Background Although lifestyle factors such as cigarette smoking, excessive drinking, obesity, low or no exercise, and unhealthy dietary habits have each been associated with inadequate sleep, little is known about their combined effect. The aim of this study was to quantify the overall impact of lifestyle-related factors on non-restorative sleep in the general Japanese population. Methods and Findings A cross-sectional study of 243,767 participants (men, 39.8%) was performed using the Specific Health Check and Guidance System in Japan. A healthy lifestyle score was calculated by adding up the number of low-risk lifestyle factors for each participant. Low risk was defined as (1) not smoking, (2) body mass index<25 kg/m2, (3) moderate or less alcohol consumption, (4) regular exercise, and (5) better eating patterns. Logistic regression analysis was used to examine the relationship between the score and the prevalence of non-restorative sleep, which was determined from questionnaire responses. Among 97,062 men (mean age, 63.9 years) and 146,705 women (mean age, 63.7 years), 18,678 (19.2%) and 38,539 (26.3%) reported non-restorative sleep, respectively. The prevalence of non-restorative sleep decreased with age for both sexes. Compared to participants with a healthy lifestyle score of 5 (most healthy), those with a score of 0 (least healthy) had a higher prevalence of non-restorative sleep (odds ratio, 1.59 [95% confidence interval, 1.29–1.97] for men and 2.88 [1.74–4.76] for women), independently of hypertension, hypercholesterolemia, diabetes, and chronic kidney disease. The main limitation of the study was the cross-sectional design, which limited causal inferences for the identified associations. Conclusions A combination of several unhealthy lifestyle factors was associated with non-restorative sleep among the general Japanese population. Further studies are needed to establish whether general lifestyle modification improves restorative sleep.
The Framingham Risk Score (FRS) has been reported to predict coronary heart disease (CHD), but its assessment has been unsuccessful in Asian population. We aimed to assess FRS and Suita score (a Japanese CHD prediction model) in a Japanese nation-wide annual health check program, participants aged 40-79 years were followed up longitudinally from 2008 to 2011. Of 35,379 participants analyzed, 1,234 had new-onset CHD. New-onset CHD was observed in diabetic men [6.00%], non-diabetic men [3.96%], diabetic women [5.51%], and non-diabetic women [2.86%], respectively. Area under the curve (AUC) of receiver operating characteristic (ROC) curve for CHD prediction were consistently low in Suita score (TC), FRS (TC) and NCEP-ATPIII FRS (TC), suggesting that these scores have only a limited power. ROC, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) and Hosmer-Lemeshow goodness-of-fit test did not show clear differences between Suita score (TC) and FRS (TC). New models combining waist circumference ≥85 cm in men or proteinuria ≥1+ in women to Suita score (TC) was superior in diabetic men and women. New models could be useful to predict 3-year risk of CHD at least in Japanese population especially in diabetic population.
Abstract Height loss is caused by osteoporosis, vertebral fractures, disc reduction, postural changes, and kyphosis. Marked long-term height loss is reportedly associated with cardiovascular disease and mortality in the elderly. The present study investigated the relationship between short-term height loss and the risk of mortality using the longitudinal cohort data of the Japan Specific Health Checkup Study (J-SHC). Included individuals were aged 40 years or older and received periodic health checkups in 2008 and 2010. The exposure of interest was height loss over the 2 years, and the outcome was all-cause mortality over subsequent follow up. Cox proportional hazard models were used to examine the association between height loss and all-cause mortality. Of the 222,392 individuals (88,285 men, 134,107 women) included in this study, 1436 died during the observation period (mean 4.8 ± 1.1 years). The subjects were divided into two groups based on a cut-off value of height loss of 0.5 cm over 2 years. The adjusted hazard ratio (95% confidence interval) was 1.26 (1.13–1.41) for exposure to height loss ≥ 0.5 cm compared to height loss < 0.5 cm. Height loss ≥ 0.5 cm correlated significantly with an increased risk of mortality compared to height loss < 0.5 cm in both men and women. Even a small decrease in height over 2 years was associated with the risk of all-cause mortality and might be a helpful marker for stratifying mortality risk.
different hemodynamic parameters in the central aorta.Subendocardial viability ratio (SEVR) represents a non-invasive measure of coronary perfusion and is defined as diastolic to systolic pressure-time integral ratio.The aim of our study was to assess the impact of SEVR on mortality in non-dialysis CKD patients.METHODS: We examined 88 CKD patients (mean age 60613.4years, 66% men, 24% diabetics, 44% smokers, mean cystatin C 2.3 mg/L).SEVR was noninvasively assessed by applanation tonometry (SphygmoCor V R , Atcor, Australia).According to the manufacturer instructions regarding normal SEVR values, patients were divided to a low (SEVR<130%, n=24) and normal SEVR group (SEVR>130%, n=64).Kaplan-Meier survival curves and Cox regression model were used in statistical analyses.Patients were observed from the date of the SEVR measurement until their death or maximally up to 2234 days or 6.1 years (mean 1747 days or 4.8 years).RESULTS: SEVR values in all patients were 79-235% (mean 151.5%;SD635%).During the follow-up period, 10 (42%) patients in the low SEVR group and 11 (17%) patients in the normal SEVR group died.A Kaplan-Meier curve showed that the survival rate of the low SEVR group was significantly lower than that of the normal SEVR group (Log Rank test: P<0.003).In a Cox regression model, which included age, smoking, diabetes, cystatin C, cholesterol, high sensitive C-reactive protein, troponin I, 24hour mean arterial pressure, only age (P<0.0001),diabetes (P<0.004), and SEVR (P<0.028)turned out to be independent predictors of death.
