Passive smoking and mortality from aortic dissection or aneurysm

Evidence on the association between passive smoking and risk of aortic dissection or aneurysm is limited. This study aimed to investigate whether passive smoking increases risk of mortality from aortic dissection or aneurysm.The Japan Collaborative Cohort (JACC) Study is a prospective community-based cohort study begun in 1988-90 and followed up to the end of 2009. We examined 48,677 individuals (mean age, 56 years; women, 46%) without history of stroke, coronary heart disease, or cancer, who provided valid responses to a lifestyle questionnaire including questions on active and passive smoking. We used 3 categories (passive smoking out of home, passive smoking at home, and passive smoking out of or at home combined) to divide never-smokers into 3 exposure groups: low, intermediate, and high exposures, respectively. The endpoint was underlying cause of death from aortic dissection or aneurysm.During the median 19-year follow-up of 48,677 study participants, 66 died of aortic dissection, and 75 of aortic aneurysm. Multivariable hazard ratios (95% confidence intervals) for the high passive-smoking group as compared with the low passive-smoking group were 2.45 (1.02-5.88) out of home, 1.82 (0.84-3.96) at home, and 2.35 (1.09-5.09) out of or at home combined. The corresponding hazard ratios for current smokers as compared with the low passive-smoking group were 3.97 (2.14-7.39), 3.41 (1.84-6.32) and 4.09 (1.99-8.39), respectively.Out-of-home passive smoking and out-of- or at-home combined passive smoking were associated with increased mortality from aortic dissection or aneurysm

Green tea consumption and risk of hematologic neoplasms: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study)

PurposeExperimental studies suggested that green tea may have an anticancer effect on hematologic neoplasms. However, few prospective studies have been conducted.MethodsA total of 65,042 individuals aged 40–79 years participated in this study and completed a self-administered questionnaire about their lifestyle and medical history at baseline (1988–1990). Of these, 52,462 individuals living in 24 communities with information on incident hematologic neoplasms available in the cancer registry, who did not have a history of cancer and provided valid information on frequency of green tea consumption, were followed through 2009. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of hematologic neoplasms according to green tea consumption were analyzed.ResultsThe incidence of hematologic neoplasms during a median follow-up of 13.3 years was 323. Compared with the never-drinkers of green tea, the multivariate HRs and 95% CIs for total hematologic neoplasms in green tea drinkers of ≤ 2 cups/day, 3–4 cups/day, and ≥ 5 cups/day were 0.65 (0.42–1.00), 0.73 (0.47–1.13), and 0.63 (0.42–0.96), respectively. The association was more prominent for acute myeloid leukemias and follicular lymphomas.ConclusionsThe present cohort study suggests a protective effect of green tea against hematologic neoplasms, especially acute myeloid leukemias

Alcohol consumption and mortality from aortic disease among Japanese men: The Japan Collaborative Cohort study

Background and aimsOnly a few population-based prospective studies have examined the association between alcohol consumption and abdominal aortic aneurysm, and the results are inconsistent. Moreover, no evidence exists for aortic dissection. We examined the effect of alcohol consumption on risk of mortality from aortic diseases.MethodsA total of 34,720 men from the Japan Collaborative Cohort study, aged 40–79 years, without history of cardiovascular disease and cancer at baseline 1988 and 1990 were followed up until the end of 2009 for their mortality and its underlying cause. Hazard ratios of mortality from aortic diseases were estimated according to alcohol consumption categories of never-drinkers, ex-drinkers, regular drinkers of ≤30 g, and >30 g ethanol per day.ResultsDuring the median 17.9-year follow-up period, 45 men died of aortic dissection and 41 men died of abdominal aortic aneurysm. Light to moderate drinkers of ≤30 g ethanol per day had lower risk of mortality from total aortic disease and aortic dissection compared to never-drinkers. The respective multivariable hazard ratios (95% confidence intervals) were 0.46 (0.28–0.76) for total aortic disease and 0.16 (0.05–0.50) for aortic dissection. Heavy drinkers of >30 g ethanol per day did not have reduced risk of mortality from total aortic disease, albeit had risk variation between aortic dissection and abdominal aortic aneurysm.ConclusionsLight to moderate alcohol consumption was associated with reduced mortality from aortic disease among Japanese men.Available online 21 September 2017, In Pres

Associations of Daily Walking Time With Pneumonia Mortality Among Elderly Individuals With or Without a Medical History of Myocardial Infarction or Stroke: Findings From the Japan Collaborative Cohort Study

Background: The association between daily walking and pneumonia mortality, stratified by the presence of disease conditions, such as myocardial infarction (MI) or stroke, was investigated.Methods: The study participants were 22,280 Japanese individuals (9,067 men and 13,213 women) aged 65–79 years. Inverse propensity weighted competing risk model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for pneumonia mortality.Results: After a median of 11.9 years of follow-up, 1,203 participants died of pneumonia. Participants who did not have a history of MI or stroke and who walked for 1 hour/day or more were less likely to die from pneumonia (HR 0.90; 95% CI, 0.82–0.98) than those walked for 0.5 hours/day. A similar inverse association of pneumonia and walking (0.5 hours/day) was observed among participants with a history of MI (HR 0.66; 95% CI, 0.48–0.90). Among the participants with a history of stroke, those who walked for 0.6–0.9 hours/day were less likely to die because of pneumonia (HR 0.65; 95% CI, 0.43–0.98).Conclusions: Regular walking for ≥1 hour/day may reduce the risk of pneumonia mortality in elderly individuals with or without cardiovascular disease history

Blood pressure levels and risk of cardiovascular disease mortality among Japanese men and women

