Shinya Hayasaka

Frequency of Citrus Fruit Intake Is Associated With the Incidence of Cardiovascular Disease: The Jichi Medical School Cohort Study

Background It has been reported that fruit intake protects against cardiovascular disease (CVD). However, most of the relevant studies were conducted in Western countries, and only a few investigated Japanese populations. The present cohort study assessed the effect of citrus fruit intake on the incidence of CVD and its subtypes in a Japanese population. Methods A baseline examination consisting of physical and blood examinations and a self-administered questionnaire was conducted during the period from April 1992 through July 1995. Dietary habits were assessed using a food frequency questionnaire that was divided into 5 categories. Citrus fruit was examined separately due to its frequent consumption by the general Japanese population. Using the Cox proportional hazards model, data from 10 623 participants (4147 men, 6476 women) who had no history of CVD or carcinoma were analyzed to assess the association between frequency of citrus fruit intake and CVD incidence. Results Frequent intake of citrus fruit was associated with a lower incidence of CVD: the hazard ratio for almost daily intake versus infrequent intake of citrus fruit was 0.57 (95% confidence interval: 0.33–1.01, P for trend = 0.04) in men and 0.51 (0.29–0.88, P for trend = 0.02) in women. Frequent intake of citrus fruit was also associated with lower incidences of both all stroke and cerebral infarction, but not hemorrhagic stroke or myocardial infarction. Conclusions Frequent intake of citrus fruit may reduce the incidence of CVD, especially cerebral infarction, in men and women.

Consumption of dairy products and death from cardiovascular disease in the Japanese General Population: The NIPPON DATA80

Background Recent Western studies show an inverse association between milk and dairy product intake and cardiovascular disease (CVD). We studied the association between consumption of milk and dairy products and CVD death in Japan. Methods Men and women aged 30 years or older were followed for 24 years. All had participated in a national nutrition survey in 300 health districts throughout Japan in 1980. The Cox proportional hazards model was used to assess mortality risk according to tertiles of milk and dairy product intake, with the high consumption group as reference. Hazard ratios (HRs) per 100-g/day increase in consumption were also estimated. Results During the 24-year follow-up period, there were 893 CVD deaths, 174 deaths from coronary heart disease (CHD), and 417 stroke deaths among 9243 participants. For women, the HRs for death from CVD, CHD, and stroke in the low consumption group were 1.27 (95% CI: 0.99–1.58; P for trend = 0.045), 1.67 (0.99–2.80; P = 0.02), and 1.34 (0.94–1.90; P = 0.08), respectively, after adjustment for age, body mass index, smoking status, alcohol drinking habits, history of diabetes, use of antihypertensives, work category, and total energy intake. With each 100-g/day increase in consumption of milk and dairy products, HRs tended to decrease for deaths from CVD (HR, 0.86; 95% CI, 0.74–0.99), CHD (0.73; 0.52–1.03), and stroke (0.81; 0.65–1.01) in women. No significant association was observed in men. Conclusions Consumption of milk and dairy products was inversely associated with CVD death among women in Japan.

Physical Activity and All-cause Mortality in Japan: The Jichi Medical School (JMS) Cohort Study

Background In April 2008, a new health check-up and health guidance system was introduced by the Japanese Government to promote increased physical activity. However, few studies have documented the health benefits of physical activity in Asian populations. We examined the association between all-cause mortality and level of physical activity in a Japanese multicommunity population-based study. Methods The Jichi Medical School Cohort Study is a multicommunity, population-based study based in 12 districts in Japan. Baseline data from 4222 men and 6609 women (mean age, 54.8 and 55.0 years, respectively) were collected between April 1992 and July 1995. The participants were followed for a mean duration of 11.9 years. To determine the association between all-cause mortality and level of physical activity, crude mortality rates per 1000 person-years and hazard ratios (HRs) with 95% confidence intervals (CI) were determined using the Cox proportional hazards model. Physical activity was categorized by using physical activity index (PAI) quartiles. The lowest (first) PAI quartile was defined as the HR reference. Results In men, the lowest mortality rate was observed in the third quartile, with 95 deaths and a crude mortality rate of 7.6; the age- and area-adjusted HR was 0.59 (95% CI, 0.45–0.76), and the mortality curve had a reverse J shape. In women, the lowest mortality rate was observed in the highest PAI quartile, with 69 deaths and a crude mortality rate of 3.5; the HR was 0.81 (95% CI, 0.58–1.12). Conclusion Our results suggest that increased physical activity lowers the risk for all-cause death in Japanese.

