Akiko Morimoto

Effects of Stroke Education of Junior High School Students on Stroke Knowledge of Their Parents Tochigi Project

Background and purpose— Educating the youth about stroke is a promising approach for spreading stroke knowledge. The aim of this study was to verify communication of stroke knowledge to parents by educating junior high school students about stroke. Methods— We enrolled 1127 junior high school students (age, 13–15 years) and their parents in the Tochigi prefecture, Japan. All students received a stroke lesson, watched an animated cartoon, and read the related Manga comic as educational aids. The students took back home the Manga and discussed what they learned with their parents. Questionnaires on stroke knowledge were given to all at baseline and immediately after the lesson. Results— A total of 1125 students and 915 parents answered the questionnaires. In the students, the frequency of correct answers increased significantly for all questions on stroke symptoms except for headache, and for all questions on risk factors after the lesson. In the parents, the correct answer rates increased for stroke symptoms except for headache and numbness in one side of the body, and for all questions on risk factors except for hypertension. Ninety-one percent of students and 92.7% of parents correctly understood the Face, Arm, Speech, and Time (FAST) mnemonic after the lesson. Conclusions— Improvement of stroke knowledge immediately after the stroke lesson was observed in parents as well as their children, which indicated that our teaching materials using the Manga was effective in delivering the stroke knowledge to parents through their children.

Effects of Intensive and Moderate Public Education on Knowledge of Early Stroke Symptoms Among a Japanese Population The Acquisition of Stroke Knowledge Study

Background and Purpose— To assess the effects of intensive and moderate public education on knowledge of early stroke symptoms among a general Japanese population. Methods— Information on early stroke symptoms was distributed by leaflet 12× and by booklet twice in an intensive intervention area >22 months, and by leaflet and booklet once each in a moderate intervention area. No distribution occurred in the control area. Before and after the intervention, a mailed survey was conducted in the 3 areas. A total of 2734 individuals, aged 40 to 74 years, who did not select all 5 correct symptoms of stroke in the preintervention survey were eligible for our analysis. Results— The numbers of correct answers selected about stroke symptoms did not differ significantly among the 3 areas in the preintervention survey (P=0.156). In the postintervention survey, the proportions of participants who selected sudden 1-sided numbness or weakness (94.2% in the intensive intervention area, 88.3% in the moderate intervention area, and 89.2% in the control area; P<0.001) and sudden severe headache (76.8%, 70.1%, and 70.4%, respectively; P<0.001) differed significantly among the 3 areas. After adjustment for confounding factors, the multivariable-adjusted odds ratios (95% confidence intervals) for correctly choosing all 5 symptoms were 1.35 (1.07–1.71) in the intensive intervention area and 0.96 (0.74–1.24) in the moderate intervention area compared with the control area. Conclusions— Our findings suggest that frequent distribution of leaflets and booklets significantly improved the short-term knowledge of community residents about early symptoms of stroke.

Effect of Body Mass Index on Insulin Secretion or Sensitivity and Diabetes

BACKGROUNDnAlthough the association between obesity and diabetes is well known, the factors predisposing to diabetes in non-obese Asians are less clearly characterized.nnnPURPOSEnTo investigate the effects of impaired insulin secretion (IIS) and insulin resistance (IR) according to BMI on the incidence of diabetes in the Saku Study.nnnMETHODSnThis 4-year cohort study involved 3,083 participants aged 30-69 years without diabetes at baseline (2006-2007). Participants were stratified by BMI (<23.0, 23.0-24.9, and ≥25). Based on insulinogenic index and homeostasis model of IR values, participants were classified into four categories: normal; isolated IIS (i-IIS); isolated IR (i-IR); and IIS plus IR. All data were collected in 2006-2011 and analyzed in 2013-2014.nnnRESULTSnFor participants with BMI <23.0, the risk of developing diabetes was higher in the i-IIS (adjusted hazard ratio=6.6; 95% CI=3.7, 11.6) and IIS plus IR groups (9.4; 3.1, 28.4) than in the normal group. For participants with BMI 23.0-24.9, risk was higher in the i-IIS (9.9; 4.4, 22.1); i-IR (3.4; 1.2, 9.5); and IIS plus IR (23.4; 9.3, 58.9) groups. Among participants with BMI ≥25, risk was higher in the i-IIS (16.9; 6.0, 47.7); i-IR (7.9; 2.8, 22.6); and IIS plus IR (26.9; 9.0, 80.8) groups. BMI was negatively associated with incidence of IIS but positively associated with IR incidence.nnnCONCLUSIONSnIndividuals with normal BMI may develop diabetes mainly through IIS, whereas individuals with high BMI may develop diabetes primarily through IR.

