Tracing all patients who received insured dialysis treatment in Japan and the present situation of their number of deaths

Background The survival rate of chronic dialysis patients in Japan remains the highest worldwide, so there is value in presenting Japan’s situation internationally. We examined whether aggregate figures on dialysis patients in the National Database of Health Insurance Claims and Special Health Checkups of Japan (NDB), which contains data on insured procedures of approximately 100 million Japanese residents, complement corresponding figures in the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). Methods Subjects were patients with medical fee points for dialysis recorded in the NDB during 2014–2018. We analyzed annual numbers of dialysis cases, newly initiated dialysis cases– and deaths. Results Compared with the JRDR, the NDB had about 6–7% fewer dialysis cases but a similar number of newly initiated dialysis cases. In the NDB, the number of deaths was about 6–10% lower, and the number of hemodialysis cases was lower, while that of peritoneal dialysis cases was higher. The cumulative survival rate at dialysis initiation was approximately 6 percentage points lower in the NDB than in the JRDR, indicating that some patients die at dialysis initiation. Cumulative survival rate by age group was roughly the same between the NDB and JRDR in both sexes. Conclusion The use of the NDB enabled us to aggregate data of dialysis patients. With the definition of dialysis patients used in this study, analyses of concomitant medications, comorbidities, surgeries, and therapies will become possible, which will be useful in many future studies.

A large-scale population-based epidemiological study on the prevalence of central sensitization syndromes in Japan

A cross-sectional study of 21,665 Japanese residents was performed to investigate the prevalence of central sensitization syndromes (CSS). CSS were assessed using the Central Sensitization Inventory (CSI-A). CSS were defined as a CSI-A score of 40 or higher. Age, sex, district, 10 CSS-related diseases (CSI-B), lifestyle, and mental factors were rated in a self-reported survey. The prevalence of CSS and its relationship with potential factors were examined by sex using descriptive and logistic regression models. The prevalence of CSS was 4.2% in all participants and was significantly higher in women (4.9%) than in men (2.7%). Adjusted odds ratios correlated with CSS for an age of 80–97 years versus 60–79 years (2.07 and 2.89), one or more CSI-B diseases (3.58 and 3.51), few sleeping hours (2.18 and 1.98), high perceived stress (5.00 and 4.91), low (2.94 and 2.71) and high (0.45 and 0.66) resilience versus moderate resilience, and exercise habits (0.68 and 0.55) in men and women (all P < 0.05). The relationship between CSS and age 20 and 59 years, ex-smokers, coffee intake, and alcohol intake differed by sex. The prevalence of CSS was estimated to be low in the healthy population. CSS correlated with CSS-related diseases and some positive and negative factors.

Association between Cardiovascular Health and Incident Atrial Fibrillation in the General Japanese Population Aged ≥40 Years

This study explores the association between lifestyle behavior and incident atrial fibrillation (AF) in the general Japanese population. Japanese residents aged ≥40 years undergoing a national health checkup in Kanazawa City were included. We hypothesized that better lifestyle behavior is associated with lower incidence of AF. Lifestyle behavior was evaluated by the total cardiovascular health (CVH) score (0 = poor to 14 = ideal), calculated as the sum of the individual scores on seven modifiable risk factors: smoking status, physical activity, obesity, patterns of eating schedule, blood pressure, total cholesterol, and blood glucose. The association between CVH and incident AF was assessed, adjusting for other factors. A total of 37,523 participants (mean age 72.3 ± 9.6 years, 36.8% men, and mean total CVH score 9 ± 1) were analyzed. During the median follow-up period of 5 years, 703 cases of incident AF were observed. Using a low CVH score as a reference, the upper group (ideal CVH group) had a significantly lower risk of incident AF (hazard ratio [HR] = 0.79, 95% confidence interval 0.65–0.96, p = 0.02), especially among those aged <75 years (HR = 0.68, 95% confidence interval 0.49–0.94, p = 0.02). Thus, ideal CVH is independently associated with a lower risk for incident AF, particularly in younger Japanese individuals (<75 years).

Abstract P187: Incident And Risk Factors For Hypertension Among Urban Japanese: The Suita Study

Introduction: According to the world health organization, an estimated 1.13 billion individuals worldwide have hypertension (HT). However, limited studies discussed the risk prediction for incident HT. We aim to evaluate the incidence of HT and identify its risk factors in urban Japanese residents. Methods: We followed up 4,314 normotensive participants at the baseline survey. Blood pressure (BP) was measured twice in the sitting position under rest. The participants have continued to visit the center every two years for regular health check-ups and all of them gave informed consent. The BP categories were defined by the ESC/ESH Guidelines. Cox regression model was used to detect HT's risks by cardiovascular risk factors. Results: During the mean follow-up period of 17.6 years, 25.8 per 1000 person-years of participants developed HT (optimal 16.7, normal 30.7, and elevated BPs 43.5 per 1000 person-years, respectively). The adjusted hazards ratio (HRs, 95% CIs) for developing HT for age groups in the 40s (HR=1.34, 95% CI=1.14 - 1.58), 50s (1.73, 1.47 - 2.04), 60s (2.26, 1.91 - 2.68), and 70s (2.95, 2.41 - 3.61), normal BP (2.23, 1.98 - 2.50), elevated BP (4.25, 3.78 - 4.76), smoking > 10 cig/d (1.21, 1.05 - 1.40), never drinking alcohol 1.22 (1.07 - 1.40), drinking alcohol ≥ 4 units/day 1.36 (1.15 - 1.60), parental history of HT (1.18, 1.03 - 1.34), fasting plasma glucose levels ≥ 126 mg/dL (1.39, 1.10 - 1.76), and chronic kidney disease (1.15, 1.02 -1.29) in the normotensive population. Conclusion: The incident and risk factors for developing HT were firstly shown in Japan. The study emphasizes the importance of controlling the risk factors for incident HT as primary prevention.