The Incidence of Venous Thromboembolism Before and After Total Knee Arthroplasty Using 16-Row Multidetector Computed Tomography

We performed a prospective study to determine the incidence of venous thromboembolism (VTE) using 16-row multidetector computed tomography (MDCT). The study included 71 patients who underwent total knee arthroplasty between September 2004 and March 2009. Multidetector computed tomography was performed 4 days before and after surgery. No patient had any presurgical symptoms of VTE. Presurgical and postsurgical incidences of pulmonary thromboembolism plus deep vein thrombosis were 0% and 13%, respectively; pulmonary thromboembolism alone, 1% and 3%, respectively; and deep vein thrombosis alone, 8% and 34%, respectively. Because asymptomatic VTE was noted in 9% of patients before surgery and 51% after surgery, we conclude that performing MDCT before and after total knee arthroplasty may be useful to clarify the incidence of VTE and to develop appropriate strategies for treatment and prevention.

Serum alanine aminotransferase concentrations in patients with Kawasaki disease.

The distribution of serum alanine aminotransferase (ALT) in patients with Kawasaki disease (KD) was observed by using data collected from a nationwide survey in Japan. In comparison with normal values of 1 to 49 IU/l ALT, the odds ratio of cardiac disorders developing in the KD patients with an ALT of 200 IU/l or more was 1.91 (95% confidence interval, 1.44 to 2.54). The elevation of the ALT in KD patients is associated with the development of cardiac disorders.

A checklist to assess the quality of reports on spa therapy and balneotherapy trials was developed using the Delphi consensus method: the SPAC checklist.

OBJECTIVE The purpose of this study was to develop a checklist of items that describes and measures the quality of reports of interventional trials assessing spa therapy. METHODS The Delphi consensus method was used to select the number of items in the checklist. A total of eight individuals participated, including an epidemiologist, a clinical research methodologist, clinical researchers, a medical journalist, and a health fitness programmer. Participants ranked on a 9-point Likert scale whether an item should be included in the checklist. RESULTS Three rounds of the Delphi method were conducted to achieve consensus. The final checklist contained 19 items, with items related to title, place of implementation (specificity of spa), care provider influence, and additional measures to minimize the potential bias from withdrawals, loss to follow-up, and low treatment adherence. CONCLUSION This checklist is simple and quick to complete, and should help clinicians and researchers critically appraise the medical and healthcare literature, reviewers assess the quality of reports included in systematic reviews, and researchers plan interventional trials of spa therapy.

Predictive blood coagulation markers for early diagnosis of venous thromboembolism after total knee joint replacement

Pulmonary embolism development may be prevented if asymptomatic venous thromboembolism (VTE) can be predicted and treated preoperatively or soon after total knee arthroplasty (TKA). The purpose of this study was to evaluate whether asymptomatic VTE can be predicted by blood coagulation markers preoperatively or early after TKA. This prospective single-centre study enrolled 68 patients (6 men, 62 women; mean age: 71 years) who underwent TKA between September 2004 and August 2009. Sixteen-row multidetector computed tomography was performed 4 days before and after surgery for diagnosis of asymptomatic VTE. Blood samples were taken to measure the plasma levels of soluble fibrin monomer complex (SFMC), D-dimer and cross-linked fibrin degradation products by leukocyte elastase (e-XDP) at 4 days preoperatively, and at 1 hour, 1 day and 4 days postoperatively. The preoperative SFMC, D-dimer and e-XDP levels did not differ significantly between the thrombus (n=36) and no-thrombus (n=32) groups. D-dimer and e-XDP levels showed the most significant increases at days 4 and 1, respectively, after surgery in the thrombus group. With cut-off points of 7.5 μg/ml for D-dimer and 8.2 U/ml for e-XDP, the sensitivities were 75% and 75%, and the specificities were 63% and 59%, respectively. By multiple logistic regression analysis, D-dimer at day 4 and e-XDP at day 1 postoperatively were independent markers for early diagnosis of VTE (odds ratio=1.61 and 1.19, P=0.01 and 0.04, respectively). The postoperative occurrence of new asymptomatic VTE may be predicted by D-dimer at day 4 and e-XDP at day 1 after TKA.

