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Initial intravenous immunoglobulin (IVIG)-refractory status and prolonged fever are established risk factors for the development of coronary artery abnormalities (CAAs) among patients with acute-phase Kawasaki disease (KD). However, whether different risk factors exist for initial unresponsiveness to IVIG and CAA development remains unclear.To evaluate whether different risk factors exist for initial unresponsiveness to IVIG and CAA development among patients with KD (stratified by age at disease onset).This retrospective cohort study included a consecutive sample of 2414 patients from a database of patients with KD from October 1, 1999, to September 30, 2019. The data were based on annual surveys (response rate, 100%) using hospital medical records across Wakayama Prefecture, Japan. Data were analyzed from March 6 to March 26, 2022.The patient's age and diagnosis of KD by board-certified pediatricians using the criteria established by the Japan KD Research Committee.Initial unresponsiveness to IVIG, defined as treatment with optional or advanced therapies, and development of CAAs. Echocardiograms performed 1 month after KD onset using the Japanese Ministry of Health criteria evaluated the presence or absence of CAAs. Odds ratios (ORs) with 95% CIs of patient age at KD onset for unresponsiveness to IVIG and developing CAAs were calculated using multivariable logistic regression models.A total of 2414 patients (1403 male patients [58.1%]; median age at onset of KD, 25 months [range, 1-212 months]) were included in the study: 550 younger than 12 months, 1342 aged 12 to 47 months, and 522 older than 47 months. A total of 535 patients (22.2%) received optional or advanced treatment and 68 patients (2.8%) developed CAAs 1 month after disease onset. The sex-adjusted OR among patients younger than 12 months for unresponsiveness to IVIG was 0.77 (95% CI, 0.59-0.99) and for development of CAAs was 1.94 (95% CI, 1.07-3.52); among those older than 47 months, the OR for unresponsiveness to IVIG was 1.32 (95% CI, 1.05-1.67) and for development of CAAs was 2.47 (95% CI, 1.39-4.39). After adjusting for IVIG administration, ORs among boys older than 47 months for unresponsiveness to IVIG was 1.14 (95% CI, 0.84-1.56) and for development of CAAs was 2.15 (95% CI, 1.08-4.30); among girls younger than 12 months, the OR for unresponsiveness to IVIG was 1.02 (95% CI, 0.65-1.60) and for development of CAAs was 3.79 (95% CI, 1.21-11.90).The results of this study suggest that risks of unresponsiveness to IVIG and the development of CAAs differ between infants with KD and older patients with KD. Residual risk factors for KD-related CAAs other than initial unresponsiveness to IVIG should be addressed, particularly in infants.

Background: Epidemiological studies show a U-shaped tendency in Kawasaki disease (KD)-related coronary artery abnormalities (CAAs) across age categories. Since studies suggest seasonal variations in KD onset, this study aimed to clarify the epidemiologic features of CAAs, considering the seasons of KD-occurrence. Methods: We analyzed 2,106 (males = 1,215, females = 891) consecutive KD cases from October 1999 through September 2017 using our electronic database of annual surveys, targeting all hospitals with pediatric departments across Wakayama, Japan. The primary outcome was the presence/absence of CAAs measured by echocardiography 1 month after KD onset. Odds ratios (ORs) and 95% confidence intervals (CIs) of combined patient age and sex for CAAs were calculated using logistic regression models adjusted for four seasons. Results: The median age was 25 (range, 1–212) months. The proportion of males decreased with increasing age. The youngest age group (1.0) in KD-occurrence. CAAs were observed in 2.8% of cases (males = 3.4%, females = 2.1%), which significantly lessened in summer than in other seasons. Moreover, 50% (n = 4/8) of cases with giant aneurysms experienced KD in autumn. Adjusted ORs for CAAs among males aged ≥60 months (3.0; 95%, CI 1.2–7.5) and females aged

