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Kanaoka K, Nishida T, Iwanaga Y, Nakai M, Tonegawa-Kuji R, Nishioka Y, Myojin T, Okada K, Noda T, Kusano K, Miyamoto Y, Saito Y, Imamura T. Oral anticoagulation after atrial fibrillation catheter ablation: benefits and risks. Eur Heart J 2024; 45:522-534. [PMID: 38117227 PMCID: PMC10873714 DOI: 10.1093/eurheartj/ehad798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND AIMS Few recent large-scale studies have evaluated the risks and benefits of continuing oral anticoagulant (OAC) therapy after catheter ablation (CA) for atrial fibrillation (AF). This study evaluated the status of continuation of OAC therapy and the association between continuation of OAC therapy and thromboembolic and bleeding events according to the CHADS2 score. METHODS This retrospective study included data from the Japanese nationwide administrative claims database of patients who underwent CA for AF between April 2014 and March 2021. Patients without AF recurrence assessed by administrative data of the treatment modalities were divided into two groups according to continuation of OAC therapy 6 months after the index CA. The primary outcomes were thromboembolism and major bleeding after a landmark period of 6 months. After inverse probability of treatment weighting analysis, the association between OAC continuation and outcomes was determined according to the CHADS2 score. RESULTS Among 231 374 patients included, 69.7%, 21.6%, and 8.7% had CHADS2 scores of ≤1, 2, and ≥3, respectively. Of these, 71% continued OAC therapy at 6 months. The OAC continuation rate was higher in the high CHADS2 score group than that in the low CHADS2 score group. Among all patients, 2451 patients (0.55 per 100 person-years) had thromboembolism and 2367 (0.53 per 100 person-years) had major bleeding. In the CHADS2 score ≤1 group, the hazard ratio of the continued OAC group was 0.86 [95% confidence interval (CI): 0.74-1.01, P = .06] for thromboembolism and was 1.51 (95% CI: 1.27-1.80, P < .001) for major bleeding. In the CHADS2 score ≥3 group, the hazard ratio of the continued OAC group was 0.61 (95% CI: 0.46-0.82, P = .001) for thromboembolism and was 1.05 (95% CI: 0.71-1.56, P = 0.81) for major bleeding. CONCLUSIONS This observational study suggests that the benefits and risks of continuing OAC therapy after CA for AF differ based on the patient's CHADS2 score. The risk of major bleeding due to OAC continuation seems to outweigh the risk reduction of thromboembolism in patients with lower thromboembolic risk.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
- Department of Cardiology, Sakurabashi-Watanabe Hospital, Umeda 2-4-32, Osaka, Osaka 530-0001, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
| | - Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
- Nara Prefecture Seiwa Medical Center, Sango, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Hosokawa R, Ojima T, Myojin T, Aida J, Kondo K, Kondo N. Estimating Health Expectancy in Japanese Communities Using Mortality Rate and Disability Prevalence. JMA J 2024; 7:21-29. [PMID: 38314416 PMCID: PMC10834173 DOI: 10.31662/jmaj.2023-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Although mortality and disability are known to be associated with health expectancy (LE), few studies have assessed the extent to which a reduction in their prevalence can extend a person's LE. Moreover, differences in this relationship based on gender have not been established. Thus, in this study, we constructed a regression model using the rate of mortality and prevalence of disability to predict LE in older adults (≥65 years) and assess the relationships between LE, mortality rate, and disability prevalence based on gender. Methods Data were collected from Japan's population registry and long-term insurance records (N = 344). Multiple linear regression was used to analyze the relationship between LE, mortality rate, and disability prevalence, stratified by gender. Results Age-adjusted mortality rate and disability prevalence significantly predicted LE and were significantly correlated with the measured LE index for both genders. For every 1% annual decrease in age-adjusted mortality, LE increased by 1.54 years for men and 2.15 years for women. Similarly, a 1% annual decrease in age-adjusted disability prevalence increased LE by 0.22 years for men and 0.32 years for women. The regression model coefficients indicated that the strength of the association between LE, mortality rate, and disability prevalence differed between genders. Our model accurately predicted LE (men: adjusted R2 = 0.968, women: adjusted R2 = 0.994). Conclusions Health promotion policies that are geared toward increasing health expectancy can be evaluated using mortality rate and disability prevalence as prognostic indicators. The strength of the association between LE, mortality, and disability differed between genders, suggesting the need for gender-specific policy planning to increase LE for both genders.
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Affiliation(s)
- Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Naoki Kondo
- Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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Takeshita S, Nishioka Y, Tamaki Y, Kamitani F, Mohri T, Nakajima H, Kurematsu Y, Okada S, Myojin T, Noda T, Imamura T, Takahashi Y. Novel subgroups of obesity and their association with outcomes: a data-driven cluster analysis. BMC Public Health 2024; 24:124. [PMID: 38195492 PMCID: PMC10775568 DOI: 10.1186/s12889-024-17648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Obesity is associated with various complications and decreased life expectancy, and substantial heterogeneity in complications and outcomes has been observed. However, the subgroups of obesity have not yet been clearly defined. This study aimed to identify the subgroups of obesity especially those for target of interventions by cluster analysis. METHODS In this study, an unsupervised, data-driven cluster analysis of 9,494 individuals with obesity (body mass index ≥ 35 kg/m2) was performed using the data of ICD-10, drug, and medical procedure from the healthcare claims database. The prevalence and clinical characteristics of the complications such as diabetes in each cluster were evaluated using the prescription records. Additionally, renal and life prognoses were compared among the clusters. RESULTS We identified seven clusters characterised by different combinations of complications and several complications were observed exclusively in each cluster. Notably, the poorest prognosis was observed in individuals who rarely visited a hospital after being diagnosed with obesity, followed by those with cardiovascular complications and diabetes. CONCLUSIONS In this study, we identified seven subgroups of individuals with obesity using population-based data-driven cluster analysis. We clearly demonstrated important target subgroups for intervention as well as a metabolically healthy obesity group.
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Affiliation(s)
- Saki Takeshita
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yuko Tamaki
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Fumika Kamitani
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Takako Mohri
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Hiroki Nakajima
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yukako Kurematsu
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
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Kan-O K, Noda T, Ogata H, Masaki K, Nishioka Y, Myojin T, Adachi T, Morita H, Imamura T, Tamari M, Kainuma K. Insights from the trends of omalizumab and mepolizumab utilization in patients with asthma: A population-based cohort study using the National Database in Japan. Respir Investig 2024; 62:113-120. [PMID: 38101278 DOI: 10.1016/j.resinv.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Biologics are increasingly being used in patients with severe uncontrolled asthma. However, the trends in their use for treating severe asthma in Japan remain unclear. METHODS The number of patients with asthma prescribed omalizumab or mepolizumab between April 2017 and March 2018 was estimated according to sex, age, and geographical region using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. RESULTS Overall, 5,014, 3,449 and 7,977 patients were prescribed omalizumab, mepolizumab, or either combination, respectively. The total number of patients prescribed biologics displayed a bimodal distribution with peaks in their early teens and seventies. Biologics were most commonly used by male and female patients in their seventies. Prescription was 1.24 times higher in males than in females up to the teenage years, whereas it was 1.95 times higher in females than in males from their twenties onwards. Omalizumab was prescribed 1.45 times more frequently than mepolizumab, especially in pediatric patients, and was prescribed 1.96 times more often to female patients than to male patients. Regional differences were observed in the proportion of patients prescribed biologics. Correlation analysis suggested a weak relationship (r = 0.3226, p = 0.0270) between the proportion of patients prescribed biologics and board-certified allergists according to the geographic region. CONCLUSIONS In Japan, biologics are prescribed more often to older patients with severe asthma compared to those in other countries. Thus, eliminating the regional disparities in asthma treatment by specialists is necessary to provide appropriate medical care to patients with severe asthma.
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Affiliation(s)
- Keiko Kan-O
- ENGAGE NDB Task Force, Tokyo, Japan; Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Hiroaki Ogata
- ENGAGE NDB Task Force, Tokyo, Japan; Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Katsunori Masaki
- ENGAGE NDB Task Force, Tokyo, Japan; Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan; Keio Allergy Center, Keio University Hospital, Tokyo, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Takeya Adachi
- ENGAGE NDB Task Force, Tokyo, Japan; Keio Allergy Center, Keio University Hospital, Tokyo, Japan; Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Department of Medical Regulatory Science, Kyoto Prefecture University of Medicine, Graduate School of Medical Science, Kyoto, Japan; Keio Frontier Research & Education Collaborative Square (K-FRECS) at Tonomachi, Keio University, Kanagawa, Japan
| | - Hideaki Morita
- ENGAGE NDB Task Force, Tokyo, Japan; Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan; Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Mayumi Tamari
- Division of Molecular Genetics, The Jikei University School of Medicine, Research Centre for Medical Science, Tokyo, Japan
| | - Keigo Kainuma
- ENGAGE NDB Task Force, Tokyo, Japan; Institute for Clinical Research, National Hospital Organization Mie National Hospital, Mie, Japan.
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Kamitani F, Nishioka Y, Koizumi M, Nakajima H, Kurematsu Y, Okada S, Kubo S, Myojin T, Noda T, Imamura T, Takahashi Y. Antithyroid drug-induced leukopenia and G-CSF administration: a long-term cohort study. Sci Rep 2023; 13:19336. [PMID: 37935745 PMCID: PMC10630492 DOI: 10.1038/s41598-023-46307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
Although antithyroid drug (ATD)-induced agranulocytosis is a significant concern, its risks associated with long-term use and re-administration are not fully elucidated. Therefore, we performed this study to determine the incidence of ATD-induced leukopenia and G-CSF administration using administrative claims database. Retrospective cohort study. This study was performed using the DeSC Japanese administrative claims database. A total of 12,491 patients with newly diagnosed Graves' disease (GD) who received methimazole or propylthiouracil between April 2014, and February 2021 among 3.44 million patients in the database were included in the study. We measured the six-year incidence of leukopenia and granulocyte colony-stimulating factor (G-CSF) administration. The incidence of leukopenia and G-CSF administration was 1.34% (168 patients) and 0.30% (38 patients), respectively. Leukopenia had a dose-dependent and biphasic incidence. The incidence of leukopenia and G-CSF administration was 37.2 (0.7%) and 8.0 (0.2%) per 1000 person-years during the first 72 days of ATD initiation, whereas it was 3.1 and 0.7 per 1000 person-years during the subsequent 6 years, respectively. The incidence of both outcomes was comparable between first administration and re-administration of ATD. The incidence of ATD-induced leukopenia and G-CSF administration was high in the first 72 days, with a reduced risk for at least 6 years thereafter. The incidence was similar between first administration and re-administration. ATD, a standard therapy, is often administered for a long period; therefore, our findings can guide the treatment of GD.