Increase in homeostasis model assessment of insulin resistance (HOMA-IR) had a strong impact on the development of type 2 diabetes in Japanese individuals with impaired insulin secretion: the Saku study.

Our aim was to assess the impact of increase in homeostasis model assessment of insulin resistance (HOMA-IR) on the development of type 2 diabetes in Japanese individuals with impaired insulin secretion (IIS). This study included 2,209 participants aged 30–69 without diabetes at baseline who underwent comprehensive medical check-ups between April 2006 and March 2007 at Saku Central Hospital. Participants were classified into eight groups according to the combination of baseline IIS status (non-IIS and IIS) and category of HOMA-IR change between the baseline and follow-up examinations (decrease, no change/small increase, moderate increase, and large increase). Type 2 diabetes was determined from fasting and 2 h post-load plasma glucose concentrations at the follow-up examination between April 2009 and March 2011. At baseline, 669 individuals (30.3%) were classified as having IIS. At follow-up, 74 individuals developed type 2 diabetes. After adjusting for confounding factors including baseline HOMA-IR values, the multivariable-adjusted odds ratios (95% confidence intervals) for type 2 diabetes in the non-IIS with a decrease (mean change in HOMA-IR: −0.47), non-IIS with a moderate increase (mean change in HOMA-IR: 0.28), non-IIS with a large increase (mean change in HOMA-IR: 0.83), IIS with a decrease (mean change in HOMA-IR: −0.36), IIS with no change/small increase (mean change in HOMA-IR: 0.08), IIS with a moderate increase (mean change in HOMA-IR: 0.27), and IIS with a large increase (mean change in HOMA-IR: 0.73) groups, relative to the non-IIS with no change/small increase (mean change in HOMA-IR: 0.08) group were 0.23 (0.04, 1.11), 1.22 (0.26, 5.72), 2.01 (0.70, 6.46), 1.37 (0.32, 4.28), 3.60 (0.83, 15.57), 5.24 (1.34, 20.52), and 7.01 (1.75, 24.18), respectively. Moderate and large increases in HOMA-IR had a strong impact on the development of type 2 diabetes among individuals with IIS in this Japanese population.

Effects of a public education campaign on the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset: The acquisition of stroke knowledge (ASK) study

Background An immediate ambulance call offers the greatest opportunity for acute stroke therapy. Effectively using ambulance services requires strengthening the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset, and encouraging the public to use ambulance services. Methods The present study utilized data from the Acquisition of Stroke Knowledge (ASK) study, which administered multiple-choice, mail-in surveys regarding awareness of early stroke symptoms and response to a stroke attack before and after a 2-year stroke education campaign in two areas subject to intensive and moderate intervention, as well as in a control area, in Japan. In these three areas, 3833 individuals (1680, 1088 and 1065 participants in intensive intervention, moderate intervention, and control areas, respectively), aged 40 to 74 years, who responded appropriately to each survey were included in the present study. Results After the intervention, the number of correctly identified symptoms significantly associated with intention to call an ambulance (P < 0.05) increased (eg, from 4 to 5 correctly identified symptoms), without increasing choice of decoy symptoms in the intensive intervention area. Meanwhile, in other areas, rate of identification of not only correct symptoms but also decoy symptoms associated with intention to call an ambulance increased. Furthermore, the association between improvement in the knowledge of stroke symptoms and intention to call an ambulance was observed only in the intensive intervention area (P = 0.009). Conclusions Our results indicate that intensive interventions are useful for strengthening the association between correct knowledge of early stroke symptoms and intention to call an ambulance, without strengthening the association between incorrect knowledge and intention to call an ambulance.

