Trends in the incidence and mortality of legionellosis in Japan: a nationwide observational study, 1999-2017

This study examined temporal trend, seasonality, and geographical variations of legionellosis incidence and mortality in Japan. This nationwide observational study used the Japanese Vital Statistics and Infectious Diseases Weekly Report (1999-2017) data to calculate legionellosis crude and age-adjusted incidence and mortality rates per 100,000 population by age and sex. Incidence was compared among the 4 seasons and regional incidence among 47 prefectures. Of 13,613 (11,194 men) people with legionellosis in Japan, 725 (569 men) were fatal. Increasing incidence trend occurred from 0.0004 (1999) to 1.37 (2017) per 100,000 population. People aged >= 70 years accounted for 43.1% overall; men's age-adjusted incidence rate was consistently approximately five times higher than for women. Significantly higher incidence occurred in summer than in winter (p=0.013). Geographically, highest incidence (>= 2.0 per 100,000 population) occurred in Hokuriku District, with increasing trends in Hokkaido and middle-part of Japan. Estimated fatality rates decreased consistently at 5.9% (95% confidence interval: - 8.1, - 3.5) annually, from 1999 to 2017, with no trend change point. Increasing legionellosis incidence occurred in Japan during 1999-2017, with declining estimated fatality rates. In this aging society and warming world, disease clinical burden may further deteriorate in future due to increasing incidence trends

Impact of the cervical cancer awareness months on public interest in Japan: A Google Trends analysis, 2012-2021

The immunization and screening rates for human papillomavirus in Japan are lower than those in other countries. We aimed to evaluate the impact of cervical cancer awareness months on public attention using Google Trends analysis. Between 2012 and 2021, we analyzed the trends in relative search volumes (RSVs) for "Shikyuu-keigan" (cervical cancer in English) in Japan, during the cervical cancer awareness month (CCAM) in January and cervical cancer prevention awareness enhancement month (CCPAEM) in November. We performed a joinpoint regression analysis to identify a statistically significant trend change point. Additionally, we compared the mean RSVs of each awareness month with the rest of the year. Significant trend change points were observed, but none were found in CCAM and CCPAEM periods. Comparison of mean RSVs among CCAM, CCPAEM, and the rest of the months did not suggest any significant increases in RSVs during these awareness periods. In conclusion, CAM and CCPAEM did not raise public interest in cervical cancer in Japan. Although the results are based on internet users, the findings might suggest a need to develop a more effective and attractive approach to achieve the 90-70-90 targets of cervical cancer prevention by 2030

Trends in the Incidence of Disseminated Cryptococcosis in Japan: A Nationwide Observational Study, 2015–2021

Background Cryptococcus species can cause severe disseminated infections in immunocompromised hosts. This study investigated the epidemiological features and trends in disseminated cryptococcosis in Japan. Methods We used publicly available Infectious Diseases Weekly Reports to obtain data on the incidence of disseminated cryptococcosis in Japan from 2015 to 2021. Patient information, including age, sex, and regional and seasonal data, were extracted. The Joinpoint regression program was used to determine the age-adjusted incidence rate (AAR) per 100,000 population, annual percentage change (APC), and average APC (AAPC). Results A total of 1047 cases of disseminated cryptococcosis were reported, of which those aged ≥ 70 years accounted for 68.8%. The AAR in men was significantly higher than that in women (median: 0.13 vs. 0.09: p = 0.0024). APC for the overall cases increased by 9.9% (95% confidence interval [95% CI] − 5.4–27.7) from 2015 to 2018 and then decreased by 3.3% (95% CI − 15.5–10.7) from 2018 to 2021. AAPC for the entire study period was 3.1% (95% CI − 1.5–8.0), indicating a possible increase in its number, although not statistically significant. In terms of regional distribution, the average AAR was highest in Shikoku District (0.17) and lowest in Hokkaido District (0.04). Northern Japan exhibited a significantly lower median AAR (median [interquartile range]: 0.06 [0.05, 0.08]) than the Eastern (0.12 [0.12, 0.13]), Western (0.11 [0.10, 0.13]), and Southern (0.14 [0.12, 0.15]) regions. No seasonal variation in incidence was observed. Conclusion The prevalence of disseminated cryptococcosis has not increased in Japan. Geographically, the incidence is lower in Northern Japan. Further investigations that incorporate detailed clinical data are required