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Affiliation(s)
- Fumika Kamitani
- Department of Diabetes and Endocrinology, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
| | - Miyuki Koizumi
- Department of Diabetes and Endocrinology, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Hiroki Nakajima
- Department of Diabetes and Endocrinology, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yukako Kurematsu
- Department of Diabetes and Endocrinology, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Nishimura Y, Inagaki Y, Noda T, Nishioka Y, Myojin T, Ogawa M, Kido A, Imamura T, Tanaka Y. Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Arch Osteoporos 2023; 18:91. [PMID: 37418095 PMCID: PMC10329059 DOI: 10.1007/s11657-023-01293-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023]
Abstract
We investigated the risk factors for mortality of hip fracture in the elderly using the National Database of Health Insurance Claims in Japan, and survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. PURPOSE Hip fracture is the most common fracture in the elderly and is known to have a high mortality rate. In Japan, to the best of our knowledge, no studies have reported on mortality risk factors for hip fracture using nationwide registry databases. This study aimed to determine the number of occurrences of hip fracture and factors that increase mortality using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. METHODS This study included extracted data from patients who were hospitalized and underwent surgical treatment for hip fracture between 2013 and 2021, using a nationwide health insurance claims database in Japan. Patient characteristics, such as sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism, were tabulated to obtain 1-year and in-hospital mortality rates. RESULTS Both 1-year and in-patient survival were significantly lower in men, older patients, patients who underwent surgery after 3 days of admission, and patients with trochanteric and subtrochanteric fractures, internal fixation, more preoperative comorbidities, blood transfusions, and pulmonary embolism. CONCLUSIONS Survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. As the number of male patients with hip fracture will increase with the aging of society, medical staff must provide sufficient information before surgery to avoid postoperative mortality.
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Affiliation(s)
- Yuki Nishimura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Yusuke Inagaki
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan.
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan.
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Munehiro Ogawa
- Department of Sports Medicine, Nara Medical University, Kashihara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Sodium-Glucose Cotransporter 2 Inhibitor Use in Early-Phase Acute Coronary Syndrome with Severe Heart Failure. Eur Heart J Cardiovasc Pharmacother 2023:7161119. [PMID: 37173281 DOI: 10.1093/ehjcvp/pvad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIMS Sodium-glucose cotransporter 2 inhibitor (SGLT2i) improves clinical outcomes in patients with heart failure (HF), but has limited evidence of SGLT2i use on early-phase acute coronary syndrome (ACS). We determined association of early SGLT2i use compared with either non-SGLT2i or dipeptidyl peptidase 4 inhibitor (DPP4i) in hospitalized patients with ACS. METHODS AND RESULTS This retrospective cohort study that used the Japanese nationwide administrative claims database included patients hospitalized with ACS aged ≥ 20 years between April 2014 and March 2021. The primary outcome was a composite of all-cause mortality or HF/ACS rehospitalization. Using 1:1 propensity score matching, the association with outcomes of the early SGLT2i use (≤14 days after admission) compared with non-SGLT2i or DPP4i was determined according to the HF treatment. Among 388 185 patients included, 115 612 and 272 573 with and without severe HF, respectively. Compared to non-SGLT2i users, the SGLT2i users had a lower hazard ratio (HR) with the primary outcome (HR: 0.83, 95% confidence interval [CI]: 0.76-0.91, p < 0.001) in the severe HF group; however, there was no significant difference in the non-severe HF group (HR: 0.92, 95% CI: 0.82-1.03, p = 0.16). SGLT2i use showed a lower risk of the outcome in patients with severe HF and diabetes compared with DPP4i (HR: 0.83, 95% CI: 0.69-1.00, p = 0.049). CONCLUSION SGLT2i use in patients with early-phase ACS showed a lower risk of primary outcome in patients with severe HF but the effect was not apparent in patients without severe HF.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Sakurabashi-Watanabe Hospital, Osaka, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
- Nara Prefecture Seiwa Medical Center, Oji, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Okada K, Noda T, Miyamoto Y, Saito Y, Imamura T. Reduction in Planned Percutaneous Coronary Interventions After the Policy Change for Ischemia Assessment in Japan. JACC Asia 2023; 3:312-314. [PMID: 37181398 PMCID: PMC10167499 DOI: 10.1016/j.jacasi.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8521, Japan @koshiroook
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Mohri T, Okamoto S, Nishioka Y, Myojin T, Kubo S, Higashino T, Okada S, Akai Y, Noda T, Ishii H, Imamura T. Risk of Lactic Acidosis in Hospitalized Diabetic Patients Prescribed Biguanides in Japan: A Retrospective Total-Population Cohort Study. Int J Environ Res Public Health 2023; 20:5300. [PMID: 37047916 PMCID: PMC10093879 DOI: 10.3390/ijerph20075300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Patient data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) are used to assess the effect of biguanide administration on rates of lactic acidosis (LA) in hospitalized diabetes mellitus (DM) patients. In this retrospective cohort study (from April 2013 to March 2016), we compare DM inpatients prescribed biguanides to DM inpatients who were not prescribed biguanides to quantify the association between biguanides and incidence of LA. In total, 8,111,848 DM patient records are retrieved from the NDB. Of the 528,768 inpatients prescribed biguanides, 782 develop LA. Of the 1,967,982 inpatients not prescribed biguanides, 1310 develop LA. The rate ratio of inpatients who develop LA and are administered biguanides to those who developed LA without receiving biguanides is 1.44 (95% CI, 1.32-1.58). Incidence rates and rate ratios for both sexes are elevated in the group prescribed biguanides for patients aged 70 years and older, markedly in those 80 years and older: 40.12 and 6.31 (95% CI, 4.75-8.39), respectively, for men and 34.96 and 5.40 (95% CI, 3.91-7.46), respectively, for women. Biguanides should be used conservatively in patients older than 70 years, particularly for those with comorbidities, and with caution in patients 80 years and older.
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Affiliation(s)
- Takako Mohri
- Department of Diabetes and Endocrinology, Nara Medical University Hospital, Nara 634-8522, Japan
| | - Sawako Okamoto
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara 634-8521, Japan
- Education Development Center, Nara Medical University, Nara 634-8521, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara 634-8521, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara 634-8521, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara 634-8521, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute Inc., Tokyo 100-8141, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University Hospital, Nara 634-8522, Japan
| | - Yasuhiro Akai
- Department of Community-Based Medicine, Nara Medical University, Nara 634-8521, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara 634-8521, Japan
| | - Hitoshi Ishii
- Department of Doctor-Patient Relationships, Nara Medical University, Nara 634-8521, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara 634-8521, Japan
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10
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Mine A, Okamoto S, Myojin T, Hamada M, Imamura T. Basic biology education in high school and acceptance of genetically modified food in Japan. PLoS One 2023; 18:e0281493. [PMID: 36745607 PMCID: PMC9901761 DOI: 10.1371/journal.pone.0281493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 02/07/2023] Open
Abstract
While many types of genetically modified (GM) food have become more available worldwide, the acceptance of GM food continues to be low. To increase this acceptance, various educational interventions have been conducted; however, conflicts remain about the safety and acceptability of GM food among laypeople, experts, and policymakers in several countries. Thus, this study aimed to clarify whether basic biology education influences Japanese people's acceptance of GM food. We examined this idea by comparing individual experiences of high school biology education based on curriculum and proficiency level. We distributed online questionnaires to 1,594 people in Japan; 1,122 valid responses (70.4%) were obtained. Results showed that the acceptance rates of GM vegetables, fish, and meat were 33.6%, 29.0%, and 29.1%, respectively. Comparing the biology knowledge test scores according to different high school biology education levels (i.e., non-learners, basic, and advanced levels) showed no significant differences between the three age groups (20s, 30s, and 40s), which corresponded to different curricula (p = 0.90); however, there were significant differences between the high school biology education levels (p<0.01). Using logistic regression analysis, we then examined the effect of high school biology education on acceptance of GM food. The results showed no significant differences between different high school biology education levels but significantly lower acceptance by the 30s and 40s groups compared with the 20s group (p<0.05). This suggests that basic biology education alone is not sufficient to change people's attitudes toward GM foods. These generational differences suggest factors other than high school biology curriculum affect different generations' acceptance of GM foods. Overall, high school biology education did not directly affect acceptance of GM foods, although those who received a higher level of education had an increased knowledge of GM foods.
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Affiliation(s)
- Akihiro Mine
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
- * E-mail: (AM); (TM)
| | - Sawako Okamoto
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
- * E-mail: (AM); (TM)
| | - Miki Hamada
- Advanced Service Development Group, Innovation Service Creation Division, Mitsubishi Research Institute, Inc., Tokyo, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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11
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Kanaoka K, Iwanaga Y, Okada K, Terasaki S, Nishioka Y, Nakai M, Kamon D, Myojin T, Soeda T, Noda T, Horii M, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Validity of Diagnostic Algorithms for Cardiovascular Diseases in Japanese Health Insurance Claims. Circ J 2023; 87:536-542. [PMID: 36709984 DOI: 10.1253/circj.cj-22-0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND We aimed to validate a claims-based diagnostic algorithm to identify hospitalized patients with acute major cardiovascular diseases (CVDs) from health insurance claims in Japan.Methods and Results: This retrospective multicenter validation study was conducted at 4 institutes, including Japanese Circulation Society-certified and uncertified hospitals in Japan. Data on patients with CVDs in departmental lists or with International Classification of Diseases, 10th Revision (ICD-10) codes for CVDs hospitalized between April 2018 and March 2019 were extracted. We examined the sensitivity and positive predictive value of a diagnostic algorithm using ICD-10 codes, medical examinations, and treatments for acute coronary syndrome (ACS), acute heart failure (HF), and acute aortic disease (AAD). We identified 409 patients with ACS (mean age 70.6 years; 24.7% female), 615 patients with acute HF (mean age 77.3 years; 46.2% female), and 122 patients with AAD (mean age 73.4 years; 36.1% female). The respective sensitivity and positive predictive value for the algorithm were 0.86 (95% confidence interval [CI] 0.82-0.89) and 0.95 (95% CI 0.92-0.97) for ACS; 0.74 (95% CI 0.70-0.77) and 0.79 (95% CI 0.76-0.83) for acute HF; and 0.86 (95% CI 0.79-0.92) and 0.83 (95% CI 0.76-0.89) for AAD. CONCLUSIONS The validity of the diagnostic algorithm for Japanese claims data was acceptable. Our results serve as a foundation for future studies on CVDs using nationwide administrative data.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine
| | | | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Manabu Horii
- Department of Cardiovascular Medicine, Nara City Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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12
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Hosokawa R, Ojima T, Myojin T, Aida J, Kondo K, Kondo N. Association between the Standardized Mortality Ratio and Healthy Life Expectancy in Japan. JMA J 2023; 6:27-35. [PMID: 36793525 PMCID: PMC9908415 DOI: 10.31662/jmaj.2022-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Healthy life expectancy (HLE) remains the principal target of various health plans. We aimed to identify the areas of priority and determinants of mortality to extend HLE across local governments in Japan. Methods HLE according to secondary medical areas was calculated using the Sullivan method. People requiring long-term care of level 2 or higher were considered unhealthy. Standardized mortality ratios (SMRs) for major causes of death were calculated using vital statistics data. The association between HLE and SMR was analyzed using simple and multiple regression analyses. Results The average (standard deviation) HLE values were 79.24 (0.85) and 83.76 (0.62) years for men and women, respectively. A comparison of HLE revealed regional health gaps of 4.46 (76.90-81.36) and 3.46 (81.99-85.45) years for men and women, respectively. The coefficients of determination for the SMR of malignant neoplasms with HLE were the highest and were 0.402 and 0.219 among men and women, respectively, followed by those of cerebrovascular diseases, suicide, and heart diseases among men and those of heart disease, pneumonia, and liver disease among women. When all major preventable causes of death were analyzed simultaneously in a regression model, the coefficients of determination were 0.738 and 0.425 among men and women, respectively. Conclusions Our findings suggest that local governments should prioritize preventing cancer deaths via cancer screening and smoking cessation measures in health plans, with a special focus on men.
