Prevalence of Chronic Kidney Disease and Variation of Its Risk Factors by the Regions in Okayama Prefecture

Objective: The prevention of chronic kidney disease (CKD) progression is an important issue from health and financial perspectives. We conducted a single-year cross-sectional study to clarify the prevalence of CKD and its risk factors along with variations in these factors among five medical regions in Okayama Prefecture, Japan. Methods and Results: Data concerning the renal function and proteinuria as well as other CKD risk factors were obtained from the database of the Japanese National Health Insurance. The proportion of CKD patients at an increased risk of progression to end-stage renal disease (ESRD), classified as orange and red on the CKD heatmap, ranged from 6–9% and did not vary significantly by the regions. However, the causes of the increased severity differed between regions where renal dysfunction was predominant and regions where there were many patients with proteinuria. CKD risk factors, such as diabetes mellitus, hypertension, hyper low-density lipoprotein-cholesterolemia, obesity, smoking and lack of exercise, also differed among these regions, suggesting that different regions need tailored interventions that suit the characteristics of the region, such as an increased health checkup ratio, dietary guidance and promotion of exercise opportunities. Conclusions: Approximately 6–9% of people are at an increased risk of developing ESRD (orange or red on a CKD heatmap) among the population with National Health Insurance in Okayama Prefecture. The underlying health problems that cause CKD may differ among the regions. Thus, it is necessary to consider intervention methods for preventing CKD progression that are tailored to each region’s health problems.

Trends in Incidence of Intracranial and Spinal Arteriovenous Shunts

Background and Purpose: To date, the incidence of intracranial and spinal arteriovenous shunts has not been thoroughly investigated. We aimed to clarify recent trends in the rates of intracranial and spinal arteriovenous shunts in Japan. Methods: We conducted multicenter hospital-based surveillance at 8 core hospitals in Okayama Prefecture between April 1, 2009 and March 31, 2019. Patients who lived in Okayama and were diagnosed with cerebral arteriovenous malformations, dural arteriovenous fistulas (DAVFs), or spinal arteriovenous shunts (SAVSs) were enrolled. The incidence and temporal trends of each disease were calculated. Results: Among a total of 393 cranial and spinal arteriovenous shunts, 201 (51.1%) cases of DAVF, 155 (39.4%) cases of cerebral arteriovenous malformation, and 34 (8.7%) cases of SAVS were identified. The crude incidence rates between 2009 and 2019 were 2.040 per 100 000 person-years for all arteriovenous shunts, 0.805 for cerebral arteriovenous malformation, 1.044 for DAVF, and 0.177 for SAVS. The incidence of all types tended to increase over the decade, with a notable increase in incidence starting in 2012. Even after adjusting for population aging, the incidence of nonaggressive DAVF increased 6.0-fold while that of SAVS increased 4.4-fold from 2010 to 2018. Conclusions: In contrast to previous studies, we found that the incidence of DAVF is higher than that of cerebral arteriovenous malformation. Even after adjusting for population aging, all of the disease types tended to increase in incidence over the last decade, with an especially prominent increase in SAVSs and nonaggressive DAVFs. Various factors including population aging may affect an increase in DAVF and SAVS.

A Grave for the King and His People: Documenting the Excavation of the Tsuki-no-wa Tomb (1953-1954)

In the summer of 1953, the small village of Yukamura in Okayama Prefecture, Japan, became a major archeological site. The excavation of the Tsuki-no-wa tomb (created in late 4th — early 5th century) was initiated by the local residents with no professional training in archeology. The project became one of the most ambitious and successful endeavors of the People’s History Movement (kokumin-teki rekishigaku undo) led by the Marxist historians in early 1950s in Japan. The “memory” of the excavation has been meticulously documented in scientific papers, tourist pamphlets, individual memoirs, as well as in the film. A short documentary, The Tsuki-no-wa Tomb (1954), was created at the behest of the people involved in the project. While the film was favorably received by the critics, the Minister of Education refused to grant it with an official “recommendation.” Today the short documentary is considered a symbol of the political and cultural mainstream, which adheres to the ideas of social equality and democracy, the importance of a scientific approach, the concept of the “monoethnic” origins of Japan, and the symbolic status of the emperor. In this paper, the paradoxical role of the Japanese leftists in supporting the dominant worldview is examined though the study of The Tsuki-no-wa Tomb. Through analyzing the cinematic text, as well as the history of its production and reception, we come to a better understanding of the ideological and organizational underpinnings of the People’s History Movement, illuminating the film’s role in the development of historical science and documentary filmmaking in postwar Japan.