The treatment guidelines for acute Kawasaki disease (KD) have been revised several times. Moreover, the criterion used to define coronary artery abnormalities (CAAs) has changed from the coronary artery's internal diameter to the Z-score. Treatment for KD and methods for evaluating CAAs vary between hospitals, so we investigated the actual status of acute KD treatment and development of CAAs under the 2012 Japanese treatment guidelines for acute KD.The 24th Japanese Nationwide Survey on Kawasaki Disease yielded 2618 patients who developed KD in the Kinki area in 2016. We sent a secondary questionnaire to each participating hospital and used the resulting data to investigate the frequency of CAAs according to Z-score, treatment by KD treatment stage, and predictors of CAAs.The response rate was 80.0%. The data for 1426 patients without major data deficiencies were examined. The frequency of CAAs was 3.0% when based on coronary artery internal diameters and 8.8% when based on Z-scores. Intravenous immunoglobulins combined with corticosteroids were administered as an initial treatment in 12.8% of cases and as a second-line treatment in 16.8% of cases. Corticosteroids, cyclosporine A, infliximab, and plasma exchange were used at similar frequencies for third-line treatment. A pretreatment maximum coronary artery Z-score of ≥1.9 and age1 year were associated with significantly higher incidences of CAAs.Using the Z-score resulted in a threefold increase in the number of patients diagnosed with CAAs. A pretreatment maximum coronary artery Z-score of ≥1.9 and age1 year are useful predictors of CAAs.

Risk factors for coronary artery lesion (CAL) development in patients with Kawasaki disease (KD) include male sex, age < 12 months, intravenous immunoglobulin (IVIG) resistance, and delayed diagnosis.. We aimed to explore the relationship between CAL development and Z-score. We enrolled 281 patients with KD who were treated with our protocol. Echocardiography was performed in three phases: pre-treatment (P1), post-treatment (P2), and 4 weeks after onset (P3). The highest Z-score of the right, left main, left anterior descending, and left circumflex coronary arteries was expressed as Zmax at each phase. P3-Zmax ≥ 2.5 represented CAL development. Clinical parameters, such as laboratory data and Z-scores, were retrospectively compared between patients with and without CAL development. Sixty-seven patients (23.8%) showed a P1-Zmax ≥ 2.0, and CAL development occurred in 21 patients (7.5%). Independent risk factors associated with CAL development were P1-Zmax, a ΔZmax (P2-Zmax - P1-Zmax) ≥ 1, male sex, < 12 months of age, and resistant to the first intravenous immunoglobulin (IVIG) administration (adjusted odds ratio [95% confidence interval]: 198 [1.01-3.92], 4.04 [1.11-14.7], 6.62 [1.33-33.04], 4.71 [1.51-14.68], 5.26 [1.62-17.13], respectively). Using receiver operating characteristic curve analysis, a P1-Zmax ≥ 1.43 detected CAL development with an area under the curve of 0.64 (sensitivity = 81.0%; specificity = 48.1%).Conclusion: Our results suggest that P1-Zmax and a ΔZmax (P2-Zmax - P1-Zmax) ≥ 1 may predict CAL development. What is Known: • KD is an acute vasculitis predominantly affecting the coronary artery of young children. • Although P1 Z-max ≥ 2.0 has been a predictor of CAL development, it has not yet been shown in Japan. What is New: • P1-Zmax and a ΔZmax ≥ 1 are presumably associated with CAL development. • In the ROC curve analysis, P1-Zmax ≥ 1.43 detected CAL development, a sensitivity (81%) and a specificity (48%). We need to consider intensified initial therapy for patients with these risk factors.

This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I2 = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I2 = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I2 = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I2 = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.

