survey (all from 2008) were created. Shared medical institution survey reference numbers were used to consolidate the data from the Patient Survey and the Survey of Medical Care Institutions, and in addition, sex and date of birth were used to consolidate the Patient Behavior Survey data. The range of satisfaction levels with hospital care among diabetic outpatients was investigated along with any relationship with the following potentially related factors: visitation status (first or repeat examination); waiting time until examination; examination duration; care-seeking status (any use of other medical facilities, etc.); diabetic complications; other complications; coverage under the Public Assistance Act; smoking cessation outpatient services; hospitals that specialized in treating diabetes (metabolic medicine); medical care on Saturday, Sunday, and public holidays; and provision of health checkups.

RESULTS

Overall, 62.3% of diabetic outpatients were either fairly or extremely satisfied with their hospital care, whereas 5.6% expressed dissatisfaction. Satisfaction levels with hospital care were found to be significantly related to visitation status, waiting time until examination, examination duration, care-seeking status, and Saturday medical care. Multivariate analysis with the factors demonstrated to be significantly related to satisfaction revealed significant relationships between high satisfaction levels and repeat examinations, short waiting times, no use of any other medical facilities, and long examinations.

CONCLUSION

Consolidating official statistics from multiple sources indicated the range of satisfaction levels with hospital care among diabetic outpatients and facilitated the clarification of factors affecting satisfaction. Reducing waiting times and ensuring sufficient time spent on examinations are important for increasing satisfaction levels with hospital care among patients with diabetes. It is hoped that official statistics can be further applied to many future public health policy studies.

Association of primary care physicians' exercise habits and their age, specialty, and workplace

Background

In this study, we investigated primary care physicians’ exercise habits, and the association of this variable with their age, specialty, and workplace.

Methods

The population of this cross-sectional study comprised 3,310 medical doctors who graduated from Jichi Medical University in Japan between 1978 and 2012. The study instrument was a self-administered questionnaire mailed in August 2012 to investigate primary care physicians’ exercise habits, age, specialty, and workplace.

Results

The 896 available primary care physicians’ responses to the self-administered questionnaire were analyzed. Their exercise frequency was as follows: daily, 104 (11.6%); at least 2–3 times per week, 235 (26.2%); no more than once a week, 225 (25.1%); no more than once a month, 278 (31.0%); and other, 52 (5.8%). Their exercise intensity was as follows: high (≥6 Mets), 264 (29.5%); moderate (4–6 Mets), 199 (22.2%); mild, (3–4 Mets), 295 (32.9%); very mild (<3 Mets), 68 (7.6%); none, 64 (7.1%); and other, 6 (0.7%). Their exercise volume was calculated to represent their exercise habits by multiplying score for exercise frequency by score for intensity. Multivariate linear regression analyses showed that the primary care physicians’ exercise volumes were associated with their age (P<0.01) and workplace (P<0.01), but not with their specialty (P=0.37). Primary care physicians in the older age group were more likely to have a higher exercise volume than those in the younger age groups (50–60 years > older than 60 years >40–50 years >30–40 years >24–30 years). Primary care physicians working in a clinic were more likely to have a higher exercise volume than those working in a university hospital, polyclinic hospital, or hospital.

Conclusion

Primary care physicians’ exercise habits were associated with their age and workplace, but not with their specialty.

Mortality among Japanese with a history of Kawasaki disease: results at the end of 2009

BACKGROUND

The long-term outcomes of Kawasaki disease (KD) are unknown.

METHODS

Fifty-two collaborating hospitals collected data on all patients who had received a new definite diagnosis of KD between July 1982 and December 1992. Patients were followed until December 31, 2009 or death. Standardized mortality ratios (SMRs) were calculated based on Japanese vital statistics data.

RESULTS

Of the 6576 patients enrolled, 46 (35 males and 11 females) died (SMR: 1.00; 95% CI: 0.73-1.34). Among persons without cardiac sequelae, SMRs were not high after the acute phase of KD (SMR: 0.65; 95% CI: 0.41-0.96). Among persons with cardiac sequelae, 13 males and 1 female died during the observation period (SMR: 1.86; 95% CI: 1.02-3.13).

CONCLUSIONS

In this cohort, the mortality rate among Japanese with cardiac sequelae due to KD was significantly higher than that of the general population. In contrast, the rates for males and females without sequelae were not elevated.

Different surgical treatment techniques used by neurosurgeons and orthopedists for syringomyelia caused by Chiari I malformation in Japan

Object

Syringomyelia is a rare disease commonly caused by Chiari I malformation. Surgery by neurosurgeons and orthopedists is a critical treatment for symptomatic patients, and surgical techniques are associated with improved symptoms for these patients. The aim of this study was to determine the different surgical techniques used by neurosurgeons and orthopedists in Japan to treat syringomyelia caused by Chiari I malformation.

Methods

Patients who had undergone a surgical treatment were identified from a 2-stage postal survey conducted in late 2009. The authors compared the type of surgery performed and its association with cavity size reduction, on the basis of whether patients were receiving care in a neurosurgery or orthopedics department.