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Affiliation(s)
- Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan,Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan,Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Naoki Kondo
- School of Public Health and Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Hosokawa R, Ojima T, Myojin T, Kondo K, Kondo N. Geriatric symptoms associated with healthy life expectancy in older people in Japan. Environ Health Prev Med 2023; 28:44. [PMID: 37423739 DOI: 10.1265/ehpm.22-00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND We investigated the relationship between characteristic geriatric symptoms and healthy life expectancy in older adults in Japan. Additionally, we determined relationship predictors that would help formulate effective approaches toward promoting healthy life expectancy. METHODS The Kihon Checklist was used to identify older people at high risk of requiring nursing care in the near future. We evaluated the association of geriatric symptoms with healthy life expectancy while considering risk factors (frailty, poor motor function, poor nutrition, poor oral function, confinement, poor cognitive function, and depression). Data from the 2013 and 2019 Japan Gerontological Evaluation Studies were used. Healthy life expectancy was assessed using the multistate life table method. RESULTS Overall, 8,956 individuals were included. For both men and women, healthy life expectancy was shorter in the symptomatic group than in the asymptomatic group for several domains of the Kihon Checklist. For men, the difference between individuals with risk factors and those with no risk factors was the maximum for confinement (3.83 years) and the minimum for cognitive function (1.51 years). For women, the difference between individuals with risk factors and those with no risk factors was the maximum for frailty (4.21 years) and the minimum for cognitive function (1.67 years). Healthy life expectancy tended to be shorter when the number of risk factors was higher. Specifically, the difference between individuals with ≥3 risk factors and those with no risk factors was 4.46 years for men and 5.68 years for women. CONCLUSIONS Healthy life expectancy was negatively associated with characteristic geriatric symptoms, with strong associations with frailty, physical functional decline, and depression. Therefore, comprehensive assessment and prevention of geriatric symptoms may increase healthy life expectancy.
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Affiliation(s)
- Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University
- Center for Well-being and Society, Nihon Fukushi University
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology
| | - Naoki Kondo
- School of Public Health and Graduate School of Medicine, Kyoto University
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14
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Outpatient cardiac rehabilitation dose after acute coronary syndrome in a nationwide cohort. Heart 2022; 109:40-46. [PMID: 35241624 DOI: 10.1136/heartjnl-2021-320434] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Cardiac rehabilitation (CR) is effective in patients with acute coronary syndrome (ACS); however, CR programmes have not been fully implemented. This study aimed to reveal the current practice of outpatient CR and the dose-effect relationship of CR in real-world settings. METHODS We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with ACS who underwent percutaneous coronary intervention between April 2014 and March 2018 were included. We analysed the implementation rate and dose of outpatient CR and the association between dose and outcomes. RESULTS Out of 202 320 patients who underwent percutaneous coronary intervention for ACS, a total of 20 444 (10%) underwent outpatient CR. The median (IQR) number of total CR sessions was 9 (3-17), and the median (IQR) duration for each session was 60 (42-60) min. Patients were divided into four groups according to the total number of sessions (≤9 times or ≥10 times) and the duration per session (<50 min or ≥50 min). Compared with the low-number/short-duration group, the adjusted HR for all-cause mortality was 1.00 (95% CI 0.80 to 1.24, p=0.97) in the low-number/long-duration group, 0.63 (95% CI 0.46 to 0.87, p=0.005) in the high-number/short-duration group and 0.74 (95% CI 0.60 to 0.92, p=0.008) in the high-number/long-duration group, respectively. CONCLUSION We found that the participation rate for outpatient CR after ACS was low and the doses of sessions vary in real-world settings. A higher number of total sessions of outpatient CR is associated with a better prognosis irrespective of the session's duration.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuichi Nishioka
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Katsuki Okada
- Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tatsuya Noda
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Nara Medical University, Kashihara, Japan
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15
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Hospital- and Patient-Level Analysis of Quality Indicators in Acute Coronary Syndrome Care: A Nationwide Database Study. Can J Cardiol 2022; 39:515-523. [PMID: 36503027 DOI: 10.1016/j.cjca.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to clarify the variations in the quality of care provided to patients with acute coronary syndrome (ACS) and to investigate the association between quality of care and mortality at both hospital and patient levels with the use of a nationwide database. METHODS Patients with ACS who underwent percutaneous coronary intervention (PCI) from April 2014 to March 2018 were included from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Twelve quality indicators (QIs) available from administrative data and the association of the QIs with all-cause mortality were investigated. RESULTS From the analysis of 216,436 patients from 1215 hospitals, adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment were high (median proportion > 90%), and adherence to outpatient cardiac rehabilitation was low (median proportion < 10%). At the hospital level, acute-phase composite QI score was associated with reduced risk-adjusted 30-day mortality (β = -0.92 [95% confidence interval -1.19 to -0.65]; P < 0.001). At the patient level, all acute-phase and subacute-phase QIs were inversely associated with 30-day and 2-year mortalities, respectively (all P < 0.001). CONCLUSIONS Substantial variations in ACS care were observed in the current nationwide database. High adherence to the QI sets was associated with significant survival gains at both hospital and patient levels. Multilevel approach in QI assessment may be effective for improvement of survival in this population.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan.
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Multifactorial Effects of Outpatient Cardiac Rehabilitation in Patients with Heart Failure: A Nationwide Retrospective Cohort Study. Eur J Prev Cardiol 2022; 30:zwac274. [PMID: 36378557 DOI: 10.1093/eurjpc/zwac274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
AIM Although cardiac rehabilitation (CR) is a strongly recommended therapy, no large study has assessed the effects of outpatient CR in patients with heart failure (HF) in real-world settings. Therefore, this study aimed to investigate the multifactorial effects of outpatient CR in patients with HF using a nationwide database. METHODS AND RESULTS This nationwide retrospective cohort study was performed using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with acute HF who underwent inpatient CR between April 2014 and March 2020 were included. The association between outpatient CR participation and all-cause mortality, rehospitalisation for HF, use of medical resources, and medical costs was analysed using propensity score matching analysis. Of 250,528 patients, 17,884 (7.1%) underwent outpatient CR. After propensity score matching, the CR (+) group was associated with a reduction in the risk of all-cause mortality (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.60-0.68, p < 0.001) and rehospitalisation for HF compared to the CR (-) group (HR: 0.87, 95% CI: 0.82-0.92, p < 0.001). The proportion of guideline-based medication use for HF at 1 year was higher in the CR (+) group than in the CR (-) group. The total medical costs from the index hospitalisation to 1.5 years after admission were similar between the groups. CONCLUSION Outpatient CR participation after discharge from HF was associated with reduced mortality and rehospitalisation for HF without increasing medical costs.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Biostatistics, National Cerebral and Cardiovascular Center
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
- Nara Prefecture Seiwa Medical Center
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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Nakai M, Iwanaga Y, Kanaoka K, Sumita Y, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Imamura T, Saito Y, Yasuda S, Miyamoto Y. Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society. Biomed Pharmacother 2022; 155:113761. [DOI: 10.1016/j.biopha.2022.113761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
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18
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Nakai M, Iwanaga Y, Kanaoka K, Sumita Y, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Imamura T, Saito Y, Yasuda S, Miyamoto Y. Contemporary use of SGLT2 inhibitors in heart failure patients with diabetes mellitus: a comparison of DPP4 inhibitors in a nationwide electric health database of the superaged society. Cardiovasc Diabetol 2022; 21:157. [PMID: 35964039 PMCID: PMC9375946 DOI: 10.1186/s12933-022-01586-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a lack of recent data reflecting the actual use of sodium-glucose cotransporter-2 (SGLT2) inhibitors for heart failure (HF) and type 2 diabetes (DM) in the superaged society. The present study investigated the association between the use of SGLT2 inhibitors and one-year prognosis in patients hospitalized across a broad spectrum of HF patients with DM in the superaged society using the Nationwide Electric Health Database in Japan. METHODS The patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2019. A cohort of 2,277 users of SGLT2 inhibitors and 41,410 users of the active comparator, dipeptidyl peptidase-4 (DPP4) inhibitors were compared. A propensity score-matched cohort study of 2,101 users of each inhibitor was also conducted. A multivariable multilevel mixed-effects survival model was conducted with adjustments, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS Among 300,398 patients discharged with HF in 4,176 hospitals, 216,016 (71.9%) were 75 years or older, and 60,999 (20.3%) took antidiabetic medications. Among them, the patients treated with SGLT2 inhibitors were younger and had a more severe status than those treated with DPP4 inhibitors. Kaplan-Meier analysis showed that patients treated with SGLT2 inhibitors had a lower mortality risk and HF readmission. In propensity-matched cohorts, SGLT2 inhibitor use was associated with a lower risk of mortality and HF readmission than DPP-4 inhibitor use (HR [95% CI]; 0.70 [0.56, 0.89] and 0.52 [0.45, 0.61], respectively). Very elderly (≥ 75 years) patients showed similar results. Favorable effects were also observed across all age groups, including ≥ 75 years, in patients with coronary artery disease or atrial fibrillation and with concomitant β-blocker, diuretics, or insulin. CONCLUSION The use of SGLT2 inhibitors at discharge was associated with a lower risk of one-year mortality and HF readmission in patients across a broad spectrum of HF with DM in the superaged society. The findings further support the benefits of using SGLT2 inhibitors in very elderly HF care and complement the current evidence.
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Affiliation(s)
- Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Japan.,Department of Biostatistics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Japan.
