Organizational aspects in one phlebology center: the Tuscany model

The author reports about the organization of the phlebology center at the University of Siena, directed since 1985 by Professor Mancini. The center is equipped with 5 phlebology outpatient settings, with own instruments for non-invasive vascular diagnostics, with one operating theatre and with own equipment for phlebological rehabilitation. At present, in this center a group of specialist doctors and experts in phlebological formation works and practices everyday more than 30 performances instrumental vascular diagnostic both in election, both also in urgency for the patients coming from the Ready Aid. The therapeutic performance, which the phlebology surgical activity, the sclerotherapy, the ulcer dressing, are carried out on specific days of the week. The organization of the Center of Phlebology has to answer indeed to the demands of the use, simplifying the procedures of access, decreasing the times of attended of the diagnostic performance and the therapeutics and the reducing to the least one the interferences with the common habits of life, kind of the elderly patients.     

The effects of childhood residence in Japan and testing language on cognitive performance in late life among Japanese American men in Hawaii

OBJECTIVES: To examine the association of years spent in Japan during childhood with cognitive test performance in late life among Japanese American men, and to assess the influence of the language used for testing on this association. DESIGN: A cross-sectional study. SETTING/PARTICIPANTS: A total of 3734 Japanese American men, aged 71-93 years, who were first- or second-generation migrants and living on Oahu Island, Hawaii. MEASUREMENTS: The outcome variable was cognitive test performance assessed using the Cognitive Abilities Screening Instrument (CASI), which was developed for cross-cultural studies of cognitive impairment. The explanatory variable of main interest was the number of years spent in Japan during school-age childhood years (ages 6-17). The associations of CASI scores with childhood years in Japan was evaluated using a stepwise multiple linear regression model in which a total of 40 potential confounders were included as covariates. RESULTS: In the total sample, there was an inverse association between CASI scores and middle childhood years in Japan. This association remained significant after controlling for age, education, socioeconomic status, traditional Japanese food consumption, pulmonary function, apolipoprotein E4, proficiency in speaking Japanese, and other possible confounders. When data were analyzed separately for subgroups according to the language preferred at testing (English or Japanese), associations between childhood years in Japan and CASI scores were in opposite directions negative for the group tested in English and positive for the group tested in Japanese. The interaction between the testing language and childhood years in Japan was statistically significant. CONCLUSIONS: There was an inverse association between years spent in Japan during school-age years of childhood and cognitive test performance in late life. This association could not be accounted for by age, education, or other confounding factors. However, this finding was not observed in participants who preferred being tested in Japanese. To assess cognitive test performance in older people, it is of prime importance to use the most optimal language for testing, usually the subject's native language.     

Use of musculoskeletal ultrasound in Japan: a survey of practicing rheumatologists

We aimed to describe how often Japanese rheumatologists currently use musculoskeletal ultrasound (MSUS), and how they are currently being trained in the use of this imaging technique. Questionnaires were sent to 200 Japanese rheumatologists: 100 to participants attending the first Scientific Meeting of the Japanese Society of Imaging in Rheumatic Diseases in 2006, and 100 to other randomly selected rheumatologists certified by the Japan College of Rheumatology. A total of 139 questionnaires (74 from meeting participants, 65 from randomly selected rheumatologists) were completed and analyzed. Twenty-four of the 74 respondents (32.4%) in the meeting participants group used MSUS imaging for patient management, while only 7 of the 65 respondents (10.8%) in the certified rheumatologists group used MSUS imaging for patient management. Sixty-five of the 74 respondents (87.8%) in the meeting participants group and 54 of the 65 respondents (83.1%) in the certified rheumatologists group considered MSUS to be a useful tool. Only a minority of respondents used MSUS in the management of their patients. Lack of training in MSUS was the principal reason for not performing MSUS. Japanese rheumatologists would prefer future training in the form of intensive courses and training sessions.     