Background: Cervical cancer is a notable vaccine-preventable disease. Previous studies support a two-pronged approach incorporating human papillomavirus (HPV) vaccination and cervical screening. Diagrams enabling the visual evaluation of cervical cancer control by displaying the HPV vaccination and cervical screening rates are lacking in both small jurisdictions and at the nation/country level. This study generated a simple scatter chart displaying both rates, enabling the identification of a relevant area in which to investigate concrete primary and secondary prophylactic measures. Methods: Data on HPV vaccination and cervical screening from local governments in Wakayama, Japan, were obtained from e-Stat for the following populations: the target population for HPV vaccination in 2013, vaccinated people, and women aged ≥ 20 years who had undergone cervical screening. The relationship between the HPV vaccination and cervical screening rates was analysed in eight public health centre units, and a scatter chart was created with prefectural average values. Then, one local government with relatively high HPV vaccination and cervical screening rates was selected for a historical case study with archived documents. Findings: HPV vaccination and cervical screening rates differed substantially among the relevant units (highest: 47.1% and 50.4%; lowest: 8.1% and 36.8%). We constructed scatter charts with four profiles of vaccination and screening rates (high-high, high-low, low-high, and low-low). Good-practice areas were characterised by the systematic implementation of community- and school-based cervical cancer awareness programmes and personalised information provision. Interpretation: This scatter chart visualises the two-pronged approach to primary and secondary cervical cancer prophylaxis for cervical cancer control in relevant areas. Such charts can help local governments prioritise measures for cervical cancer control among target residents. To promote cervical cancer control, a plan-do-check-act cycle should be implemented in the relevant cancer control area through a person-centred perspective for target residents, especially those who have missed HPV vaccinations. Funding: None. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Not applicable.

There are many psychosocial and biomedical risk factors for postpartum depression (PPD). However, associations between co-resident family members and PPD risk have not been examined. This study investigated whether co-resident family members were associated with risk for PPD during 1 month postpartum among Japanese women, and if these associations were modified by household income and their perceived partner's involvement in childcare. The sample comprised 86,490 women. Data were drawn from the Japan Environment and Children's Study, a large-scale national cohort study started in 2011. Our major predictor was co-resident family members when they registered around the first trimester of the women's pregnancy: partner, parent(s), parent(s)-in-law, or child(ren). The outcome was PPD at 1 month after delivery, assessed by the Edinburgh Postnatal Depression Scale. Adjusted odds ratios (OR) for family members and PPD incidence were calculated using multivariable logistic regression analysis. Subgroup analyses were conducted by household income and perceived partner's involvement in childcare. Adjusted ORs (95% confidence interval) for PPD for those not living with their partner, parent(s), parent(s)-in-law, or child(ren) compared with those who lived with these family members were 1.21 (1.07-1.37), 1.13 (1.03-1.24), 0.91 (0.84-0.98), and 1.42 (1.31-1.53), respectively. The level of perceived partner's involvement in childcare changed the identified association between family member and PPD. We found that "who a pregnant woman lives with" affects the risk of PPD in the first month postpartum, and high levels of perceived partner's involvement in childcare reduced harmful effects/increased protective effect of family members on PPD incidence. These findings suggested that interventions to increase perceived partner's support for childcare may be effective in preventing PPD, regardless of living situation.

Background Maternal smoking during pregnancy is a major risk for adverse perinatal outcomes, as well as children's health status. Thus, it is important to describe maternal smoking status during pregnancy and child-rearing to devise better intervention strategies. However, there have been no longitudinal studies to describe the status. Thus, in this study, we aimed to describe maternal smoking status during pregnancy and child-rearing based on population-based maternal and child health information. Moreover, we explored the factors associated with maternal smoking relapse after delivery. Methods We performed a survey of 1,220 mothers in a Japanese rural area who responded to a questionnaire upon registration of their pregnancies. When their children received health checkups at 4, 18, and 36 months of age, maternal smoking status was also surveyed. We then performed multiple logistic regression analysis to explore factors associated with maternal smoking relapse after delivery. Results Ultimately, the total number of mothers with data available for longitudinal analysis was 727 (59.6%). At the time of pregnancy registration, there were 74 current smokers (10.2%) and 176 former smokers (24.2%). Among them, 59 (33.5%) relapsed after delivery. Under 28 years of maternal age at pregnancy registration (OR 2.6; 95% CI, 1.2-5.4) was associated with maternal smoking relapse after delivery. Conclusions Longitudinal analyses showed that about 60% of mothers who smoked before and after delivery failed smoking cessation. In addition, younger mothers were significantly likely to relapse smoking after delivery.