An experimental comparison of rebate and matching in charitable giving: The case of Japan

This study uses a Japanese nationwide sample and experimentally compares rebate and matching, both of which are schemes intended to lower the price of monetary donation. Standard economic theory predicts that the two schemes will have the same effect on individuals’ donation behavior when their donation price is equivalent. However, we conduct an incentivized economic experiment through the Internet on 2300 Japanese residents, and find that matching, which lowers the donation price by adding a contribution from a third-party, increases individuals’ donation expenditures compared to rebate, which lowers it through a refund from a third-party. The experimental result shows that the donation expenditure in a 50% rebate treatment drops by approximately 126 Japanese yen compared to the control, while in a 1:1 matching treatment with essentially the same price of donation as the 50% rebate, the expenditure conversely rises by approximately 56 Japanese yen. This tendency is consistent with the results of previous experimental studies comparing the two schemes. We further empirically confirm that the superiority of 1:1 matching over 50% rebate is not conclusively influenced by the participants’ confusion or misunderstanding, or budget constraint lines’ difference between the two schemes. Although the Japanese government has previously enriched rebate’s content, the level of monetary donations by the Japanese people is still low on an international scale. Based on this study’s findings, we discuss the possibility that implementing matching into the society effectively encourages their donation behavior.

How culture affects validity: understanding Japanese residents’ sense-making of evaluating clinical teachers

ObjectivesTraditionally, evaluation is considered a measurement process that can be performed independently of the cultural context. However, more recently the importance of considering raters’ sense-making, that is, the process by which raters assign meaning to their collective experiences, is being recognised. Thus far, the majority of the discussion on this topic has originated from Western perspectives. Little is known about the potential influence of an Asian culture on raters’ sense-making. This study explored residents’ sense-making associated with evaluating their clinical teachers within an Asian setting to better understand contextual dependency of validity.DesignA qualitative study using constructivist grounded theory.SettingThe Japanese Ministry of Health, Labour and Welfare has implemented a system to monitor the quality of clinical teaching within its 2-year postgraduate training programme. An evaluation instrument was developed specifically for the Japanese setting through which residents can evaluate their clinical teachers.Participants30 residents from 10 Japanese teaching hospitals with experience in evaluating their clinical teachers were sampled purposively and theoretically.MethodsWe conducted in-depth semistructured individual interviews. Sensitising concepts derived from Confucianism and principles of response process informed open, axial and selective coding.ResultsTwo themes and four subthemes were constructed. Japanese residents emphasised the awareness of their relationship with their clinical teachers (1). This awareness was fuelled by their sense of hierarchy (1a) and being part of the collective society (1b). Residents described how the meaning of evaluation (2) was coloured by their perceived role as senior (2a) and their experienced responsibility for future generations (2b).ConclusionsJapanese residents’ sense-making while evaluating their clinical teachers appears to be situated and affected by Japanese cultural values. These findings contribute to a better understanding of a culture’s influence on residents’ sense-making of evaluation instruments and the validity argument of evaluation.

The Dulwich Boys and their Successors

To meet the need for linguists in the war with Japan, the War Office finally responded to pressure from SOAS and in 1942 instituted a series of language courses at SOAS in London. For the first course, which consisted only of men, schoolboys were recruited from all over Britain and they were accommodated at Dulwich College during their 18-month course, so they became known as the Dulwich Boys. Frank and Otome Daniels were the key teachers, but Daniels had to recruit many more teachers as the courses expanded, including some Canadians of Japanese origin, some Japanese residents in the UK who were released from internment so that they could teach, and assorted others. Other courses at SOAS were taught by linguists and phoneticians with no knowledge of Japanese who nevertheless successfully trained students to recognize and understand spoken military Japanese, a skill that they put to good use monitoring air-to-ground communications in the Burma Campaign.

Characteristics of Flood Fatalities in Japan’s Typhoon Hagibis in 2019: Secondary Analysis of Public Data and Media Reports

Objective: Typhoon Hagibis struck Japan on October 12, 2019. This study documents and characterizes deaths caused by Hagibis and helps identify strategies to reduce mortality in future disasters. Methods: Japanese residents, who were killed by Typhoon Hagibis, as reported by Japan’s Fire and Disaster Management Agency, were considered for the study. Details were collected from mainstream Japanese media, and flooding data from hazard maps published by local municipalities. Results: Out of the 99 total fatalities, 65 (73.0%) were aged 65 years or above. Among those who drowned indoors (20), 18 (90.0%) lived in high-risk areas of flooding, and their bodies were found on the first floor of their residences. A total of 10 (55.6%) out of the 18 fatalities lived in homes with 2 or more floors, indicating that they could have moved upstairs to avoid the floodwater. However, 6 (33.3%) could not do so due to existing health issues. Conclusions: Relatively elderly people, particularly those in areas at high risk of flooding, were most affected. Seeking higher ground is a standard safety measure in times of flooding, but this may not be possible for everyone depending on their health status, structure of their residence, and the depth of floodwaters.