Results

A total of 232 patients with syringomyelia caused by Chiari I malformation were included in this study. Two-thirds of patients were treated in a neurosurgery department and the other third in an orthopedics department. Neurosurgeons preferred foramen magnum decompression (FMD) with dural patch grafting, and orthopedists preferred FMD with dural dissection. Foramen magnum decompression with dural patch grafting was associated with better outcomes than was dural dissection with regard to the following: motor impairment (66% vs 39%, p < 0.05), sensory disturbance (60% vs 43%, p = 0.051), pain (67% vs 47%, p < 0.05), and cavity size (74% vs 58%, p < 0.05). Improved motor function was associated more with cavity size reduction than with sensory disturbance and pain.

Conclusions

Surgical procedures and outcomes differed, depending on whether the patient's care was managed in a neurosurgery or orthopedics department. Outcomes were better after FMD with dural patch grafting.

Prevalence and Demographic Distribution of Adult Survivors of Child Abuse in Japan

A cross-sectional study was conducted with a national epidemiological survey to investigate the prevalence and demographic distribution of adult survivors of child abuse in Japan. A self-administered questionnaire was used to measure the history of child abuse and the demographic characteristics. The participants reported the following 4 types of child abuse: physical abuse (3%), sexual abuse (0.6%), neglect (0.8%), and psychological abuse (4%). Significant unequal distribution of child abuse was found to be associated with sex, living region, marital status, job status, and educational status. We determined the prevalence of adult survivors of child abuse in Japan and found that their demographic characteristics were unequally distributed. Policy makers and public health providers should take these demographic disparities into account in considering effective public health interventions for survivors of child abuse.

Hypertension in Mongolia: an overview

OBJECTIVES

Although hypertension is the primary cause of morbidity and mortality from cardiovascular diseases in Mongolia, reviews about hypertension in this country have not been reported, to our knowledge. Information on the overview of this disease may be useful to establish measures and policy to prevent hypertension and its related complications. The aim of our article is to summarize the current situation vis-à-vis hypertension in Mongolia.

METHODS

Population-based studies that provided relevant information on hypertension in Mongolia were searched through PubMed, abstract books of the Mongolian Medical University resources from cardiologists, epidemiological databases and reliable websites of national organizations. Available articles from 1970 to present were selected.

RESULTS

A high prevalence of hypertension, which varied according to geographic location, exists among Mongolian people. The prevalence of hypertension may be influenced by nutritional factors, sedentary lifestyle, socioeconomic status and environmental factors in particular.

CONCLUSIONS

The high prevalence of hypertension among Mongolian people can be a serious health problem in this country. Defining ethnic features of hypertension and related conditions will be the initial step that may lead to prevention of this disease. Further research and positive efforts to prevent hypertension appear necessary for Mongolians.

[Self-injury in Japan: epidemiological features from the nationwide survey data of 2010]

OBJECTIVES

The purpose of this study was to examine the epidemiological features of self-injury in Japan, and to investigate the factors associated with a history of self-injury, using nationwide random sample data on Japan in 2010.

METHODS

Questionnaires were distributed to 2,693 subjects, aged 16-49 years, randomly selected from the all over Japan using 2-stage stratified random sampling; the answers regarding self-injury were analyzed. Potential risk factors were compared between those who answered that they had a history of self-injury (self-injury group) and those who answered that they did not (non-self-injury group).

RESULTS

Responses were obtained from 1,540 participants (response rate, 57.2%). Lifetime prevalence of having 1 or more self-injury events was 7.1% overall (3.9% for men; 9.5% for women) and approximately half of them reported a repetitive history of self-injury. Lifetime prevalence of self-injury was highest in those aged 16-29 years (9.9%, 16-29 years; 5.6%, 30-39 years; 5.7%, 40-49 years). Lifetime prevalence among women (16-29 years, 30-39 years, and 40-49 years) decreased with age (15.7%, 7.5%, and 5.8%, respectively), however, that among men increased with age (3.0%, 3.4%, and 5.5%, respectively). Compared with the non-self-injury group, those in the self-injury group were significantly more likely to have a history of cigarette smoking (self-injury group, 47.5%; non-self-injury group, 28.2%; adjusted odds ratio [95% confidence interval]: 2.18 [1.32-3.58]), childhood abuse (23.6% and 3.7%, respectively, 4.24 [2.18-8.25]), induced abortion (30.3% and 12.7%, respectively, 1.93[1.13-3.30]); moreover, they were significantly less likely to answer that they had a happy life when they were junior high school students (41.1% and 78.6%, respectively, 0.45 [0.25-0.79]). In addition, those in the self-injury group were more likely to report a history of parental divorce, that they did not have good communication with their parents, and that they did not have respect and appreciation for their parents; however, these factors were not significant after adjustment.

CONCLUSION

These results are consistent with those of previous research reports in which the lifetime prevalence of self-injury was high among women aged 16-29 years, and in which self-injury was more likely to occur among individuals who had a history of cigarette smoking and childhood abuse. Such individuals should be provided care to prevent self-injury. In addition, from a social point of view, research examining family environments including these factors is required.