In this study, we examined the changes in the demographic characteristics of foreign residents in Japan (FRJ) and the current status of FRJ from a global health perspective. We also considered child maltreatment that occurred in FRJ families and language problems in child welfare. Japan's official statistics in the end of 2017 indicated that there were more than 2.56 million FRJ from over 190 countries. This population was diverse with heterogeneous characteristics, such as age structure, dwelling place, marital status, and childbirth. At the end of 2017, there were 219,982 FRJ children aged 0-14 of various nationalities, including Chinese, Brazilian, South Korean, North Korean, Filipino, Vietnamese, Peruvian, Nepalese, and Indian. In 2010, we conducted our first survey of child maltreatment in FRJ families, targeting 219 child protection centers across Japan. Between April 2007 and August 2010, 1,639 child maltreatment cases were reported from 56% of these centers. Details of 1,111 cases were collected and descriptive analyses were conducted. The male-to-female ratio was 0.88 and the median age was 8 years: however, the age distribution showed that females were significantly older than males (P < 0.01). The proportions of physical abuse, child neglect, emotional abuse, and sexual abuse were 38%, 33%, 21%, and 7%, respectively. Native language problems created numerous challenges and required a large amount of effort from child welfare practitioners. However, most solutions to identified problems were still at the beginning stage and some were found to be ineffective. More interdisciplinary and integrated researches are needed targeting child welfare of FRJ. An ethical framework for good counseling practices should be developed.

In 1952, the Japanese Society for Hygiene had once passed a resolution at its 22nd symposium on population control, recommending the suppression of population growth based on the idea of cultivating a healthier population in the area of eugenics. Over half a century has now passed since this recommendation; Japan is witnessing an aging of the population (it is estimated that over 65-year-olds made up 27.7% of the population in 2017) and a decline in the birth rate (total fertility rate 1.43 births per woman in 2017) at a rate that is unparalleled in the world; Japan is faced with a “super-aging” society with low birth rate. In 2017, the Society passed a resolution to encourage all scientists to engage in academic researches to address the issue of the declining birth rate that Japan is currently facing. In this commentary, the Society hereby declares that the entire text of the 1952 proposal is revoked and the ideas relating to eugenics is rejected. Since the Society has set up a working group on the issue in 2016, there have been three symposiums, and working group committee members began publishing a series of articles in the Society’s Japanese language journal. This commentary primarily provides an overview of the findings from the published articles, which will form the scientific basis for the Society’s declaration. The areas we covered here included the following: (1) improving the social and work environment to balance between the personal and professional life; (2) proactive education on reproductive health; (3) children’s health begins with nutritional management in women of reproductive age; (4) workplace environment and occupational health; (5) workplace measures to counter the declining birth rate; (6) research into the effect of environmental chemicals on sexual maturity, reproductive function, and the children of next generation; and (7) comprehensive research into the relationship among contemporary society, parental stress, and healthy child-rearing. Based on the seven topics, we will set out a declaration to address Japan’s aging society with low birth rate.

Highlights • Smoking in young adulthood is more common among those from households with smokers. • Being from smoking households is linked to low educational levels in young adulthood. • More childhood household smokers corresponds to worse outcomes for young adults. • Exposure to household smokers in childhood appears to perpetuate health inequality., Smoking in young adulthood is a risk factor for future health-related disabilities and a cause of expanding health inequalities. Education and smoking are inversely associated. Using population-based representative data, this study aimed to clarify how the presence of household smokers during childhood related to both current smoking status and educational attainment among young adults. Surveys were distributed to young adults (19–20 years) invited to coming-of-age ceremonies in 2014–2017 in a rural area in Japan. Data were collected on low educational attainment (defined as ≤ 12 years of education), current smoking status, and childhood household smoking status. We used logistic regression models to calculate odds ratios (ORs) of low educational attainment for household smoking status. A total of 17.6% of men (n = 1077) and 3.8% of women (n = 1021) were current smokers. Current smoking was more common among participants from households with smokers (P