Objective:To examine the association of blood pressure (BP) with cardiovascular mortality in real-world settings and investigate whether that association varied by use of antihypertensive medication at baseline.Methods:Data from 27 728 Japanese men and women, aged 40–79 years, free of stroke, coronary heart disease, cancer, and kidney disease at entry (1988–1990) were used in this study. Mortality surveillance was completed through 2009, resulting in 449 800 person-years of follow-up. Hazard ratios for cardiovascular mortality were analysed by BP category (based on 2018 European guidelines) at admission.Results:There were 1477 deaths from cardiovascular diseases (CVDs). Relative to high-normal BP at admission, the multivariable hazard ratios (95% confidence intervals) of CVD were 0.85 (0.69–1.04) for optimal BP; 0.96 (0.81–1.15) for normal BP; 1.26 (1.09–1.46) for Grade 1 hypertension; and 1.55 (1.31–1.84) for Grade 2–3 hypertension. A similar linear association was observed among persons not taking antihypertensive medication at admission. Among patients treated for hypertension, a U-shaped association with CVD mortality was observed; hazard ratios = 2.31 (1.25–4.27), 1.68 (1.05–2.69), 1.56 (1.10–2.22), and 1.63 (1.13–2.36), respectively. Similar patterns were observed for stroke and coronary heart disease, although not always statistically significant.Conclusion:BP categories at baseline were linearly and positively associated with CVD mortality overall and also among participants not taking antihypertensive medication. A higher risk of mortality from CVD was observed among patients already treated for hypertension with optimal and normal BPs than those with high-normal BP, suggesting the importance of careful monitoring of BP and comorbidities of such patients

Passive smoking and chronic obstructive pulmonary disease mortality: findings from the Japan collaborative cohort study.

OBJECTIVES:To elucidate the association between passive smoking at home and chronic obstructive pulmonary disease (COPD) mortality via a large-scale nationwide cohort study in Japan.METHODS:Never smokers (n = 34,604) aged 40-79 years at baseline (1988-1990; 4884 men, 29,720 women) were included in the analysis. Passive smoking at home was measured based on self-reported frequency of weekly exposure to passive smoking at home. An inverse probability of treatment-weighted competing risk model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for COPD mortality.RESULTS:During a median follow-up of 16.4 years, 33 participants (10 men, 23 women) died of COPD. The HR for participants exposed to passive smoking at home ≤4 days per week or those who had almost daily exposure to passive smoking at home had a significantly increased risk of COPD mortality (HR 2.40, 95% CI 1.39-4.15, HR 2.88, 95% CI 1.68-4.93, respectively)

Blood soluble Fas levels and mortality from cardiovascular disease in middle-aged Japanese: The JACC study.

Limited evidence has been available on the relationship between apoptosis and cardiovascular disease in population-based samples. We examined whether blood soluble Fas (sFas) are associated with mortality from cardiovascular diseases.In a nested case-control study under a large prospective cohort, the Japan Collaborative Cohort (JACC) Study, where a total of 39,242 subjects, 40-79 years of age, provided serum samples and were followed up for 9 years, we measured sFas levels among cases and controls, matched for sex, age, area of residence and year of serum storage. Conditional logistic regression models were used to calculate odds ratio (95% CI) of mortality from stroke and stroke types, according to quartiles and 1-SD increment of sFas levels.During the follow-up (1988-1997), we identified 233 (121 in men and 112 in women) deaths from total stroke, comprising 49 (18 and 31) subarachnoid hemorrhages, 55 (27 and 28) intraparenchymal hemorrhages, 71 (44 and 27) ischemic strokes, and 97 (53 and 44) coronary heart diseases. After adjustment for cardiovascular risk factors, the multivariable odds ratio (95% CI) of subarachnoid hemorrhage associated with a 1-SD increment of sFas (1.3 ng/ml in both men and women) was 4.04 (1.07-15.3; p = 0.04). No association was found between blood sFas levels and risk of intraparenchymal hemorrhage, ischemic stroke or coronary heart disease.Higher blood sFas levels were associated with higher mortality from subarachnoid hemorrhage, suggesting a potential role of apoptosis factors in the development or prognosis of subarachnoid hemorrhage

Relationship between nerve fiber layer defect and the presence of epiretinal membrane in a Japanese population: The JPHC-NEXT Eye Study

The study subjects were residents of Chikusei city, Japan, aged 40 years or older who attended annual health check-up programs and participated in the JPHC-NEXT Eye Study which performed non-mydriatic fundus photography of both eyes. The relationship of glaucomatous fundus changes such as optic disc cupping (cup to disc ratio ≥ 0.7) and retinal nerve fiber layer defect (NFLD) with the presence of epiretinal membrane (ERM) were examined cross-sectionally. A total of 1990 persons gave consent to participate in this study in 2013. The overall prevalence of ERM was 12.9%. Of these, 1755 had fundus photographs of sufficient quality and no history of intraocular surgery (mean age: 62.3 ± 10.0 years). After adjusting for age, sex and refractive error, NFLD was positively associated with the presence of ERM (odds ratio [OR]: 2.48; 95% confidence interval [CI]: 1.24, 4.96; P = 0.010), but optic disc cupping was not (OR: 1.33; CI: 0.71, 2.48; P = 0.37). The results did not necessarily suggest an association between glaucoma and ERM, but indicated an association between NFLD and ERM

The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students

BACKGROUND: Most medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning between school years among medical students and residents. METHODS: Questionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan. RESULTS: PIT results showed an increase in moral sensitivity in 4(th )and 5(th )year students followed by a decrease in 6(th )year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires. CONCLUSION: This study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan