疫学アプローチを用いた大気汚染の循環器疾患リスクファクターに対する影響の研究：タイにおける縦断コホート研究

京都大学新制・課程博士博士(工学)甲第23494号工博第4906号新制||工||1766(附属図書館)京都大学大学院工学研究科都市環境工学専攻(主査)教授 高野 裕久, 教授 米田 稔, 准教授 上田 佳代学位規則第4条第1項該当Doctor of Philosophy (Engineering)Kyoto UniversityDFA

Long-term air pollution exposure and self-reported morbidity: A longitudinal analysis from the Thai cohort study (TCS)

[Background] Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand. [Methods] This longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005–2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM₁₀, O₃, NO₂, SO₂, and CO. [Results] After controlling for potential confounders, we found that an IQR increase in PM₁₀ was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO₂ was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O₃ and NO₂. [Conclusions] Long-term exposure to air pollution, especially for PM₁₀ and SO₂ was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population

Precancerous Gastric Lesions with Helicobacter pylori vacA+/babA2+/oipA+ Genotype Increase the Risk of Gastric Cancer

Objective. The clinical outcomes of gastric diseases such as chronic gastritis, peptic ulcer, and gastric cancer have been attributed to the interplay of virulence factors of Helicobacter pylori (H. pylori), host genetic susceptibility, and host immune responses. This study investigated the presence of cagA, vacA, iceA2, babA2, and oipA genes and their association with clinical outcomes. Methods. Chronic gastritis, atrophic gastritis, and intestinal metaplasia specimens were obtained from patients who underwent endoscopy and surgical resection between January 2017 and December 2018; specimens from gastric cancer patients treated between January 2014 and December 2018 were also added. H. pylori infection and virulence genes (cagA, vacA, iceA2, babA2, and oipA) were determined using real-time PCR. The association between H. pylori genotypes and clinical outcomes were evaluated using multivariate regression model analysis. The overall survival of gastric cancer patients was compared between genotype combinations. Results. H. pylori was positive in 166 patients with chronic gastritis, precancerous gastric lesions, and gastric cancer. The genes vacA, babA2, and oipA were most prevalent in chronic gastritis (73%), precancerous gastric lesions (62%), and gastric cancer (91%), respectively. The vacA, babA2, and oipA genes were associated with increased risk of gastric cancer (OR = 1.23; 95% CI = 1.13–3.32; P=0.033, OR = 2.64; 95% CI = 1.44–4.82, P=0.024, and OR = 2.79; 95% CI = 1.58–5.41; P=0.031, respectively). Interestingly, H. pylori vacA+/babA2+/oipA+ genotype infection was associated with increased risk of gastric cancer (OR = 3.85, 95% CI = 1.67–5.77, P=0.014). Conclusion. In this present study, we reported on the virulence genes of H. pylori infection to reveal their association with increased risk of chronic gastritis, precancerous gastric lesions, and gastric cancer. Precancerous gastric lesions with H. pylori vacA+/babA2+/oipA+ genotype increased the risk of gastric cancer

Long-term air pollution exposure and self-reported morbidity:a longitudinal analysis from the Thai cohort study (TCS)

Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand.This study was supported by the International Collaborative Research Grants Scheme with joint grants from the Wellcome Trust UK (grant number GR071587MA) and the Australian National Health and Medical Research Council (NHMRC) (grant number 268055). It was also supported by a global health grant from the NHMRC (grant number 585426)

Long-term air pollution exposure and serum lipids and blood sugar: A longitudinal cohort study from the electricity generating authority of Thailand study