This study evaluated the effects of childhood experiences of parental corporal punishment (CP) and neglectful parenting (NP) on Japanese university students' endorsement of parental CP (EPP) to discipline children, in relation to subjective happiness (SH). A total of 536 undergraduate students who showed no physical symptoms completed anonymous paper-based questionnaires addressing demographic characteristics, undergraduate classes, and recent health conditions on SF-8 (PCS, MCS). It was found that the proportions of participants who experienced pervasive CP and NP were larger in men than in women (36.5% vs. 19.4% for CP; 22.1% vs. 9.7% for NP). Multiple regression analyses (n = 346) revealed that the CP score was associated with positive EPP (β = 0.310, p < 0.001). Further, students whose major was nursery education reported significantly lower level of EPP; however, neither SH nor good recent health conditions significantly reduced EPP. The NP score was inversely associated with the SH score (β = -0.253, p < 0.001) (n = 346). In conclusion, childhood experiences of parental CP may affect adolescents' views related to their own parenting. Further investigation using internationally comparable methodologies, especially in prospective cohort studies, is warranted, not only in Japan but also in other Asian countries.

Japanese apricot (Prunus mume; ume) is a traditional food in Japan that has been shown to have various beneficial health effects. There is some evidence to suggest that ume is also effective against allergic disease. Here, we conducted a cross-sectional epidemiological pilot study to examine the association between ume intake frequency and allergic symptoms including rhinitis in 563 adults (288 men and 275 women) who resided in Wakayama, Japan. After adjusting for age, present illness and medication, women with high ume intake had significantly lower odds ratio (OR) for the presence of symptoms of allergy [OR: 0.49 with 95% confidence interval (CI): 0.25–0.97]. Therefore, we investigated the anti-allergic effect of ume on passive cutaneous anaphylaxis (PCA) reaction in immunoglobulin E (IgE)-sensitized mice. The animal study demonstrated that oral administration of ume extract attenuated the PCA reaction and mast cell degranulation. Furthermore, RBL-2H3 mast cells were used to identify anti-allergic ume compounds. The following ume compounds inhibited IgE-mediated mast cell degranulation: vanillin, syringic acid, protocatechuic aldehyde, lyoniresinol and p-coumaric acid. These results suggested that ume has the potential to inhibit mast cell degranulation and may be associated with reduced risk of allergic symptoms in women.

Age and Seasonal Variation in Kawasaki’s Disease In Wakayama Prefecture, Japan, children older than 7 years of age in whom Kawasaki’s disease developed were more likely to be female, have disease o...