Clinical characteristics of pain in chronic venous insufficiency]

Since the report of the 1st International Conference of Phlebology at Chambéry, devoted to venous pain, the subject has scarcely attracted attention apart from the meeting of the Benelux Society of Phlebology devoted to "pain in the legs". Pain due to superficial venous insufficiency has scarcely changed in nature for 30 years and remains one of the major presenting symptoms in phlebology. Acute or chronic, punctate or diffuse, modifications in this functional symptomatology have been accentuated, or have varied in their aspects under the influence of certain fashions or certain habits of modern life, i.e.: sedentary behaviour, underfloor heating, the use of oral contraceptives or of menopausal hormone replacement therapy. However, the distribution of the various aspects of venous pain remains in the same proportions as those described by the authors cited previously. While the etiological diagnosis must essentially eliminate all other causes: arterial, neurological, muscular, articular, it is essential not to neglect deep venous insufficiency of the gemellar veins, often responsible for a wide range of symptomatology and still all too often neglected. The pathogenesis of this pain not only involves the concept of pain receptors but also the appearance of algogenic metabolites at the site of the microcirculatory unit, to which endothelial cells are particularly sensitive during stasis. In fact, pain is the expression of disorders concerning local exchanges, whether thermal, pressure, metabolic or hemorheological. It is the alarm bell of venous insufficiency and merits the attention of the phebologist who must thus undertake active treatment before problems become irreversible.     

The 12th International Rheumatology Symposium in Tokyo

Abstract

We aimed to describe how often Japanese rheumatologists currently use musculoskeletal ultrasound (MSUS), and how they are currently being trained in the use of this imaging technique. Questionnaires were sent to 200 Japanese rheumatologists: 100 to participants attending the first Scientific Meeting of the Japanese Society of Imaging in Rheumatic Diseases in 2006, and 100 to other randomly selected rheumatologists certified by the Japan College of Rheumatology. A total of 139 questionnaires (74 from meeting participants, 65 from randomly selected rheumatologists) were completed and analyzed. Twenty-four of the 74 respondents (32.4%) in the meeting participants group used MSUS imaging for patient management, while only 7 of the 65 respondents (10.8%) in the certified rheumatologists group used MSUS imaging for patient management. Sixty-five of the 74 respondents (87.8%) in the meeting participants group and 54 of the 65 respondents (83.1%) in the certified rheumatologists group considered MSUS to be a useful tool. Only a minority of respondents used MSUS in the management of their patients. Lack of training in MSUS was the principal reason for not performing MSUS. Japanese rheumatologists would prefer future training in the form of intensive courses and training sessions.     

Assessment of coronary intervention in Japan from the Japanese Coronary Intervention Study (JCIS) Group.

BACKGROUND: The first nationwide survey of the situation in Japan (the 1997 SJ) regarding percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) was conducted by the Japanese Coronary Intervention Study (JCIS) group and the results of the second nationwide, continuous survey of Japan in 2000 (the 2000 SJ) are presented here. METHODS & PROCEDURES: A questionnaire was collected from 8,268 facilities (99.93%). In the 2000 SJ, the total number of coronary arteriography (CAG) performed was 543,046 (428 CAGs per 105 population). The estimated ratio of CAG to patients with coronary artery disease (CAD) in Japan is approximately 1.4-fold that in the US. Total numbers of PCI and CABG performed were 146,992 and 23,584, and increased to 134% and 130%, respectively, over the 3 years. PCI facilities with an annual number of PCIs performed of more than 100 were 40.2%, and the respective CABG facilities were 8.3%. The ratio of PCI to CABG was 6.23 in the 2000 SJ, and was several times higher than the ratio in Western countries. CONCLUSION: The situation in Japan regarding the number of CAG, PCI, and CABG procedures performed is very different from that in Western countries. This provides important information for diagnosis, treatment and guidelines for Japanese patients with CAD.     

HIV-Related Risk Behaviors Among Japanese Tourists in the Khaosan Road Area, Bangkok, Thailand

This study investigated HIV-related drug use and sexual behaviors among Japanese tourists in the Khaosan Road area in Bangkok, Thailand. A stratified sample of 150 Japanese tourists anonymously self-administered a structured questionnaire. Approximately two thirds of participants had used illicit drugs. Among drug users, 33% and 49% had used marijuana during the past 6 months in Japan and in Thailand, respectively. Study participants tended to engage in riskier sex in Japan than in Thailand. In Thailand, 9% had not always used condoms with sex workers for vaginal sex. The majority of participants had engaged in sex with sex workers under the influence of alcohol in Japan (88%) and in Thailand (71%). Those who had engaged in high-risk sexual behaviors in Japan were more likely to engage in the same behaviors in Thailand, and vice-versa. Drug abuse and HIV/AIDS prevention programs targeting young Japanese tourists should be established in Thailand.     

