Longitudinal relationships between cardiovascular events, risk factors, and time-dependent sleep duration

   Background: Although many studies have evaluated the relationships between sleep duration and cardiovascular (CV) events/risk factors, longitudinal associations with time-dependent sleep duration have not been adequately assessed. Methods: A retrospective, longitudinal study was conducted involving individuals aged 20 years or older that received annual health check-ups at St. Luke’s International Hospital from 2005 to 2010. Data collection included self-reported demographic, clinical and health habit information (including sleep duration; < 6, 6–7, 7–8, ≥ 8 h), baseline examinations, and laboratory measures for each year. We conducted mixed effects analyses to examine the associations between non-fatal CV events, risk factors, and time-dependent sleep duration longitudinally. Results: Of the total of 31,830 participants enrolled, 70.1% of participants changed their sleep dura­tion, and 365 participants experienced CV events during follow-up periods. Compared to those reporting 7–8 h of sleep, those reporting less than 6 h of sleep were significantly more likely to experience non-fatal CV events (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.03–3.07; p = 0.04), but other groups were not (OR 1.12; 95% CI 0.70–1.77; p = 0.64 for 6–7 h and OR 1.22; 95% CI 0.68–2.23; p = 0.50 for ≥ 8 h). The shortest sleep duration was associated with a higher likelihood of obesity/overweight status (OR 1.49; 95% CI 1.32–1.69; p < 0.01). Conclusions: Individuals reporting less than 6 h of sleep were significantly more likely to have non-fatal CV events than those reporting 7–8 h of sleep. For the risk factors, short sleep duration was associ­ated with obesity/overweight status

Manuel Antunes (1918-1985) A rara excelência de um mestre exemplar

Breve biografia de Manuel Antunes (1918-1985) enquanto docente e investigador da Faculdade de Letras da Universidade de Lisboa.info:eu-repo/semantics/publishedVersio

Behavioral factors associated with SARS-CoV-2 infection in Japan.

BACKGROUND: The relative burden of COVID-19 has been less severe in Japan. One reason for this may be the uniquely strict restrictions imposed upon bars/restaurants. To assess if this approach was appropriately targeting high-risk individuals, we examined behavioral factors associated with SARS-CoV-2 infection in the community. METHODS: This multicenter case-control study involved individuals receiving SARS-CoV-2 testing in June-August 2021. Behavioral exposures in the past 2 weeks were collected via questionnaire. SARS-CoV-2 PCR-positive individuals were cases, while PCR-negative individuals were controls. RESULTS: The analysis included 778 individuals (266 [34.2%] positives; median age [interquartile range] 33 [27-43] years). Attending three or more social gatherings was associated with SARS-CoV-2 infection (adjusted odds ratio [aOR] 2.00 [95% CI 1.31-3.05]). Attending gatherings with alcohol (aOR 2.29 [1.53-3.42]), at bars/restaurants (aOR 1.55 [1.04-2.30]), outdoors/at parks (aOR 2.87 [1.01-8.13]), at night (aOR 2.07 [1.40-3.04]), five or more people (aOR 1.81 [1.00-3.30]), 2 hours or longer (aOR 1.76 [1.14-2.71]), not wearing a mask during gatherings (aOR 4.18 [2.29-7.64]), and cloth mask use (aOR 1.77 [1.11-2.83]) were associated with infection. Going to karaoke (aOR 2.53 [1.25-5.09]) and to a gym (aOR 1.87 [1.11-3.16]) were also associated with infection. Factors not associated with infection included visiting a cafe with others, ordering takeout, using food delivery services, eating out by oneself, and work/school/travel-related exposures including teleworking. CONCLUSIONS: We identified multiple behavioral factors associated with SARS-CoV-2 infection, many of which were in line with the policy/risk communication implemented in Japan. Rapid assessment of risk factors can inform decision making

Coronavirus Disease 19 (COVID-19) Vaccine Effectiveness Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Delta-Dominant and Omicron-Dominant Periods in Japan: A Multicenter Prospective Case-control Study (Factors Associated with SARS-CoV-2 Infection and the Effectiveness of COVID-19 Vaccines Study)

Background. Although several coronavirus disease 2019 (COVID-19) vaccines initially showed high efficacy, there have been concerns because of waning immunity and the emergence of variants with immune escape capacity.Methods. A test-negative design case-control study was conducted in 16 healthcare facilities in Japan during the Deltadominant period (August-September 2021) and the Omicron-dominant period (January-March 2022). Vaccine effectiveness (VE) against symptomatic severe acute respiratory syndrome coronavirus 2 infection was calculated for 2 doses for the Deltadominant period and 2 or 3 doses for the Omicron-dominant period compared with unvaccinated individuals.Results. The analysis included 5795 individuals with 2595 (44.8%) cases. Among vaccinees, 2242 (55.8%) received BNT162b2 and 1624 (40.4%) received messenger RNA (mRNA)-1273 at manufacturer-recommended intervals. During the Delta-dominant period, VE was 88% (95% confidence interval [CI], 82–93) 14 days to 3 months after dose 2 and 87% (95% CI, 38–97) 3 to 6 months after dose 2. During the Omicron-dominant period, VE was 56% (95% CI, 37–70) 14 days to 3 months since dose 2, 52% (95% CI, 40–62) 3 to 6 months after dose 2, 49% (95% CI, 34–61) 6+ months after dose 2, and 74% (95% CI, 62–83) 14+ days after dose 3. Restricting to individuals at high risk of severe COVID-19 and additional adjustment for preventive measures (ie, mask wearing/high-risk behaviors) yielded similar estimates, respectively.Conclusions. In Japan, where most are infection-naïve, and strict prevention measures are maintained regardless of vaccination status, 2-dose mRNA vaccines provided high protection against symptomatic infection during the Delta-dominant period and moderate protection during the Omicron-dominant period. Among individuals who received an mRNA booster dose, VE recovered to a high level