Purpose Among the factors that adversely affect the time needed for ambulance transport, one factor for which intervention is possible is the time it takes to choose a medical receiving facility. This research clarified the characteristics of the time, location, and severity of medical emergencies in which the choice of hospital was difficult.Methods The research covered a 1-year period from January 1 through December 31, 2014, investigating all incidents of ambulance transport for patients in Wakayama Prefecture, except for those involving pediatric patients, amounting to a total of 41,574 incidents. Of those, the number of referrals was missing in 129 cases and the remaining 41,445 incidents were analyzed. Cases with 4 or more referrals were adopted as an indicator of difficulty in choosing a hospital. Using binary logistic regression analysis, odds ratios (ORs) with 95% confidence intervals (CIs) were computed for the times and locations of emergency calls, and the degree of injury or illness. A comprehensive analysis was performed, and stratified analysis by Major Diagnostic Category (MDC) was performed, examining external injuries, burns, and poisoning; nervous system disorders; digestive system, liver, biliary tract, and pancreatic disorders; respiratory disorders; and circulatory system disorders.Results The distribution of numbers of referrals ranged from 1 to 12, and 79.6% of cases involved 1 referral, while cases with 4 or more referrals made up 3.5% of the total. In the overall analysis, for cases with 4 or more referrals, call times were examined using weekday working hours as a reference; all other times had high ORs (at 95%CI). The highest OR (95%CI) of 4.0 (3.2-5.0) was for late nights during weekends and holidays. Regarding the degree of injury or illness, using moderate and mild injuries as a reference, the number of referrals (3 times or fewer) was significantly lower for severe injuries and incidents of death (0.8;0.7-0.9). However, in the results of the stratified analysis by MDC, external injuries, burns, and poisoning; severe injury; and death each had an OR (95%CI) of 1.4 (1.0-1.8).Conclusion The relationship between the time, location, and severity of medical emergencies was examined using the number of referrals as an indicator of difficulty with hospital choice in ambulance transport. This research clarified that cases late at night during weekends and holidays, and moderate and mild injuries caused the most difficulty, and that the problems depended on the secondary medical district.

O bjective: To describe our personal experience of the potential of a rare disease patient organization for fostering patient autonomy and creating a space for the practice of power sharing between physicians and patients. M e t hods: Using self-reflection and personal autobiographical experience while drawing on the conceptual framework of patient-centredness, we critically reflect on and formulate lessons from our experiences as a patient/researcher and physician/researcher active in a rare disease patient organization for hereditary angioedema established in Japan in 2013. Results: We identified multiple ways in which patient advocacy meetings shifted the patient-physician relationship to one of sharing power and responsibility. Appearing without his or her symbolic white coat, the physician is transformed into a person. In the context of shared group activities, the patient emerges as a person and one who is increasingly an informed and informing actor. Conclusion: A dedicated rare disease patient organization has the potential to function as a catalyst for moving from a paternalistic to a power-sharing model of the patient-physician relationship. It can act as a transformative resource for all key actors. Practice implications: The patient organization potentially reduces formal barriers and allows for the practice of effective patient-physician interactions, even in a cultural setting where paternalism generally shapes relationships. This can build social capital for both patient and physician.

Medications or lifestyle changes to prevent or improve hypertension often press considerable efforts on patients suffering from mild hypertension. Beverages including Umezu polyphenols (UP), polyphenols in Japanese plums, may help them to control their blood pressure. Healthy medical students, workers, and community dwellers who had some concerns about their blood pressure were randomized in a doubleblind manner into UP ingesting and placebo groups. The first two samples (medical students and workers) were placed in a preliminary study, and based on the results from that study, and the dose of UP for the community dwellers was determined. All three groups were followed for 5 weeks, and blood pressure, as well as biochemical markers related to hypertension and atherosclerosis and self-perceived quality-of-life outcomes, was monitored during that period. Group × time interactions on blood pressure changes were examined. For the community dwellers, blood pressure changes did not significantly differ between the UP ingesting and placebo groups. And although studies of students and workers showed subtle differences in blood pressure among the UP and placebo groups, a dose-dependent effect of UP on decreasing blood pressure could not be confirmed. On the other hand, anti-oxidative effects of UP were confirmed especially among male drinkers who were community dwellers. For the community dwellers, self-perceived physical health significantly improved in those who ingested UP. In conclusion, UP might prevent oxidation. A longer monitoring period as well as a higher dose of UP might enable us to confirm effects of UP against hypertension.