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Hospital, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan
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19
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Kanaoka K, Nishida T, Nishioka Y, Myojin T, Kubo S, Soeda T, Okada K, Noda T, Iwanaga Y, Miyamoto Y, Sakata Y, Imamura T, Saito Y. The impact of hospital case volume on the outcomes after catheter ablation for atrial fibrillation according to the ablation technology. J Cardiovasc Electrophysiol 2022; 33:1394-1402. [PMID: 35437814 DOI: 10.1111/jce.15495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The appropriate hospital case volume for catheter ablation (CA) in patients with atrial fibrillation (AF) according to the ablation technology has not been fully examined. This study aimed to investigate the association between the hospital case volume for AF and periprocedural complications and AF recurrence. METHODS In this retrospective cohort study, we used data from the National Database of Health Insurance Claims and Specific Health Checkups, which covers almost all healthcare insurance claims data in Japan. We included patients with AF who underwent first-time CA from April 2014 to March 2020. Using mixed-effect logistic regression, we analyzed the effect of the annual case volume for AF ablation on acute periprocedural complications and 1-year success rate off antiarrhythmic drugs according to the ablation technology (radiofrequency ablation or cryoballoon ablation). RESULTS Among 270 116 patients, 207 839 (77%) patients underwent radiofrequency ablation and 56 648 (21%) patients underwent cryoballoon ablation. Of all patients, acute complications occurred in 5411 (2.0%) patients, and the recurrence at 1 year was 71 511 (27%). In the radiofrequency ablation group, acute complications and 1-year AF recurrence according to case volume decreased as the annual case volume increased to up to 150-200 cases/year. However, in the cryoballoon ablation group, these outcomes were similar regardless of the case volumes. CONCLUSION The case-volume effect was noted in the radiofrequency ablation group, but not in the cryoballoon ablation group. Our results may affect the selection of ablation technology, especially in smaller case-volume hospitals.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yuichi Nishioka
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Noda
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoaki Imamura
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
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Nishioka Y, Kubo S, Okada S, Myojin T, Higashino T, Imai K, Sugiyama T, Noda T, Ishii H, Takahashi Y, Imamura T. The Age of Death in Japanese patients with type 2 and type 1 diabetes: A descriptive epidemiological study. J Diabetes Investig 2022; 13:1316-1320. [PMID: 35395140 PMCID: PMC9340860 DOI: 10.1111/jdi.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022] Open
Abstract
This study clarified the age of death in patients with or without diabetes using the largest health insurance database in Japan. This population‐based retrospective cohort study was performed using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) data. The ages of death between people with and without diabetes were compared. A total of 142,277,986 patients (74,488,962 women and 67,789,024 men) over 6 years, including 4,647,016 females, and 6,507,817 males with diabetes, were included. 2,786,071 females and 2,975,876 males died over 6 years, including 652,699 females and 954,655 males with diabetes. The average age of death in patients with diabetes was 2.6 years less than that of patients without diabetes. This descriptive epidemiological study illustrated the difference in age at death of patients with and without diabetes.
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Affiliation(s)
- Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara.,Department of Diabetes and Endocrinology, Nara Medical University, Nara
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, Nara
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara
| | | | - Kenjiro Imai
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Takehiro Sugiyama
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara
| | - Hitoshi Ishii
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University, Nara
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara
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21
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Sato S, Kainuma K, Noda T, Ebisawa M, Futamura M, Imamura T, Miyagawa A, Nakajima S, Ogawa Y, Inomata T, Kan-o K, Kurashima Y, Masaki K, Myojin T, Nishioka Y, Sakashita M, Tamari M, Morita H, Adachi T. Evaluation of adrenaline auto-injector prescription profiles: A population-based, retrospective cohort study within the National Insurance Claims Database of Japan. Allergol Int 2022; 71:354-361. [PMID: 35331624 DOI: 10.1016/j.alit.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adrenaline is the first-line medication for managing anaphylaxis. A better understanding of prescription trends for adrenaline auto-injectors (AAIs) is important to improving patient care as well as information on health education interventions and medical guidelines. However, it has been difficult to gather comprehensive data in a sustainable manner. Thus, we aimed to investigate trends in AAI prescriptions in Japan. METHODS We searched the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), a unique and comprehensive database of health insurance claims, and investigated prescriptions for AAIs for all ages (April 2017 to March 2018). We assessed the annual number of prescriptions per person as well as prescription rates per 100,000 population per year by age, sex, and geographic region. RESULTS A total of 88,039 subjects (56,109 males, 31,930 female) and 116,758 devices (1.33 AAIs per patient per year) were prescribed AAIs at least once a year for all ages. The prescription rate for AAIs was 69.5 per 100,000 population-years. Patients aged 0-9 years were prescribed AAIs at the rate of 278.9 per 100,000 population-years. Patients aged 0-19 years were 6.4 times more likely to be prescribed AAIs than those over 20 years of age. Males were more frequently prescribed AAIs than females in all age groups, except for those aged 20-24 years. We also evaluated differences in prescription rates by geographic region. CONCLUSIONS This comprehensive evaluation revealed trends in AAI prescriptions, thus helping develop preventive strategies with respect to anaphylaxis in Japan.
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22
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Kubo S, Noda T, Myojin T, Nishioka Y, Kanno S, Higashino T, Nishimoto M, Eriguchi M, Samejima K, Tsuruya K, Imamura T. Tracing all patients who received insured dialysis treatment in Japan and the present situation of their number of deaths. Clin Exp Nephrol 2022; 26:360-367. [PMID: 34973086 PMCID: PMC8930944 DOI: 10.1007/s10157-021-02163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
Background The survival rate of chronic dialysis patients in Japan remains the highest worldwide, so there is value in presenting Japan’s situation internationally. We examined whether aggregate figures on dialysis patients in the National Database of Health Insurance Claims and Special Health Checkups of Japan (NDB), which contains data on insured procedures of approximately 100 million Japanese residents, complement corresponding figures in the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). Methods Subjects were patients with medical fee points for dialysis recorded in the NDB during 2014–2018. We analyzed annual numbers of dialysis cases, newly initiated dialysis cases– and deaths. Results Compared with the JRDR, the NDB had about 6–7% fewer dialysis cases but a similar number of newly initiated dialysis cases. In the NDB, the number of deaths was about 6–10% lower, and the number of hemodialysis cases was lower, while that of peritoneal dialysis cases was higher. The cumulative survival rate at dialysis initiation was approximately 6 percentage points lower in the NDB than in the JRDR, indicating that some patients die at dialysis initiation. Cumulative survival rate by age group was roughly the same between the NDB and JRDR in both sexes. Conclusion The use of the NDB enabled us to aggregate data of dialysis patients. With the definition of dialysis patients used in this study, analyses of concomitant medications, comorbidities, surgeries, and therapies will become possible, which will be useful in many future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-021-02163-z.
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Affiliation(s)
- Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Saho Kanno
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tsuneyuki Higashino
- Management Innovation Division, Mitsubishi Research Institute, Inc, 10-3, Nagatacho 2-Chome, Chiyoda-Ku, Tokyo, 100-8141, Japan
| | - Masatoshi Nishimoto
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Kenichi Samejima
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
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23
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Myojin T, Noda T, Kubo S, Nishioka Y, Higashino T, Imamura T. Development of a New Method to Trace Patient Data Using the National Database in Japan. ABE 2022. [DOI: 10.14326/abe.11.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | | | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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Nakanishi Y, Tsugihashi Y, Akahane M, Noda T, Nishioka Y, Myojin T, Kubo S, Higashino T, Okuda N, Robine JM, Imamura T. Comparison of Japanese Centenarians' and Noncentenarians' Medical Expenditures in the Last Year of Life. JAMA Netw Open 2021; 4:e2131884. [PMID: 34739063 PMCID: PMC8571656 DOI: 10.1001/jamanetworkopen.2021.31884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Although research has shown that centenarians tend to experience shorter periods of serious illness compared with other age groups, few studies have focused on the medical expenditures of centenarians as a potential indicator of the scale of medical resources used in their last year of life. OBJECTIVE To compare Japanese centenarians' and noncentenarians' monthly medical expenditures during the year before death according to age and sex. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used linked national health and long-term care insurance data collected from April 2013 to March 2018 in Nara Prefecture, Japan, for residents aged 75 years or older who were insured under the Medical Care System for older adults and died between April 2014 and March 2018. Data were analyzed from April 2013 to March 2018. EXPOSURES Age of 100 years or older (centenarians) vs 75 to 99 years (noncentenarians). MAIN OUTCOMES AND MEASURES The numbers of unique inpatients and outpatients and medical expenditures related to decedents' hospitalization and outpatient care were extracted and analyzed based on sex and age group. The Jonckheere-Terpstra test was used to identify trends in unadjusted medical expenditures by age group, and generalized estimating equations were used to estimate monthly median expenditures by age group with adjustment for comorbidity burden and functional status. RESULTS Of 34 317 patients aged 75 to 109 years (16 202 men [47.2%] and 18 115 women [52.8%]) who died between April 2014 and March 2018, 872 (2.5%) were aged 100 to 104 years (131 men [15.0%] and 741 women [85.0%]) and 78 (0.2%) were aged 105 to 109 years (fewer than 10 were men). The analysis of unadjusted medical expenditures in the last year of life showed a significant trend of lower expenditures for the older age groups; the median adjusted total expenditures during the 30 days before death by age group were $6784 (IQR, $4884-$9703) for ages 75 to 79 years, $5894 (IQR, $4292-$8536) for 80 to 84 years, $5069 (IQR, $3676-$7150) for 85 to 89 years, $4205 (IQR, $3085-$5914) for 90 to 94 years, $3522 (IQR, $2626-$4861) for 95 to 99 years, $2898 (IQR, $2241-$3835) for 100 to 104 years, and $2626 (IQR, $1938-$3527) for 105 to 109 years. The proportion of inpatients among all patients in the year before death also decreased with increasing age: 4311 of all 4551 patients aged 75 to 79 years (94.7%); 43 of all 78 patients aged 105 to 109 years (55.1%); 2831 of 2956 men aged 75 to 79 years (95.8%); 50.0% of men aged 105 to 109 years (the number is not reported owing to the small sample size); 1480 of 1595 women aged 75 to 79 years (92.8%); and 55.7% of women aged 105 to 109 years (the number of women is not reported to prevent back-calculation of the number of men). Specifically, 274 of 872 patients aged 100 to 104 years (31.4%) and 35 of 78 patients aged 105 to 109 years (44.9%) had not been admitted to a hospital in the year before death. CONCLUSIONS AND RELEVANCE This cohort study found that medical expenditures in the last year of life tended to be lower for centenarians than for noncentenarians aged 75 years or older in Japan. The proportion of inpatients also decreased with increasing age. These findings may inform future health care services coverage and policies for centenarians.
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Affiliation(s)
- Yasuhiro Nakanishi
- Department of Health and Welfare Services, National Institute of Public Health, Wako, Saitama, Japan
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yukio Tsugihashi
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, Wako, Saitama, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute Inc, Chiyoda, Tokyo, Japan
| | - Naoko Okuda
- Japan Medical Association Research Institute, Tokyo, Japan
| | - Jean-Marie Robine
- Mécanismes Moléculaires Dans les Démences, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, University of Montpellier, Montpellier, France, and Paris Sciences & Lettres Research University, Montpellier, France
- Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Société, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Ecole des Hautes Études en Sciences Sociales, University of Paris, Paris, France
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Nishioka Y, Noda T, Okada S, Myojin T, Kubo S, Higashino T, Nakajima H, Sugiyama T, Ishii H, Imamura T. Association between influenza and the incidence rate of new-onset type 1 diabetes in Japan. J Diabetes Investig 2021; 12:1797-1804. [PMID: 33660948 PMCID: PMC8504904 DOI: 10.1111/jdi.13540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
AIM This study aimed to determine whether there is an association between influenza and new-onset type 1 diabetes. MATERIALS AND METHODS This population-based retrospective cohort study used data from the National Database of Health Insurance Claims and Specific Health Check-ups of Japan. Influenza was defined based on drug prescriptions and the onset of type 1 diabetes was defined using specific medical codes indicating a diagnosis of type 1 diabetes. The incidence rate ratio of new-onset type 1 diabetes within 180 days after an influenza diagnosis was calculated and it was compared with that at other times using Poisson regression and generalized estimating equations. Sensitivity analyses were performed to confirm the robustness of this finding. RESULTS The data of 10,400 patients with new-onset type 1 diabetes were analyzed, including 2,196 (952 male 1,244 female) patients diagnosed with influenza between 1 September 2014 and 31 August 2017. Although only patients with type 1 diabetes were included, adjusted analysis showed that individuals had a 1.3-fold (95% confidence interval: 1.15-1.46) higher risk of developing type 1 diabetes in the first 180 days after influenza diagnosis than that at other times. CONCLUSIONS In this Japanese population-based cohort, the risk of new-onset type 1 diabetes may increase after the diagnosis of influenza. These results, which must be confirmed in other populations, suggest that influenza may be a causal factor for new-onset type 1 diabetes. The molecular mechanisms underlying the potential etiological relationship between influenza and type 1 diabetes should be elucidated.