Serum Macro TSH Level is Associated with Sleep Quality in Patients with Cardiovascular Risks – HSCAA Study

Macro thyroid-stimulating hormone (TSH) has been reported to be associated with seasonality and regulated by changes in day length in rodents, different from free TSH. In the present study, we investigated structural differences between macro TSH and free TSH levels in human serum, as well as the association of macro TSH with sleep quality. We enrolled 314 patients registered in the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA) study. Sleep quality shown by actigraphy, sleep physical activity, and percent sleep in all and TSH closely matched subjects were significantly associated with high macro TSH levels. Macro and free TSH were similarly increased following thyrotropin-releasing hormone (TRH) stimulation, while circadian changes associated with those were distinct. To further analyze the structure of macro TSH, serum samples were separated by gel filtration chromatography. Although treatment with glycosidase did not affect morbidity, the macro TSH fraction had a markedly low affinity to the Con A column as compared with free TSH, indicating a distinct glycosylation structure. In conclusion, an increase in serum macro TSH is associated with low sleep quality and regulated in a manner distinct from free TSH, potentially due to an altered glycosylation structure.

Association between symptoms of bilateral numbness and/or paresthesia in the feet and postural instability in Japanese patients with diabetes

AbstractAimnThis study assessed the association between symptoms of bilateral numbness and/or paresthesia in the feet and postural instability in Japanese patients with diabetes.MethodsThis cross-sectional study included 303 patients with diabetes, aged 40–88xa0years, who were referred to an outpatient diabetic clinic between January and July 2013 at Shiga University of Medical Science Hospital. A posturography test was used to evaluate postural sway in patients. Indices of postural sway were the total length and the enveloped area. Analysis of covariance was used to estimate the multivariable-adjusted means of indices of postural sway according to the presence or absence of symptoms of bilateral numbness and/or paresthesia in the feet.nResultsOf 303 patients, 35 (11.6xa0%) had symptoms of bilateral numbness and/or paresthesia in the feet. After adjustment for age, sex, diabetic retinopathy, regular exercise, body mass index, hemoglobin A1c level, and quadriceps’ strength, patients with symptoms had higher levels of postural sway length and an enveloped area in the posturography test than those without symptoms. In addition, we observed similar results when we analyzed 234 patients aged ≥60xa0years.ConclusionsOur findings suggest that patients who had symptoms of bilateral numbness and/or paresthesia in the feet may have more postural instability than those without symptoms.

Association between alcohol consumption and incidence of impaired insulin secretion and insulin resistance in Japanese: The Saku study