Maternal age at first childbirth has increased in most developed countries in the past 20 years. The purpose of this study is to investigate effects of maternal age at delivery and parity on successful initiation of exclusive breastfeeding (EBF). This retrospective study investigated 1193 singleton dyads with vaginal-delivered at 37–42 gestational weeks during January and December in 2011 at one large “Baby-Friendly” certified hospital in Japan. A multivariate logistic regression model was used to evaluate individual and combined effects of maternal age and parity on successful initiation of EBF after adjusted for pre-pregnancy body mass index, gestational weight gain, pregnancy complications, mothers' underlying illness, smoking and alcohol drinking habits, gestational week at delivery, child's sex and nurturing support from grandparents. Success rates of EBF at one month after child delivery was 69.4% in primiparous aged ≥ 35 (group A: n = 284), 73.5% in multiparous aged ≥ 35 (group B: n = 268), 74.3% in primiparous aged, Highlights • Maternal age at first childbirth has increased notably in Japan, in the past 20 years. • This study investigated 1193 singleton full-term dyads. • The successful rate of EBF was the lowest in primiparous aged ≥ 35 mothers.

Background: Metabolic syndrome has become a major worldwide public health problem. We examined the relationship between coffee consumption and the prevalence of metabolic syndrome among Japanese civil servants.Methods: The study participants were 3284 employees (2335 men and 948 women) aged 20 to 65 years. Using data from their 2008 health checkup records, we analyzed the relationship between coffee consumption and the prevalence of metabolic syndrome. Metabolic syndrome was defined according to the Japanese criteria.Results: Metabolic syndrome was diagnosed in 374 of the 2335 men (16.0%) and 32 of the 948 women (3.4%). In univariate and multiple logistic regression analyses, the odds ratios (ORs) among men for the presence of metabolic syndrome were 0.79 (95% CI: 0.56–1.03) and 0.61 (0.39–0.95), respectively, among moderate (≥4 cups of coffee per day) coffee drinkers as compared with non-coffee drinkers. Among all components of metabolic syndrome, high blood pressure and high triglyceride level were inversely associated with moderate coffee consumption in men, after adjusting for age, body mass index, smoking status, drinking status, and exercise. However, in women, moderate coffee consumption was not significantly associated with the prevalence of metabolic syndrome or its components.Conclusions: Moderate coffee consumption was significantly associated with lower prevalence of metabolic syndrome in Japanese male civil servants.

This study sought to construct a developmental and context-sensitive framework that could be used to identify, understand and respond to adolescent sexual behaviours.We reviewed work being conducted on adolescent sexual development, health and safety, interviewed UK-based professionals working on sexual health and child protection, and, having identified the Traffic Light Tool (TLT) designed by Family Planning Queensland and then developed by Brook in the UK, we conducted expert interviews. Finally, we reviewed in-house consultation, training and evaluation documentation provided by Brook.We identified the Traffic Light Safeguarding Project as offering a framework for thinking about and responding to youth sexuality. The concept of safeguarding allows us to go beyond the narrower mandate of child protection, and link up the activities of different stakeholders working around child and adolescent sexual health. We were able to confirm that the TLT was functioning as an effective safeguarding tool to: (1) identify and respond to adolescent sexual behaviours, and (2) support professionals to communicate confidently with adolescents about sexuality and risk taking. We confirmed the possibilities for developing a Japanese version of the tool.A safeguarding perspective can help us to move away from a narrowly risk-based approach to child and adolescent sexuality. Development and dissemination of a Japanese version of the TLT can help professionals distinguish between healthy (normal) and unhealthy (risky) sexual behaviours at each developmental stage and more confidently respond to these behaviours.

Background To clarify the contribution of patient age to the development of coronary artery lesions (CALs) associated with Kawasaki disease (KD), epidemiologic features and prognostic factors were investigated using hospital-based complete enumeration surveys in a specific area. Methods Consecutive KD cases identified between October 1999 and September 2012 in Wakayama Prefecture, Japan, were analyzed. The primary outcome measure was the presence/absence of CALs (giant aneurysm, mid- or small-sized aneurysm, and dilatation) on echocardiography 1 month after disease onset. Demographics and medical treatment factors were compared between the patients with and without CALs. Odds ratios (ORs) and 95% confidence intervals (CIs) of explanatory variables (age, gender, and factors related to high-dose intravenous immunoglobulin treatment) for the development of CALs were determined. Results The median age of the 1415 patients (796 males, 619 females) was 25 months after excluding 2 children of foreign residents; 2.2% of the patients had a past history of KD, and 1.8% showed incomplete presentation. CALs were observed in 3.3% (4.0% of males, 2.3% of females; P = 0.080). The ORs of CALs among patients 48 months old (3.1, 95% CI 1.5–6.6) were significantly higher than values in 11- to 48-month-olds. Conclusions The effect of patient age on the development of CALs was found to be U-shaped, with the bottom at ages 11 to 48 months. This finding was based on a 13-year cohort of consecutive KD cases in a specific area with little selection bias and is consistent with previously reported results.