Anticipated Increase in the Number of Patients Who Require Dialysis Treatment Among the Aging Population of Japan

The aging population is anticipated to have a large impact on the number of incident dialysis patients, as the risk of end‐stage kidney disease increases with age. This study aimed to examine trends in the sex‐ and age‐specific incidence rates of dialysis between 2008 and 2012, and to assess the impact of population aging on the number of incident dialysis patients over the next decade in Japan. Incidence was calculated using published data and Japan's population statistics. The 2012 incidence was extrapolated, and projected future demographic changes within the Japanese population were used to estimate the number of incident dialysis patients in 2020 and 2025. As a general trend, the sex‐ and age‐specific incidence rates of dialysis decreased gradually between 2008 and 2012, except among men aged ≥80 years. The total number of incident dialysis patients was projected to increase by 12.8% from 36 590 in 2012 to 41 270 in 2025. Greater increases were observed in the oldest age group (≥85 years). In 2025, the number of incident dialysis patients in this group was projected to increase by 92.6% in men and 62.2% in women. This study shows the number of patients who initiate dialysis treatment is projected to increase over the next decade in Japan due to aging of the population. Effective strategies are needed to offset the challenges faced by the aging population, with a particular focus on octogenarians and older, given the notable proportion of patients requiring dialysis treatment in the future.     

Impact of obesity on annual medical expenditures and diabetes care in Japanese patients with type 2 diabetes mellitus

Aims/Introduction

Diabetes and obesity are important health and economic concerns. We investigated the influence of obesity on diabetes control, the annual medical expenditures and medications in Japanese patients with type 2 diabetes who were relatively lean in comparison with those in Western countries.

Materials and Methods

A total of 402 Japanese patients with type 2 diabetes were enrolled and their annual medical expenditures investigated. Obesity was defined as body mass index ≥25 kg/m², according to the obesity classifications from the Japan Society for the Study of Obesity.

Results

A total of 165 patients (41.0%) were classified as obese. The obese group was younger, had poor glycemic control and higher frequency of hypertension than the non‐obese group. The median total annual medical expenditures for all participants was ¥269,333 (interquartile range ¥169,664–437,437), which was equivalent to approximately $US2,450. The annual medical expenditure was significantly higher in patients with obesity than in non‐obese patients (P < 0.001). This difference was mainly attributed to the annual expenditures for medication and hospitalization. In particular, the medication expenditures and the average number of drug classes for hyperglycemia and hypertension were significantly higher in the obese group.

Conclusions

Japanese patients with type 2 diabetes and obesity had higher annual medical expenditures and a larger number of medications, but their diabetes control care was insufficient in comparison with those without obesity. Further studies are required to assess the effect of reducing bodyweight on diabetes control and costs.     

The Japanese society of alcohol-related problems

This paper presents an outline of the Japanese Society of Alcohol-Related Problems. The precursor of the Society was the Japan Alcoholism Treatment Research Group, inaugurated in 1979, by merging two local research groups in the Tokyo and Osaka areas, both of which were exclusive gatherings of psychiatrists associated with alcoholism clinics. The Research Group developed into the Society in 1992, as the number of participants including those from other medical professions increased yearly, and the subjects of the group widened to include all addictive behaviours. In reflecting the process of establishment, it is unique in many aspects as a scientific society. The Society is not a science-orientated body for presentation of new research findings. The main programme of the annual meeting is therefore a set of symposia in which members participate and discuss clinical and/or social problems arising from dependency on alcohol or drugs. Perhaps because of its content, the annual meeting is attended each year by the largest number of participants among all the societies in Japan concerned with alcohol and drugs. For the next several years, the Society's activities will be directed at (1) establishment of guidelines for early identification of and intervention in alcohol-related problems; (2) expansion of its membership to include those in related fields of medicine and non-medical professions; (3) improvement of the system of journal publication; and (4) creation of a system for timely adequate response to social problems associated with drugs and alcohol.     