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Affiliation(s)
- Yuichi Nishioka
- Department of Public HealthHealth Management and PolicyNara Medical UniversityNaraJapan
- Department of Diabetes and EndocrinologyNara Medical University HospitalNaraJapan
| | - Tatsuya Noda
- Department of Public HealthHealth Management and PolicyNara Medical UniversityNaraJapan
| | - Sadanori Okada
- Department of Diabetes and EndocrinologyNara Medical University HospitalNaraJapan
| | - Tomoya Myojin
- Department of Public HealthHealth Management and PolicyNara Medical UniversityNaraJapan
| | - Shinichiro Kubo
- Department of Public HealthHealth Management and PolicyNara Medical UniversityNaraJapan
| | - Tsuneyuki Higashino
- Healthcare and Wellness DivisionMitsubishi Research Institute, IncTokyoJapan
| | - Hiroki Nakajima
- Department of Diabetes and EndocrinologyNara Medical University HospitalNaraJapan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information CenterResearch InstituteNational Center for Global Health and MedicineTokyoJapan
- Department of Health Services ResearchFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Hitoshi Ishii
- Department of Diabetes and EndocrinologyNara Medical University HospitalNaraJapan
- Department of Doctor‐Patient RelationshipsNara Medical UniversityNaraJapan
| | - Tomoaki Imamura
- Department of Public HealthHealth Management and PolicyNara Medical UniversityNaraJapan
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Kuwata H, Nishioka Y, Noda T, Kubo S, Myojin T, Higashino T, Takahashi Y, Ishii H, Imamura T. Association between dipeptidyl peptidase-4 inhibitors and increased risk for bullous pemphigoid within 3 months from first use: A 5-year population-based cohort study using the Japanese National Database. J Diabetes Investig 2021; 13:460-467. [PMID: 34559464 PMCID: PMC8902379 DOI: 10.1111/jdi.13676] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/23/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION We assessed the association between dipeptidyl peptidase-4 inhibitors (DPP-4is) and bullous pemphigoid (BP) and time-dependent changes in the risk for developing BP after DPP-4i initiation. MATERIALS AND METHODS The present population-based, real-world study was carried out using the Japanese National Database dataset collected between 2013 and 2018. To assess independent correlations between DPP-4is and the development of BP, the self-controlled case series method was used. RESULTS Among the cohort followed up for a median of 1,540 days, 53,027 patients were likely to develop BP. The possible incidence rate of BP in all 150,328,339 patients was 10.4/100,000 person-years. Among the 9,705,814 patients with type 2 diabetes, 15,634 were likely to develop BP. The possible incidence rate of BP in patients with type 2 diabetes was 38.1/100,000 person-years, whereas that in patients with type 2 diabetes who did and did not use DPP-4is was 40.7 and 30.0/100,000 person-years, respectively. Analysis of the 28,705 patients with type 2 diabetes likely to develop BP after initial DPP-4i use showed a risk ratio of 2.15 (95% confidence interval [CI] 1.75-2.63), 1.70 (95% CI 1.37-2.11), 1.44 (95% CI 1.15-1.82), 1.25 (95% CI 0.98-1.59), 0.84 (95% CI 0.63-1.10), 0.84 (95% CI 0.64-1.11) and 1.05 (95% CI 0.92-1.20), for the risk period of ≤30, 31-60, 61-90, 91-120, 121-150, 151-180 and 181-365 days, respectively. CONCLUSIONS Although DPP-4is were associated with increased risk for BP, the risk was particularly significant within 3 months from first use.
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Affiliation(s)
- Hirohito Kuwata
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Japan
| | - Yuichi Nishioka
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Japan.,Department of Public health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Tatsuya Noda
- Department of Public health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Shinichiro Kubo
- Department of Public health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute, Tokyo, Japan
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Japan
| | - Hitoshi Ishii
- Department of Doctor-Patient Relationships, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public health, Health Management and Policy, Nara Medical University, Kashihara, Japan
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Ojima T, Hosokawa R, Myojin T, Aida J, Kondo K, Kondo N. 936Descriptive study of healthy life expectancy in all secondary medical areas in Japan. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Healthy life expectancy (HLE) is an index combined with mortality and morbidity. Monitoring HLE is useful to assess and stimulate health promotion policies/programmes. Though HLE in national or prefectural areas have often been observed, further data in smaller areas are required. The aim of the study is to reveal descriptive features of HLE in secondary medical areas, that is almost same as public health centre jurisdictions and median of population is 214 thousand, in Japan.
Methods
HLE by gender in all 341 secondary medical areas were calculated using Sullivan method. Population data was used from resident registry. Mortality data was from vital statistics of total death in 2016-2018. Data of proportions of unhealthy people was from long-term care insurance data in 2017 using proportion of people with care level 2 (almost bed ridden level) or more severe. Finally, maps of HLE of all of Japan were drawn.
Results
Means (standard deviations, maximums, minimums, means of ranges of 95% confidence intervals) of HLE at birth are 79.21 (0.86, 81.36, 76.90, 0.92) and 83.75 (0.62, 85.45, 81.99, 0.80) years for males and females, respectively. Areas with short HLE were prevalent in Tohoku region (northern part), while that with long HLE in Chubu region (central part).
Conclusions
Descriptive features of HLE in smaller areas of all of Japan can be firstly clarified.
Key messages
Monitoring HLE in local areas would be feasible and useful in some countries. Precision of HLE of areas of these population size would be acceptable.
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Affiliation(s)
| | | | | | - Jun Aida
- Tohoku University, Sendai, Japan
| | - Katsunori Kondo
- Chiba University, Chiba, Japan
- National Center for Geriatrics and Gerontology, Obu, Japan
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Kamitani F, Nishioka Y, Noda T, Myojin T, Kubo S, Higashino T, Okada S, Akai Y, Ishii H, Takahashi Y, Imamura T. Incidence of lower limb amputation in people with and without diabetes: a nationwide 5-year cohort study in Japan. BMJ Open 2021; 11:e048436. [PMID: 34404707 PMCID: PMC8372805 DOI: 10.1136/bmjopen-2020-048436] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION This study was conducted to investigate the incidence and time trend of lower limb amputation (LLA) among people with and without diabetes. RESEARCH DESIGN AND METHODS This retrospective population-based cohort study was based on the national claims data in Japan, comprising a total population of 150 million. Data of all individuals who had LLA from April 2013 to March 2018 were obtained. We analysed the sex-adjusted and age-adjusted annual LLA rate (every fiscal year) in people with and without diabetes for major and minor amputation. To test for time trend, Poisson regression models were fitted. RESULTS In the 5-year period, 30 187 major and 29 299 minor LLAs were performed in Japan. The sex-adjusted and age-adjusted incidence of major and minor LLAs was 9.5 (people with diabetes, 21.8 vs people without diabetes, 2.3, per 100 000 person-years) and 14.9 (people with diabetes, 28.4 vs people without diabetes, 1.9, per 100 000 person-years) times higher, respectively, in people with diabetes compared with those without. A significant decline in the annual major amputation rate was observed (p<0.05) and the annual minor amputation rate remained stable (p=0.63) when sex, age and people with and without diabetes were included as dependent variables. CONCLUSIONS This is the first report of the national statistics of LLAs in Japan. The incidence of major and minor LLAs was 10 and 15 times higher, respectively, in people with diabetes compared with those without. A significant decline in the major amputation rate was observed, and the annual minor amputation rate remained stable during the observation period. This information can help to create an effective national healthcare strategy for preventing limb amputations, which affect the quality of life of patients with diabetes and add to the national healthcare expenditure.
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Affiliation(s)
- Fumika Kamitani
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuichi Nishioka
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute, Inc, Tokyo, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhiro Akai
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
- Center for Postgraduate Training, Nara Medical University, Kashihara, Nara, Japan
- Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Ishii
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
- Department of Doctor-Patient Relationships, Nara Medical University, Kashihara, Nara, Japan
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Nishioka Y, Takeshita S, Kubo S, Myojin T, Noda T, Okada S, Ishii H, Imamura T, Takahashi Y. Appropriate definition of diabetes using an administrative database: A cross-sectional cohort validation study. J Diabetes Investig 2021; 13:249-255. [PMID: 34327864 PMCID: PMC8847127 DOI: 10.1111/jdi.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023] Open
Abstract
Aims/Introduction The purpose of the present study was to quantify errors in the diagnosis of diabetes for use in the national database, using a sufficient population size. Materials and methods A claims database constructed by the JMDC (Tokyo, Japan), using standardized disease classifications and anonymous record linkage, was used in this validation study. We included patients with health insurance claims data from April 2005 to March 2019 in the JMDC claims database. We excluded patients without a record of specific health checkups in Japan. Sample size calculation was based on a 5% prevalence of diabetes and 0.4% absolute accuracy (i.e., 1,250,000 individuals), to calculate the sensitivity, specificity, positive predictive value and negative predictive value. Results In total, 2,999,152 patients were included in this study, of which 165,515 were classified as having diabetes based on specific health checkups (validation cohort prevalence of 5.5%). The newly devised algorithm had three elements – the diagnosis‐related codes for diabetes without suspected flag, the medication codes for diabetes and then these two codes on the same record – and yielded a sensitivity of 74.6%, positive predictive value of 88.4% and Kappa Index of 0.80 (the highest values). Conclusions In future claims database studies, our validated algorithms will be useful as diagnostic criteria for diabetes.
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Affiliation(s)
- Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan.,Department of Diabetes and Endocrinology, Nara Medical University, Nara, Japan
| | - Saki Takeshita
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, Nara, Japan
| | - Hitoshi Ishii
- Department of Doctor-Patient Relationships, Nara Medical University, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University, Nara, Japan
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30
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Suzuki S, Noda T, Nishioka Y, Myojin T, Kubo S, Imamura T, Kamijo H, Sugihara N. Evaluation of Public Health Expenditure by Number of Teeth among Outpatients with Diabetes Mellitus. Bull Tokyo Dent Coll 2021; 62:55-60. [PMID: 33583882 DOI: 10.2209/tdcpublication.2020-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The relationship between public health expenditure and number of teeth was investigated in patients with diabetes mellitus using data obtained from the Japanese National Database of Health Insurance Claims and Specific Health Checkups. Data on medical, dental, and pharmacy claims generated between April 2015 and March 2016 were analyzed in patients with diabetes mellitus aged 50-74 years who used outpatient services during this period. Patients initiating medical and pharmacy claims related to diabetes mellitus were defined as having diabetes mellitus. Number of teeth was defined as number of teeth in conjunction with periodontitis due to the nature of the data source. Descriptive statistics were used to investigate the association between number of teeth and public health expenditure. Data on a total of 1,017,758 patients with diabetes mellitus were analyzed. Patients with the fewest teeth incurred higher medical expenses. The largest mean difference in medical expenditure was observed between patients with 5-9 teeth and those with over 28 teeth. The results of this study suggest that public health expenditure on patients with diabetes mellitus differs based on number of teeth.