Maternal vaccination for seasonal influenza is currently not listed as a routine vaccination in the national vaccination schedule of Japan. However, many pregnant women voluntarily receive an influenza vaccination. We explored the factors related to influenza vaccine uptake. We particularly focused on factors related to any recommendation, such as advice or suggestions from another individual. We conducted a cross-sectional web-based questionnaire survey in Japan among pregnant women or mothers who had recently given birth in March 2017 and 2018. Logistic regression models were used to determine the factors influencing vaccination uptake. Key individuals regarding maternal vaccination were examined using the network visualization software Gephi. The total number of valid responses was 2204 in 2017 and 3580 in 2018. Over 40% of respondents had been vaccinated with the seasonal influenza vaccine at some point in both years. Of the vaccinated respondents, over 80% received advice regarding the influenza vaccination. Obstetricians were the most common source of advice in both years. Among respondents who chose more than two sources, the largest link in the network of sources was found between the obstetrician and family members. Attention to public concern or potential recommenders, by public health authorities, not just pregnant women, about the benefits of maternal influenza vaccination is important.
Abstract Background and Aims CKD progression in Japanese patients with advanced chronic kidney disease (CKD)—an estimated glomerular filtration rate (eGFR) <45 ml/min/1.73m2—has remained largely unexamined. Method We conducted a nationwide cohort study of Japanese patients with advanced CKD. We recruited 2,249 advanced CKD patients (eGFR<45/ml/min/1.73m2) receiving nephrologist care from a national sample of 31 facilities throughout Japan, randomly selected with stratification by region and facility size, aligned with the international CKD Outcomes and Practice Patterns Study (CKDopps). From baseline data, we calculated annual eGFR decline by CKD stage and causes of CKD over 4 years before enrollment. Variability of eGFR decline was calculated from standard error of the regression. Results The reported causes of CKD were 552(25%) had diabetic kidney diseases (DKD), 131(6%) had PKD, 591(26%) had nephrosclerosis, 299(13%) had glomerulonephritis, and 676(30%) had other renal diseases. Of 1939 eligible patients with eGFR data more than two years, median (IQR) annual eGFR declines (ml/min/1.73m2/year) in PKD and DKD patients were 2.30 (1.16, 3.38) and 1.18 (0.23, 3.69) in G3b, 2.60 (1.81, 3.40) and 1.97 (0.20, 4.75) in G4, and 4.00 (2.00, 5.60) and 3.94 (2.05, 7.05) in G5, respectively. These eGFR declines were significantly faster than those of other kidney diseases. On the other hand, the variability of the decline in PKD patients was significantly smaller than that of DKD patients (0.43 vs 0.71, p<0.001). This trend was consistent in all CKD stages. Conclusion Our study clarified that, similar to DKD patients, annual eGFR decline of PKD patients was significantly faster than those of other kidney diseases throughout all stages. Furthermore, the variability of the decline in PKD patients was smaller than those of others. These data suggest that comprehensive nephrology care should be needed especially for these patients.
Background: Previously, we evaluated the confounding effect of relative humidity on temperature-mortality relation in Japan using 1972-1995 dataset, and concluded that humidity did not confound the relation. Since then, we accumulated the data up to 2010. Another finding was that absolute humidity was better variable than relative humidity in evaluating the humidity effect on influenza incidence. Aims: To show the absolute humidity effect on heat-mortality relation using the extended dataset. Methods: We used daily deaths of 65+ years of age and controlled the year trend by setting each year's minimum level mortality to be the reference. As the main weather variable, we used daily maximum temperature. Using distributed lag non-linear model, we set the lag effect of daily maximum temperature up to 15 days. In conducting regression analyses, we used two models, i.e., without and with absolute humidity term along with daily maximum temperature-lag crossbasis. The temperature-mortality relation shows V-shaped pattern, and we used only "heat" part of the temperature range and calculated the excess mortality ratio, i.e.,"without" to "with." Results: The without/with ratio was between 0.90 to 1.10. In this regard, the effect of absolute humidity was not large. However, the ratio tended to exceed one in northern part and southern areas tended to have lower than unity ratios. Conclusions: The absolute humidity effect on heat-mortality relation appeared to be related to climate. If this is generalizable, we need to incorporate humidity variable in the model for future projection of heat-related excess mortality. Acknowledgements: This study was supported by the Environment Research and Technology Development Fund (S-8 & S10) of the Ministry of the Environment, Japan, and the Global Research Laboratory (grant K21004000001-10A0500-00710) through the National Research Foundation of Korea (NRF), funded by the Ministry of Education, Science and Technology, Korea.
The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.
Heat stroke management will be a major challenge following the Fukushima nuclear plant accident that occurred due to the Great East Japan Earthquake. In this article, a number of actions to meet this challenge are proposed.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
