Suketaka Iwanaga

Legionella pneumophila in Rainwater on Roads

During rain, transient puddles form on roads, and this water is splashed into the air by moving vehicles. To determine whether this water contains Legionella pneumophila, we collected samples from roads. We found that L. pneumophila are abundant in these puddles, especially during warm weather.

The Framework Convention on Tobacco Control (FCTC) and Japanese anti-tobacco measures

Japanese anti-tobacco measures are reviewed and checked the relationship between the FCTC and its changes. Japan is making efforts to follow the FCTC, but it is insufficient and present anti-tobacco measures seem to have only a little impact on decreasing smoking rates. More effective measures should be developed for reducing smoking rates and for making smoke-free society.

Associations of Serum Retinol, α-Tocopherol, and γ-Tocopherol with Biomarkers among Healthy Japanese Men

Retinol, α-tocopherol, and γ-tocopherol are fat-soluble vitamins acting as antioxidants via the prevention of lipid oxidation. Little is known about circulatory levels in healthy individuals. The present cross-sectional study aimed at elucidating the relationship between these antioxidants and clinical biomarkers in 206 male (median age 41 years, range 23–67) employees from companies located in the Okayama Prefecture, Japan. Subjects younger than 40 years (n = 94) showed a positive association of the frequency of alcohol consumption with the circulating retinol (β = 0.344, p = 0.001) and γ-tocopherol levels (β = 0.219, p = 0.041), and an inverse association of fast insulin with serum retinol (β = −0.301, p = 0.009). In participants older than 40 years (n = 112) we found that an inverse association of HOMA-R with serum retinol (β = −0.262, p = 0.021), α-tocopherol (β = −0.236, p = 0.035), and γ-tocopherol levels (β = −0.224, p = 0.052); and cigarette smoking was inversely associated with the levels of serum α-tocopherol (β = −0.286, p = 0.008) and γ-tocopherol (β = −0.229, p = 0.040). We further found negative relationships between serum ferritin and the retinol (β = −0.211, p = 0.032) and α-tocopherol levels (β = −0.223, p = 0.022) in men over 40 years of age. The present study suggests that the circulatory levels of antioxidant vitamins may modulate the action of insulin and that higher levels of iron might decrease the levels of antioxidant vitamins in the blood.

A patient with Legionnaires' disease transferred after a traffic accident.

Legionnaires’ disease (LD) ranks among the three most common causes of severe pneumonia, but is often not specifically diagnosed. Among patients with LD, 40% to 50% of the patients develop neuromuscular signs and symptoms. A patient with LD transferred to our department after a traffic accident. When the patient arrived at our hospital, his respiratory rate was 27 breaths per min. His pulse was 148 beats per min and blood pressure was 116/57 mm Hg. Temperature was 39.6°C. He had copious watery diarrhoea and had been diagnosed as having acute gastroenteritis. The patient had urinary incontinence, gait disturbance, mild headache, fatigue and excessive decrease in spontaneous speech. A urinary antigen test for Legionella pneumophila turned out to be positive. LD commonly involves the neuromuscular system. Although this may be an atypical case of LD, it implies the need for awareness of LD.

Effect of 23-valent pneumococcal polysaccharide vaccine on medical expenses in Japan

Results Period A: From April 2009 till March 2012 Period B: From April 2012 till September 2012 The medical expenses for pneumonia of the vaccinated group (n=13689) and the non-vaccinated (n=126110) group are compared using the medical practitioners’ receipt for health insurance claim. The medical examination rates in Period A were 0.403 per year in the vaccinated and 0.227 per year in the non-vaccinated. Those in period B were 0.549 in the vaccinated and 0.331 in the non-vaccinated. The increasing rate of the vaccinated seems to be suppressed compared to non-vaccinated. Medical expenses in Period A were £365.2 in the vaccinated and £293.9 in the non-vaccinated. Those in Period B were £371.9 in the vaccinated and £172.1 in the non-vaccinated. The increase in medical expense seems to be suppressed by the vaccination. Conclusion The rate of the vaccinated in this prefecture is small. And the Period B is too short. Also it seems that those that are vaccinated have some diseases or are compromised. However the vaccination seems to be effective in reducing medical examination rate of pneumonia and reducing the medical expenses for it. These data have some limitations. Pneumonia on the medical practitioners’ receipt is not only caused by pneumococcus but also other causes such as virus. As the bills of medical treatment are issued every month, rates of diseases are sometimes overestimated. And the medical expenses for the inpatient was not calculated as they were not admitted only for pneumonia. Effect of 23-valent pneumococcal polysaccharide vaccine seems to reduce pneumonia and medical expenses even in a local area.