AIMSnTo investigate the effect of alcohol consumption on impaired insulin secretion and insulin resistance in Japanese.nnnMETHODSnThe participants in this 5-year cohort study were 2100 Japanese aged 30-74u202fyears without type 2 diabetes mellitus, impaired insulin secretion, or insulin resistance who underwent a medical checkup including 75-g OGTT between April 2008 and March 2009 at Saku Central Hospital. Alcohol consumption was categorized as follows: non-drinker (0u202fg/week), light drinker (1-139u202fg/week in men and 1-69u202fg/week in women), moderate drinker (140-274u202fg/week in men and 70-139u202fg/week in women) and heavy drinker (≥275u202fg/week in men and ≥140u202fg/week in women). The hazard ratios (HRs) and 95% CIs among light to heavy drinkers for incidence of impaired insulin secretion (insulinogenic index ≤51.7) and insulin resistance (HOMA-IRu202f≥u202f2.5), detected by an OGTT at the time of a follow-up medical checkup before the end of March 2014, were estimated by multivariable adjusted Cox proportional hazard models as reference values for non-drinkers.nnnRESULTSnThere were 708 cases of impaired insulin secretion and 191 cases of insulin resistance. The HRs (95% CIs) for impaired insulin secretion in light, moderate and heavy drinkers were 1.16 (0.96-1.40), 1.35 (1.07-1.70) and 1.64 (1.24-2.16), respectively (P for trend <0.001). For insulin resistance, the HRs were 1.22 (0.84-1.76), 1.42 (0.91-2.22) and 1.59 (0.96-2.65), respectively (P for trendu202f=u202f0.044).nnnCONCLUSIONnAlcohol consumption was positively associated with the incidence of both impaired insulin secretion and insulin resistance.

Plasma leptin concentration is associated with fatigue severity in patients with cardiovascular risk factors – HSCAA study

Fatigue induced by complex dysfunctions of the central nervous system is frequently complained by patients with cardiovascular risk factors. Although leptin is considered to regulate the central nervous system, there are no reports regarding its association with fatigue in those patients. This cross-sectional study included 347 patients with cardiovascular risk factors. Fatigue score and plasma leptin concentration were measured. In addition, abdominal fat accumulation, systemic inflammation, sleep condition, and functions of hypothalamus-pituitary axis and autonomic system were estimated. Plasma leptin concentration (natural logarithm transformed) was significantly and positively (r=0.222, p<0.001) associated with fatigue score, and significantly (p<0.001) higher in the moderately-fatigued group (2.32±0.75ng/ml, mean±SD, n=52) than in the normally-fatigued group (1.85±1.02ng/ml, mean±SD, n=295). Multiple logistic regression analysis showed that plasma leptin concentration was significantly and independently associated with a moderately-fatigued condition independent of other factors, including age, gender, presence of diabetes, hypertension, dyslipidemia, alcohol consumption habit, urinary free cortisol, serum high-sensitive CRP concentration, visceral and subcutaneous fat area, apnea/hypopnea index, sleep efficiency, and heart rate variability. Hyperleptinemia may contribute to fatigue severity in patients with cardiovascular risk factors.

Relationship between outpatient visit frequency and hypertension control: A 9-year occupational cohort study

The purpose of this study was to investigate the relationship between the frequency of outpatient visits and hypertension control as determined from health insurance records. This 9-year cohort study in Japan was based on 518 participants with hypertension who underwent health checkups in 2004. Participants were aged 35–56 years and none had a history of cardiovascular or cerebrovascular disease. All were covered by the same employee health insurer. Mean annual outpatient visit days at a hospital/clinic during the 9-year period were classified within four quartiles (Q1, Q2, Q3, Q4). Uncontrolled hypertension was defined as a systolic blood pressure (BP) ⩾140u2009mmu2009Hg and a diastolic BP ⩾90u2009mmu2009Hg. Logistic regression analysis was used to estimate the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of uncontrolled hypertension in groups Q1, Q2 and Q3 vs. Q4. The median (25th–75th percentile) annual outpatient visit days was 9.4 (4.0–15.5). Uncontrolled hypertension was observed in 62.4% of the participants in 2013. The multivariable-adjusted ORs and 95% CIs for uncontrolled hypertension in Q1, Q2 and Q3 vs. Q4 were 4.03 (2.28–7.12), 1.67 (0.99–2.81) and 1.44 (0.86–2.41), respectively. Uncontrolled hypertension increased significantly as the number of outpatient visits decreased (P for trend <0.001). This tendency was maintained when participants taking antihypertensive agents at baseline were excluded. Our study showed an inverse relationship between outpatient visit frequency and uncontrolled hypertension.