The purpose of this study was to compare calcaneal bone mineral density (CBMD) between female collegiate athletes and controls and to examine the relationship between CBMD and physical characteristics, maximal oxygen uptake, and nutrient and dietary intake. The subjects were 16 tennis players, 30 volleyball players, and 45 controls. CMBD was measured using quantitative ultrasound. The tennis and volleyball players showed significantly higher mean CBMD than that of the controls. The results did not change even after the mean values were adjusted for body height. CBMD was significantly correlated with body height, body weight, lean body mass, and maximal oxygen uptake, but was not correlate with nutrient and dietary intake. Thus, in the present study, CBMD was more closely related to physical characteristics than nutrient and dietary intake.
Evaluating the performance of a health promotion program to lower the risk of cardiovascular disease requires comparison with a suitably selected reference. Typically, the reference includes easily accessible participants who declined or were not enrolled in the intervention program. Unfortunately, the selected reference often fails to be comparable for many of the risk factor attributes that might determine the success or failure of the intervention. In response, we developed a propensity score that results in a reference sample with features that are similar to those enrolled in the health promotion program. Participants who received repeat physical examinations in Japan from 2008 to 2009 were identified as candidates for enrollment in an intensive health promotion program to lower the risk of cardiovascular disease (N = 33,009). Those who attended at least one session of the health promotion program were selected as the intervention group (N = 1,114). The remainder were selected as reference group I (N = 31,895). Among the latter, those with a high propensity for enrollment into the intervention group based on a logistic regression model were selected as reference group II (N = 3,008). A group III reference was similarly defined based on a linear regression propensity score (N = 2,992). Characteristics of the intervention and reference groups were compared. In the intervention group, subjects were younger and less likely to smoke cigarettes or eat breakfast than reference group I (P<0.001). Declines in body weight, waist circumference, and blood pressure between the repeated examinations from 2008 to 2009 were significantly greater in the intervention versus reference group I. Other than age, differences between the intervention and reference groups II and III failed to persist. In conclusion, identifying a reference group based on a propensity score results in a group of individuals with characteristics similar to those enrolled in a health promotion program. Comparison of the reference and intervention groups could result in improved assessments of the performance of health promotion programs.
We characterized the distribution of cardiac troponin I (cTnI) levels determined using a newly developed, highly sensitive assay reagent, and examined the relationship between blood cTnI levels and medical checkup items of examinees in our hospital. Among the 283 participants in the study, the number of those with cTnI equal to or below the background level (zero concentration) was 279 when measured by the conventional method, while 9 when measured by the highly sensitive method. cTnI levels were significantly higher in males and positively associated with the age. The multiple regression analysis revealed that male sex and age were independent factors for increased cTnI levels. When the participants were classified into “non-healthy subjects” and “healthy subjects” according to criteria based on personal medical history, present illness and laboratory test values, 166 participants (94 males and 72 females) were classified into healthy subjects and 117 participants into non-healthy subjects. About 70% of the 117 non-healthy subjects met criteria of hypertension and/or dyslipidemia. cTnI levels were significantly higher in the non-healthy subjects than in the healthy subjects. In addition, non-healthy subjects with hypertension, declined kidney function, or dyslipidemia showed significant high blood cTnI levels. In conclusion, the highly sensitive assay system can measure low blood cTnI levels in medical checkup examinees, suggesting that it can detect slight myocardial changes associated with cardiomyopathy. The blood cTnI reference value as myocardial markers should be set considering gender and age.
Since Warren and Marshall's discovery of Helicobacter pylori, tremendous break-through has occurred in the natural history of gastroduodenal diseases. Nowadays, not only chronic gastritis and peptic ulcer disease, but also non-cardia gastric cancers have been recognized as diseases originating from H. pylori infection. In Japan, gastric cancer screening program by using barium X-ray photofluorography has been conducted for more than 40 years. However, we have to reconsider the efficacy and cost-performance of this classical screening system and to remodel by including the target strategy against H. pylori. Since 2013, the national insurance system in Japan approved the H. pylori eradication therapy for patients with H. pylori-infected gastritis, which covers most of the H. pylori-infected cohorts. To extinguish the gastric cancer from Japan in near future, new screening and treatment strategy would be required in this field.