Only a few studies have investigated the association between long-term exposure to air pollution and alterations of serum lipids and blood sugar level in developing countries. The present longitudinal study examined associations between long-term air pollution exposure and serum lipids [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] and fasting glucose (FG) in workers of the Electricity Generating Authority of Thailand (EGAT) in the Bangkok metropolitan region (BMR) of Thailand. We performed secondary analyses using the data obtained from 1, 839 participants (mean age, 58.3 years as of 2002) of the EGAT1 cohort study (2002–2012). The average concentration of each air pollutants (PM₁₀, O₃, NO₂, SO₂, and CO) at the sub-district level in BMR from 2002 to 2012 were estimated using the ordinary kriging method. Exposure periods were averaged to 3 months prior to laboratory testing. Linear mixed effects models were used to estimate associations between air pollution and serum lipids and blood sugar. After controlling for potential confounders, an interquartile range increment of PM₁₀, SO₂, and CO was associated with elevated LDL-C [6.6% (95%CI: 4.3, 9.0), 11.1% (7.2, 15.2), and 1.9% (1.1, 2.7), respectively] and FG [2.8% (1.5, 4.2), 6.8% (4.5, 9.1), and 1.1% (0.6, 1.5), respectively]. In addition, PM10, SO2, and CO were inversely associated with HDL-C [-1.8% (−3.7, 0.1), −3.3% (−6.2, −0.3), and −1.1 (−1.7, −0.5), respectively]. O₃ was negatively associated with TC, LDL-C, TG, and FG. These findings suggest inhalation of air pollutants may increase the risk of impaired metabolism of glucose and lipids

Health information literature across the cultural evolutionary divide

This paper details the process involved in developing the theoretical framework of factors for a major study entitled “Factors influencing the implementation of ICD-10 in Saudi public hospitals”. An original systematic review strategy, together with specific features of Endnote bibliographic manager software, were used to classify the global literature, separating it into the categories of developed nations and developing nations and, again, nationally according to the national modifications of ICD-10. Finally, the separated literature was examined under three categories, namely Health information, Organization, and National, in order to cast light on how such a process could be implemented in Saudi public hospitals. The issue has not been previously discussed in the Saudi literature. Saudi Arabia is attempting to implement ICD-10 from scratch without the background of a history of earlier ICD version usage. The results of the systematic review indicate a combination of barriers facing healthcare organizations in implementing ICD-10, including a lack of training, specialists, awareness, technology, resources, and some administration barriers. However, in terms of the reality of developing nations, more applicable practical advice was found in the healthcare literature of Thailand, rather than in that of the OECD nations. As ICD-10 is a new phenomenon in Saudi public hospitals and, based on the findings of this paper, it is possible that implementation may best be underpinned by Rogers’ Theory of Diffusion of Innovations, although certain factors that are essential for its success illustrate that an organizational application Maslow’s Triangle applies in dealing with these factors first

Survey on medical records and EHR in Asia-Pacific region: languages, purposes, IDs and regulations

Objectives: To clarify health record background information in the Asia-Pacific region, for planning and evaluation of medical information systems. Methods: The survey was carried out in the summer of 2009. Of the 14 APAMI (Asia-Pacific Association for Medical Informatics) delegates 12 responded which were Australia, China, Hong Kong, India, Indonesia, Japan, Korea, New Zealand, the Philippines, Singapore, Thailand, and Taiwan. Results: English is used for records and education in Australia, Hong Kong, India, New Zealand, the Philippines, Singapore and Taiwan. Most of the countries/regions are British Commonwealth. Nine out of 12 delegates responded that the second purpose of medical records was for the billing of medical services. Seven out of nine responders to this question answered that the second purpose of EHR (Electronic Health Records) was healthcare cost cutting. In Singapore, a versatile resident ID is used which can be applied to a variety of uses. Seven other regions have resident IDs which are used for a varying range of purposes. Regarding healthcare ID, resident ID is simply used as healthcare ID in Hong Kong, Singapore and Thailand. In most cases, disclosure of medical data with patient’s name identified is allowed only for the purpose of disease control within a legal framework and for disclosure to the patient and referred doctors. Secondary use of medical information with the patient’s identification anonymized is usually allowed in particular cases for specific purposes. Conclusion: This survey on the health record background information has yielded the above mentioned results. This information contributes to the planning and evaluation of medical information systems in the Asia-Pacific region