Background: Obesity is an established risk factor for hypertension and end stage kidney disease. There is little information on how obesity relates to risk of impaired renal function in apparently healthy individuals. We investigated associations of body mass index (BMI) with timed 24-hour creatinine clearance (Ccr) and glomerular filtration rate (GFR) in the cross-sectional population-based INTERLIPID Study, ancillary study of the International Study on Macro- and Micro-Nutrients and Blood Pressure (INTERMAP). Methods: INTERLIPID participants ages 40-59 y from 5 INTERMAP research samples (4 Japanese and 1 Hawaiian) were investigated. Participants were ethnically all Japanese. Two timed 24-hour urine specimens were collected by each participant and analyses were performed in a central laboratory. Values of serum creatinine (Scr) were assayed by Jaffe’s method in a Japanese central laboratory. Data were analyzed from 1,338 Japanese, 570 men and 563 women in Japan, 100 men and 105 women in Hawaii. Measures of kidney function were 24-hour Ccr (ml/min) and GFR (ml/min/1.73m 2 ). Ccr was calculated by equation (urine creatinine х urine volume)/(Scr х 1440); GFR was calculated as Ccr х (1.73/body surface area (BSA)). BSA was estimated by the DuBois formula. In addition, estimated GFR (eGFR) was calculated by use of the Modification of Diet in Renal Disease (MDRD) Study equation, 186 х Scr -1.154 х age -0.203 х 0.742 (if female). All statistical analyses were stratified by gender. Adjusted mean values of Ccr, GFR, and eGFR in quartiles of BMI were estimated using analysis of covariance. Model 1 was adjusted for age; model 2, for age and urine volume; model 3 for variables in model 2 plus blood pressure, pulse rate, physical activity, smoking habit, alcohol consumption, urinary sodium excretion, HbA1c, and total serum cholesterol. Results: Ccr (mean (SD)) were 107.5 (18.9) in men in Japan, 91.9 (17.0) in women in Japan, 123.4 (25.1) in men in Hawaii, and 98.5 (20.3) in women in Hawaii. BMI quartile ranges were in men Q1 16.8-22.3, Q2 22.3-24.1, Q3 24.1-26.1, and Q4 26.1-42.9; in women Q1 15.9-21.2, Q2 21.2-23.0, Q3 23.0-25.1, and Q4 25.1-47.0. In men, BMI was positively related to multivariate-adjusted Ccr and GFR ( P for trend across BMI quartiles P for trend 0.001). In women, BMI was positively related to multivariate-adjusted Ccr ( P for trend across BMI quartiles Conclusions: These results indicate that excess BMI may lead to higher Ccr, and that the MDRD equation may underestimate GFR in middle-aged overweight or obese Japanese men.

We report a case of transient abnormal myelopoiesis (TAM) with Down's syndrome. As the blast cells had additional chromosome abnormalities (50,XY,+12,+14,+21 x 2), a possibility of acute leukemia was considered from a cytogenetic point of view. But the abnormal clone gradually disappeared without antileukemic therapies. Viewing it together with previous reports of TAM with additional chromosome abnormalities in Down's syndrome babies, its presence does not immediately indicate an aggressive clinical course as in acute leukemia and spontaneous complete hematological remission may be achieved. Thus, a careful follow-up should precede cytogenetic findings helping to determine the therapeutic intervention.