Smoking, drinking, sleeping habits, and other lifestyle factors and the risk of systemic lupus erythematosus in Japanese females: findings from the KYSS study

Many risk factors have been proposed for systemic lupus erythematosus (SLE). However, there is little information about the relationship between lifestyles and SLE in Japan. Two case control studies were conducted in Kyushu, southern Japan, and in Hokkaido, northern Japan, to examine the relationship between lifestyles and development of SLE in females. The participants were 78 patients and 329 controls in Kyushu and 35 patients and 188 controls in Hokkaido. Smoking was associated with an increased risk of SLE after adjusting for age in both regions. However, in Hokkaido, this association between smoking and SLE did not reach statistical significance after adjusting for alcohol drinking. The present study suggests that smoking may increase the risk of SLE among Japanese females.     

Simultaneous vaccination in Japanese travelers

BACKGROUND: Simultaneous vaccination is not common in Japan because there is little information available on its effects. Some people are quite concerned about the possibility of adverse reactions due to simultaneous vaccination. The objective of this study was to evaluate whether the frequency and severity of adverse effects are increased by simultaneous vaccination in comparison to single vaccination. METHOD: A retrospective observational study was conducted in 399 asymptomatic travelers who visited the travel clinic during the period January-July 2005. One hundred forty-two participants were given a single vaccination, 257 participants were given simultaneous vaccination. Travel-specific vaccinations were for hepatitis A, hepatitis B, tetanus, rabies and Japanese encephalitis, and routine vaccines were for diphtheria+tetanus, measles, mumps and oral polio vaccine. To evaluate adverse effects, travelers were asked to complete a prepared questionnaire after vaccination. RESULTS: Adverse effects were reported by 26.3% of travelers, with 21.8% reporting local reactions and 4.5% reporting systemic reactions. The simultaneous vaccination group reported significantly more frequent adverse effects than those reported by the single vaccination group. Particularly, tetanus vaccination was shown to significantly raise the risk of adverse effects (P<0.001). However, no serious adverse effects were reported. CONCLUSIONS: Simultaneous vaccination was feasible for Japanese travelers because most problems were generally minor and related to local reactions at the sites of injections. Provision of a simultaneous vaccination schedule should motivate more Japanese travelers to obtain immunizations and thereby reduce the risk of vaccine-preventable diseases.     

A survey of the clinical course and management of Japanese patients deficient in natural anticoagulants

Few data are available on the clinical course of Japanese patients deficient in natural anticoagulants (antithrombin (AT), protein C, and protein S). We conducted a nationwide survey to reveal the clinical course of these patients. Questionnaires were sent to 321 council members of the Japanese Society on Thrombosis and Hemostasis, Japanese Society for Vascular Surgery, and Japanese Society of Phlebology. A total of 103 responses were obtained and data of 183 patients were collected. Of 183 patients, 142 (78%) experienced at least one episode of venous thromboembolism (VTE). The first VTE occurred before the age of 40 years in 71 patients (45%). Venous thromboembolism recurred in 15 (39%) patients with AT deficiency and 19 (18%) patients with other deficiencies. These findings suggest that half of the first episodes of VTE in patients deficient in natural anticoagulants occur before middle age and the risk of VTE recurrence is high in patients with AT deficiency.     

Effects and contents of nutrition education relating to sarcopenia and frailty for Japanese older adults: A systematic review