When arrhythmias are detected during health checkups, physicians must consider 1) whether the arrhythmia should be treated or may be left untreated, and 2) whether the arrhythmia may lead to a fatal outcome in the future on the basis of the presence/absence of symptoms and the type of arrhythmia. This document describes how to assess the risk of severe and possibly fatal arrhythmias in patients found to have abnormal ECG findings such as premature ventricular complexes (PVCs) during health checkups. The most important factor for the risk of fatal arrhythmia is the presence or absence of structural heart disease. Physicians should be able to recognize abnormal findings on a 12-lead ECG suggestive of heart diseases such as ST-T changes associated with left ventricular hypertrophy, ischemic ST-T changes, and ECG findings of old myocardial infarction, and recommend the patients to undergo echocardiography, stress ECG, coronary CT, or other appropriate examinations. The Lown classification was advocated as it was useful in classifying the severity of PVCs and prescribing antiarrhythmic drugs according to the severity scale, but this is only useful for patients in the coronary care unit (CCU) or those with severe heart disease. The risk of sudden death is considered low when structural heart disease is ruled out even when the PVC is rated as severe in the Lown classification. There are ECG findings that indicate the risk of sudden death in patients with no arrhythmias on a 12-lead ECG. For example, the ε wave at the terminal portion of the QRS complex in V1, V2 or V3 is specific to arrhythmogenic right ventricular cardiomyopathy (ARVC). The document also describes “idiopathic ventricular fibrillation” (IVF) that is defined as ventricular arrhythmia in the absence of structural heart disease. Long QT syndrome, a type of IVF, is a genetic cardiac abnormality that can lead to syncope, seizure or sudden death due to polymorphic ventricular tachycardia. Brugada syndrome, another type of IVF, is a condition that is characterized with typical ST elevation patterns in V1~V3 leads and may lead to sudden death due to ventricular fibrillation, and is classified into the coved type and the saddle back type according to the ST wave form. Recent automatic ECG analyzers recognize the patterns of these waveforms and report them as “Brugada syndrome is suspected”. Physicians should interview such patients for their history of syncope and family history of sudden death to determine whether further examinations are needed or not. Early repolarization syndrome and short PR interval syndrome, which have been recently reported as new entities of IVF, are also described. When physicians and laboratory professionals look for slight abnormal findings in routine ECGs, appropriate measure can be taken to prevent cardiovascular events. An understanding of warning ECG abnormalities is essential.
The goals of osteoporosis management consist in preventing osteoporotic fractures. It is vitally important that those at high risk of fracture proactively seek medical consultation and osteoporosis screening or bone health check-up programs play a major role in encouraging them to do so. However, 70% of the healthcare facilities offering such programs draw on quantitative ultrasound (QUS) for bone health examinations. While being convenient and free from exposure to radiation, QUS involves different parameters and yields highly variable data depending on the equipment used. Thus, QUS is not only unsuitable as a modality for definitive diagnosis but also has a dubious role in screening. Against this background, I would like to propose the use of microdensitometry (MD) in screening programs as a modality that allows not only osteoporosis screening but also diagnosis of osteoporosis. Furthermore, MD allows a large number of patients to be examined in a short time and does not require any further instrument beyond a radiographic imaging device, with the most recent of these devices requiring only half of the radiation dose required in conventional devices. I would also like to propose the use of “loco-check” in combination with MD, as it allows evaluation of locomotor function as part of bone health check-up programs. Additionally, I would also like to propose the use of 25(OH)D, a measure of vitamin D, which is shown to be useful in detecting those with low bone mineral density and at high risk of bone fracture, while this marker has yet to be covered by health insurance. Bone health check-up programs are intended to detect those potentially affected by osteoporosis for treatment. Thus, in this review, I have focused on how future bone health check-up programs may be envisioned in light of current osteoporosis management approaches.