A nationwide trend analysis in the incidence and mortality of Creutzfeldt-Jakob disease in Japan between 2005 and 2014

In the era of hyper-ageing, Creutzfeldt-Jakob disease (CJD) can become more prevalent as an important cause of dementia. This study aimed to evaluate the trends in crude and age-adjusted CJD-associated mortality and incidence rates in Japan using national vital statistics data on CJD-associated deaths among individuals aged over 50 years, as well as the government-funded nationwide CJD surveillance data (pertaining to the years 2005-2014) in Japan. The data were analysed using the Joinpoint Regression Program to estimate the long-term trends and average annual percentage changes (AAPCs). Overall, the AAPCs of age-adjusted CJD-associated mortality rates rose significantly over the study period (3.2%; 95% confidence interval [CI] 1.4-5.1%). The AAPC of the age-adjusted incidence rates also increased (overall 6.4%; 95% CI 4.7-8.1%). The CJD-associated increases in the mortality and incidence rates were especially prominent among adults over the age of 70 years. Given this trend in aging of population, the disease burden of CJD will continue to increase in severity. Our findings thus recommend that policymakers be aware of the importance of CJD and focus on preparing to address the increasing prevalence of dementia

Trends in the Nontuberculous Mycobacterial Disease Mortality Rate in Japan: A Nationwide Observational Study, 1997–2016

Background. The incidence of nontuberculous mycobacterial (NTM) infections has been increasing worldwide, becoming a significant healthcare burden especially among elderly people. This study aimed to evaluate the trends in NTM-associated mortality in Japan. Methods. This study used vital statistics data and data on all NTM-associated deaths (N = 18 814) among individuals aged >= 40 years in Japan from 1997 to 2016. We calculated the crude and age-adjusted mortality rates by age and sex and used joinpoint regression to analyze trends and estimate the average annual percentage change (AAPC). We compared crude NTM- and tuberculosis-associated mortality rates by sex. Results. The overall crude annual mortality rate increased from 0.63/100 000/year in 1997 to 1.93/100 000/year in 2016 and was the highest among individuals aged 80-84 years. The AAPC of the crude mortality rates among men of all ages and women aged 40-59 years were stable but increased among women aged 60-79 years (3.5%; 95% confidence interval [CI ], 2.8-4.3) and >= 80 years (4.3%; 95% CI, 3.7-4.9). Among men, the age-adjusted mortality rates did not show a significant trend, while among women, the rates increased over the study period (AAPC, 4.6%; 95% CI, 2.7-6.6). In women, the crude NTM-associated mortality rate exceeded the tuberculosis mortality rate in 2014, 2015, and 2016. Conclusions. NTM mortality increased in Japan between 1997 and 2016, especially among the elderly female population. Given the increasing NTM-associated mortality and the susceptible aging population, public health authorities in Japan should pay greater attention to NTM infections

ジュツゼン シンダンシエタ タンノウ ネンテンショウ ノ 1レイ

We report on a case of torsion of the gallbladder, whitch was correctly diagnosed preoperatively using pre-operative imaging with ultrasound and computed tomography. A 88-year-old woman was admitted to the hospital because of diarrhea and fever. Increased levels of WBC, CRP were noted in laboratory test. An Abdominal ultrasound showed a swollen gallbladder with a thicked wall in the body and funds, floating gallbladder and a high echo level lesion with an acoustic shadow in the gallbladder. Abdominal computed tomography showed a gallbladder with a spirally twisted neck and small gass lesion. Diagnostic imaging demonstrated acute inflammatory changes in the gallbladder with an abnormal arrangement of the gallbladder. These results suggested necrotizing cholecystitis with tortion of the gallbladder. During the operation, the gallbladder was found to be enlarged and twisted 360 degrees in a clockwise direction at the neck of the gallbladder, resulting in gangrenous change. A cholecystectomy was successfully performed and the patient was discharged in good condition, 23 days after the operation

Comparison of Two Electrosurgical Modes for Endoscopic Submucosal Dissection of Superficial Colorectal Neoplasms: A Prospective Randomized Study