This systematic review aimed to clarify whether nutrition education relating to sarcopenia and frailty for Japanese older adults has been effective and to identify the content of nutrition education that is provided to participants. We examined relevant studies published before January 2021. The inclusion criteria were as follows: (i) studies on nutrition education provided by experts; (ii) studies on Japanese participants aged 60 years or older; (iii) full papers published in English or Japanese; and (iv) studies with outcomes that include measurement items related to sarcopenia and frailty. A search strategy was designed using keywords such as “Japan” or “Japanese” and “nutrition education.” In total, 798 titles and 179 abstracts were examined, and 63 full texts were selected for reading. Ten articles met all the inclusion criteria. Only two studies aimed to determine the effectiveness of nutrition education. We could not clarify whether nutrition education relating to sarcopenia and frailty for Japanese older adults was effective. However, we did identify various nutrition education contents on sarcopenia and frailty for Japanese older adults. Further studies are needed as follows: (i) studies designs that can determine whether nutrition education is effective; (ii) studies in which the content of the cooking training can be reproduced; (iii) studies in which the intervention group and the control group have the same educational content with different duration and frequency; (iv) studies that are written in English; and (v) studies that are conducted on men. Geriatr Gerontol Int 2021; 21: 1084–1092 .     

Mass screening for gastric cancer performed in Costa Rica]

We performed mass screening for gastric cancer by means of X-ray in Costa Rica from 1996 through 1999. Screening was performed on 10,064 subjects and 69 gastric cancers were detected (screening group). During the same period 172 gastric cancer patients were referred to us (non-screening group). Results of screening in Japan (Japanese group) were quoted from the annual report of the Japanese Society of Gastroenterological Mass Survey. This study is a comparison of these 3 groups. The detection rate was 0.68% in the screening group, 0.11% in the Japanese group. The operability was 92.7%, 76.1%, 97.0%, the resectability 96.8%, 83.2%, 98.6%, the rate of early gastric cancer 64.5%, 30.3%, 65.9%, and the rate of curability A 79.0%, 38.5%. 82.6% in the screening group, non-screening group and Japanese group respectively. The results in the screening group were exactly equal to those in the Japanese group. These results show that the same results can be obtained in Costa Rica as in Japan, if screening is performed with the same diagnostic level and skill as in Japan.     

Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study.

The prevalence of stage 3 to 5 chronic kidney disease (CKD) in Japan (18.7%) is considerably higher than that in the United States (4.5%). This study investigated in the Japanese general population whether this higher prevalence of CKD might reflect to a progressive decline of renal function, and in turn to the increased risk of end-stage renal disease. A decline in renal function over 10 years was examined in 120,727 individuals aged 40 years or older who participated in the annual health examination program of the two periods over 10 years, 1988-1993 and 1998-2003. Renal function was assessed with estimated glomerular filtration rate (GFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) Study equation modified by a Japanese coefficient. The rate of GFR decline in the participants was 0.36 mL/min/1.73 m2/year on average. In the male population aged 50-79, the mean rate of GFR decline was significantly higher in the presence of hypertension than in its absence. The rate of GFR decline was more than two times higher in participants with proteinuria than in those without proteinuria in both sexes. The rate was significantly higher in participants with an initial GFR<50 mL/min/1.73 m2 among the groups younger than age 70 and in participants with an initial GFR<40 mL/min/1.73 m2 in the group with age 70-79. Based on the slow rate of GFR decline, we concluded that the decline in renal function progresses slowly in the Japanese general population. Hypertension, proteinuria and lower GFR were found to be significant risk factors for a faster decline of GFR.     

An Analysis of the Development of Colonic Diverticulosis in the Japanese

PURPOSE There are quite different characteristics between colonic diverticulosis in the West and that in Asia, including Japan. These differences include the predominance of a few diverticula over others, right-sidedness, young generation, male, and few complications. In Japan, colonic diverticulosis started increasing in the 1970s. This study was performed to obtain exact evidence of diverticular development in contemporary Japanese by observing changes in diverticula in the same individuals examined over a period of ten or more years. METHODS This study included 82 subjects (56 (68 percent) males and 26 (32 percent) females) who underwent barium enema examinations repeatedly for more than ten years from 1982 to 2000. The diverticula were categorized according to their location in the colon: right, left, or bilateral. They were also categorized by whether they appeared individually, were scattered with two to nine diverticula, or were numerous with ten or more diverticula. RESULTS At the beginning of observation, the most frequent location was the right side (55; 67 percent), followed by bilateral (20; 24 percent) and the left side (7; 9 percent). Ten or more years later, the number on the right side had decreased to 39 (48 percent). The number of bilateral diverticula had increased to 38 (46 percent), and the number on the left had barely changed, to 5 (6 percent). The number of diverticula increased from 253 to 604 (239 percent) in the right and from 380 to 929 (244 percent) in the bilateral. The initially very small number in the left increased from 9 to 48 (533 percent). The data show marked increases in the right and bilateral diverticula, and also the spread from the right side to the left side. CONCLUSION In contemporary Japanese, although the right predominated initially, diverticulosis showed a strong tendency to increase and spread from the right to the bilateral. The number of bilateral diverticula also tended to increase. The left did not change much. Presented at the meeting of The Japan Society of Coloproctological Dysfunction, Tokyo, Japan, September 1, 2001.     

Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis

There are no evidence-based-criteria for the diagnosis, severity assessment, of treatment of acute cholecysitis or acute cholangitis. For example, the full complement of symptoms and signs described as Charcot’s triad and as Reynolds’ pentad are infrequent and as such do not really assist the clinician with planning management strategies. In view of these factors, we launched a project to prepare evidence-based guidelines for the management of acute cholangitis and cholecystitis that will be useful in the clinical setting. This research has been funded by the Japanese Ministry of Health, Labour, and Welfare, in cooperation with the Japanese Society for Abdominal Emergency Medicine, the Japan Biliary Association, and the Japanese Society of Hepato-Biliary-Pancreatic Surgery. A working group, consisting of 46 experts in gastroenterology, surgery, internal medicine, emergency medicine, intensive care, and clinical epidemiology, analyzed and examined the literature on patients with cholangitis and cholecystitis in order to produce evidence-based guidelines. During the investigations we found that there was a lack of high-level evidence, for treatments, and the working group formulated the guidelines by obtaining consensus, based on evidence categorized by level, according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence of May 2001 (version 1). This work required more than 20 meetings to obtain a consensus on each item from the working group. Then four forums were held to permit examination of the Guideline details in Japan, both by an external assessment committee and by the working group participants (version 2). As we knew that the diagnosis and management of acute biliary infection may differ from country to country, we appointed a publication committee and held 12 meetings to prepare draft Guidelines in English (version 3). We then had several discussions on these draft guidelines with leading experts in the field throughout the world, via e-mail, leading to version 4. Finally, an International Consensus Meeting took place in Tokyo, on 1–2 April, 2006, to obtain international agreement on diagnostic criteria, severity assessment, and management.     

Epidemiology of hypertension in China and Japan

Hypertension is a major risk factor for cardiovascular disease in Chinese and Japanese with a low to moderate serum cholesterol level. The prevalence of hypertension is diverse in Chinese populations with different geographic region, lifestyles and cultures. The same diversity was observed in Japan in the past, but recently the regional difference has become smaller. The large decline in stroke mortality in Japan was followed by a reduction in the prevalence of hypertension and the lowering level of blood pressure. This is partly explained by various community-based hypertension control programmes. Chinese populations are now showing similar patterns as those observed in Japan. These populations still have high proportions of undetected hypertensives and untreated patients in China. In both Chinese and Japanese, high salt consumption is one of the most important risk factors for hypertension. In addition to this, the increase in body weight, smoking and alcohol consumption in Chinese people seems to be the major factors for the increasing trends in hypertension. Control of hypertension and lowering blood pressure in the population level should be the important strategies for the prevention of cardiovascular disease in Chinese and Japanese.     

Smoking,drinking, sleeping habits,and other lifestyle factors and the risk of systemic lupus erythematosus in Japanese females: findings from the KYSS study

Abstract

Many risk factors have been proposed for systemic lupus erythematosus (SLE). However, there is little information about the relationship between lifestyles and SLE in Japan. Two case control studies were conducted in Kyushu, southern Japan, and in Hokkaido, northern Japan, to examine the relationship between lifestyles and development of SLE in females. The participants were 78 patients and 329 controls in Kyushu and 35 patients and 188 controls in Hokkaido. Smoking was associated with an increased risk of SLE after adjusting for age in both regions. However, in Hokkaido, this association between smoking and SLE did not reach statistical significance after adjusting for alcohol drinking. The present study suggests that smoking may increase the risk of SLE among Japanese females.