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Affiliation(s)
- Seitaro Suzuki
- Department of Epidemiology and Public Health, Tokyo Dental College
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University.,Department of Diabetes and Endocrine Medicine, Nara Medical University
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Hideyuki Kamijo
- Department of Social Security for Dentistry, Tokyo Dental College
| | - Naoki Sugihara
- Department of Epidemiology and Public Health, Tokyo Dental College
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31
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Kanaoka K, Soeda T, Terasaki S, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Watanabe M, Kawakami R, Sakata Y, Imamura T, Saito Y. Current Status and Effect of Outpatient Cardiac Rehabilitation After Percutaneous Coronary Intervention in Japan. Circ Rep 2021; 3:122-130. [PMID: 33738344 PMCID: PMC7956885 DOI: 10.1253/circrep.cr-20-0143] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background:
Although cardiac rehabilitation (CR) has been reported to be associated with better clinical outcomes in patients with cardiovascular diseases, there are few nationwide studies about CR participation by patients with coronary artery disease in Japan. Methods and Results:
We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2018. Patients were divided into 2 groups (acute coronary syndrome [ACS] and stable coronary artery disease [sCAD]), and the rates of participation in in- and outpatient CR after percutaneous coronary intervention (PCI) were investigated. Propensity score-matched analysis was performed and the association between outpatient CR participation and all-cause mortality 3 months after PCI was examined. Overall, 616,664 patients (ACS, n=202,853; sCAD, n=413,811) were analyzed. The participation rates of CR increased annually. The participation rate was higher for inpatient than outpatient CR in both the ACS (52% vs. 9%, respectively) and sCAD (15% vs. 3%, respectively) groups. Prognosis was better for patients with than without outpatient CR in both the ACS (hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.47–0.59) and sCAD (HR 0.72; 95% CI 0.65–0.80) groups. Conclusions:
Outpatient CR was associated with a better prognosis in patients with ACS or sCAD. The participation rates of outpatient CR following PCI were extremely low in Japan.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Satoshi Terasaki
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
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32
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Tsugihashi Y, Akahane M, Nakanishi Y, Myojin T, Kubo S, Nishioka Y, Noda T, Hayashi S, Furihata S, Higashino T, Imamura T. Long-term prognosis of enteral feeding and parenteral nutrition in a population aged 75 years and older: a population-based cohort study. BMC Geriatr 2021; 21:80. [PMID: 33509118 PMCID: PMC7842076 DOI: 10.1186/s12877-020-02003-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background Enteral feeding and parenteral nutrition (PN) using gastrostomy (GS) and a nasogastric tube feeding (NGT) and PN should be initiated for older patients based on their prognoses. This study aimed to investigate the long-term prognosis of patients aged ≥75 years who underwent enteral feeding via GS and NGT as well as PN. Methods A population-based cohort study was conducted using Japan’s universal health insurance claims in the Nara Prefecture. This study enrolled 3,548 patients aged ≥75 years who received GS (N=770), NGT (N=2,370), and PN (N=408) during hospital admissions between April 2014 and March 2016. The GS group was further categorized into secondary GS (N=400) with preceding NGT or PN within 365 days and primary GS (N=370) without preceding NGT or PN groups. In the secondary GS group, 356 (96%) patients received NGT (versus PN). The outcome was mortality within 730 days after receiving GS, NGT, and PN. Cox regression analyses in cases with or without malignant diseases, adjusted for sex, age, comorbidity, and hospital type, were performed to compare mortality in the groups. Results Of the 3,548 participants, 2,384 (67%) died within 730 days after the initiation of GS and NGT and PN. The 2-year mortality rates in the secondary GS, primary GS, NGT, and PN groups were 58%, 66%, 68%, and 83% in patients without malignancies and 67%, 71%, 74%, and 87% in those with malignancies, respectively. In the non-malignant group, Cox regression analysis revealed that secondary GS (hazard ratio (HR) = 0.43, 95% CI: 0.34–0.54), primary GS (HR = 0.51, 95% CI: 0.40–0.64), and NGT (HR = 0.71, 95% CI: 0.58-0.87) were statistically significantly associated with lower mortality compared with PN. Conclusions Approximately 58% to 87% patients aged ≥75 years died within 730 days after initiation of nutrition through GS, NGT, or PN. Patients with non-malignant diseases who received secondary GS exhibited better 2-year prognosis than those who received NGT or PN. Healthcare professionals should be aware of the effectiveness and limitations of enteral feeding and PN when considering their initiation.
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Affiliation(s)
- Yukio Tsugihashi
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan.
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, 351-0197, Wako-shi, Saitama, Japan
| | - Yasuhiro Nakanishi
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| | - Shuichiro Hayashi
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| | - Shiori Furihata
- Healthcare and Wellness Division, Mitsubishi Research Institute, Inc, 10-3, Nagatacho 2-Chome, Chiyoda-Ku, 100-8141, Tokyo, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute, Inc, 10-3, Nagatacho 2-Chome, Chiyoda-Ku, 100-8141, Tokyo, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
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Itami H, Morita K, Nakai T, Uchiyama T, Sugimoto S, Sasaki S, Matsuoka M, Myojin T, Nitta Y, Okabe F, Fujii T, Hatakeyama K, Mitoro A, Sho M, Ohbayashi C. Gastritis cystica profunda is associated with aberrant p53 and Epstein-Barr virus in gastric cancer: A clinicopathological, immunohistochemical and in situ hybridization study. Pathol Int 2020; 71:42-50. [PMID: 33084164 DOI: 10.1111/pin.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022]
Abstract
Gastritis cystica profunda (GCP) is a lesion characterized by cystic gastric glands within the submucosa. Some studies have reported that GCP is a precancerous lesion. Here, we investigated the association between GCP and gastric cancer. Gastric cancer specimens were taken from 1432 patients undergoing surgery or endoscopic submucosal resection and were classified as GCP or non-GCP. The clinicopathological features, immunohistochemistry and in situ hybridization expression of p53, Ki-67, KCNE2, Epstein-Barr virus (EBV) and programmed death ligand 1 (PD-L1) were compared between the two groups, as well as between GCPs and normal pyloric glands. One hundred and eighty patients (12.6%) had GCPs. In the GCP group, no cancerous lesions were found within the GCPs, but 13% were linked to GCPs and 60.2% were located above or near GCPs. Aberrant p53 expression, EBV-positive cancer cells and PD-L1 scores were significantly higher in the GCP group. The p53 score and Ki-67 labelling index were significantly higher and the KCNE2 score was significantly lower in GCPs than in pyloric glands. Although we suggest GCP is paracancerous, GCP has high proliferation activity and gastric cancer with GCP is associated with aberrant p53 and EBV. GCP is associated with aberrant p53 expression and EBV.
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Affiliation(s)
- Hiroe Itami
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Kohei Morita
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Sumire Sugimoto
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Shoh Sasaki
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Minami Matsuoka
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tomoya Myojin
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Fumi Okabe
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Akira Mitoro
- Department of Gastroenterology and Endocrinology, Nara Medical University, Nara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
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Nishioka Y, Noda T, Okada S, Myojin T, Kubo S, Higashino T, Ishii H, Imamura T. Incidence and seasonality of type 1 diabetes: a population-based 3-year cohort study using the National Database in Japan. BMJ Open Diabetes Res Care 2020; 8:8/1/e001262. [PMID: 32994226 PMCID: PMC7526280 DOI: 10.1136/bmjdrc-2020-001262] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/16/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION To investigate the incidence of type 1 diabetes by age group (0-19, 20-39, 40-59, ≥60 years) in Japan and whether there is seasonality in this incidence. RESEARCH DESIGN AND METHODS The incidence of type 1 diabetes from September 2014 to August 2017 was estimated using 2013-2018 data from the National Database of Health Insurance Claims and Specific Health Check-ups of Japan. The incidence rate was analyzed using Tango's Index and the self-controlled case series method. RESULTS Overall, 10 400 of the 79 175 553 included individuals were diagnosed with type 1 diabetes. The incidence of type 1 diabetes from September 2014 to August 2017 was 4.42/100 000 person-years. The incidence rates for men aged 0-19, 20-39, 40-59, and ≥60 years were 3.94, 5.57, 5.70, and 3.48, respectively. Among women, the incidence rates for the same age ranges were 5.22, 4.83, 4.99, and 3.31, respectively. Tango's index showed that the incidence rate of type 1 diabetes was significantly associated with seasons among those aged 0-19 years. Further, the self-controlled case series method showed a significant interaction between age and season, with the incidence of type 1 diabetes being higher in spring for patients younger than 20 years of age. CONCLUSIONS In Japan, men aged 40-59 years and women aged 0-19 years are the groups with the highest incidence of type 1 diabetes. Further, the incidence of younger-onset diabetes in Japan was higher in spring (from March to May).
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Affiliation(s)
- Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute, Inc, Tokyo, Japan
| | - Hitoshi Ishii
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Hosokawa R, Ojima T, Myojin T, Aida J, Kondo K, Kondo N. Associations Between Healthcare Resources and Healthy Life Expectancy: A Descriptive Study across Secondary Medical Areas in Japan. Int J Environ Res Public Health 2020; 17:ijerph17176301. [PMID: 32872538 PMCID: PMC7503367 DOI: 10.3390/ijerph17176301] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022]
Abstract
Japan has the highest life expectancy in the world. However, this does not guarantee an improved quality of life. There is a gap between life expectancy and healthy life expectancy. This study aimed to reveal the features of healthy life expectancy across all secondary medical areas (n = 344) in Japan and examine the relationship among healthcare resources, life expectancy, and healthy life expectancy at birth. Data were collected from Japan’s population registry and long-term insurance records. Differences in healthy life expectancy by gender were calculated using the Sullivan method. Maps of healthy life expectancy were drawn up. Descriptive statistics and correlation analysis were used for analysis. The findings revealed significant regional disparities. The number of doctors and therapists, support clinics for home healthcare facilities and home-visit treatments, and dentistry expenditure per capita were positively correlated with life expectancy and healthy life expectancy (correlation coefficients > 0.2). They also revealed gender differences. Despite controlling for population density, inequalities in healthy life expectancy were observed, highlighting the need to promote social policies to reduce regional disparities. Japanese policymakers should consider optimal levels of health resources to improve life expectancy and healthy life expectancy. The geographical distribution of healthcare resources should also be reconstituted.