Endoscopic submucosal dissection (ESD) is reportedly one of the standard treatment strategies for large superficial colorectal neoplasms in Japan because of its high en bloc resection rate. A few technical issues regarding ESD should be considered, one of which is the selection of the Endo-cut I mode versus the Swift-coagulation mode as the electrosurgical unit mode setting during submucosal dissection. We seek to determine which of these two modes is more suitable for submucosal dissections of colorectal tumors with regard to procedure time and safety

Comparison of Features in the Evaluation of Symptomatology and Social Adjustment between Mothers and Other Family Members of Schizophrenic Patients in Japan

This study examined symptomatology and social adjustment evaluated by a key person in the family of schizophrenic outpatients using the Katz Adjustment Scale. Although there were no differences seen in descriptions of symptomatology between 66 cases evaluated by mothers and 38 cases by other family members, significant differences were seen in assessment of social adjustment. Compared to other family members, mothers\u27 expectation toward patients\u27 socially expected activities was higher and mothers showed strong dissatisfaction with patients\u27 free-time activities. Mothers showed more severe attitudes toward patients than other family members, but the evaluation of social adjustment by mothers showed a significant correlation with the severity of BPRS symptom evaluation by psychiatrists

ドウジキ ニ 1ガタ トウニョウビョウ オ ハッショウシ タセンセイ ジコ メンエキ ショウコウグン IIIガタ ト シンダンシ エタ コウキ コウレイシャ ノ ドウホウ ショウレイ

We herein presented a case of a ７９-year-old woman who was referred to our hospital with dry mouth and polyuria that had persisted for three months prior to her admission. She developed Hashimoto disease at ７３ years old and pernicious anemia at ７８ years old. Her blood glucose level was ６８２ mg/dl, HbA１c １４．６％, and urinary ketone was positive ; therefore, she was diagnosed with diabetic ketosis. Acute-onset autoimmune type １ diabetes mellitus was diagnosed based on the diagnostic criteria for acute-onset type １ diabetes mellitus （２０１２） by the committee of the Japan Diabetes Society. Autoimmune polyglandular syndrome was subsequently diagnosed based on the complications of type １ diabetes and Hashimoto’s thyroiditis. Her ８７-year-old brother had developed acute-onset autoimmune type １ diabetes ２ months before his sister was hospitalized. Autoimmune polyglandular syndrome type III was also diagnosed because he had autoimmune thyroid disease. No epidemiological data are currently available for late elderly with acute-onset type １ diabetes in Japan. To the best of our knowledge, this is the first case of acute-onset autoimmune type １ diabetes mellitus that developed around the same time period in an elderly brother and sister who were diagnosed with autoimmune polyglandular syndrome type III. Common genetic and environmental factors were etiologically implicated in the almost simultaneous onset between these siblings

Nagasaki Schizophrenia Study : Outcome of a 15-year Follow-up of an Incident Cohort

The Nagasaki World Health Organization (WHO) Collaborating Center for Research and Training in Mental Health conducted the WHO Coordinated Multi-Center Study of the Long-term Course and Outcome of Schizophrenia as a part of the International Study on Schizophrenia (ISoS). The study used 107 patients who were initially diagnosed as having ICD-9 schizophrenia for the WHO Collaborative Study on the Determinants of Outcome of Severe Mental Disorders (DOSMeD). Subjects were first collected in 1979-1980 for an incidence study of schizophrenia in Nagasaki. In this 15-yearfollow- up study, 7 subjects died, 43 subjects were lost to follow-up and 57 were successfully traced. Among the 7 death cases, 4 suicides were confirmed and 1 was suspected. During the 15-year period, 25 (44%) of the 57 living subjects displayed continuous psychotic course type schizophrenia. During the last 2 years, 14 (25%) were not psychotic ; 31 (54%) were continuously psychotic. Global Assessment of Functioning Scale for Symptomatology (GAF-S) indicated symptomatological outcomes : 16 (28%) had severe symptoms (GAF-S70). Social outcome was evaluated using the Global Assessment of Functioning Scale for Disability (GAF-D): 28 (49%) showed poor adjustment (GAF-D70). The overall time trend was almost evenly divided in thirds : 20 (35%) were getting better, 18 (32%) were the same and 19 (33%) were worse. The present study showed that the outcome of schizophrenia is not always poor, although some patients display a continuous course and poor outcome