Incidence of Symptoms and Accidents During Baths and Showers Among the Japanese General Public

Background Bathing is a deeply ingrained custom among Japanese; however, data on the incidence rate of symptoms and accidents during bathing have not yet been reported for the Japanese general public. Methods We conducted a population-based cross-sectional study of 617 Japanese adults who attended a specialized health checkup. Participants completed a self-administered questionnaire to assess weekly frequencies of bathtub bathing and showering and the frequency of symptoms/accidents (falling, loss of consciousness, and other) during these activities in the past year. We calculated the incidence rates of accidents per 10 000 baths/showers and 95% confidence intervals (CIs) and compared the clinical characteristics of participants who had symptoms/accidents with those who did not. Results The incidence rates of accidents per 10 000 bathtub baths and showers were 0.43 (95% CI: 0.22–0.84) and 0.24 (95% CI: 0.04–1.37). Although these rates are low, there were 740 000 bathtub bathing-related accidents in Japan, due to the fact that bathing is an almost-daily habit. There was no significant difference in clinical characteristics between groups Conclusions We collected basic information on the incidence of bathing-related accidents in Japan. Falls and loss of consciousness during bathing or showering can potentially lead to a serious accident, so the general public should be educated about the possibility of such accidents during bathing.

Factors Influencing Collaborative Activities between Non-Professional Disaster Volunteers and Victims of Earthquake Disasters

Background Assistance from non-professional disaster volunteers (hereinafter, volunteers) is essential for disaster victims to recover physically and rebuild their lives; however, disaster victims in some areas are reluctant to accept assistance from volunteers. This study explored factors that may influence collaborative activities between volunteers and victims of earthquake disasters. Methods From July to September 2008, a self-reporting questionnaire survey was conducted with all 302 leaders of neighborhood associations in a city within Niigata Prefecture at the time of the Niigataken Chuetsu-oki Earthquake in 2007. Each factor was determined based on the Health Belief Model. Multiple regression analysis was conducted, using collaborative activities as the objective variable. Results From 261 valid responses received (response rate 86.4%), 41.3% of leaders collaborated with volunteers, and 60.2% of associations had residents who collaborated with volunteers. Collaboration with volunteers was significantly and positively related to perceived severity of an earthquake disaster (standardized partial regression coefficient β = 0.224, p<0.001) and neighborhood association activities during the earthquake disaster (β = 0.539, p<0.001). A positive and marginally significant relation was found between such collaboration and sense of coherence within a community (β = 0.137, p = 0.06), social capital (β = 0.119, p = 0.08), and perceived benefits (β = 0.116, p = 0.09). Conclusion Collaboration between disaster victims and volunteers during the response to an earthquake may require the preemptive estimation of damage by residents during normal times and the enhancement of neighborhood association activities during a disaster. For residents to have such estimation abilities, public institutions should provide information related to anticipated disaster damage and appropriate disaster prevention training and education. In addition, residents should create a disaster prevention map with other residents. Lastly, promoting neighborhood association activities may require the participation of many residents in disaster drills and education as well as a preemptive discussion of neighborhood activities during a disaster.

Physical Activity and Cardiovascular Disease in Japan: The Jichi Medical School Cohort Study

Background Many studies have reported an association between physical activity and cardiovascular disease (CVD); however, the effect of physical activity remains controversial. Few such studies have been conducted in Japan. Therefore, we examined the relationship between physical activity and death from CVD using prospective data from a Japanese population. Methods From a prospective cohort study that comprised 12 490 participants, data from 9810 were analyzed. From April 1992 through July 1995, a baseline survey was conducted in 12 communities in Japan. The participants were followed up until December 2005. Physical activity was assessed using the physical activity index (PAI). PAI scores were grouped in quartiles: Q1 was the lowest PAI quartile and Q4 was the highest. Hazard ratios (HRs) for death from CVD, stroke, and myocardial infarction (MI) were calculated for all PAI quartiles. Results The mean follow-up period was 11.9 years, during which time 194 participants died of CVD. With Q1 as the reference, the HRs for death from CVD in Q2, Q3, and Q4, were 0.62 (95% confidence interval, 0.40–0.98), 0.53 (0.31–0.88), and 0.40 (0.22–0.73), respectively, in men, and 0.71 (0.38–1.32), 0.52 (0.26–1.04), and 0.48 (0.22–1.05), respectively, in women. The HRs for death from CVD subtypes were similar but not statistically significant. Conclusions Among a Japanese population, physical activity was associated with a decreased risk of death from CVD. However, more evidence is needed to elucidate the relationships between physical activity and CVD subtypes.