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Affiliation(s)
- Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
- Correspondence: ; Tel.: +81-75-751-4154
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan;
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara 634-8521, Japan;
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
- Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Miyagi 980-8575, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba 263-8522, Japan;
- Center for Well-being and Society, Nihon Fukushi University, Aichi 470-3295, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Naoki Kondo
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan;
- Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
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Fujii T, Uchiyama T, Matsuoka M, Myojin T, Sugimoto S, Nitta Y, Okabe F, Sugimoto A, Sekita-Hatakeyama Y, Morita K, Itami H, Hatakeyama K, Ohbayashi C. Evaluation of DNA and RNA quality from archival formalin-fixed paraffin-embedded tissue for next-generation sequencing - Retrospective study in Japanese single institution. Pathol Int 2020; 70:602-611. [PMID: 32542983 DOI: 10.1111/pin.12969] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022]
Abstract
Genetic analysis on formalin-fixed paraffin-embedded (FFPE) tissue specimens has become a mainstream method, from conventional direct sequencing to comprehensive analysis using next-generation sequencing (NGS). In this study, we evaluated the quality of DNA and RNA extracted from FFPE sections, derived from surgical specimens of different tumor types. Electrophoresis was performed using a 4200 TapeStation to evaluate DNA and RNA fragmentation. DNA Ct values were higher and significantly increased over a period of 4 years compared with those from cell lines or frozen tissues. The RNA integrity number equivalent (RIN) ranged from 1 to 4.1 and DV200 ranged from 7.3 to 81%. Twelve of the 108 cases were analyzed by NGS using the AmpliSeq Cancer HotSpot Panel v2 on a Miniseq system. A sufficient number of reads and coverage were obtained in all cases. Our results revealed that NGS analysis was sufficient for FFPE-derived DNA within 4 years of preservation. Conversely, approximately 20% of the RNA derived from FFPE within 4 years from the collection could be inappropriate for gene analysis based on RIN and DV200. It was suggested that FFPE would be adequate for genetic analysis, although it is desirable to store frozen specimens for the tumor tissues to be subjected to genetic analysis.
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Affiliation(s)
- Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Minami Matsuoka
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Tomoya Myojin
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Sumire Sugimoto
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Fumi Okabe
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Aya Sugimoto
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Yoko Sekita-Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Kohei Morita
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Hiroe Itami
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
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Nishioka Y, Okada S, Noda T, Myojin T, Kubo S, Ohtera S, Kato G, Kuroda T, Ishii H, Imamura T. Absolute risk of acute coronary syndrome after severe hypoglycemia: A population-based 2-year cohort study using the National Database in Japan. J Diabetes Investig 2020; 11:426-434. [PMID: 31581351 PMCID: PMC7078084 DOI: 10.1111/jdi.13153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS/INTRODUCTION Although the epidemiological relationship between hypoglycemia and increased risk of acute coronary syndrome (ACS) has been well established, the time period for increased risk of ACS after a severe hypoglycemic episode remains unknown. The present study aimed to determine the ACS risk after a severe hypoglycemic episode. MATERIALS AND METHODS We carried out a retrospective population-based cohort study based on national claims data in Japan. We retrieved data of diabetes patients aged ≥35 years collected from April 2014 to March 2016. The absolute risk of ACS was defined as the occurrence of an emergency percutaneous coronary intervention after a severe hypoglycemic episode. RESULTS In total, data of 7,909,626 patients were included in the analysis. The absolute risk of ACS was 2.9 out of 1,000 person-years in all patients. ACS risk in patients with severe hypoglycemic episodes was 3.0 out of 1,000 person-years. Severe hypoglycemic episodes increased the absolute risk of ACS in patients aged ≥70 years, but not in patients aged <70 years. The absolute risk of ACS was 10.6 out of 1,000 person-years within 10 days of a severe hypoglycemic episode. There was a significant trend between shorter duration after an episode and higher ACS risk. CONCLUSIONS Severe hypoglycemia was associated with an increased risk of ACS in elderly diabetes patients. ACS risk increased with a shorter period after a severe hypoglycemic episode, suggesting that severe hypoglycemia leads to an increased risk of ACS in diabetes patients. These findings show that it is important to avoid severe hypoglycemia while treating diabetes, particularly in elderly patients.
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Affiliation(s)
- Yuichi Nishioka
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
- Department of DiabetologyNara Medical UniversityNaraJapan
| | - Sadanori Okada
- Department of DiabetologyNara Medical UniversityNaraJapan
| | - Tatsuya Noda
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
| | - Tomoya Myojin
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
| | - Shosuke Ohtera
- Division of Medical Information Technology and Administration PlanningKyoto University HospitalKyotoJapan
| | - Genta Kato
- Solutions Center for Health Insurance ClaimsKyoto University HospitalKyotoJapan
| | - Tomohiro Kuroda
- Division of Medical Information Technology and Administration PlanningKyoto University HospitalKyotoJapan
| | - Hitoshi Ishii
- Department of DiabetologyNara Medical UniversityNaraJapan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
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Sasaki S, Hirose T, Nobusawa S, Myojin T, Morita K, Nakai T, Hirato J, Ohbayashi C. Anaplastic diffuse leptomeningeal glioneuronal tumor associated with H3 K27M mutation. Human Pathology: Case Reports 2019. [DOI: 10.1016/j.hpcr.2019.200296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hayashi S, Noda T, Kubo S, Myojin T, Nishioka Y, Higashino T, Akahane M, Imamura T. Data regarding fracture incidence according to fracture site, month, and age group obtained from the large public health insurance claim database in Japan. Data Brief 2019; 23:103780. [PMID: 31372427 PMCID: PMC6661064 DOI: 10.1016/j.dib.2019.103780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/04/2019] [Accepted: 02/14/2019] [Indexed: 01/29/2023] Open
Abstract
The National Database of Health Insurance Claims and Specific Health Checkups of Japan includes all health insurance claims submitted in Japan and is considered representative of almost all health claims in Japan. Data regarding fracture incidence, based on the documented diagnoses in the claims and relevant procedure codes, were extracted from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. This data paper includes fracture incidence according to fracture site, month, and age group for the population in Kanto area (Tokyo and surrounding areas), which consists of approximately 42 million people. These data provide supplementary material to be interpreted for the article "Variation in Fracture Risk by Season and Weather: A Comprehensive Analysis across Age and Fracture Site Using a National Database of Health Insurance Claims in Japan" Hayashi et al., and serve as one of the largest epidemiological datasets regarding seasonal differences in fracture incidence according to fracture site and age group.
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Affiliation(s)
- Shuichiro Hayashi
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8521, Japan
| | - Tatsuya Noda
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8521, Japan
| | - Shinichiro Kubo
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8521, Japan
| | - Tomoya Myojin
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8521, Japan
| | - Yuichi Nishioka
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8521, Japan
| | - Tsuneyuki Higashino
- Management Innovation Division, Consulting Unit, Mitsubishi Research Institute, Inc., 2-10-3 Nagata-cho, Chiyoda-ku, Tokyo, 100-8141, Japan
| | - Manabu Akahane
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8521, Japan
| | - Tomoaki Imamura
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8521, Japan
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Hayashi S, Noda T, Kubo S, Myojin T, Nishioka Y, Higashino T, Imamura T. Variation in fracture risk by season and weather: A comprehensive analysis across age and fracture site using a National Database of Health Insurance Claims in Japan. Bone 2019; 120:512-518. [PMID: 30576867 DOI: 10.1016/j.bone.2018.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/29/2018] [Accepted: 12/17/2018] [Indexed: 12/29/2022]
Abstract
Although age- and season-specific effects on fracture risk have been reported, the effects of seasonality across different age groups and for different fracture sites have not yet been clarified. Therefore, our study aimed to comprehensively investigate the effects of seasonality on fracture risk across age and fracture sites using a large-scale population database of fracture incidence. Fracture data were accumulated over a 3-year period in the region of Tokyo and in surrounding areas, which accounts for a total population of 42 million. Information on fracture occurrence, fracture site, and patient demographics were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Over the study period, 508,051 fractures were identified across the following five age groups: 0-19, 20-39, 40-64, 65-79, and 80+ years. The incidence rate for fractures in 10 site groups was calculated. Fracture risk was the highest in the spring and autumn for children aged 0-19 years and was the highest in the winter for elderly individuals (65-79 and 80+ years). Toe fractures, which occurred more frequently in the summer, were the most notable exception. The risk of fracture of the distal radius and hip was associated with daily temperature and rainfall and was elevated on days with a mean temperature higher than that of the previous day. Fracture risk exhibited seasonal variations that differed between children and elderly individuals and between toe fractures and fractures at other sites. These findings can help us understand the epidemiology of fractures and develop preventive strategies, as well as aid in the allocation of healthcare resources.
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Affiliation(s)
- Shuichiro Hayashi
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8521, Japan
| | - Tatsuya Noda
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8521, Japan.
| | - Shinichiro Kubo
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8521, Japan
| | - Tomoya Myojin
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8521, Japan
| | - Yuichi Nishioka
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8521, Japan
| | - Tsuneyuki Higashino
- Management Innovation Division, Consulting Unit, Mitsubishi Research Institute, Inc., 2-10-3 Nagata-cho, Chiyoda-ku, Tokyo 100-8141, Japan
| | - Tomoaki Imamura
- Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8521, Japan
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Itami H, Nakamine H, Takeda M, Nakai T, Myojin T, Matsuoka M, Sasaki S, Uchiyama T, Morita K, Fujii T, Hatakeyama K, Ohbayashi C. Immunohistochemical Reappraisal Regarding the Frequency of Primary Salivary Gland Follicular Lymphoma. Int J Surg Pathol 2018; 27:48-54. [PMID: 29972093 DOI: 10.1177/1066896918784349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although it has been described that extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas) are the most common type among primary salivary gland lymphomas (SGLs), some studies revealed that the frequency of follicular lymphomas (FLs) was as high as that of MALT lymphomas. However, it has been reported that many of these FLs may have developed in lymph nodes attached to the capsule of the glands or intraglandular lymph nodes. Clinical, histological, immunohistochemical, and cytogenetic features of 11 SGL cases, which were extracted from our surgical pathology file consisting of consecutive pathology cases, were reevaluated to further characterize whether they were actually primary SGLs. There were 3 (27%) cases of FLs, 5 (46%) cases of MALT lymphomas, and 3 (27%) cases of diffuse large B-cell lymphomas. Although all of our FL cases fulfilled the criteria of primary SGL, tumors of several FL cases were surrounded by podoplanin (by D2-40)-positive elongated vessels or linear structures indicative of nodal subcapsular sinuses (open or remnant). This finding would support the aforementioned possibility, and podoplanin staining is necessary before concluding that a FL is a primary SGL.
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Affiliation(s)
| | | | - Maiko Takeda
- 1 Nara Medical University, Kashihara, Japan.,3 National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
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Myojin T, Ojima T, Kikuchi K, Okada E, Shibata Y, Nakamura M, Hashimoto S. Orthopedic, ophthalmic, and psychiatric diseases primarily affect activity limitation for Japanese males and females: Based on the Comprehensive Survey of Living Conditions. J Epidemiol 2016; 27:75-79. [PMID: 28142015 PMCID: PMC5328730 DOI: 10.1016/j.je.2016.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background Healthy life expectancy (HLE) is used as one of the primary objectives of fundamental health promotion plans and social development plans. Activity limitation is used to calculate HLE, but little study has been done to identify determinants of activity limitation in order to extend HLE. The purpose of this study is to identify diseases and injuries that commonly lead to activity limitation to prioritize countermeasures against activity limitation. Methods We used anonymous data from the 2007 “Comprehensive Survey of Living Conditions,” collected by the Ministry of Health, Labour and Welfare of Japan according to the Statistics Act, Article 36. We used logistic regression analyses and calculated odds ratios (ORs) after adjusting for age and sex. Limitation in daily activities was applied as the dependent variable, and each disease/injury was applied as an independent variable in this analysis. Furthermore, population attributable fractions (PAFs) were calculated. Results The provided data included 98,789 subjects. We used data for 75,986 valid subjects aged 12 years or older. The following diseases showed high PAF: backache (PAF 13.27%, OR 3.88), arthropathia (PAF 7.61%, OR 4.82), eye and optical diseases (PAF 6.39%, OR 2.01), and depression and other mental diseases (PAF 5.70%, OR 11.55). PAFs of cerebrovascular diseases, hypertension, and diabetes were higher for males than for females; on the other hand, PAFs of orthopedic diseases were higher among females. Conclusions Our results indicate that orthopedic diseases, ophthalmic diseases, and psychiatric diseases particularly affect activity limitation.