The prolongation of life expectancy for the elderly in the developed world has created several issues requiring urgent appropriate responses for certain clinical phenotypes, such as geriatric syndrome. Among these phenotypes, frailty and dementia are thought to play important roles, and their mutual interaction, diagnosis, and preventive measures must be clarified and developed based on highly refined evidence-based epidemiologic studies. Geriatric syndrome is characterized by various signs including delirium, falls, incontinence, pressure ulcers, and general functional declines, and the resulting frailty promotes impairments in IADL and ADL associated with a dependent state of daily living. Although studies on the relation between frailty and dementia have been sparse, several recent epidemiologic studies have disclosed that the prevalence of dementia among individuals with frailty and the prevalence of frailty among individuals with dementia exhibit similar tendencies. One of these studies was a prospective 5-year follow-up cohort study performed on 407 non-frail subjects (78 ± 4 years), in which the following 4 predictors for frailty were identified: decreased timed walk (<3 seconds/5 meters), increased pulse pressure (>60mmHg), decreased cognitive function (subjective), and increased hearing deficit (subjective), with 93% negative and 70% positive predictive values. Since all these predictors are also risk factors for cognitive impairment, frailty and dementia might be mutually related in some way. Also, a generalized concept of geriatric syndrome and new conceptual models addressing the pathophysiology of geriatric syndromes in a manner reflecting the complex interaction between frailty and dementia were discussed. Although further studies are needed to confirm these results, some sort of evaluation and preventive measures for both frailty and dementia should be proposed to the elderly from the standpoint of health evaluations and health promotion. Especially, cognitive hearing science should be extensively studied to promote hearing rehabilitation procedures, and the effects of antihypertensive medication should also be explored with special reference to the specific domains of cognitive function that can be affected.
Japan Atherosclerosis Society Guidelines for Prevention of Cardiovascular Diseases in Japan-2012 version recommends managing dyslipidemia in addition to other risk factors. Risk factors that should be considered strict management include hyper LDL-cholesterolemia, diabetes mellitus, no cardiogenic cerebral infarction, peripheral arterial disease, and chronic kidney disease. For the primary prevention, we recommend to use absolute risk, the coronary artery disease (CAD) death rate of 10 years calculated based on the results of the NIPPON DATA80 risk evaluation chart. However, setting of the LDL-cholesterol (LDL-C) target value does not have the evidence; the management target value is an aim but not absolute value. As a result of RCT and meta-analysis by use of statin, it is important to use 20-30% of LDL-C reductions because 30% of major coronary events declined with statin are observed. Though a CAD morbidity and mortality in Japan is far lower than Europe and America, the diagnostic criteria and the target management value of the LDL-C becomes the severe standard. The reason is because we aim for maintaining the low absolute risk from CAD. Dyslipidemia should be treated with the lifestyle modification and recommend traditional Japanese food and nutrients intake “The Japan Diet”. As for the drug treatment, drug that an effect and safety were confirmed in randomized controlled trial (RCT) is recommended. Since, the guidelines provide information to make treatment decision, the last judgment of the treatment of the individual patient must be done by a chief physician.
To catch up recent advance in medical practice and include recent clinical evidences for better cardiovascular prognosis of the patients, Japanese Society of Hypertension renews the guideline for the management of hypertension in 2014. Office blood pressure values to define hypertension remain unchanged. However, the importance of home blood pressure is strengthened in this revision. Indeed, to detect masked hypertension, new guideline clearly states that home blood pressure values should be used to diagnose hypertension, even if it differs from office blood pressure profile. Another important revision is that target of blood pressure is changed to 150/90 mmHg for patients over 75 y/o. In 2013, guideline for the treatment of chronic kidney disease (CKD) was revised by Japanese Society of Nephrology. CKD is defined as abnormality of urinalysis persisting for more than 3 months and/or estimated glomerular filtration rate (eGFR) less than 60 mL/min. Major changes in new guideline are that diabetic nephropathy is separated from the other nephropathy, and that diabetic nephropathy utilizes albuminuria instead of proteinuria for the classification of CKD. CKD stage is also revised by dividing stage 3 into 2 stages; stage 3a (eGFR 60-45 mL/min) and 3b (45-30 mL/min).