Evaluation of risk factors for perforated peptic ulcer

Abstract Background The aim of this study was to evaluate the prediction factors for perforated peptic ulcer (PPU). Methods At St. Luke’s International Hospital in Tokyo, Japan, a case control study was performed between August 2004 and March 2016. All patients diagnosed with PPU were included. As control subjects, patients with age, sex and date of CT scan corresponding to those of the PPU subjects were included in the study at a proportion of 2 controls for every PPU subject. All data such as past medical histories, physical findings, and laboratory data were collected through chart reviews. Univariate analyses and multivariate analyses with logistic regression were conducted, and receiver operating characteristic curves (ROCs) were calculated to show validity. Sensitivity analyses were performed to confirm results using a stepwise method and conditional logistic regression. Results A total of 408 patients were included in this study; 136 were a group of patients with PPU, and 272 were a control group. Univariate analysis showed statistical significance in many categories. Four different models of multivariate analyses were conducted, and significant differences were found for muscular defense and a history of peptic ulcer disease (PUD) in all models. The conditional forced-entry analysis of muscular defense showed an odds ratio (OR) of 23.8 (95% confidence interval [CI]: 5.70–100.0), and the analysis of PUD history showed an OR of 6.40 (95% CI: 1.13–36.2). The sensitivity analysis showed consistent results, with an OR of 23.8–366.2 for muscular defense and an OR of 3.67–7.81 for PUD history. The area under the curve (AUC) of all models was high enough to confirm the results. However, anticoagulants, known risk factors for PUD, did not increase the risk for PPU in our study. The conditional forced-entry analysis of anticoagulant use showed an OR of 0.85 (95% CI: 0.03–22.3). Conclusions The evaluation of prediction factors and development of a prediction rule for PPU may help our decision making in performing a CT scan for patients with acute abdominal pain

Validation Study of a Disease-specific Module, the Asthma Health Questionnaire (AHQ) Using Japanese Adult Asthmatic Patients

Background: An asthma-specific questionnaire, the Asthma Health Questionnaire (AHQ) was developed for Japanese asthmatic patients. A self-administered 37-item version (AHQ-37) consisting of 36 disease-specific items and a Face Scale was designed for socially active patients. Methods: Exploratory factor analysis, test-retest reliability, internal consistency, concurrent validity and longitudinal validity were evaluated. A total of 326 asthma patients (202 men; range of age from 18 to 65 years) answered the AHQ-37 twice. Results: Each item of the AHQ-37 was well accepted by the patients with answering rates of 95 to 100%. Six subscales (Asthmatic Symptoms, Emotion, Daily Activity, Factors which Worsened Symptoms, Social Activity and Economics) were extracted by factor analysis. Psychometric testing showed high feasibility, good repeatability and good internal consistency. The Face Scale moderately correlated with all subscales except for Economics, indicating that the Face Scale alone could measure global quality of life (QOL) functioning of asthmatic patients. Concurrent validity with peak-flow values was insufficient (Spearman’s correlation coefficient = 0.05−0.27), showing that the peak flow alone could not estimate QOL. In longitudinal validity, however, changes in peak-flow values had an impact on the Asthmatic Symptoms, Daily Activity and Factors which Worsened Symptoms (P = 0.000−0.419), indicating that changes in peak-flow were important to asthmatic patients’ QOL. Conclusions: The QOL of asthmatic patients must be evaluated by asthma-specific questionnaires, such as the AHQ-37

A Case of IgG4-Related Hypophysitis Presented with Hypopituitarism and Diabetes Insipidus

Immunoglobulin (Ig) G4-related systemic syndrome is a recently described entity characterized by elevated serum IgG4 and tissue infiltration of IgG4-positive plasma cells. Pituitary gland can be involved as hypophysitis. We report a case of a 72-year-old man, who presented with general fatigue and weakness. Laboratory tests revealed diabetes insipidus as well as hypopituitarism including adrenal insufficiency, hypogonadism, and hypothyroidism. His serum IgG4 was elevated. MR images showed enlargement of the pituitary stalk. Multiple nodules in bilateral kidneys were pointed out in the abdominal CT. Histological examination of the nodules showed increased IgG4-positive plasma cells. We diagnosed him with IgG4-related kidney disease and hypophysitis. After treatment with hydrocortisone, his symptoms improved. The follow-up images showed that almost all renal nodules disappeared and his pituitary stalk was shrinking. Our case appears to be very sensitive to glucocorticoid and suggests the possibility of treating IgG4-related hypophysitis successfully with a lower dose of glucocorticoid