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Affiliation(s)
- Tomoya Myojin
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Keiko Kikuchi
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Eisaku Okada
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yosuke Shibata
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shuji Hashimoto
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Kawakami S, Myojin T, Cho HS, Hatamachi T, Gokon N, Kodama T. Thermochemical Two-step Water Splitting Cycle using Ni-ferrite and CeO2 Coated Ceramic foam Devices by Concentrated Xe-light Radiation. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.egypro.2014.03.210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Mesothelioma is a malignancy with poor prognosis. It is chiefly caused by asbestos exposure and its symptoms can occur about 30-50 yr after the initial exposure. This study aims to predict the future trends in mesothelioma mortality in Japan using a method that is an alternative to the age-cohort model. Our approach is based on a risk function that links mesothelioma mortality combined with data pertaining to the population, size of the labor force, and quantity of asbestos imports. We projected the number of deaths occurring in individuals aged 50-89 for yr 2003-2050 using risk functions. Our results have indicated that mesothelioma mortality among Japanese people aged 50-89 yr will continue to increase until 2027 and reach a maximum of 66,327 deaths in the years 2003-2050. Our estimate has also suggested that the number of mesothelioma deaths could be significantly reduced if there were adequate compliance with the administrative level guidelines for occupational asbestos exposure.
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Affiliation(s)
- Tomoya Myojin
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Japan
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Konno A, Myojin T, Matsumoto T, Tsujita T, Uchiyama M. An impact dynamics model and sequential optimization to generate impact motions for a humanoid robot. Int J Rob Res 2011. [DOI: 10.1177/0278364911405870] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
When a human needs to generate a large force, they will try to apply an impulsive force with dynamic cooperation of the whole body. In this paper we first discuss impact dynamics of humanoid robots and then propose a way to generate impact motions for a humanoid robot to exert a large force while keeping a balance. In the impact motion generation, Sequential Quadratic Programming (SQP) is used to solve a non-linear programming problem in which an objective function and constraints may be non-linear functions of the motion parameters. Impact motions are generated using SQP so that the impact force is maximized while the angular momentum is minimized. Breaking wooden boards with a Karate chop is taken as a case study because it is a typical example of tasks that utilize impulsive force. A humanoid robot motion for the Karate chop is generated by the proposed method. In order to validate the designed motion, experiments are carried out using a small humanoid robot Fujitsu HOAP-2. The Karate-chop motion generated by the proposed method is compared with the motion designed by a human. The results of breaking the wooden boards experiments clearly show the effectiveness of the proposed method.
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Affiliation(s)
- Atsushi Konno
- Department of Aerospace Engineering, Tohoku University, Sendai, Japan
| | - Tomoya Myojin
- Department of Aerospace Engineering, Tohoku University, Sendai, Japan
| | - Takaaki Matsumoto
- Department of Aerospace Engineering, Tohoku University, Sendai, Japan
| | - Teppei Tsujita
- Department of Aerospace Engineering, Tohoku University, Sendai, Japan
| | - Masaru Uchiyama
- Department of Aerospace Engineering, Tohoku University, Sendai, Japan
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Itoi S, Odaka J, Yuasa K, Akeno S, Nakajima A, Suenaga A, Noda T, Akimoto S, Myojin T, Ikeda Y, Masuda Y, Takai N, Yoshihara K, Sugita H. Distribution and species composition of juvenile and adult scombropids (Teleostei, Scombropidae) in Japanese coastal waters. J Fish Biol 2010; 76:369-378. [PMID: 20738713 DOI: 10.1111/j.1095-8649.2009.02493.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Two scombropid fishes, Scombrops boops and Scombrops gilberti, are closely related and commercially important species in Japan. These species are often confused in commercial markets because of their morphological similarity. In this study, scombropid specimens collected from various Japanese coastal waters were subjected to polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis and phylogenetic analysis of the 16S rRNA gene in mitochondrial DNA. These analyses showed that all the scombropid specimens collected from localities in the Sea of Japan were identified as S. boops, whereas those from the Pacific Ocean included two species, S. boops and S. gilberti. Almost all juvenile (<200 mm standard body length, S(L)) S. gilberti originated from the Pacific coastal waters of the northern Japan, whereas adults (>400 mm S(L)) were found only in deep water off the Izu Peninsula to the Izu Islands. This suggests that S. gilberti might migrate extensively during its life cycle. In addition, differences in the number of specimens and the distribution between the two species suggest that S. gilberti is less abundant than S. boops in Japanese waters.
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Affiliation(s)
- S Itoi
- Department of Marine Science and Resources, Nihon University, Fujisawa, Kanagawa 252-8510, Japan.
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Abstract
The occurrence and density of distribution of nerves and endocrine cells that are immunoreactive for neuropeptides in the bovine pancreas were studied by immunohistochemistry. The six neuropeptides localized were galanin (GAL), substance P (SP), methionine-enkephalin (MENK), neuropeptide Y (NPY), calcitonin gene-related peptide (CGRP) and vasoactive intestinal polypeptide (VIP). The exocrine pancreas was shown to have an appreciable number of GAL- and SP-immunoreactive nerve fibres but few fibres showing immunoreactivity for VIP and CGRP. Numerous MENK-, GAL-, SP-, and NPY-immunoreactive nerve fibres were seen in the endocrine portion of the pancreas. Nerve cell bodies in the intrapancreatic ganglia showed immunoreactivity for all of the neuropeptides except CGRP. Endocrine cells showing immunoreactivity for GAL and SP were observed in the large islets and islets of Langerhans, respectively. The present results indicate a characteristic distribution of neuropeptides in the bovine pancreas, which may regulate both exocrine and endocrine secretions of pancreas.
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Affiliation(s)
- T Myojin
- Department of Veterinary Anatomy, Obihiro University of Agriculture and Veterinary Medicine, Japan
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Nishizawa M, Myojin T, Nishino Y, Nakai Y, Kamata M, Aida Y. A carboxy-terminally truncated form of the Vpr protein of human immunodeficiency virus type 1 retards cell proliferation independently of G(2) arrest of the cell cycle. Virology 1999; 263:313-22. [PMID: 10544105 DOI: 10.1006/viro.1999.9905] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vpr, one of the accessory gene products of HIV-1, is a 96-residue protein with several functions. It is involved in import of the HIV-1 preintegration complex into the nucleus of nondividing cells, in cellular differentiation, inducing cell cycle arrest at the G(2)/M phase, in immune suppression, and in enhancement of replication of the virus. We found recently that Vpr interferes with the proliferation of mouse NIH3T3 fibroblasts but fails to arrest these cells in the G(2) phase. Thus, it seems possible that Vpr might retard cell proliferation via a novel pathway that is distinct from G(2) arrest. To elucidate the mechanism by which Vpr induces the retardation of cell growth, we developed a panel of expression vectors that encoded Vpr molecules with deletions of specific putative domains, namely, the first alpha-helical domain, the second alpha-helical domain, a leucine zipper-like domain, and an arginine-rich carboxy-terminal domain. These vectors were introduced into HeLa cells since expression of Vpr can induce G(2) arrest in such cells. A carboxy-terminally truncated form of Vpr, C81, which failed to induce G(2) arrest, led to the G(1) arrest and retained the ability to prevent cell proliferation. All the other mutant proteins had completely lost the capacity to induce G(2) arrest and to suppress growth. Substitutions of Ile/Leu for Pro at positions 60, 67, 74, and 81 within the leucine zipper-like domain of Vpr or of C81 revealed that Ile60, Leu67, and Ile74 play an important role in the C81-induced suppression of growth, while Ile74 and Ile81 were found to be indispensable for Vpr-induced G(2) arrest. Collectively, our results strongly suggest that Vpr can retard cell proliferation independently of G(2) arrest of the cell cycle.
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Affiliation(s)
- M Nishizawa
- Tsukuba Life Science Center, The Institute of Physical and Chemical Research (RIKEN), 3-1-1 Koyadai, Tsukuba, Ibaraki, 305-0074, Japan
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Iwashige T, Myojin T, Ohi K, Shibasaki M, Atsukawa R. [Effects of a rehabilitation program for alcoholic inpatients based on the MMPI]. Nihon Arukoru Yakubutsu Igakkai Zasshi 1997; 32:548-57. [PMID: 9483937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 53 male inpatients of alcohol dependence syndrome (ICD-10) at the time of their admission to the Alcoholism Rehabilitation Program (ARP) of Shiga Mental Health Center Hospital and again at the time of their discharge. The pretreatment profile had high peaks above 60 on the scale F, Hs, D, Hy, Pd, Pa, Pt, Sc and MAS. The 20 scales in the 27 examined scales changed significantly after the 84 days' treatment in the direction of reduced symptoms (Table 3). The changes in scores between pre and post treatment objectively showed that the ARP was effective as the treatment of alcoholism. It might be the base of all the recovery that the subjects regained their intelligence through the sobriety. Their changes in scores failed to predict their prognoses.
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Affiliation(s)
- T Iwashige
- Shiga Mental Health Center Hospital, Japan
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Nishino Y, Myojin T, Kamata M, Aida Y. Human immunodeficiency virus type 1 Vpr gene product prevents cell proliferation on mouse NIH3T3 cells without the G2 arrest of the cell cycle. Biochem Biophys Res Commun 1997; 232:550-4. [PMID: 9125220 DOI: 10.1006/bbrc.1997.6186] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Human immunodeficiency virus type 1 Vpr is a 96-amino-acid virion-associated protein that arrests cells in the G2 phase of the cell cycle in peripheral blood lymphocytes, HeLa, 293, 293T, A549, Jurkat, CEM, SupT1, CV-1 and COS1 cells. When we transfected Vpr expression vector into mouse NIH3T3 and then cultured it in the presence of G418, NIH3T3 cells were the drug resistant cells yielded. The surviving colonies, however, exhibited a degenerating morphology up to 8 approximately 20-fold smaller than the control vector colonies. In addition, the growth of NIH3T3 cells transiently transfected with Vpr expression vector declined dramatically compared with that of transfectants with control vector, suggesting that Vpr significantly interferes with cell proliferation of NIH3T3 cells. Cell cycle characterization by flow cytometry indicated that expression of Vpr did not induce G2 cessation in NIH3T3. These findings strongly suggest that Vpr has a novel pathway to retard cell growth independently and arrests the G2 phase of the cell cycle.
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Affiliation(s)
- Y Nishino
- Laboratory of Gene Technology and Safety, Institute of Physical and Chemical Research (RIKEN), Ibaraki, Japan
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